February 11th, 2012
In recent years, autism spectrum disorders (ASD) have gained a great deal of attention for the rising prevalence of the diagnosis. This has created a greater level of awareness in our community, but also has lead to some misunderstandings about what ASD is. ASD is a developmental disability that affects three areas of functioning; these are language/communication, social functioning, and behavior. In the early years, an individual with ASD presents difficulties either in social communication, imaginative play, or social interaction. Over time, the characteristics described below also become evident.
A person with ASD typically has an early history of language delay. Some children even have a regression in language skills, meaning that they start to develop language, but then stop speaking. This regression can be gradual or sudden. The good news, however, is that most people with autism spectrum disorders develop language, particularly with the help of intervention.
Individuals with ASDs also tend to use language in an idiosyncratic manner. These idiosyncrasies include using language in a repetitive manner (echolalia), speaking with an unusual tone of voice, using formal language, and speaking in an invented language/using invented words. Some children speak much like an adult would. Conversation is also difficult for people with ASD. Someone with ASD may talk a lot, but it is hard for them to engage in a reciprocal conversation, meaning that they might talk on and on about one topic or try to bring conversations about varying topics back to a topic of particular interest. Others might not respond at all to the social use of language. In children with ASD, there is also sometimes a difficulty with pretend, imaginary play. This is sometimes an area of play that children with ASD do not enjoy.
Individuals with ASD vary in terms of their interest in engaging socially with others. Some people with ASD really want to have friends and interact with others, while some people with ASD prefer to spend time alone, not interacting with others. In both groups, peer relationships are difficult. Those who want to engage with friends often have difficulty with the reciprocal nature of social relationships, so skills such as turn-taking, sharing, and allowing for everyone to influence the progression of play can be a struggle.
Another often problematic area of social development for individuals with ASD is the use of nonverbal behaviors to regulate social interactions. This means that a person with ASD may have trouble using eye contact, so they may avoid making eye contact, or they may make too much eye contact such that it appears they are staring. Facial expression and gesture also may be implicated here, so that the person with ASD may have a limited range of facial expressions (e.g. always smiling) or do not use or inconsistently use gestures such as waving goodbye and pointing.
Individuals with ASD may also have trouble with a concept known as “socioemotional reciprocity.” This means that social skills such as comforting others who are hurt or sad, responding appropriately when someone approaches them, and initiating social contact in an appropriate manner may be difficult for them.
Finally, individuals with ASD have trouble in many cases with “shared enjoyment.” Shared enjoyment refers to behaviors such as smiling, making eye contact, and saying enthusiastic comments, such as, “This is great!” when happy and excited about something.
Interests and Behaviors:
People with ASD often have strong interests that captivate them. These interests can pervade play, conversation, leisure time, and academics, and in many cases, the individual is incredibly knowledgeable about their topic of interest. A person may have one interest that they maintain for years and years, or they may have an intense interest for a month or two, and then shift to a new intense interest.
Individuals with autism also are often interested in the parts of objects. For example, instead of playing with matchbox cars by setting up a racing scenario, they may prefer to turn the car over and watch the wheels spin. Individuals with ASD also may engage in repetitive motor behaviors, such as hand flapping or finger flicking. These mannerisms may be brief and subtle, or they may be very obvious.
Finally, people with ASD often adhere to routinized behavior. For instance, they may insist on taking the same route to school everyday, or keeping the same strict schedule day after day. Many parents don’t recognize these routines until an unexpected disruption occurs and their child becomes very upset.
ASDs can be diagnosed at a range of ages, from early childhood through adulthood. No matter what age, diagnosis can be a valuable way to secure the supports and services an individual might need to meet their potential.
Carolyn Kessler, Ph.D., is a child psychologist with more than 10 years of experience working with children, adolescents, and their families on issues related to behavior management and parenting, anxiety disorders, mood disorders, developmental disabilities, and ADHD. Family training is a key component of her therapy. Dr. Kessler specializes in the diagnosis and treatment of autism spectrum disorders. She is a Codirector of Psychology Services at the New York University Child Study Center’s Institute for Pediatric Neuroscience and is in private practice in Park Slope, Brooklyn, where she provides assessment, treatment, and consultation to families and schools. In addition to standardized testing of IQ, achievement, memory, and behavior, her assessment skills include the use of the Autism Diagnostic Observation Schedule (ADOS), an instrument on which Dr. Kessler trains other professionals, as well as the Autism Diagnostic Interview- Revised (ADI-R).