Autism spectrum disorder (ASD) is defined as a condition characterized by persistent deficits in social communication and social interaction across multiple contexts that includes restricted, repetitive patterns of behavior, interests, and activities. These characteristics must be present in the early developmental period, although they may not become fully manifest until later in life, and cause significant impairment in social, occupational, or other important areas of current functioning.

According to a 2012 study by the Center for Disease Control and Prevention (CDC), 1 in 68 children were diagnosed with ASD (Christensen et al., 2012). The occurrence of ASD is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189) (Christensen et al., 2012).  Autism is found in all racial, ethnic and socioeconomic groups (Christensen et al., 2012) and is found throughout the world.

Behavioral characteristics of ASD can include:

• Deficits in social-emotional reciprocity. This can include having an abnormal social approach, failure of normal back-and-forth conversation, reduced sharing of interests, or emotions, and failure to initiate or respond to social interactions.
• Deficits in nonverbal communicative behaviors used for social interaction. This can include abnormalities in eye contact and body language, deficits in understanding and using gestures, and limited use of facial expressions and nonverbal communication.
• Deficits in developing, maintaining, and understanding relationships. Children with ASD may demonstrate difficulty adjusting their behavior to suit various social contexts, difficulty with imaginative play, difficulty in making friends, or an absence of interest in peers.
• Stereotyped or repetitive motor movements, use of objects, or speech. This can include simple motor stereotypies, lining up toys or flipping objects, echolalia, and idiosyncratic phrases.
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior. Examples include extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat the same food every day.
• Highly restricted, fixated interests that are abnormal in intensity or focus. Children with ASD may exhibit a strong attachment to or preoccupation with unusual objects or have excessively circumscribed or perseverative interests.
• Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment. Examples include an apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, or visual fascination with lights or movement (American Psychiatric Association, 2013).

How can treatment help?

The clinicians at our center take a holistic approach to working with children with autism because there is no single treatment paradigm that meets the needs of every child. The approach that works best is tailored to the child’s specific needs, and once an evaluation of the child’s language and sensorimotor skills is conducted, treatment plans are developed.

Overall, children are more likely to develop communication skills in an environment that is designed to support their communication attempts. We provide treatment in a child-friendly environment that minimizes visual and auditory distractions and provides consistent, accurate language models. This facilitates joint attention, increases children’s ability to process information, and gives them a reason to want to communicate. Once a child is enticed by the environment, he is provided with a functional means to communicate within that context.

By presenting multi-modal communication models (combining gestures, pictures, words, and/or objects), our clinicians engage children in play and develop routines to foster the acquisition of functional communication. Routines are typically activities of high interest for children with autism and provide a positive tool for language learning. The predictability of a story such as Eric Carle’s Brown Bear, Brown Bear, What Do You See? or a song such as The Wheels on the Bus gives children an avenue to learn the script and offer words and/or gestures with minimal prompting from the clinician. These scripts can be expanded, and the language generalized to other contexts.

In many cases, children with autism demonstrate difficulties assimilating sensory information from the environment. This negatively impacts their ability to attend to and respond to adult prompts. By working closely with occupational therapists, speech-language pathologists can better understand how to tailor therapy techniques to reduce the impact of sensory overloads and open up the pathways to develop communication.

It is important to remember that a diagnosis of autism need not always imply a poor prognosis. Language skills and overall intellectual level are the strongest factors related to ultimate progress. With early and intense identification and intervention, many children can be mainstreamed in the school setting, and approximately one-third of individuals with ASD attain some degree of partial independence as adults.

Resources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

Christensen, D.L., Baio, J., Van Naarden Braun, K., Bilder, D., Charles, J., Constantino, J.N., D. . . Yeargin-Allsopp, M. (2012). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sties, United States, 2012. Morbidity and Mortality Weekly Reports, Surveillance Summaries, 2016;65 (no. SS-3): 1-23.