UPDATES ON AUTISM SPECTRUM DISORDER

Questions and Answers on ASD
by Lirio S Covey, AAAP President

· What are the diagnostic features of ASD?

There are four specifications of the ASD symptoms: 1) persistent deficits in social interactions and communication across multiple life contexts (home, school, peer relationships); 2) restricted and repetitive patterns of behaviors, interests, or activities; 3) symptoms are observable in early childhood (in a few cases during adolescence, and more rarely, during adulthood); 4) ASD symptoms range in severity.

The original view of autism is its neurological and behavioral character. An emerging view is that autism is a whole body condition involving other organs and that the disturbances in the biological systems are part of the autism process. Various common medical conditions, for example, gastrointestinal disorders, pulmonary disorders, as well as psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), anxiety, and bipolar disorder, are experienced by persons with ASD during their lifetime.

· Who can make a diagnosis?

Detection and diagnosis of ASD remain on the level of clinical observation usually made first by the parents and family, then confirmed, following diagnostic criteria, by professionals trained in child and adult psychiatry, developmental pediatrics, and psychology with specialization in special needs and disabilities acting as a team. No biological markers of ASD yet exist.

· How common, or rare, is ASD?

Worldwide, ASD is estimated to afflict at least 1% of children. This prevalence rate has been increasing.

In the United States, it was estimated in 2002 that ASD affected every 110 children; in 2008, this estimate grew to 1 out of every 88 children; most recently, based on 2010 data, ASD was estimated to affect 1 of every 68 children aged 8 years of age.

Prevalence data on ASD in the Philippines is not yet available; informal estimates suggest that more than 500,000, maybe even close to one million Filipinos, children and adults, have ASD.

· Why is the rate of ASD on the rise?

The reasons are unclear. Improvements in diagnosis of ASD is the most widely held interpretation of available data by autism researchers. Because of increased awareness, families are more able to recognize the unusual behaviors of children with autism, more clinical tools are available for assessing the presence of ASD symptoms, and clinicians, such as developmental pediatricians and child psychiatrists, are more familiar with the established ASD symptoms.

· What are the causes of ASD?

Genetic factors are considered to have a dominant role. These genetic factors can be inherited or result from random mutations. Environmental factors are also suspected causal factors; these can affect the fetus during pregnancy, or may represent toxic exposures during infancy and early childhood. Recent research has indicated important contributions of mother’s or father’s older age. Childhood vaccines were erroneously identified as a cause of autism by an English researcher, as was the “cold mother” by Bruno Bettelheim, but these theories have been strongly debunked.

· Do persons with Asperger’s Syndrome fall in the ASD spectrum?

Yes. In the current diagnostic system of the American Psychiatric Association (DSM-5), persons who meet the ASD diagnosis no longer fall into sub-categories (as in earlier diagnostic versions) but fall on a spectrum, usually referred to as mild, moderate, profound and severe. Other specifications refer to the ASD range of symptoms according to functioning level, referred to as low, mild, moderate, and high functioning.

Persons who were categorized as having Asperger’s Syndrome usually fall in the high functioning range of ASD. Typically, they are not limited in language or other cognitive ability, but are impaired in their abilities for social interaction and communication.

· How is a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) related to ASD?

ADHD and ASD are separate diagnostic entities; nevertheless, both conditions can occur in the same person. Both disorders typically first appear during childhood. Whereas ADHD symptoms are greatly reduced or resolved during adulthood in as many as half of persons diagnosed with ADHD as children, ASD symptoms can potentially last throughout the affected person’s lifetime (although cases where children diagnosed with ASD grow up to exhibit normalcy in adulthood have been reported).

· What are proven treatments for ASD?

Thus far, the most reliably effective therapeutic approaches have been behaviorally based. Most commonly implemented in special schools and clinics is Adaptive Behavior Analysis (ABA). This behavioral treatment is intensive and requires long-term consistency.

In the US, risperidone (Rizperdal) and aripiprazole (Abilify) have been approved by the Federal Drug Administration as drug treatments for persons with ASD. These medications have been shown to reduce irritability and improve attention.

Numerous therapeutic approaches for ASD have been developed and are undergoing testing, such as massage therapy, mindfulness, and supplements such as omega-3 fatty acids , but all remain on the experimental level.

· Is ASD a lifelong condition?

ASD symptoms are often observable before the age of 3 years, but for some persons, particularly those on the moderate or high functioning level, ASD symptoms may not be apparent until adolescence or adulthood. In most cases, ASD symptoms persist throughout the person’s lifetime. Thus, the majority of persons with ASD are adults.

There have been anecdotal reports of children who were diagnosed with ASD but shed these symptoms in later years (see New York Times article – The Kids Who Beat Autism – http://nyti.ms/1zypbdQ). These identified “cures” were usually characterized by supportive families and community facilities that provided intensive and consistent educational and other therapeutic interventions.

· What services or help should be offered to adults with ASD?

The present and future needs of adults with autism are the same as those of adults, without autism. These include opportunities for work at their level of ability, socializing with peers as well as mixed age groups, physical exercise, and recreational activities.

It should be noted, however, that, because of their limited ability to express pain and other adverse feelings, persons, adults, as well as children, with ASD must be closely monitored for the presence of medical and psychological illness.

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