Autism Spectrum Disorder

Jill Schettini
PSC 220

Abstract:
This paper discusses the five subsets of autism, autistic disorder, Aspergers, Retts
syndrome, childhood disintegrative disorder (CDD), and pervasive developmental
disorder not otherwise specified (PDD-NOS) in depth. Each subset is explained with
symptoms and possible causes. It also explains a few different academic strategies that
are helpful for students with ASD. Finally we discuss the new DSM-5 criteria and how it
affects the autistic community.

Autism has many different facets and subcategories; this paper will explain each
one as well as ways to accommodate those affected by ASD. The National Institute of
Neurological Disorders and Stroke defines autism as a range of complex
neurodevelopment disorders, characterized by social impairments, communication
difficulties, and restricted, repetitive, and stereotyped patterns of behavior (Autism Fact
Sheet). Autism has a variety of symptoms and there are several other disorders with
similar traits that are placed under the autism spectrum disorder (ASD) category. These
five subtypes of ASD vary in severity from nonverbal and possibly intellectually disabled
to minor delays socially and cognitively (Hughes, Katsiyannis, McDaniel, Ryan, &
Sprinkle, 2011, p. 56). These subtypes are, Autistic Disorder, Aspergers syndrome,
Childhood Disintegrative Disorder (CDD), Rett Syndrome, and Pervasive Developmental
Disorder Not Otherwise Specified (PDD-NOS).
Autistic disorder is a pervasive developmental disorder marked by three defining
features with onset before age 3 (Heward, 2009, p. 258).

The three features are:

qualitative impairment of social interaction (lack of social skills, limited eye contact,
inability to comprehend social cues), qualitative impairment of communication (delay in
language skills, lack of conversational skills), and restricted, repetitive, and stereotyped
patterns of behavior (overly preoccupied with one topic, repetitive mannerisms)
(Heward, 2009, p.258). Autistic disorder is the most common of the ASD; with roughly
35% of children that are diagnosed are nonverbal and surprisingly only 33% having
average intelligence. The NICHD has five characteristics or red flags that parents and
doctors can use to help diagnose AD, they are; 1) not babbling or cooing by age 12
months, 2) does not gesture by 12 months 3) does not say single words by 16 months 4)

does not say two word phrases by his or her self by 24 months and 5) Has any loss of
any language or social skill at any age (Symptoms).
There is no known cause of autistic disorder although there is quite a bit of controversy
regarding immunizations being a factor.
Aspergers syndrome was originally diagnosed as a personality disorder under the
name autistic psychopathy in 1944 by Austrian pediatrician Hans Asperger. It wasnt
until 1981 when an English doctor published a study about children with the same
symptoms that Dr. Aspergers patients had and named the syndrome after him. The
NINDS defines Aspergers as; an autism spectrum disorder one of a distinct group of
neurological conditions characterized by a greater or lesser degree of impairment on
language and communication skills as well as repetitive or restrictive patterns of thought
and behavior. It is considered the high functioning end of the autism spectrum
(Aspergers Syndrome Fact Sheet, n.d). Early diagnosis of Aspergers is sometimes
difficult since those affected have normal language development, its not until a child hits
the ages of 5 or 6 that the signs can occur. Other symptoms include; lack of inflection in
speech, almost obsessively interested in one subject, very self orientated, lack of eye
contact while in a conversation, inability to grasp social cues. There is no known cause of
Aspergers but research is leaning towards brain abnormalities as well as genetic and
environmental factors. For a child to be diagnosed with AD they must have a normal
language development and intelligence, but have significant impairment in social
interaction and other important areas of human functioning.
Rett syndrome is a lesser known of the disorders. This disorder is very rare and is
predominately found in girls. Rett syndrome is a childhood neurodevelopmental disorder

that affects females almost exclusively. The child generally appears to grow and develop
normally, before symptoms begin. Loss of muscle tone is usually the first symptom.
Other early symptoms may include a slowing of development, problems crawling or
walking, and diminished eye contact. As the syndrome progresses, a child will lose
purposeful use of her hands and the ability to speak. Compulsive hand movements such
as wringing and washing follow the loss of functional use of the hands. The inability to
perform motor functions is perhaps the most severely disabling feature of Rett syndrome,
interfering with every body movement, including eye gaze and speech (NINDS Rett
Syndrome Info Page). Since Retts is rare, there is not much information on it.
According the NINDS, Rett syndrome only affects one in 10,000 to 15,000 females at
birth across all races and ethnicities worldwide.
Childhood disintegrative disorder (CDD) is another very rare condition, this time
mainly affecting boys. CDD affects one in 50,000 and symptoms dont appear until age
three or four. Similar to Retts the child begins to lose their language, motor, social and
other skills that they had previously obtained.

The cause of CDD is still unknown but

brain and nervous system problems seem to be a factor. Some symptoms include; delay
or lack of spoken language, impairment in nonverbal behaviors, inability to start or
maintain a conversation, lack of play, loss of bowel and bladder control, loss of
communication skills, and problems forming relationships with other children or family
members ("Childhood Disintegrative Disorder," n.d.). CDD can be misdiagnosed as
autistic disorder because of the similarities and can be treated in the same way.
The final disorder, pervasive developmental disorder- not otherwise specified
(PDD-NOS) is a group of disorders characterized by delays in the development of

socialization and communication skills. Parents may note symptoms as early as infancy,
although the typical age of onset is before 3 years of age (NINDS Pervasive
Developmental Disorders Information Page). Many children diagnosed with PDD-NOS
meet some but not all of the criteria for autism disorder. Symptoms include, problems
with using and understanding language, difficulty relating to people, objects and events,
unusual play with toys and other objects, difficulties with change, repetitive body
motions or behavior patterns age (NINDS Pervasive Developmental Disorders
Information Page). Interestingly enough, Aspergers CDD and Retts are all included in
the PDD-NOS umbrella.
Now that the subsets have been described, now we can explore how to help
children with ASD academically. With many states adapting the Common Core State
Standards there has been a bit of discussion on how this will affect students with ASD.
In Language Arts, many students with ASD have difficulty understanding the big picture
when it comes to comprehension. An example of this would be a student reading a story
about a family going on a camping trip and as they were hiking they see a deer in the
woods. A student with ASD may focus their attention on the deer instead of the family
because they are interested in wildlife. Because of their focus on one small factor,
learning how to assimilate information, discovering meaning and comprehending
information is difficult for students (Constale, Grossi, Moniz & Ryan, 2013, p 8).
There are several strategies that educators can use to assist students with ASD.
Social stories are a great way to help students visualize how to act in a situation that they
may struggle with. Social stories are brief, individually designed stories that are used to
enhance social understanding by providing specific and personally tailored social skill

lesson to a student with ASD (Auger, n.d., p.262). These stories can be used at any grade
level and can be modified to fit any circumstance. The most convenient thing about
social stories is that not only are they easily accessible they can be used for a wide range
of situations from using the bathroom to making friends. Figure 1 is a great example of a
social story that can be used for students at any grade level. Since many students with
ASD have trouble focusing on the big picture, these stories are short enough and dont
have much detail so they are easier for them to grasp. Although social stories are a great
aide for teacher and students alike, they cant be used alone, prompting, imitation and
positive reinforcement are supplemented with the story to help the student better grasp
the concepts in the story (Cosgrave, n.d.).
Another approach used with ASD students is applied behavior analysis (ABA).
ABA is a systematic process of studying and modifying observable behavior through a
manipulation of the environment (Hughes, Katsiyannis, McDaniel, Ryan, & Sprinkle,
2011, p. 60). ABA is based off of the research of B.F. Skinner, who used a type of reward
system in his research. This approach is best used in a one on one situation at first, and
requires constant reinforcement and correction for the students behavior. In order for
ABA to be successful, both teachers and parents must be involved in the process. ABA
can be useful to assist modify bad behaviors in children with ASD not only in the
classroom but at home as well. This approach helps children with a range of skills as
basic as listening and imitating to more complex skills such as reading and actively
carrying on a conversation. This approach, like the Social stories is appropriate for all
ages, although research has shown that earlier intervention helps the children get into
mainstream classes easier.

Graphic organizers can also be a great tool for students with ASD. This tool can
be helpful for any subject that requires written responses (essays, short stories, papers).
Writing assignments can be overwhelming for anyone, but when one adds on the stress of
the inability to retain the information needed to complete the assignment. Many students
with ASD also have difficulty with executive functioning, organizing thoughts and
words, so a graphic organizer is a perfect tool to help them break up a daunting task of
writing. The organizer could be something as simple as circling answers to a question or
as complex as breaking down a concept into several boxes. Figure 2 is a good example of
a graphic organizer a student might use.
Beginning in May of 2013, the Diagnostic and Statistical Manual of Mental
Disorders has published its fifth edition, which has revamped the criteria for diagnosis of
autism as well as removing the specific subsets discussed above. People who were
originally diagnosed with one of those disorders will still meet the criteria for ASD but
may need to be reevaluated to ensure they are still receiving the proper treatments. The
new criteria for ASD as stated by DSM-5 is: A. persistent deficits in social
communication and social interaction across multiple context, as manifested by the
following, currently or by history, 1. Deficits in social-emotional reciprocity, ranging, for
example, from abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or
respond to social interactions. 2. Deficits in nonverbal communication behaviors used for
social interaction, ranging, for example, from poorly integrated 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,

ranging, for example, from difficulties adjusting behavior to suit various social contexts;
to difficulties in sharing imaginative play or in making friends; to absence of interest in
peers. B. Restrictive, repetitive patterns of behavior, interest or activities, am manifested
by at least two of the following, currently or by history: 1. Stereotyped or repetitive
motor movements, use of objects, or speech 2. Insistence on sameness, inflexible
adherence to routines, or ritualized patterns or verbal nonverbal behavior 3. Highly
restricted, fixated interest that is abnormal in intensity or focus 4. Hyper- or hypo activity
to sensory input or unusual interests in sensory aspects of the environment. C. Symptoms
must be present in early developmental period (but may not become fully manifest until
social demands exceed limited capacities, or may be masked by learned strategies later in
life). D. Symptoms cause clinically significant impairment in social, occupational, or
other important areas of current functioning. E. These disturbances are not better
explained by intellectual disability (intellectual developmental disorder) or global
developmental delay. Intellectual disability and autism spectrum disorder frequently cooccur; to make comorbid diagnosis of autism spectrum disorder and intellectual
disability, social communication should be below that expected for general
developmental level (DSM-5 Diagnostic Criteria, n.d.). Although many of the subsets of
autism are now all lumped together researchers feel that by doing so will improve the
diagnosis without being too specific.
After all the research it seems that even though DSM-5 has grouped all of the
subsets of autism together there is still quite a bit of information about each one out there.
Since this is still a new update, many people may not agree or understand the reasoning

behind. But just as most things, research is constantly changing and technology is helping
us learn more and more information about ASD.

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Figure 1. This would be a typical social story to use for a student of any age. (Social Stories, 2012)

Figure 2. An example of a graphic organizer used for a student with ASD (Stevenson-Bennett, 2013).

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References:
www.autismspeaks.org
www.ninds.nih.gov
www.autism-society.org

Auger, R. W., Ph. D. (n.d.). Autism Spectrum Disorders: A Research Review for School
Counselors. ASCA Professional School Counseling, 16(4), 256-268.
Autism Spectrum Disorder. (2013). Retrieved from American Psychiatric Publishing
website:
http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.p
df
Childhood disintegrative disorder. (n.d.). Retrieved from Medicine Plus, A service of the
U.S National Library of Medicine website:
http://www.nlm.nih.gov/medlineplus/ency/article/001535.htm
Constable, S., Grossi, B., Moniz, A., & Ryan, L. (2013). Meeting the Common Core
State Standards of Students with Autism; The Challenge for Educators. Teaching
Exceptional Children, 45(3), 6-13.
Cosgrave, G. (n.d.). Social Stories. Retrieved from Educate Autism website:
http://www.educateautism.com/social-stories.html#.U1vSm61dV_A
Heward, W. L. (2009). Exceptional Children an Introduction to Special Education (Ninth
ed.). Upper Saddle River, NJ: Pearson Education.
Hughes, E. M., Katsiyannis, A., McDaniel, M., Ryan, J. B., & Sprinkle, C. (2011).
Research- Based Educational Practices for Students With Autism Spectrum Disorders.
Teaching Exceptional Children, 43(3), 56-64.
Social Stories. (2012, February 12). Retrieved from Hear n Speak website:

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http://hearnspeak.blogspot.com/2012/02/social-stories.html
Stevenson-Bennett, E. (2013, December 30). Creating Sentences. Retrieved from
Awesomeness and Autism
website: http://awesomenessandautism.blogspot.com/

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