Autism Spectrum Disorder: The Keys

Autism Spectrum Disorder: The Keys to Diagnosing Early

Autism is a spectrum disorder, characterized as such for the broad array of symptoms and developmental possibilities reflected in those who suffer there from. At its core definition, autism is qualified as such by a "qualitative impairment in social interaction" which may result in an individual with severe impairment in any combination of conditions including notable impairments in nonverbal communicational ability and posturing, an incapacity to development meaningful personal relationships, an apparent disinterest in formulating relationships or engaging others collaboratively and a distinct absence in the expression of emotional attachment. (ANI, 1) To a more specific definition, we may refer to the notation that "autism is diagnosed on the basis of abnormalities in the areas of social development, communicative development, and imagination, together with marked repetitive or obsessional behaviour or unusual, narrow interests." (Baron-Cohen, 1)

The study's primary interest in autistic children between birth and the age of six is based on the presumption that many sufferers are denied the full opportunity for support and assistance because diagnosis and a full understanding of the spectrum disorder can be elusive. Often, children who may be perceived as developmentally delayed, or who may suffer from social problems unnoticed by parents or guardians, may exhibit early symptoms of autism. However, many of such symptoms are often missed due to the complexity of the condition and the very wide array of incarnations and symptom-sets that autism may take. Thus, the proposed literature review fleshed out here below will be primarily concerned with identifying some of the clearest characteristics of the autism spectrum disorder from which parents and early-education teachers can begin to recognize those suffering from the condition and, consequently, to establish the appropriate course of treatment, therapy and education for the individual in question.

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The primary purpose of this research examination is to provide a basic outline of the variance of symptoms by which the condition of autism may be identified at the youngest possible age in order to ensure the best opportunity for treatment. Therefore, the study conducted here below will be a literature review, with a focus on the various forms and evidences taken by the spectrum disorder. All sources consulted have been selected with intent to clarify the variance of possible incarnations and clues which can be reflected by the presence of an autism spectrum condition.

In addition to some combination of the impairments noted in the Introduction, one who is classified as possessing autism will also suffer from a distinctly debilitating impairment of communicational development, which may be manifested in a "delay in, or total lack of, the development of spoken language" and even distinguished by an incapacity to pantomime relevant gestures communicating thoughts and ideas. (ANI, 1) Other common forms of impairment relating to linguistic development which may combine to classify one as autistic will be the inability in those with the capacity for speech to engage in or maintain conversation with others, in the inane use of repetitive or 'idiosyncratic language,' and an apparent absence in the capacity to engage in creative or socially spontaneous us of developed communication tools. (ANI, 1) Parents of children who exhibit a delay in responsiveness to spoken language or whose initial communication takes on a form lacking in the nuance of real expression such as personal connectivity or emotional display, there may be cause for concern.

Another conditionality of diagnosis, in addition to impaired social and linguistic ability, will be some incarnation of an obsessive compulsive personality, relating most often to repetitive behaviors existing within a limited and patterned context. Autistic individuals will demonstrate an abnormal preoccupation with a specific object or activity, with some combination of conditions providing evidence thereof. Among these, the individual may show "an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus." (ANI, 1) Other conditions likely to be combined here with are a rigid and ritualized engagement of specialized objects related to the preoccupation and a potentially obsessive disturbance with regard to performance of such ritual use, the repetitive display of certain physical actions seemingly unrelated to the effective engagement of fixated objects and a "persistent preoccupation with parts of objects." (ANI, 1)

In general, these conditions conspire to create a debilitating array of disorders impacting the individual's life and most often detain the individual from independence or success in defining personal relationships. Signs for these propensities will function as a warning that some developmental issues may be preventing the child from pursuing normal education or socialization. Still, the autism spectrum is referred to thusly because it does encompass an array of different possible forms, making more complex the already pressing challenge to identify its presence early. Certain variations of the condition which are less severe and therefore often less immediately detectable, may yet be extremely debilitated if not diagnosed and treated.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), through which the American Psychiatric Association publishes currently accepted terms for identification and reference to specific disorders. Here, autism is identified as a pervasive developmental disorder, held in the same category which concerns Rett's Disorder and Asperger's Syndrome, the latter of which must be addressed in this discussion.

The DSM IV sets the series of conditions for identifying and diagnosing the variant of Autism Spectrum Disorder (ASD) conditions according to the functional capacities of the individual with the disorder. Under the general heading of the Autism Spectrum Disorder there are a wide array of symptoms which need not necessarily all apply to an individual in order for said individual to be characterized as suffering form autism.

To this end is a consideration of Asperger or Asperger's Syndrome, which describes possession of a host of symptoms relating to the Autism Spectrum Disorder but often distinguished there from by higher levels of awareness, functionality and linguistic development.. According to Klin et al. (2000), "Asperger Syndrome (AS) is a serious and chronic neurodevelopmental disorder which is presently defined by social deficits of the type seen in autism, restricted interests as in autism, but, in contrast to autism, relative preservation of language and cognitive abilities." (Klin et al., 25) This also leads to a consideration of High Functioning Autism (HFA), thought by some researchers to be directly synonymous with Asperger Syndrome. This is a pertinent view, as quite often, those autism sufferers with higher developmental opportunities and a greater capacity for linguistic development will find greater opportunity to engage compensatory talents.

The distinction between Autism and Asperger Syndrome is significant, making diagnosis or differentiation for either more challenging. However, those individuals most often classified in the latter category are typically deemed thusly in accordance to their relatively high level of functional development in spite of the presence of the cognitive differences affiliated with the autism disorder. According to the direct definition delivered in the research encountered here, it can be generally stated that "if an individual meets all of the criteria for HFA except communicative abnormality/history of language delay, they are said to have Asperger's syndrome (AS)." (Baron-Cohen, 1) According to this definition, Asperger's Syndrome is thought to be a disorder, particularly notable as such for the various social, emotional and communicational qualities which it has in common with autism. Already noted are the social delays and disorientation toward the development of normal emotional interaction with others. These are useful triggers in at least recognizing that some aspect of the child's development is impaired and will demand special attention in education and therapy.

However, there are other commonalities with autism which are more specified and therefore more compelling. For instance, quite often in Asperger's Syndrome, "the individual exhibits an unusual intense, circumscribed interest, or restricted, repetitive, and stereotyped patterns of behaviour interests, and activities." (Klin et al., 26) It is differentiated once again from autism however in the respect that this obsessive attention to a specific subject matter or object(s) need not necessarily be correlated to repetitive motions or "preoccupations with part objects or nonfunctional elements of play materials." (Klin et al., 26) Nonetheless the abnormal and limiting formulation of a specialized interest demonstrates a commonality in object orienation with that displayed commonly by the autistic. Such commonalities cause some researchers to question the rationality in distinguishing Asperger's from autism, arguing instead that as High Functioning Autism, Asperger's is merely one category of the disorder. Indeed, some perspective on the subject divide autism sufferers into categories of High Function (HFA), Medium Function (MFA) and Low Function (LF). (Kutscher, 1) These categories are generally defined by the IQ levels which often tend to correlate positively with the abilities of autism sufferers. To the point, diagnosis is often hardest to accept in those children who early on exhibit a certain precociousness or who evidence intense fixations in distinct subject areas, as these can be mistaken for aptitudes.

Indeed, it is faulty to assume that mental deficiency is a necessary condition of the autism disorder. Where IQ is concerned, variation suggests otherwise. As noted in the located research, "individuals with autism may have an IQ at any level. By convention, if an individual with autism has an IQ in the normal range (or above), they are said to have 'high-functioning autism' (HFA)." (Baron-Cohen, 1) For a parent with a young child who exhibits signs of true intelligence or even of prominent and unique talents, the understanding of autism as a disorder becomes somewhat difficult to accept.

This leads us to consider a question which remains today up for ongoing debate in diagnosis and treatment perpsecitve. Namely, it is argued that the term disorder is improperly applied to those with symptoms of autism which might otherwise display the capacity for a healthy and full development as individuals. Accordingly, the research conducted here brings us into contact with an article which "considers whether Asperger Syndrome (AS) or high-functioning autism (HFA) necessarily lead to disability or whether AS/HFA simply lead to 'difference'. It concludes that the term 'difference' in relation to AS/HFA is a more neutral, value-free, and fairer description than terms such as 'impairment', 'deficiency' or 'disability'; that the term 'disability' only applies to the lower functioning cases of autism; but that the term 'disability' may need to be retained for AS/HFA as long as the legal framework only provides financial and other support for individuals with a disability." (Baron-Cohen, 1) This suggests primarily that balance is required in understanding Asperger's Syndrome and High Functioning Autism, which may subject individuals to unique perceptual challenges but which may not appropriately be understood as disorders. This suggests that autism and its related conditions occur in far too great a variety of symptomatic forms in order to be deconstructed effectively along the lines of such a distinction.

This type of debate, however, only further confutes the already difficult task of identifying the presence or absence of the condition in young potential subjects. Fortunately, symptoms are not the only element available for consideration in achieving a diagnosis. To the contrary, the discourse on autism has increasingly come to recognize that there are clear genetic forces which factor into the occurrence of autism and which might offer clues for diagnosis. Moreover, there is a recognition within the context of this discussion that there may exist a certain genetic makeup predisposing a normally developed or non-Pervasive Developmental Disorder (PDD) individual to a set of traits which correspond in their combined presence with symptoms and traits associated with autism and related PDDs.

This genetic makeup is referred to as the autism phenotype, which pertains to the proposition that amongst sufferers of PDD conditions or autism, genetic relatives to these sufferers and individuals living in developmental normalcy, there is a pool of potentially shared characteristics. Said characteristics, as further discussion will indicate, are correlated to behavior, emotional disposition, communication barriers, physical distinctions and some savant features. (Bishop et al., 1431)

Therefore, at the center of this discussion is the key definitional basis stating tha "the concept of the 'broad phenotype' of autism refers to the finding that relatives of people with autism often have mild forms of autistic-like characteristics, such as social and communicative difficulties" to name just a few. (Bishop et al., 1431) Thus, discussion on this subject has concerned the value of identifying the characteristics said to define the phenotype in both sufferers and their relations.

It is here appropriate to consider the pool from which relevant characteristics are drawn. The characteristics which define the severely handicapping neurological condition, autism, vary from one sufferer to the next. As stated in the above examination of its condition, the diagnosis and treatment of autism will vary considerably based on the severity and permutation of the conditions present in the subjected individual. Moreover, autism itself is deeply shrouded in mystery. There are a great many competing and complimentary theories relating to the presence of autism which suggest its causes may be some combination or diversity of factors causing the deleterious genetic mutation preventing proper neurological development.

One thing which is certain and which causes us to question with even greater intensity the true factorial basis for the occurrence of autism is its rising prominence in the United States. Indeed, the exponential nature of its rise in occurrence qualifies it for epidemic status. As of 2006, "autism in the United States ha[d] been increasing for two and a half decades, from one child in 10,000 to one in 500 or perhaps even 166 today." (Easterbrook, 1) This constitutes an alarming increase in occurrence of that which had generally been understood to be a genetic disease.

The discussion of the phenotypic conditions pertaining to autism require us to consider some of the genetic theories relating to autism, though these do little to address the issue of its epidemic rise in modern occurrence. A compelling finding on the subject dictates that there is a direct connection, nonetheless, between the presence of autism in the child and some string of this disorder in the genetic material of the family. To this end, "studies of families ascertained through a single autistic proband suggest that the genetic liability for autism may be expressed in nonautistic relatives in a phenotype that is milder but qualitatively similar to the defining features of autism." (Piven et al., 185) This suggests that there may be some correlation between the presence of autism in an individual and the genetic makeup of the individual's family. Moreover, we may suggest that where autism is already documented, a family may be believed to be in a category of higher susceptibility for a recurrence of this condition. This should serve as a point to highlight in attempting to diagnose its presence. Family history and the presence of developmental abnormalities in siblings or parents can help us to ascertain the likelihood that a developmental issue in the young child is a part of the autism spectrum disorder.