Challenges in social communication and interaction, and restricted or repetitive behavior are general characteristics of Autism Spectrum Disorders, Some children develop speech, and then regress, or lose communication skills. Others echo or repeat what they hear. Many individuals with ASD do learn to talk, while others rely on technology, sign or pictures to communicate. However, conversational skills, gestures and non-verbal communication remain difficult for most individuals with ASD.
About ASD
Autism Spectrum Disorder or ASD is a condition defined by atypical or impaired development in social interaction and communication skills and the presence of repetitive behaviors and restricted interests. ASD is considered a “spectrum disorder,” because there are many characteristics that vary from person to person, and these can change over time as a result of intervention and development. For example, one child with ASD may struggle to learn to use words to communicate while another may be capable of carrying on a long conversation, but will only care to talk about certain topics. Many show a strong aptitude in one area, while remaining weak in some others. Some people may refer to individuals with ASD as being “on the spectrum.”
About the language we use...
CARD believes that people are able to identify themselves as they wish. Some people we support prefer use “identify first” language to refer to themselves. They may say they are autistic (adjective), or an autistic (noun), or an Aspie (noun or adjective), or neurodivergent (adjective). Many professionals have be trained by the larger disability community to use “person-first” language (such as a “person with autism” or “child with ASD”). The person-first movement stemmed from years of people with disabilities being described with words that emphasized only one aspect of who they were, which placed stereotypes and limitations placed on them, rather than a person with multiple dimensions, strengths, and needs. This website follows the tradition of a person-first approach. We believe, as our self-advocate friend Stephen Shore says, “When you’ve met one person with autism…you’ve met one person with autism.” However we honor each of our constituents’ choice to identify themselves as they see fit.
Incidence
As of 2021, ASD is estimated to occur at a rate of 1 in every 44 children. It occurs 4 to 5 times more often in boys than in girls. Symptoms are present before the age of three, although diagnosis may occur later. ASD affects individuals from all racial, ethnic and social backgrounds.
Characteristics
Social Interaction & Communication Challenges
Persons with ASD often have difficulty interacting with others, learning to play with peers, and developing friendships, even though some may be very interested in having friends. They often have difficulty using and understanding eye contact, facial expressions, and social rules. They can be unaware of the interests and perspectives of other people, and may, therefore, become socially isolated and misunderstood. Communication may be absent, but may also be rich in vocabulary with little appreciation for the give and take of conversation. Specific indicators include deficits in social- emotional reciprocity, non-verbal behaviors used for social interaction, and developing and maintaining relationships.
Interests and Behavior
Cause
Nobody knows what causes ASD. Scientists believe that there are chemical and biological differences in how the brain functions, and there may be genetic factors involved. Parents do not cause autism spectrum disorders. No factors in a child’s experience or in parenting styles are responsible for ASD.
Prognosis
ASD is a lifelong condition that is considered a disability under IDEA and ADA, but with intensive and early intervention, individuals with ASD can and do make excellent progress and improve their quality of life. Some people embrace their ASD while others see it as a significant challenge to the life they desire. Autism is not a disease, or something that needs to be cured. However, for those seeking to improve their social and communication skills, sensory issues, or interests and attention, there are many intervention strategies designed to address these challenges associated with ASD.
What happened to those other Autism Labels?
Autism Spectrum Disorder or ASD is a brain-based developmental disability characterized by atypical or impaired development in social interaction and communication and the presence of repetitive behaviors or restricted interests. Until 2013, the psychological label cluster for all persons on the autism spectrum was officially Pervasive Developmental Disorder or PDD instead of ASD. Several subtypes, including autism, PDD-NOS, Rett Syndrome, and Asperger’s Syndrome were defined, and specific diagnosis was based on the subtype an individual best fit.
In 2013, the American Psychiatric Association did away with these different subtype labels, stating that trying to distinguish between the various subtypes was like “trying to cleave meatloaf at the joints.” Henceforth, the American Medical community will use the general term ASD to refer to individuals diagnosed anywhere on the autism spectrum. There is still much controversy about this decision.
Although specific subtypes will no longer be used to by the medical and scientific community to describe individuals with ASD after 2013, the labels may still be used by individuals diagnosed before this date. Read on for more information on the historic labels.
What is Autism?
Autistic Disorder, most commonly called “autism,” was first defined in the manual for psychological conditions in the 1940s. In 2013, the American Psychiatric Association rewrote the diagnostic code, and discontinued the use of the term in favor of the label Autism Spectrum Disorders. The criteria used to diagnose autism prior to 2013 are presented below:
An individual who would be diagnosed with Autistic Disorder would demonstrate at least 2 of the items listed in the social interaction impairments group, at least one from the communication group, and at least one from the restricted interests group, and at least six indicators across categories, with onset prior to the age of 3. Schizophrenia must also be ruled out.
• Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
• Failure to develop peer relationships appropriate to developmental level.
• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
• Lack of social or emotional reciprocity.
• Delay in, or total lack of development of spoken language not accompanied by an attempt to compensate through alternative modes of communications such as gesture or mime.
• Stereotyped or repetitive use of language or idiosyncratic language.
• Lack of varied, spontaneous make believe play or social imitative play appropriate to developmental level.
• In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
• Persistent preoccupation with parts of objects.
• Apparently inflexible adherence to specific, nonfunctional routines or rituals.
• Stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements).
¿Qué es el Desorden del Espectro Autista?
What is Asperger's Syndrome?
Although Asperger’s Disorder is not used as a formal diagnosis in the USA after 2013, many individuals with ASD will continue to embrace this label.
To have received a diagnosis of Asperger’s Disorder (also called Asperger’s Syndrome, or “AS”) a person must demonstrate an average or above average IQ, and normal onset of speech development. People with AS communicate verbally, sometimes having very advanced vocabularies. They may be very concrete in their thinking. They may also become “obsessed” with a topic or have repetitive behaviors. Despite their intelligence and communication abilities, they have trouble making and keeping friends, and following the social rules that we all learn without formal instruction. They can also take things very literally and have issues with idioms. If a teacher is speaking to the class and the class is fooling around, the teacher may say “Ok class, knock it off!” The student with Asperger’s may respond by knocking his books off his desk. The student took this direction at face value, and not as the teacher intended. The teacher may misunderstand and think this student is being rude or silly.
Individuals with AS tend to have trouble with flexible thinking, and may have rituals or rigidities that result in meltdowns and tantrums when unable to follow their routine. You may not notice they have a disability at first glance. However, when you are able to observe closely and get to know the individual, you will see that their problems come from a difficulty in understanding social interactions.
Asperger’s may not be spotted right away because the characteristics at first glance may seem typical, and the diagnosis often comes later. There have been cases of people not being diagnosed until adulthood. You may know someone who has these traits but is not diagnosed. They may seem a bit uncoordinated and are often referred to as “little professors”. In a school setting, they may be disorganized and not fond of homework.
An individual who would be diagnosed with Autistic Disorder would demonstrate at least 2 of the items listed in the social interaction impairments group, at least one from the communication group, and at least one from the restricted interests group, and at least six indicators across categories, with onset prior to the age of 3. Schizophrenia must also be ruled out.
Autism Speaks has prepared a comprehensive resource for families of children diagnosed with Asperger's.
What is PDD-NOS?
You may have been told that a child has “PDD” (which stands for Pervasive Developmental Disorder). This term was used to speak generally about the individual’s profile of skill problems in the three core areas affected by ASD. The common features of these diagnoses are that they all are affected by varying amounts of difficulty with the three core areas: social interaction, communication problems, and unusual or restricted interests and attention. If the individual showed difficulties in each of these areas, the doctor may have diagnosed the child has as having “Pervasive Developmental Disorder-Not Otherwise Specified.” It is very difficult to give an exact diagnosis without an extensive evaluation, so many medical professionals just said “PDD” even though that is like a witness describing a hit and run car accident to a police officer by saying “The guy was driving a car” instead of “he was driving a green Honda Civic.”
PDD-NOS was the diagnosis given if the individual showed at least one symptom in each of the three core areas. The “Not Otherwise Specified” means that either the doctor did not do an extended evaluation in order to determine if the individual met one of the other subtypes of Pervasive Developmental Disorder, or although the individual has difficulties in all three areas,
any other form of autism spectrum disorder was ruled out. It is also possible the pediatrician or doctor may not have been sure of the exact subtype, or they may have wanted to see how a young child responded to therapy or intervention before making a definitive diagnosis. Doctors also tended to give this diagnosis to younger children because the very young children may not exhibit some of the traits of autism until they get a little older. You will often see this PDD-NOS diagnosis given to the very young; after being re-evaluated when they are a bit older, the diagnosis may be updated to ASD.
Diagnosing very small children is extremely difficult because they can change so much in the first five years of life. For example, it is very hard to evaluate communication during a short doctor appointment if the child isn’t saying anything yet, or is crying a lot. They may be shy, speech delayed, or autistic. So, many pediatricians simply provided the general category label at that time, and deferred a diagnosis until later.