Autism Spectrum Disorder

Autism Spectrum Disorder

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Introduction

                 Autism is a condition marked by a broad spectrum of challenges with social skills, persistent behavior, and verbal and nonverbal communication. Since it has a range of conditions, it is also called an autism spectrum disorder (ASD) (Campisi et al., 2018). It may be defined by sensory problems of an individual either under or over-reacting to stimuli. Moreover, autistic individuals may display varying abilities in terms of cognitive skills where they do well in activities involving both visual and recent memory, but struggle in independent thinking and nonverbal or symbolic actions. A combination of various research evidence from less than a decade ago in America and historical, anecdotal information, linked foreign-born mothers who are black, Filipino, central/south Americans and Hispanic as having a higher risk to give birth to susceptible children as compared to the US-born (Ousley & Cermak, 2014). However, a gap still exists since there are no conclusive studies substantially linking nativity or race with the etiology of ASD.

             An increment of ASD cases worldwide, with a notable percentage of about 0.5-1, has been witnessed. Males are in a higher proportion than females owing to an array of factors such as biological disparities (genetics and sex chromosomes), under-diagnosis in females, and the ability to mask their difficulties. Often, behavioral indicators of ASD appear as early as between the first and the second year of development. Identification of the symptoms at this preliminary age is crucial, failure to which can yield severe limitations. Early spotting enhances management while there is a high function in the IQ, while delay can cause inadequate adaptive capacity (Pennington, Cullinan & Southern, 2014). There is no apparent study connecting socioeconomic class and autism prevalence. Nevertheless, different hypotheses have been developed to argue that people living in illiteracy, poverty, and low household incomes experience moderate cases due to lack of exposure in testing and diagnosis.

Current developments in understanding the causes of autism

        On account of increased scientific research and knowledge, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has classified several disorders in the broad category of autism spectrum disorder (Frazier et al., 2012). According to the American Psychiatric Association DSM, autism is defined as a behavioral disorder initially thought to be a pervasive developmental disorder. Conversely, it has been contemporarily categorized as a neurodevelopmental illness. DSM-5, as opposed to the previous DSM-IV, takes a dimensional approach to amplify understanding of manifestation. As a pervasive developmental disorder, there was a lack of specificity, and continued use of this category yielded diagnostic confusion and palpable overlaps compared to single spectrum classification.

          The DSM-5 workgroup consisted of an extensive compendium of participants including child psychiatrists, pediatric neurologists, developmental-behavioral pediatricians as well as child psychologists. The process, which spans for a time series of five years and utilized over 2500 hours, involved teleconferences twice a week, a semiannual in-person meeting, and web conferences. Merging of autism spectrum disorders into a single diagnosis has been heavily supported and justified by the available empirical evidence combined with longstanding and consistent clinical accomplishments, stating that a unique spectrum has a better assessment on time progression, symptom presentation, and management (Skuse et al., 2004). On the other hand, a gap still exists for the inclusivity of all other missing cases done even before the development of the criteria.

              Additionally, continuous and updated data is a priority in the studies of ASD (Park at el., 2016). Tracking the trends on gender ratios and prevalence in age, race, and socioeconomic status gives an extensive understanding of causative factors and conditions of ASD. To underpin this epidemiologically, a meta-analysis data covering two years was presented implicating factors like older parental age, pregnancy complications, maternal medication use, and neonatal health. Five thousand cases and 50,000 controls were used in a cohort study on SSRI exposure to maternal prenatal. A chronological follow-up was done to pregnant women right from conception to establish the basis of depression that sets in during the exposure and its relationship with autism.

Moreover, the taking of biological samples from both the mother and father during the widow period epitomized another procedure. Widow period is deemed prone to environmental factors influence. Babies are followed up to a period of 36months (Hymen, Levi & Myers, 2020). Potential gaps still exist in exogenous environmental chemical effects on autism and the alleged defensive capability of folic acid against autism.

Social, environmental and genetic factors that cause ASD

             The field of etiology in autism is one that has attracted many researchers for the determination of its relationship with genetic, social, and environmental factors. However, the accomplished research remains unsatisfactory (Embarti & Curatolo, 2018). Of all the elements given consideration by the majority of the researchers, a consensual agreement among them revealed that genetics are predominantly significant. Nonetheless, environmental factors also have a role to play. The contributory major environmental factors include heavy metals, specific foods, illnesses, phenols used in plastics, pesticides as well as illicit drugs.

          Twin studies have been conducted to add to the tremendous research done in the last 20years on genetic factors. In the first case of 11 monozygotic and10 dizygotic twins, four of the monozygotic twins were conformant with autism with none in the dizygotic category. Further, 9 out of the 11 monozygotic were classified to contain some form of neurobiological impairment, while only 1 of the ten dizygotic pairs displayed such. The conclusion was that autism spectrum disorder is associated to a greater extent by genetic composition (Geschwind & State, 2015).

        Despite weak connections, pathogen exposure studies allude to the closeness of autism to environmental factors. A study was done by a child psychiatric at New York University involving a sample size of 243 children who were, while in their mothers’ wombs, exposed to rubella. In the end, 37% of the sample was affected by intellectual disability, a form of neurodevelopment disorder. Also, 9 of them were diagnosed with autism (Matson & Sturmey, 2011). Moreover, drugs taken during pregnancy can have a profound adverse effect on the fetus. A study involving 100 individuals from Sweden whose mothers had ingested thalidomide during pregnancy, captured four of their patients having distinctive autistic characteristics. It confirmed the hypothesis that a drug taken during pregnancy could exponentially increase the risk of suffering autism.

Existing intervention for ASD

 ABCs Model

            The use of social ABCs has become an integral part of daily care and the handling of autistic individuals. Fundamentally, it’s a tool that helps in understanding a person’s behavior, purpose, reason, and cause, especially in students. One person can possess various traits that are considered problematic, but only one of them can be scrutinized at a tome under the ABC model. Four main reasons for a particular behavior are sufficiently covered, including attention, escape, and avoidance, tangible and sensory reinforcement. It involves the victims and their caretakers.  Correctly and consistently recording the sporadic behaviors of autistic individuals as occurrences improve the knowledge on them.  It is mainly a two-dimensional or a three-dimensional representation of a particular idea used to communicate, understand or teach a concept

Early Start Denver Model (ESDM)

             It’s an intervention aimed at according therapy to autistic children between the ages of 12-48 months based on applied behavior analysis (ABA). In this model, there is a collaboration of therapists and parents who use play to build rapport. Cognitive, social, and language abilities of the autistic child are exponentially improved owing to the joint activities of the two parties. Applied Behavioral Analysis (ABA) is based on breaking down skills into small tasks in an extremely structured fashion, and the strengthening thought to be positive while deterring any inappropriate action. The ABA methods highly criticize the other techniques of intervening autism in that they try to make autistic children forget that they are autistic. Zurcher compares those the teaching of autistic children of how to overcome autism as a gay who thinks can live happily by hiding his homosexuality than the one who is ‘out'(Zurcher, 2012).

  Picture Exchange Communication System (PECs)

              In this method, small cards are used to represent things that the child needs, for example, food or toys. When the child wishes to communicate, he or she picks up the card of the situation he or she needs. The parent picks the card in exchange for the desired item; the method is later used to teach more profound concepts and ideas once the child knows how to get the desired thing (Bondy and Frost, 1998). The behavioral theory of pairing the completed task with something that is mainly desirable by the child would lead to more successful objectives finished. The argument is reliant on using socially acceptable motivations to get as many tasks done as possible. The social motivation is mainly for the lot that is suffering from the lack of social awareness

          The use of visual systems can boost a child’s understanding of the communication of his or her environment, for example, pictures and gestures. Hodgdon (1995) states that the use of visual support enhances the child’s understanding because it builds on the child’s strength rather than pressuring the area of immense difficulty. Visual strategies do not eliminate vocal exchange but used in conjunction with keywords to enhance the receptive meaning of spoken words.

Conclusion

          Although there is no apparent cause of autism as well as specifically known clinical management, showing compassion, care, and empathy to the victims by friends, family, and caregivers is of the essence. Being autistic may mean a lot of things and, among them, limited interactions and hence discrimination in the society (Lord et al., 2018). It is, therefore, of paramount importance for the community to be vigilant in improving and maintaining the standards of these individuals (Martin & Milton, 2017). Just like people with hearing problems as well as vision problems, children and people with autism need early diagnosis if at all they have to survive the world. This calls for active participation of involved cohorts. How well the kids are going to develop through their adult life depends mainly on being equipped with language skills.

References

Campisi, L., Imran, N., Nazeer, A., Skokauskas, N., & Azeem, M. (2018). Autism spectrum disorder. British Medical Bulletin, 127(1).

Emberti Gialloreti, L., & Curatolo, P. (2018). Autism spectrum disorder: Why do we know so little? Frontiers in Neurology, 9, 670.

Frazier, T., Youngstrom, E., Speer, L., Embacher, R., Law, P., Constantino, J., … & Eng, C. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 28-40.

Geschwind, D., & State, M. (2015). Gene is hunting in autism spectrum disorder: On the path to precision medicine. The Lancet Neurology, 14(11), 1109-1120.

Hyman, S., Levy, S., & Myers, S. (2020). Identification, evaluation, and management of children with an autism spectrum disorder. Pediatrics, 145(1).

Lord, C., Elsabbagh, M., Baird, G., & Veenstra-Vanderweele, J. (2018). Autism spectrum disorder. The Lancet, 392(10146), 508-520.

Martin, N., & Milton, D. (2017). Supporting the inclusion of autistic children. In Martin, N., & Milton, D. Supporting inclusive practice and ensuring opportunity is equal for all (pp. 111-124). Routledge.

Matson, J., & Sturmey, P. (Eds.). (2011). International handbook of autism and pervasive developmental disorders. Springer Science & Business Media.

Ousley, O., & Cermak, T. (2014). Autism spectrum disorder: Defining dimensions and subgroups. Current Developmental Disorders Reports, 1(1), 20-28.

Park, H., Lee, J., Moon, H., Lee, D., Kim, B., Kim, J., … & Paek, S. (2016). A short review of the current understanding of autism spectrum disorders. Experimental Neurobiology, 25(1), 1-13.

Pennington, M. L., Cullinan, D., & Southern, L. B. (2014). Defining autism: variability in state education agency definitions of and evaluations for autism spectrum disorders. Autism research and treatment, 2014.

Skuse, D., Warrington, R., Bishop, D., Chowdhury, U., Lau, J., Mandy, W., & Place, M. (2004). The developmental, dimensional, and diagnostic interview (3di): A novel computerized assessment for autism spectrum disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 548-558.

Zurcher, A. (2013). Tackling that troublesome issue of ABA and ethics. Emma’s Hope Book: Living being Autistic.

Frost, L. A., & Bondy, A. S. (1994). PECS training manual. Newark: Pyramid Educational Consultants.

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