Autism Spectrum Disorder (ASD)

What is ASD? | Signs & Symptoms | Diagnosis | Severity Levels | Treatment | FAQ

Autism spectrum disorder (ASD) is a broad term used to describe a group of neurodevelopmental disorders. Characteristics of these disorders include problems with communication and social interaction [1]. People with ASD often demonstrate restricted, repetitive, and stereotyped interests or patterns of behaviour.

Typically, autism symptoms start to display themselves in early childhood, between 12 and 24 months of age. Early on, symptoms may include a marked delay in language or social development.

Autism arises more often in males than females. Additionally, mental health professionals estimate that 1 in 150 children have ASD in Singapore [2].

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) divides symptoms of autism into two categories: problems with communication and social interaction, and restricted or repetitive patterns of behaviour or activities [3].

Individuals with ASD may find themselves faced with difficulties when it comes to maintaining and developing relationships. This could be due to problems with communication and social interaction that include [4]:

• Struggling with communication, including difficulties sharing emotions and interests, or maintaining a back-and-forth conversation
• Issues with nonverbal communication, such as trouble maintaining eye contact or reading body language
  • It is common to see individuals with ASD being unsure of how to behave or avoiding social situations as they struggle to read and understand social cues

Restricted or repetitive patterns of behaviour or activities include [5]:

• Repetitive movements, motions, or speech patterns
  • Rigid adherence to specific routines or behaviours, making it difficult for them to cope with changes
• An increase or decrease in sensitivity to sensory information
  • For example, a negative reaction to certain sounds, fascination with visual lights or movements, or excessive touching of objects
• Over-fixation on specific subjects, activities, objects or interests
  • For example, a person with autism that is preoccupied with cars will obsessively read books, watch films and study cars to learn everything about the topic

Diagnosing an individual with ASD can be difficult as there are no medical tests, like blood tests, to determine if one indeed suffers from ASD. Hence, doctors generally assess an individual’s current behaviour and past developments to make a diagnosis [6].

According to the DSM-V, an individual has to meet the following criteria to be diagnosed with ASD:

• Deficits in social-emotional reciprocity
  • E.g. failure of normal back-and-forth conversation, reduced sharing of interests or emotion, failure to initiate or respond to social interactions
• Deficits in nonverbal communicative behaviors
  • E.g. abnormal eye contact and body language, difficulty understanding and using gestures, lack of nonverbal communication
• Deficits in developing, maintaining, and understanding relationships
  • E.g. difficulties adjusting behavior to various social contexts, difficulties in making friends, absence of interest in peers

• Stereotyped or repetitive motor movements, use of objects, or speech
  • E.g. Lining up toys or flipping objects, echolalia, idiosyncratic phrases
• Inflexible adherence to routines, or ritualised patterns of verbal or nonverbal behaviour
  • E.g. Needing to take the same route or eat the same food every day and showing distress with changes
• Highly restricted, fixated interests that are abnormal in intensity or focus
  • E.g. Preoccupation with unusual objects, excessively  perseverative interests
• Hyper- or hypo reactivity to sensory input
  • E.g. Apparent indifference to pain/temperature, excessively smelling or touching of objects, visual fascination with lights or movement

• 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).
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
• These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

The ways in which people with autism learn, think and problem-solve range from highly skilled to severely challenged. Some people with ASD may be dependent on significant support in their day-to-day lives, while others may need less support and, for some, can live completely independently. The DSM-5 provides an overview of the severity level for ASD based on social communication impairment and restricted, repetitive patterns of behaviour [7] [8].

Unfortunately, there is no cure for autism. However, therapy or other treatment options can alleviate and manage the symptoms of autism. 

Such therapy & treatment options include:

Behavioural therapy aims to enforce desired behaviours and discourage undesired behaviours to improve an individual’s skills. Typically, it is based on Applied Behaviour Analysis (ABA) [9], a widely accepted and common treatment approach for people with ASD.

Some common types of ABA used to treat ASD include [10]:

• Discrete Trial Training (DTT)
  • A step-by-step process to teach individuals skills for them to reach a desired behaviour or response
  • Concepts are broken down into smaller and simpler parts for easy understanding
  • Positive reinforcement is often used to encourage desired behaviour
• Early Intensive Behavioral Intervention (EIBI)
  • One-to-one interaction between an adult and child under the supervision of a trained professional
  • A structured approach to build positive behaviours, teach skills and reduce unwanted behaviors in children below the age of 5 with ASD

Speech Therapy [11] helps to improve an individual’s communication skills by learning verbal or non-verbal ways of communicating

People with ASD might not get the food they need for their growth and development as they are selective of the food they eat depending on its taste and texture. Furthermore, research has found that individuals with ASD tend to have generally thinner bones than those without ASD [12]. As such, Nutritional Therapy [13] ensures that those with ASD get the nutrients they need for their wellbeing

There are medications that can help people with ASD function better by treating certain symptoms associated with ASD, especially certain behaviours. For instance, there are medications that can help to manage high energy levels, inability to concentrate, depression, mood, seizures and anxiety.

It is important to keep in mind not every medication is effective in managing symptoms of ASD and that every individual’s response to medication is unique [14].