Defining Autism Spectrum Disorder

The autism spectrum is a range of neurodevelopmental conditions, primarily characterized by significant difficulties in social interactions, differences in communication, and presentations of rigid and repetitive behavior. Unusual responses to sensory input, including high or low sensitivity, sensory discrimination, and sensory-based motor impairments are also highly prevalent. It is commonly referred to as autism and officially designated autism spectrum disorder (ASD).

A spectrum disorder can manifest very differently from person to person: any given person is likely to show some, but not all of the characteristics associated with it, and may show them to very different degrees. Different autistic people might show strikingly different characteristics, and the same person may also present differently at different times. The autism spectrum was historically divided into sub-categories, but there were persistent questions over the validity of these divisions, and the most recent editions of the major English-language diagnostic manuals, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, published in 2022) and International Classification of Diseases (ICD-11, released in 2021 both list ASD as a single disorder.

(Wikipedia, n.d/Autism Spectrum)

DSM Diagnostic Criteria)

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), released in 2022, is the current version of the DSM. The fifth edition, DSM-5, released in May 2013, was the first to define ASD as a single diagnosis, which is continued in DSM-5-TR.ASD encompasses previous diagnoses, which included Asperger disorder, childhood disintegrative disorder, PDD-NOS, and the range of diagnoses, which included the word autism. Rather than distinguishing between these diagnoses, the DSM-5 and DSM-5-TR adopt a dimensional approach to diagnosing disorders that fall underneath the autistic spectrum umbrella in one diagnostic category. Within this category, the DSM-5 and the DSM include a framework that differentiates each individual by dimensions of symptom severity, as well as by associated features (i.e., the presence of other disorders or factors that likely contribute to the symptoms, other neurodevelopmental or mental disorders, intellectual disability, or language impairment). The symptom domains are social communication and restricted, repetitive behaviors, with the option of a separate severity – the negative impact of the symptoms on the individual – being specified for each domain rather than an overall severity. Prior to the DSM-5, the DSM separated social deficits and communication deficits into two domains. Further, the DSM-5 changed to an onset age in the early developmental period, with a note that symptoms may manifest later when social demands exceed capabilities, rather than the previous, more restricted 3 years of age. These changes continue in the DSM-5-TR.

The DSM-5 characterizes ASD by two primary symptoms: impairments in social communication and fixated or restricted behaviors or interests and associated features. These deficits are present in early childhood (often by age 3) and lead to clinically significant functional impairment. Previously, in the DSM-IV-TR, impairments in social interactions and impairments in communication were considered two separate symptoms; however, these have been combined in the DSM-5. The restriction of onset age has also been loosened from three years of age (as per the DSM-IV-TR) to the “early development period,” with a note that symptoms may manifest later when demands exceed capabilities.

(Wikipedia, n.d/Autism Spectrum)

The image below from Wikimedia Commons show the three functional levels of autism.

Etiology

While specific causes of ASD have yet to be found, the research literature has identified many risk factors that may contribute to its development. These risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify general risk factors, but it is much more difficult to pinpoint specific factors.

Characteristics of ASD

Autism has characteristics first appearing during infancy or childhood and generally follows a steady course without remission. Autistic people may be severely impaired in some respects but average, or even superior, in others. Overt features gradually begin after the age of six months, become established by age two or three years, and tend to continue through adulthood, although often in a more muted form. Other aspects, such as atypical eating, are common but not essential for diagnosis.

(Wikipedia, n.d/Autism Spectrum)

Autism spectrum disorders are characterized by impairments in communication and social interactions and by repetitive and stereotypic behaviors. Other characteristics might include unusual responses to sensory experiences, difficulty with transitions, and resistance to change.

The term spectrum disorder means that the disorder can present with mild to severe characteristics. Individuals with autism can be:

• highly intelligent or cognitively delayed;
• highly verbal or functionally nonverbal;
• “oddly” sociable or have no social interactions whatsoever;
• singularly, almost obsessively, focused on one interest or appear to have no interest at all in their environment;
• either over- or under-reactive to sensory input.

Students with ASD can present some particular challenges for educators. No single individual with ASD appears characteristically just like another. In addition, social interactions and communication between students with ASD and their peers and teachers may be difficult.

Stanley I. Greenspan, a pediatric neuropsychiatrist who specializes in autism spectrum disorders, refers to autism simply as a “disorder of relating and communicating.”

Often, students with ASD have difficulty processing language auditorily, especially metaphors, innuendoes, and jokes. These students will struggle in a classroom where much of the information is presented verbally. However, these same students sometimes have great visual memory, which can be used productively in the classroom. Students with ASD (as well as visual learners) will benefit from instruction delivered in picture icons or written sequentially.  (Pilewskie, 2009)

Restricted and Repetitive Behaviors

Children with ASD may exhibit repetitive or restricted behavior, including:

• Stereotypic—repetitive movement, such as hand flapping, head rolling, or body rocking.
• Compulsive behavior—exhibiting intention to follow rules, such as arranging objects in stacks or lines.
• Sameness—resistance to change; for example, insisting that the furniture not be moved or sticking to an unvarying pattern of daily activities.
• Restricted behavior—limits in focus, interest, or activity, such as preoccupation with a single television program, toy, or game.
• Self-injury—movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging.

(Boundless.com)

Other Common Characteristics of ASD

• little or no infant babbling
• not pointing to show interest or not showing interest when something is indicated
• limited language skills e.g. having a smaller vocabulary than peers or difficulty expressing themselves in words
• having a reduced interest in other children or carers, possibly with more interest in objects
• having trouble understanding other’s feelings or talking about their own feelings
• showing interest in others, but not knowing how to play with them or relate to them
• avoiding playing pretend games
• unusual or limited use of toys
• avoiding eye-contact
• wanting to be alone
• increased sensitivity to the smell, texture, sound, taste or appearance of things
• being upset by changes in routine, possibly with trouble adapting to the changes
• avoiding hugs, except when they want them
• difficulty expressing needs using verbal speech or gestures
• repeating words or phrases, or using them in place of typical language (I.e. scripted language, echolalia)
• repeating actions over and over again
• making unusual movements, expressions, actions or positions
• apparently losing skills once held e.g. stopping using specific language

In addition, a small percentage of people on the autism spectrum can exhibit notable ability, for example, in mathematics, music or artistic reproduction, which in exceptional cases is referred to as savant syndrome.^[43][44]

(Wikipedia, n.d/Autism Spectrum)

Treatment

There is no known cure for ASD, and treatment tends to focus on the management of symptoms. The main goals when treating children with ASD are to lessen associated deficits and family distress and to increase quality of life and functional independence. No single treatment is best, typically tailored to the individual person’s needs. Intensive, sustained special-education programs and behavior therapy can help children acquire self-care, social, and job skills early in life. The most widely used therapy is applied behavior analysis (ABA); other available approaches include developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.

There has been increasing attention to the development of evidence–based interventions for young children with ASD. Unresearched alternative therapies have also been implemented (for example, vitamin therapy and acupuncture). Although evidence-based interventions for children with ASD vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing behaviors that are thought to be problematic.

Universal Design for Learning  UDL

This paper aims to provide suggestions for practical UDL support recommendations to enhance the utilization of research-based practices to promote academic achievement through multiple forms of engagement, representation, and expression for children with ASD. (Denning and Moody, 2013)

General Teaching Strategies

Teachers can visually deliver instruction in the following ways: (these are general teaching strategies)

• Use multisensory delivery. Dramatic presentations, comics, PowerPoint presentations, overheads, movies, and online resources involve both auditory and visual processing.
• Use color. Color-coded notebooks or colored markers and pens can help students differentiate subjects. Color can also be used to highlight directions.
• Use visual cues. Schedules, calendars, timetables, and lists of items to complete can be placed on students’ desks. These can take a variety of forms: written, pictures or symbols, and photos. Alphabet and number lines or mnemonic devices also provide visual cues for students. Bulletin boards, banners, posters, and flashcards reinforce content area knowledge.
• Use guided notes or other handouts to help students stay focused during verbal instruction.
• When information must be presented verbally, teachers can support students with ASD when they:
  • Demonstrate/model/act out instructions; use hand signals.
  • Complete the first examples with students.
  • Repeat instructions after allowing 10 seconds for processing time; speak slowly and clearly, modify tone and pace.
  • Put instructions in the same place always.
  • Simplify; analyze tasks and break them into small steps.
  • Provide extra time and resources.
  • Involve students in presentations.
  • Team teach.

  Students with ASD might also need a variety of adapted materials. Many of these adaptations fit the definition of an “assistive technology.”

  • low-vocabulary books, audio and video tapes,
  • AAC (augmentative and alternative communication) devices and voice output devices,
  • talking calculators,
  • educational software designed for struggling learners or children with ASD,
  • manipulatives,
  • different types of paper – textured, graph, lined papers (raised lines, colored lines and mid-lines),
  • sticky notes,
  • a variety of writing utensils: golf pencils, magic markers, highlighters, chalk holders, pencil grips, and stamps and stamp pads,
  • slant writing boards, recipe stands,
  • desk organizers

  Many students with ASD are not “fond” of writing, whether they are engaged in the mechanical process itself or the slow process of translating oral language into the written word. Because so much of the curriculum output expected from students includes written work, it is imperative to have alternatives for students with ASD to demonstrate their knowledge of what has been presented in a lesson.

  The following are some alternative ideas for students with ASD to demonstrate their knowledge: (general teaching strategies)

  • oral tests
  • PowerPoint presentations
  • dramatic presentations
  • dioramas
  • graphs and diagrams
  • comic strips
  • storyboards
  • flow charts
  • sign language

  Special education teachers, speech-language pathologists, and occupational therapists can be a source of ideas for other instructional methods to support students in demonstrating knowledge of specific curriculum and content standards.

Another area of concern for students with ASD is social skills – the challenge of relating to others in an acceptable manner. The social skills impairment of individuals with ASD significantly differentiates them from students with other disabilities. Instruction in these skills is imperative for students on the autism spectrum to communicate in class, build friendships, and participate in the community. Social skills impairments can be manifested in a number of ways, including:

• lack of reciprocity, or the give-and-take of conversation,
• inability to initiate conversation,
• lack of spontaneous sharing of interests and enjoyment,
• inability to take the perspective of others,
• lack of appropriate social pragmatics (i.e., proximity to others, body language, vocal tone, interruptions, and responses to facial and other physical gestures),
• inability to understand humor, sarcasm and innuendo,
• monologues on the individuals’ specific interests.

Social skills seem to “just come naturally” to typically developing children. However, students with ASD need to be taught these skills directly and practiced often.

There are several proven methods that can support social skills instruction. Often these skills are taught by speech-language therapists and intervention specialists. Some of these techniques and methods include: (boldfaced strategies are also considered evidenced-based practices)

• social stories,
• role-playing,
• video modeling,
• labeling and recognition of emotions in self and others,
• structured small-group instruction, including typical peers for review of learning objectives, often involving games, role-playing, and discussions (example: simple peer mediation role-playing),
• informal groups, such as “friends groups” or “lunch bunch,” where social skills can be applied in natural settings and spontaneously facilitated for reinforcement or correction,
• structured outdoor or indoor recess to apply social skills with or without facilitation and to measure for generalization of skills in a large setting.

Many of these skills can be taught for whole-class instruction. For example, as a special education consultant for a student with Asperger Syndrome (now called Level 1 autism) included in a general education fifth-grade classroom, I gave direct instruction in conflict management to that student and a couple of his classroom peers. I used scripted “conflicts” that the students role-played.

The students were given a simple sequential procedure for conflict management. After learning the procedure and acting out several scripts, they were given written prompts for which they had to develop their own dialogue. Once the three students became proficient in the methods, we took the role-play, scripts, and prompts to the whole fifth-grade class, where all the students participated in learning the conflict management procedures. We used the same methods but in a shorter amount of time. All students, including those with ASD, benefited from this method of instruction. This is an example of how social skills instruction can be taught, and generalized to a classroom setting.

This article has just touched on some ideas for teaching communication and social skills to students with ASD. It is always necessary to read a student’s IEP (Individualized Education Program) to determine the best approaches to facilitating instruction in the classroom.

(Pilewskie, 2009)

Adapted from : Dillon SR, Adams D, Goudy L, Bittner M and McNamara S (2017) Evaluating Exercise as Evidence-Based Practice for Individuals with Autism Spectrum Disorder. Front. Public Health 4:290. doi: 10.3389/fpubh.2016.00290

Evidence-Based Practices

While the exact definition may vary between professions, EBP can generally be defined as an instructional strategy, intervention, or teaching program that is grounded in scientifically based research (21). Within legislation, the Individuals with Disability Education Improvement Act of 2004 lacks a definition, but does imply that teachers use EBPs, mandating instructional interventions grounded in “scientifically based research,” when teaching students with disabilities (22). Conversely, the newly passed Every Student Succeeds Act of 2015 (ESSA) (3), after which the reauthorization of IDEA may be modeled, does clearly define evidence-based as:

an activity, strategy, or intervention that—(i) demonstrates a statistically significant effect on improving student outcomes or other relevant outcomes based on—(I) strong evidence from at least 1 well-designed and well-implemented experimental study; (II) moderate evidence from at least 1 well-designed and well-implemented quasi-experimental study; or (III) promising evidence from at least 1 well-designed and well-implemented correlational study with statistical controls for selection bias; or (ii) (I) demonstrates a rationale based on high-quality research findings or positive evaluation that such activity, strategy, or intervention is likely to improve student outcomes or other relevant outcomes; and (II) includes ongoing efforts to examine the effects of such activity, strategy, or intervention (22).

Assistive Technology and Related Service Providers Links

Supplementary Resources for Extended Learning

Jorgenson, C.M. et al, (n.d). Teaching Students with Autism. Supporting Belonging/Participation/Learning, National Education Association (NEA). Retrieved from http://www.nea.org/assets/docs/Autism_Guide_final.pdf  (96 page teacher guide)

AFIRM Modules, Autism Focused Intervention Resources and Modules, 

The National Professional Development Center on Autism Spectrum Disorder

Domings, Y, Crevecoeur Y. Ralabate, P. , (2014)  Universal Design for Learning: Meeting the Needs of Learners with Autism Spectrum Disorders. Retrieved from http://archive.brookespublishing.com/documents/boser-udl-for-students-with-autism.pdf

Image Attribution

The image below from Wikimedia Commons shows the three functional levels of autism from an autistic perspective. https://commons.wikimedia.org/wiki/File:Three_Levels_of_Autism_1.png

References

Boundless.com (n.d.) Psychology/Textbooks/Boundless Psychology/Psychological Disorders/Neurodevelopmental Disorders/Autism Spectrum Disorder, CC-BY-SA 4.0

Denning, C. B., Moody, A. K., (2013). Supporting Students with Autism Spectrum Disorders in Inclusive Settings: Rethinking Instruction and Design. Electronic Journal for Inclusive Education, 3(1). from http://corescholar.libraries.wright.edu/cgi/viewcontent.cgi?article=1153&context=ejie

Dillon SR, Adams D, Goudy L, Bittner M and McNamara S (2017) Evaluating Exercise as Evidence-Based Practice for Individuals with Autism Spectrum Disorder. Front. Public Health 4:290. doi: 10.3389/fpubh.2016.00290  CC-BY

Gilmore, H. (2019). Levels of Autism: Understanding the Different Types of ASD. Psych Central. Retrieved on July 29, 2020, from https://pro.psychcentral.com/child-therapist/2019/11/levels-of-autism-understanding-the-different-types-of-asd/

Pilewskie, A, (2009). Some Ideas for Instructing Students with Autism Spectrum Disorders, Ohio State University, Retrieved 3.29.19 http://www.oercommons.org/courses/some-ideas-for-instructing-students-with-autism-spectrum-disorders/view This work is licensed under an Attribution-ShareAlike 3.0 Unported Creative Commons license.

The IRIS Center. (2014). Autism spectrum disorder: An overview for educators. Retrieved from https://iris.peabody.vanderbilt.edu/module/asd1/   Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The IRIS Center. (2016). Autism spectrum disorder (part 2): Evidence-based practices. Retrieved from https://iris.peabody.vanderbilt.edu/module/asd2/ Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Wikipedia (n.d.) Autism Spectrum From https://en.wikipedia.org/wiki/Autism_spectrum 

Updated  7.10.24