Autism Spectrum Disorder

Excerpt

Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), the diagnostic criteria for autism spectrum disorder are:

1. Pervasive difficulties in social communication across multiple contexts, as manifested by all of the following, currently or by history:

   1. Deficits in social-emotional reciprocity ranging from abnormal social approach and failure of normal back-and-forth conversation to reduced sharing of interests, emotions, or affect to a failure in initiating or responding to social interactions.

   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging from poorly integrated verbal and nonverbal communication to abnormalities in eye contact and body language or deficits in understanding and use of gestures to a total lack of facial expressions and nonverbal communication.

   3. Deficits in developing, maintaining, and understanding relationships that ranges from difficulties adjusting behavior to suit various social contexts to difficulties in sharing imaginative play or making friends to the absence of interest in peers.

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following, currently or by history:

   1. Stereotyped or repetitive motor movements, use of objects, or speech (eg, simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (eg, extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, needing to take the same route or eating the same food every day).

   3. Highly restricted, fixated interests that are abnormal in intensity or focus (eg, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (eg, apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

3. Symptoms must be present in the early developmental period (but may not fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

5. These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay. Intellectual developmental disorder and ASD frequently co-occur. To make comorbid diagnoses of ASD and intellectual developmental disorder, social communication should be below that expected for the general developmental level.

An important aspect of the DSM-5-TR diagnostic criteria is the use of specifiers of current severity, level of intellectual impairment, level of language impairment, association with known genetic or medical conditions or environmental factors, and if comorbid catatonia is present, allowing the clinician to communicate a more detailed clinical description when diagnosing ASD. See Image. Severity Specifiers for Autism Spectrum Disorder, Table. The diagnosis of ASD replaces a spectrum of conditions such as autistic disorder, Asperger disorder, and pervasive developmental disorder not otherwise specified that were previously diagnosed separately in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

According to the Centers for Disease Control and Prevention, 15% to 20% of the world's population exhibits some form of neurodivergence. Neurodiversity refers to the diversity of minds and brains in the world, as each individual is unique, and there is no single "right" way of thinking. The term neurodiversity is often used for neurological and developmental conditions such as ASD, attention-deficit/hyperactivity disorder, and learning disabilities to describe non-pathological variations in the function of human brains. Neurodivergent individuals are frequently stigmatized and devalued. Neurodiversity embraces the concept that differences need not be viewed as deficits.

Although healthcare professionals often use person-first language, such as "individual with autism," many adults with autism prefer identity-first language, such as "autistic person." Healthcare professionals should use the patient's preferred language. Parents and families with children diagnosed with ASD confront numerous challenges—social isolation, emotional frustrations, strained relationships, and financial burdens. The rate of ASD in siblings is higher, especially in monozygotic twins. Significant barriers to care exist for individuals with autism, and clinicians need to have a framework to facilitate care. One such framework is the SPACE (sensory, predictability, acceptance, communication, empathy) model, which addresses 5 core autistic needs:

1. Sensory needs: Sensory sensitivities are common for people with autism, and sensory issues can make healthcare environments inaccessible. Sensory overload in a medical environment can lead to involuntary shutdowns or meltdowns.

2. Predictability: Autistic individuals need routine and structure and may experience extreme anxiety with change or new experiences.

3. Acceptance: Stigma and stereotypes are damaging to people with autism, who require understanding, a holistic approach, and appropriate accommodations.

4. Communication: When stressed, people with autism may experience challenges with verbal communication and may do better with augmentative and alternative communication methods such as writing or using electronic devices.

5. Empathy: Autistic people may experience hyper-empathy, leading to shutdown. Healthcare professionals may find the perspective of the autistic person challenging.