The autism spectrum , also known as autism spectrum disorder ( ASD ), is a range of conditions classified as a neurodevelopmental disorder. Individuals diagnosed with autism spectrum disorders present with two types of symptoms: problems in social communication and social interaction, and restricted, repetitive behavior patterns, interests or activities. Symptoms are usually recognized between one and two years. Long-term problems may include difficulties in creating and maintaining relationships, maintaining work, and performing everyday tasks.
The cause of the autism spectrum is uncertain. Risk factors include having an older parent, a family history of the condition, and certain genetic conditions. Diagnosis is based on symptoms. DSM-5 redefined autism spectrum disorders to include previous diagnosis of autism, Asperger syndrome, unexplained pervasive developmental disorder (PDD-NOS), and disintegrative disorder of childhood.
Treatment efforts are generally individualized to the person's condition. Drugs can be used to try to help fix certain related problems. The evidence to support the use of drugs, however, is not very strong. The autism spectrum is estimated to affect about 1% of people (62.2 million globally by 2015). Men are diagnosed more often than women.
Video Autism spectrum
Classification
In the United States, revisions to the autism spectrum disorder (ASD) are presented in the 5th version of the Diagnostic and Statistical Statistical Manual (DSM-5), released May 2013. The new diagnosis includes the earlier diagnosis of autistic disorders, Asperger's syndrome, disintegrative disorder of childhood, and PDD-NOS. Compared with the diagnosis of DSM-IV autistic disorder, the diagnosis of ASS DSM-5 no longer includes communication as a separate criterion, and has incorporated social interaction and communication into one category. A slightly different diagnostic definition is used in other countries. For example, ICD-10 is the most commonly used diagnostic guide in the UK and EU. Rather than categorize this diagnosis, DSM-5 has adopted a dimensional approach to diagnosing disorders that fall under the umbrella of the autism spectrum. Some have suggested that individuals on the autism spectrum may be better represented as a single diagnostic category. In this category, the DSM-5 has proposed a framework for differentiating individuals based on severity dimensions, as well as related features (ie, known genetic disorders, and intellectual disabilities).
Other changes to DSM include breaking down social deficits and communications into a single domain. Thus, an individual with an ASD diagnosis will be described in terms of the severity of social communication symptoms, the severity of behavior or fixed or limited interest, and related features. The limitation of age onset has also been relaxed from 3 years to "early developmental period", with the notion that symptoms may manifest later when social demands exceed capability.
Autism forms the core of autism spectrum disorders. Asperger's syndrome is closest to autism in signs and possible causes; unlike autism, people with Asperger's syndrome usually have no delay in language development, according to older DSM-4 criteria. PDD-NOS is diagnosed when criteria are not met for more specific disorders. Some sources also include Rett syndrome and disintegrative disorder of childhood, which share some signs with autism but may have unrelated causes; other sources distinguish them from ASD, but categorize all the above conditions into a pervasive developmental disorder.
Autism, Asperger syndrome, and PDD-NOS are sometimes referred to as autistic disorders instead of ASD, whereas autism itself is often called an autistic disorder, autism of childhood- or infantile autism . Although the old term pervasive developmental disorder and the new term autism spectrum disorder are mostly or entirely overlapping, the earlier is intended to describe a specific set of diagnostic labels, while the second refers to a postulated spectrum disorder that connects various conditions. ASD is part of a broader autism phenotype (BAP), which describes individuals who may not have ASD but have autistic features, such as avoiding eye contact.
Maps Autism spectrum
Characteristics
Under DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. This deficit is present in early childhood, and leads to clinically significant functional impairment. There is also a unique form of autism called autistic savantism, in which a child can display amazing skills in music, art, and numbers without practice. Because of its relevance to different populations, self-injury behavior (SIB) is not considered a core characteristic of the ASD population but about 50% of those with ASD take part in some head-banging, self-biting type and are more at risk than the group others with developmental defects.
Other characteristics of ASD include limited and recurrent behaviors (RRBs) that include a large number of specific movements and actions, and may even include certain behavioral traits as defined in the Diagnostic and Statistical Manual for Mental Disorders.
Asperger's Syndrome is distinguished from autism in DSM-IV by lack of delays or deviations in early language development. In addition, people diagnosed with Asperger syndrome do not have significant cognitive delays. PDD-NOS is considered "subthreshold autism" and "atypical autism" because it is often characterized by symptoms of autism or milder symptoms in only one domain (such as social difficulties). DSM-5 eliminates four separate diagnoses: Asperger's Syndrome, Other Pervasive Not Performed Pervasive Disorders (PDD-NOS), Child Degenerative Disorders, and Autistic Disorders and incorporates it under the Autism Spectrum Disorder diagnosis.
Development course
Autism spectrum disorders are thought to follow two possible developmental programs, although most parents report that symptom onset occurs within the first year of life. One development program is more gradual, in which parents report concerns in development during the first two years of life and the diagnosis is made around the age of 3-4 years. Some of the early signs of ASD in this course include a decrease in face view, failure to change when a name is called, failure to show interest by showing or pointing, and pretending to play delayed.
The second development is characterized by normal or near-normal development followed by loss of skill or regression within the first 2-3 years. Regression can occur in a variety of areas, including communication, social, cognitive, and self-help skills; However, the most common regression is the loss of language.
There continues to be a debate over differential outcomes based on these two course developments. Several studies have shown that regression is associated with worse outcomes and others report no difference between those with early gradual onset and those who have regression periods. Although there is conflicting evidence around the results of language in ASD, several studies have shown that cognitive abilities and language at age 2 1 / 2 can help predict language skills and production after age 5. Overall, the literature emphasizes the importance of early intervention in achieving positive longitudinal outcomes.
Social skills
Social skills present the greatest challenge to individuals with ASD. This causes problems with friendship, romantic relationships, everyday life, and vocational success. Marriage is less common for those with ASD. Many of these challenges are related to their behavioral and atypical communication patterns. All of these problems come from cognitive impairment. The difficulty in this thought process is called the "mind theory" or mind blindness that translates that the mind has trouble with the process of thinking and realizes what is going on around them.
Communication skills
Communication deficits are generally characterized by disorders of mutual concern and social reciprocity, challenges with verbal language cues, and poor non-verbal communication skills such as lack of eye contact and meaningful movement and facial expression. Language behaviors that are usually seen in children with autism may include recurrent or rigid language, special interest in conversation, and unusual language development. Many children with ASD develop language skills at an uneven pace in which they easily gain some aspects of communication, while never fully developing other aspects. In some cases, children remain completely nonverbal throughout their lives, despite varying levels of literacy and nonverbal communication skills.
They may not use body language or may ignore gestures such as eye contact and facial expression if they provide more information than can be processed by people at the time. Similarly, they have trouble recognizing subtle emotional expressions and identifying what emotions mean for conversation. They struggle with understanding the context and implied situations of conversation or print, and have difficulty forming conclusions about the content. It also causes a lack of social awareness and unusual language expression.
It is also common for individuals with ASD to communicate a strong interest in a particular topic, speaking in a monologue like a lesson about their passion rather than allowing mutual communication with whomever they are talking to. What seems like self-engagement or indifference to others comes from the struggle to realize or remember that others have their own personality, perspectives, and interests. The expression of language by those on the autism spectrum is often characterized by repetitive and rigid language. Often children with ASD repeat certain words, numbers, or phrases during interactions, words unrelated to the topic of conversation. They can also point to a condition called echolalia in which they respond to questions by repeating the inquiry instead of answering. However, this repetition can be a meaningful form of communication, the way individuals with ASD try to express a lack of understanding or knowledge of answers to questions.
Cause
While specific causes of autism spectrum disorders have not been found, many of the risk factors identified in the research literature may contribute to their development. Risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify common risk factors, but it is much more difficult to determine specific factors. In the current state of knowledge, predictions can only be global and therefore require the use of common markers.
Genetic risk factors
Of all the alleged causes of autism, genetics has been shown to provide the highest risk of being diagnosed with autism. If a family member uses the autism spectrum, there is a 50 percent chance that other family members will be diagnosed with the disorder as well, and being a twin gives 69-90 percent chance of an ASD diagnosis. In addition, studies show that there is a much higher level of concordance among monozygotic twins than with dizygotic twins. There seems to be no single gene that causes autism. On the contrary, there appears to be several genes involved, each of which is a risk factor for the autism spectrum disorder component. Genes for autism have been found in 2q, 7q, and 15q chromosome arms. The SHANK gene family has been associated with ASD symptoms. In particular, Shank3 gene has been associated with a more severe deficit than other genes in the family. Genetics seems to interact with environmental factors.
Prenatal and perinatal risk factors
Some prenatal and perinatal complications have been reported as possible risk factors for autism. These risk factors include maternal gestational diabetes, maternal and fetal age above 30, first-trimester bleeding, prescription drug use (eg valproate) during pregnancy, and meconium in amniotic fluid. While the study is not conclusive on the association of these factors for autism, each of these factors has been identified more frequently in autistic children compared to their non-autistic siblings and others usually develop younger. Although it is unclear whether any single factor during the prenatal phase affects the risk of autism, complications during pregnancy can be a risk.
Low vitamin D levels in early development have been hypothesized as a risk factor for autism.
Vaccination controversy
Perhaps the most controversial claim about the etiology of autism is the "vaccine controversy". This allegation, arising from a case of scientific error, indicates that the autism outcome of brain damage is caused by (1) measles, mumps, rubella (MMR) vaccine itself, or by (2) thiomersal, vaccine preservative. No convincing scientific evidence supports this claim, and further evidence continues to disprove them, including the observation that the rate of autism continues to increase despite the elimination of thimerosal from routine childhood vaccines. A 2014 meta-analysis examines ten major studies on autism and vaccines involving 1.25 million children worldwide; it was concluded that neither the MMR vaccine, which never contained thimerosal, nor the thimerosal or mercury vaccine component, led to the development of ASD.
Pathophysiology
In general, neuroanatomical research supports the concept that autism may involve combinations of brain enlargement in some areas and reduction in others. These studies show that autism can be caused by abnormal nerve growth and pruning during the early stages of prenatal and postnatal brain development, leaving some brain areas with too many neurons and other areas with too few neurons. Several studies have reported overall brain enlargement in autism, while others show abnormalities in several areas of the brain, including the frontal lobe, the mirror neuron system, the limbic system, the temporal lobe, and the corpus callosum.
In functional neuroimaging studies, when performing the theory of mind and emotional response of task faces, medians on the autism spectrum showed less activation in the primary and secondary somatosensory cortex of the brain than the median members of the precise sample control population. These findings coincide with reports showing abnormal patterns of cortical thickness and gray matter volume in regions of the autistic person's brain.
Mirror neuron system
The neuron mirror system (MNS) consists of a brain area network that has been linked to the process of empathy in humans. In humans, MNS has been identified in the inferior frontal gyrus (IFG) and inferior parietal lobe (IPL) and allegedly activated during imitation or behavioral observation. The relationship between mirror neuron dysfunction and autism is tentative, and it remains to be seen how mirror neurons may be associated with many important characteristics of autism.
"Social brain" interconnect
A number of separate brain and tissue areas between the areas involved in dealing with others have been discussed together under the rubric of "social brains". In 2012, there is a consensus that the autism spectrum is likely to be related to interconnection issues between these areas and networks, rather than problems with specific regions or networks.
Temporal lobe
Temporal lobe function is associated with many of the deficits observed in individuals with ASD, such as receptive language, social cognition, joint attention, action observation, and empathy. The temporal lobe also contains superior temporal sulcus (STS) and fusiform facial area (FFA), which may mediate facial processes. It has been argued that dysfunction in STS underlies the social deficit characteristic of autism. Compared with developing individuals, a fMRI study found that individuals with high-functioning autism had reduced activity in FFA when looking at facial images.
Mitochondrial dysfunction
It has been suggested that ASD may be associated with mitochondrial disease (MD), a basic cellular disorder with the potential to cause disturbance in various body systems. A recent meta-analysis study, as well as other population studies have shown that about 5% of children with ASD meet the classic MD criteria. It is unclear why MD occurs considering that only 23% of children with ASD and MD come with mitochondrial DNA disorders (mtDNA).
Serotonin
It has been hypothesized that increased serotonin activity in the developing brain may facilitate the occurrence of autism spectrum disorders, with associations found in six of eight studies between the use of selective serotonin reuptake inhibitors (SSRIs) by pregnant women and their development. ASD by children exposed to SSRIs in the antenatal environment. This study can not definitively infer SSRIs causing an increased risk for ASD because of the bias found in the study, and the authors call for more definitive and better studies.
Diagnosis
Evidence-based assessment
ASD can be detected as early as 18 months or even younger in some cases. A reliable diagnosis can usually be done at two years of age. The various expressions of ASD symptoms present a diagnostic challenge for doctors. Individuals with ASD may be present at various developmental times (eg, toddlers, children, or adolescents), and the expression of symptoms may vary during development. In addition, physicians should distinguish between pervasive developmental disorders, and may also take into account similar conditions, including intellectual disabilities unrelated to pervasive developmental disorders, specific language disorders, ADHD, anxiety, and psychotic disorders.
Taking into account the unique challenge of diagnosing ASD, the specific practice parameters for its assessment have been published by the American Academy of Neurology, the American Academy of Child and Psychiatry, and a consensus panel with representatives from various professional societies. Training parameters outlined by these communities include preliminary examination of children by general practitioners (ie, "Level 1 screening") and for children who fail early examination, comprehensive diagnostic assessments by experienced physicians (ie "Level 2 Evaluation" ). In addition, it has been suggested that assessment of children with ASD assumptions is evaluated within the framework of development, including some informants (eg, parents and teachers) from various contexts (eg, home and school), and employing multidisciplinary professional teams (eg, clinical psychologists , neuropsychologists, and psychiatrists).
After a child shows early evidence of an ASD tendency, psychologists administer a variety of psychological assessment tools to assess ASD. Among these measures, Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) are considered as "gold standards" for assessing autistic children. The ADI-R is a semi-structured parent interview that investigates for symptoms of autism by evaluating current child behavior and developmental history. The ADOS is an interactive semistructured ASD symptom evaluation that is used to measure social and communication skills by raising several opportunities (or "pressing") for spontaneous behavior (eg, eye contact) in a standard context. Other questionnaires (for example, the Autism Child Valuation Scale, Autism Care Evaluation Checklist) and cognitive function tests (eg, Peabody Picture Vocabulary Test) are usually included in the ASD assessment battery.
In the UK, there are several diagnostic uses of the Diagnostic Interviews for Social and Communication Disorders (DISCO) developed for use in the Social and Communication Disorder Center, by Lorna Wing and Judith Gould, both as clinical and research instruments for use with children and persons adults of all ages. DISCO is designed to get a picture of the whole person through their story of development and behavior. In clinical work, the main goal is to facilitate understanding patterns over time specific skills and disorders underlying overt behaviors. If no information is available, the physician should get as much information as possible about the details of his current skills and behavior patterns. This type of dimensional approach to clinical description is useful for prescribing treatment.
Comorbidity
Autism spectrum disorders tend to be very comorbid with other disorders. Comorbidity may increase with age and can worsen the course of adolescents with ASD and make intervention/treatment more difficult. Distinguishing between ASD and other diagnoses can be a challenge, since ASD traits often overlap with other symptoms of interference, and ASD characteristics make traditional diagnostic procedures difficult.
The most common medical condition occurring in individuals with autism spectrum disorders is a seizure or epileptic disorder, which occurs in 11-39% of individuals with ASD. Tuberous sclerosis, a medical condition in which a non-malignant tumor grows in the brain and other vital organs, occurs in 1-4% of individuals with ASD.
The intellectual disability is some of the most common comorbid disorders with ASD. Recent estimates suggest that 40-69% of individuals with ASD have some degree of intellectual disability, are more likely to be severe for women. Some of the genetic syndromes that cause intellectual disabilities can also be comorbid with ASD, including fragile X syndrome, Down syndrome, Prader-Willi syndrome and Angelman, and Williams syndrome.
Learning disabilities are also very comorbid in individuals with ASD. Approximately 25-75% of individuals with ASD also have some level of learning disability.
Various anxiety disorders tend to coincide with autism spectrum disorders, with an overall comorbidity level of 7-84%. The rate of comorbid depression in individuals with ASD ranges from 4-58%. The association between ASD and schizophrenia remains a controversial subject under follow-up investigation, and recent meta-analyzes have examined genetic, environmental, infection and immune factors that may be shared between the two conditions.
The deficit in ASD is often associated with behavioral problems, such as difficulty following directions, being cooperative, and doing things on other people's terms. Symptoms similar to attention deficit hyperactivity disorder (ADHD) may be part of an ASD diagnosis.
Sensory processing disorders are also comorbid with ASD, with comorbidity rates of 42-88%.
Treatment
There is no known cure for autism, although those with Asperger's Syndrome and those with autism and needing little-to-no support are more likely to experience reduced symptoms over time. The main goal of treatment is to reduce the associated deficit and family pressure, and to improve the quality of life and functional independence. In general, a higher IQ correlates with a greater response to treatment and improved treatment outcomes. Although evidence-based interventions for autistic children vary in their methods, many adopt psychoeducational approaches to improve cognitive, communication, and social skills while minimizing problem behavior. It has been argued that there is no single best treatment and treatment is usually tailored to the needs of the child.
An intensive and continuous special education program and early behavioral therapy can help children acquire self-care, social, and occupational skills. Available approaches include applied behavioral analysis, developmental models, structured teaching, speaking and language therapy, social skills therapy, and occupational therapy. Among these approaches, interventions either treat a comprehensive autistic feature, or focus treatment on a specific area of ​​deficit. Generally, when educating those with autism, specific tactics can be used to convey information effectively to these individuals. Using as much social interaction as possible is key in targeting an individual's autistic inhibition of person-to-person contact. In addition, research has shown that using semantic grouping, which involves assigning words to a typical conceptual category, can be useful in encouraging learning.
There has been increasing attention to the development of evidence-based interventions for children with ASD. The two theoretical frameworks outlined for early childhood intervention include applied behavioral analysis (ABA) and social-pragmatic developmental model (DSP). Although ABA therapy has a strong evidence base, especially in relation to initial home-based therapy. The effectiveness of ABA can be limited by the diagnostic severity and IQ of people affected by ASD. The Journal of Clinical Child and Adolescent Psychology has regarded two early childhood interventions as "established": a comprehensive ABA of individuals, and teacher-implements implemented by teachers combined with DSP.
Another evidence-based intervention that has demonstrated efficacy is the parenting training model, which teaches parents how to apply the various ABA and DSP techniques themselves. Various DSP programs have been developed to explicitly provide an intervention system through home parent implementations.
A number of untested alternative therapies have also been applied. Many cause damage to people with autism and should not be used unless proven to be safe.
In October 2015, the American Academy of Pediatrics (AAP) proposed new evidence-based recommendations for early intervention in ASD for children under 3. This recommendation emphasizes early engagement with developmental and behavioral methods, support by and for parents and caregivers, and focus on the core and related symptoms of ASD.
Epidemiology
The latest estimate of the US Centers for Disease Control is that 1 out of every 68 children, or 14.7 per 1,000, has some form of ASD in 2010. Reviews tend to estimate 6 per 1,000 prevalence for overall autism spectrum disorder, although prevalence rates vary for each each developmental disorder in the spectrum. The prevalence of autism has been estimated at 1-2 per 1,000, Asperger Syndrome at about 0.6 per 1000, disintegrative disruption of children at 0.02 per 1,000, and PDD-NOS at 3.7 per 1,000. This figure is consistent across cultures and ethnic groups, since autism is considered a universal disorder.
While the level of autism spectrum disorder is consistent across cultures, they vary greatly by sex, with boys more often exposed than girls. The average male-to-female ratio for ASDs was 4.2: 1, affecting 1 in 70 men, but only 1 in 315 women. Women, however, are more likely to have associated cognitive impairment. Among those with ASD and intellectual disability, the sex ratio may be closer to 2: 1. The prevalence difference may be the result of gender differences in expression of clinical symptoms, with autistic women exhibiting less atypical behavior and, therefore, less likely to received an ASD diagnosis.
History
Controversy has surrounded claims about the etiology of autism spectrum disorders. In the 1950s, the "mother refrigerator theory" emerged as an explanation for autism. This hypothesis is based on the idea that autistic behavior stems from emotions of frigidity, lack of warmth, and cold, distant, rejecting the attitude of a mother's child. Naturally, parents of children with autism spectrum disorders suffer from mistakes, guilt, and self-doubt, especially since the theory is embraced by medical institutions and largely unmatched until the mid-1960s. The "mother refrigerator" theory has since been continually refuted in scientific literature, including a systematic review of 2015 which shows no relationship between caregiver interactions and language outcomes in ASD.
Other controversial claims suggest that watching large amounts of television can lead to autism. This hypothesis is largely based on research showing that the increase in the level of autism in the 1970s and 1980s is linked to the current growth of cable television.
Society and culture
Caregiver
Families who care for the faces of autistic children add stress from a number of different causes. Parents may be surprised and anxious about the diagnosis, and they may struggle to understand their child's diagnosis and find the right treatment option. They also struggle emotionally. In the words of a doctor whose two children were diagnosed with autism, "At the time of diagnosis, it feels like the death of your hopes and dreams."
More than half of parents aged over 50 years are still living with their children because about 85% of people with ASD have difficulty living independently. By the time most parents reach 50, 17% still have children living with them.
Autistic rights movement
Autism rights movement (ARM) is a social movement within the neurodiversity movement that encourages autistic people, their caregivers, and the community to adopt neurodiversity positions, and to accept autism as a variation in function rather than disorder to be cured. ARM supports multiple objectives, including greater acceptance of autistic behavior, therapy that teaches the ability to cope with autistic individuals rather than therapy that is focused on mimicking the behavior of neurotypical peers, creating social networks and events that allow autistic people to socialize in their own terms. , and recognition of the autistic community as a minority group.
Proponents of autism and neurodiversity rights believe that the spectrum of autism is genetic and should be accepted as a natural expression of the human genome. This perspective is different from the other two different views:
- The perspective that autism is caused by genetic defects and should be addressed by targeting the autism (s) gene
- The perspective that autism is caused by environmental factors, such as vaccines and pollution, and can be cured by addressing environmental causes. This is a less common view, but also against the neurodiversity.
This movement is controversial; the general criticism posed against autistic activists is that many who have Asperger's Syndrome or are otherwise functioning are high, and therefore do not represent the views or experience of all people with autism.
Academic performance
The number of students identified and served as being eligible for autism services in the United States has increased from 5,413 children in 1991-1992 to 370,011 children in the 2010-2011 school year. The US Department of Health and Human Services reports about 1 in 68 children at 8 years of age diagnosed with autism spectrum disorder (ASD) despite the usual onset between the ages of 2 and 4.
Increasing the number of students with ASD in schools presents significant challenges for teachers, school psychologists, and other school professionals. These challenges include developing a consistent practice that best supports the social and cognitive development of the growing number of students with ASD. While there are many studies that address assessment, identification, and support services for children with ASD, there is a need for further research to be focused on these topics within the school context. Further research on appropriate support services for students with ASD will provide school psychologists and other education professionals with specific direction for advocacy and service delivery aimed at improving school outcomes for students with ASD.
Attempts to identify and use best practice interventions for students with autism also pose challenges because they rely too heavily on popular or popular interventions or curricula. Some evidence suggests that although these interventions work for some students, there is still a lack of specificity for the type of student, under what environmental conditions (one-one, special instruction or general education) and for the deficit they target to work best. Further research is needed to identify what assessment methods are most effective for identifying the level of educational needs for students with ASD.
References
External links
- Autism spectrum in Curlie (based on DMOZ)
Source of the article : Wikipedia
0 Comments