Autism Spectrum Disorder (ASD)
On this page:
- Diagnostic Criteria
- Asperger’s (high functioning Autism)
- Link to a guide on Asperger’s by Tony Attwood
- Classroom strategies to use when working with children on the ASD spectrum
Autism Speaks (www.autismspeaks.org) provides the full-text of the diagnostic criteria for autism spectrum disorder (ASD) and the related diagnosis of social communication disorder (SCD), as they appear in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As of May 2013, psychologists and psychiatrists will be using these criteria when evaluating individuals for these developmental disorders.
Social (Pragmatic) Communication Disorder 315.39 (F80.89)
A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.
Autism Spectrum Disorder 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
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 communicative behaviors used for social interaction, ranging, for example, 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, 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.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later 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 co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)
Table 2 Severity levels for autism spectrum disorder
|Severity level||Social communication||Restricted, repetitive behaviors|
“Requiring very substantial support”
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
“Requiring substantial support”
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.
Asperger’s (High Functioning Autism)
What Is Asperger Syndrome? (text from Autism Speaks. org)
Asperger syndrome is an autism spectrum disorder (ASD) considered to be on the “high functioning” end of the spectrum. Affected children and adults have difficulty with social interactions and exhibit a restricted range of interests and/or repetitive behaviors. Motor development may be delayed, leading to clumsiness or uncoordinated motor movements. Compared with those affected by other forms of ASD, however, those with Asperger syndrome do not have significant delays or difficulties in language or cognitive development. Some even demonstrate precocious vocabulary – often in a highly specialized field of interest.
The following behaviors are often associated with Asperger syndrome. However, they are seldom all present in any one individual and vary widely in degree:
• limited or inappropriate social interactions
• “robotic” or repetitive speech
• challenges with nonverbal communication (gestures, facial expression, etc.) coupled with average to above average verbal skills
• tendency to discuss self rather than others
• inability to understand social/emotional issues or nonliteral phrases
• lack of eye contact or reciprocal conversation
• obsession with specific, often unusual, topics
• one-sided conversations
• awkward movements and/or mannerisms
More on ASD
The link below opens up a comprehensive guide to Asperger’s that may be a useful resource if you wish to gain a more thorough understanding of Apserger’s. Please note the guide was written prior to the new diagnostics manual (DSM 5).
Classroom Strategies for Teachers regarding learner’s with Asperger’s
Children whose needs are not at the severe end of the spectrum have been and can be successfully included within mainstream schools. This has been most successful where schools have been given opportunities to understand the implications of Asperger syndrome or autism for the child and have had the opportunity to explore strategies and interventions. There will need to be flexibility and a recognition that the child may need some approaches different to those used for the other children. Close working with parents is also essential, to ensure consistency and mutual support.
Classroom practice for children with autism or Asperger syndrome in mainstream school will need to take into account the following issues:
- the child’s lack of generalisation of learning (every situation appears different to the child)
- the lack of incidental learning (everything needs to be directly taught)
- the literalness of understanding
- difficulties in becoming involved in group activities including play and games
- possible reactions to over-stimulation and the fact that this can easily occur in situations that other children cope well with
- observed behaviours which might be seen as simple naughtiness or non-compliance may in fact have a range of other meanings for the child with autism or Asperger syndrome (i.e. the observed ‘naughty’ or ‘non-compliant’ behaviour may in fact be the child’s only way … of indicating the need for help or attention, or the need to escape from stressful situations,… of obtaining desired objects, … of demonstrating his/her lack of understanding, … of protesting against unwanted events, … of gaining stimulation).
The programme for an individual pupil will need to be based on the assessments of the pupil’s individual needs and developed by close collaboration of all those involved with the pupil. However, Basic strategies would include:
- Providing a very clear structure and a set daily routine (including for play). Ensuring the pupil knows the day’s programme at the start of each day and can make frequent reference to this throughout the day, e.g. providing a ‘picture board’ with the day’s activities ‘laid out’.
- Providing warning of any impending change of routine, or switch of activity.
- Using clear and unambiguous language. Avoiding humour/irony, or phrases like “my feet are killing me or it’s raining cats and dogs”, which will cause bewilderment,
- Addressing the pupil individually at all times (for example, the pupil may not realise that an instruction given to the whole class also includes him/her. Calling the pupil’s name and saying “I need you to listen to this as this is something for you to do” can sometimes work; other times the pupil will need to be addressed individually).
- Repeating instructions and checking understanding. Using short sentences to ensure clarity of instructions.
- Using various means of presentation – visual, physical guidance, peer modelling, etc.
- Ensuring consistency of expectation among all staff… and avoiding any ‘backing-down’ once a reasonable and manageable target has been set.
- Recognising that some change in manner or behaviour may reflect anxiety (which may be triggered by a [minor] change to routine).
- Not taking apparently rude or aggressive behaviour personally; and recognising that the target for the pupil’s anger may be unrelated to the source of that anger.
- Specific teaching of social rules/skills, such as turn-taking and social distance.
- Minimising/removal of distractors, or providing access to an individual work area or booth, when a task involving concentration is set. Colourful wall displays can be distracting for some pupils, others may find noise very difficult to cope with.
- Seeking to link work to the pupil’s particular interests.
- Protecting the pupil from teasing at free times, and providing peers with some awareness of his/her particular needs.
- Allowing the pupil to avoid certain activities (such as sports and games) which s/he may not understand or like ; and supporting the pupil in open-ended and group tasks.
- Allowing some access to obsessive behaviour as a reward for positive efforts.
More strategies which are helpful:
- Allow more time to complete assignments, tests, and projects.
- Break assignments and projects down into small sections that can be completed one at a time so that the child does not feel overwhelmed with the work.
- Create a standard way of presenting change in advance of the event. A key phrase like “Today will be different” may be helpful if used consistently. You may want to explain the changes — for example, a substitute teacher — privately as well as with the class.
- Create a structured, predictable, and calming environment.
- Create a unique prompt or signal that you can use with the child to redirect his attention back to the assignment whenever necessary.
- Create fewer transitions throughout the day. For example, try to create a schedule that eliminates unnecessary movement from one location to another.
- Enjoy and make use of your child’s verbal and intellectual skills. Fixations can be used by making their chosen subject the center of teaching and using the child’s expertise to raise peer interest and respect (i.e., have him give a report or make a model of his favorite subject to share with the class.)
- For children with Aspergers, it may be necessary to use more visual instruction, particularly with younger students. Use pictures, images, drawings, and similar aids when discussing vocabulary words, history lessons, scientific subjects, and abstract topics.
- Foster a climate of tolerance and understanding in the classroom. Consider assigning a peer helper to assist the child in joining group activities and socializing.
- Have a crisis plan in place in the case of emotional outbursts that might occur due to the student’s inability to cope or interact with others. This plan should be coordinated with other educators, specialists, and administration, and may include providing a supervised quiet place for the child to go if needed.
- In some cases, cooperative learning groups will not only improve social skills but also allow the child to exhibit his abilities in certain subjects. Choose the cooperative groups carefully, and continue to monitor the behaviour of the student and his peers.
- It may be necessary to focus individual lessons around that particular child. If so, continue to work in conjunction with the special education teacher when designing these lessons.
- Learn the usual triggers and the warning signs of a rage attack or “melt-down” and intervene early, before control is lost. Help your child learn self-calming and self-management skills. Remain calm and non-judgmental to reduce stress, remind yourself that your child “can’t” rather than “won’t” react as others do.
- Maintain a safe environment. This means controlling other students who would be a distraction or a problem for the child with Aspergers.
- Place the child at the front of the room, and include him in question and answer sessions within the class.
- Prepare the student in advance for any changes in routine or other unexpected activities.
- Provide whatever support and information you can to the parents. Kids with Aspergers Syndrome often have sleep disorders and the family may be sleep-deprived. Other parents show frustration due to the long search for a diagnosis and services. They may also face disbelieving professionals or family members who erroneously blame poor parenting for the behaviours they see.
- Set firm expectations regardless of the assignment. In many cases, students with Aspergers may not want to do assignments that hold no interest for them. It is important to establish and maintain control within the classroom, and this should include a child with Aspergers as well.
- Try to provide a predictable schedule. Although this is sometimes difficult to do, students with Aspergers thrive on routine.
- Use direct teaching to increase socially acceptable behaviours, expected greetings and responses, and group interaction skills. Demonstrate the impact of words and actions on other people during real-life interactions and increase awareness of emotions, body language, etc.
- Use positive reinforcement of good behaviour whenever possible.
It is probable that these children will not take any advantage from counselling or from activities such as Circle Time. Instead, adults will need to constantly monitor the context to identify possible sources of uncertainty, peer-interaction problems, or other sources which could lead to stress for the pupil and consequent difficult behaviour. Once such possible sources are identified adults may be able to create changes in the context that diverts the potential difficulties (such as establishing an enhanced tolerance of the observed behaviours and style), or act as a ‘mediator’ to help resolve any problems.
Close liaison with parents and with other professionals (Educational Psychologist, Speech and language Therapist, Paediatrician) will need to be maintained. This will enable close monitoring of the pupil’s progress in social and communication skills, and scholastic performance. It will also be important for sharing the process of interpreting behaviours and identifying triggers for negative or anxious episodes.