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What is ASD?
What is ASD?
Autism spectrum disorder (ASD) is a spectrum disorder characterized by social deficits in the face of a predominately non-autistic society and by the presence of restricted and repetitive behaviors and interests.
Autism spectrum disorder (ASD) is a spectrum disorder characterized by social deficits in the face of a predominately non-autistic society and by the presence of restricted and repetitive behaviors and interests.
ASD is categorized as the following:
ASD is categorized as the following:
ASD is a neurodevelopmental disorder.
(World Health Organization, 2022)ASD is rooted in the brain's structure as it develops.
- Symptoms will most often first appear (onset) in the early developmental period (often diagnosable as early as 2 years old).
- There are no true "cures" for ASD because the disorder is built into the brain's structure.
- ADHD is heavily rooted in genetics; heritability up to 90% (Sandin et al., 2017).
Characteristics of ASD include:
Characteristics of ASD include:
ASD is common.
2-3% of children experience ASD (Center for Disease Control and Prevention [CDC], 2022).
ADHD is more common in males.
The ratio is around 4:1 (World Health Organization, 2022).
The higher ratio of female patients who experience coöccurring conditions suggests that less severe cases may be going overlooked in girls (World Health Organization, 2022).
Autism may not be obvious.
Autism may not be obvious.
Many autistic adolescents and adults utilize masking.
(World Health Organization, 2022)Masking involves covering up or disguising autistic traits in public.
Masking is energy- and focus-intensive and often results in burnout.
Masking tends to be more common and stronger in female patients.
Masking may be done subconsciously without intention or notice.
How Does ASD Present?
How Does ASD Present?
ASD may present differently for individuals of different ages
ASD may present differently for individuals of different ages
Infancy (<4):
Infancy (<4):
Communication skills or development may plateau or regress (rare).
Preschool age (3-5):
Preschool age (3-5):
May express discomfort with eye contact.
May express discomfort with physical affection.
May not engage in social imaginary play.
May have delayed language onset, or precocious language which is not used for social conversation.
May be socially withdrawn.
May express obsessive or repetitive preoccupations.
May express disinterest in playing with peers or may prefer parallel play.
May express sensory sensitivities (eg. to everyday sounds or foods).
Middle childhood (6-12):
Middle childhood (6-12):
May express resistance towards or discomfort with unfamiliar experiences.
May express marked reaction towards minor unexpected changes in routine or environment.
May be over-focused on details.
May express rigid behavior or thought.
Symptoms of anxiety may become evident.
Adolescence (13-18):
Adolescence (13-18):
Coping ability may become overwhelmed by increasing expectations and social complexity.
Mental disorders (including depression) may present.
Adulthood (18+):
Adulthood (18+):
Coping ability may become overwhelmed by high expectations and social complexity.
May struggle to maintain social groups; may or may not have the same difficulty with maintaining individual friendships.
Birch, Nera. This graphic shows what the autism spectrum really looks like. The mighty. https://themighty.com/2020/03/autism-spectrum-wheel/
ASD is a spectrum disorder
ASD is a spectrum disorder
This means that the different traits of autism can present with different levels of support needs for each individual.
This means that the different traits of autism can present with different levels of support needs for each individual.
The spectrum should not be viewed in the form of a gradient spectrum because support needs may differ by trait.
A better model for the spectrum is a radar chart which can map support needs based on individual traits.
Common Coöccurring Psychiatric Conditions
Common Coöccurring Psychiatric Conditions
70-95% of children and adolescents, and 73-81% of adults with ASD experience a coöccurring psychiatric condition (Mosner et al., 2019).
Disorders of intellectual development:
(World Health Organization, 2022)Disorders of intellectual development:
ICD-11 link: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f605267007
Experienced by 35.2% of patients with ASD (CDC, 2022).
Attention-deficit/hyperactivity disorder (ADHD):
(World Health Organization, 2022)Attention-deficit/hyperactivity disorder (ADHD):
ICD-11 link: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f821852937
Experienced by 71% of children and adolescents with ASD (Mosner et al., 2019).
Almost always inattentive presentation (~60%) or combined presentation (~40%) (Mosner et al., 2019).
May be related to the concept of concentration deficit disorder or sluggish cognitive tempo (see Introduction to ADHD page).
Oppositional-defiant disorder (ODD):
(World Health Organization, 2022)Oppositional-defiant disorder (ODD):
ICD link: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1487528823
Experienced by 40% of children and adolescents with ASD (Mosner et al., 2019).
Anxiety disorders:
(World Health Organization, 2022)Anxiety disorders:
ICD-11 link: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1336943699
Experienced by 34% of children and adolescents with ASD (Mosner et al., 2019).
Mood disorders (including depression):
(World Health Organization, 2022)Mood disorders (including depression):
ICD-11 link: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f76398729
Experienced by 29% of children and adolescents with ASD (Mosner et al., 2019).
ASD Myths and Misconceptions
ASD Myths and Misconceptions
Misconception: Autistic people all have mental or learning disabilities.
Misconception: Autistic people all have mental or learning disabilities.
Fact: Only 35.2% of patients with ASD experience an intellectual disability,† and 44% have average to above-average intelligence.
(Earl et al., 2017)Misconception: Autism only occurs in boys.
Misconception: Autism only occurs in boys.
Truth: Autism is four times more common in boys, but still occurs in girls.
Autistic traits in girls are likely often overlooked due to presentation differences and this misconception.
Misconception: Autism is caused by vaccines.
Misconception: Autism is caused by vaccines.
Truth: Autism is a neurodevelopmental disorder rooted in genetics with a heritability of up to 90%.
(Sandin, 2017)Misconception: Autistic people lack the ability to empathize.
Misconception: Autistic people lack the ability to empathize.
Truth: Rather than autistic individuals being unable to understand and empathize with non autistic (allistic) individuals, there is a disconnect between autistic and allistic individuals that goes both ways.
(Gernsbacher & Yergeau, 2019; Milton, 2012)That is, allistic people have just as much trouble understanding and empathizing with autistic people as autistic people do understanding and empathizing with allistic people.
Within their own demographics, neither have this struggle (this is referred to as the double empathy problem).
Sources and resources
Sources and resources
International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. Licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).
Sandin, S., Lichtenstein, P., Kuja-Halkola, R., Hultman, C., Larsson, H., & Reichenberg, A. (2017). The Heritability of Autism Spectrum Disorder. JAMA, 318(12), 1182–1184. https://doi.org/10.1001/jama.2017.12141
Center for Disease Control and Prevention. (2022, March 2). Data and statistics on autism spectrum disorder. https://www.cdc.gov/ncbddd/autism/data.html
Mosner, M. G., Kinard, J. L., Shah, J. S., McWeeny, S., Greene, R. K., Lowery, S. C., Mazefsky, C. A., & Dichter, G. S. (2019). Rates of Co-occurring Psychiatric Disorders in Autism Spectrum Disorder Using the Mini International Neuropsychiatric Interview. Journal of autism and developmental disorders, 49(9), 3819–3832. https://doi.org/10.1007/s10803-019-04090-1
Earl, R.K., Peterson, J., Wallace, A.S., Fox, E., Ma, R., Pepper, M., & Haidar, G. (2017, June). Autism spectrum disorder: A reference guide. Bernier Lab, Center for Human Development and Disability, University of Washington. https://depts.washington.edu/uwhatc/PDF/TF-%20CBT/pages/1%20Therapist%20Resources/Bernier-Lab-UW-Autism-Spectrum-Disorder-Reference-Guide-2017.pdf
Gernsbacher, M. A., & Yergeau, M. (2019). Empirical Failures of the Claim That Autistic People Lack a Theory of Mind. Archives of scientific psychology, 7(1), 102–118. https://doi.org/10.1037/arc0000067
Milton, Damian (2012) On the ontological status of autism: the ‘double empathy problem’. Disability & Society, 27 (6). pp. 883-887. https://doi.org/10.1080/09687599.2012.710008
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