What is ASD?
1. How do experts define ASD?
Outside of defining ASD biomedically, I find this to be an accurate, intellectual explanation:
“Autism is a genetically-based human neurological variant. The complex set of interrelated characteristics that distinguish autistic neurology from non-autistic neurology is not yet fully understood, but current evidence indicates that the central distinction is that autistic brains are characterized by particularly high levels of synaptic connectivity and responsiveness. This tends to make the autistic individual’s subjective experience more intense and chaotic than that of non-autistic individuals: on both the sensorimotor and cognitive levels, the autistic mind tends to register more information, and the impact of each bit of information tends to be both stronger and less predictable.
Autism is a developmental phenomenon, meaning that it begins in utero and has a pervasive influence on development, on multiple levels, throughout the lifespan. Autism produces distinctive, atypical ways of thinking, moving, interaction, and sensory and cognitive processing. One analogy that has often been made is that autistic individuals have a different neurological “operating system” than non-autistic individuals.”
Nick Walker /neurocosmopolitanism.com
Walker is Autistic and works as a psychotherapist and consultant. I refer to him frequently and greatly appreciate his efforts to improve education about the spectrum.
Kartzinel (2009) provides a straightforward definition that helps parents to understand what their child is actually experiencing-
Autism is simply the abnormal response to everyday stimuli. These stimuli are routine, such as a child not responding when his name is called, not responding appropriately to the senses (for example, high pain threshold), not responding to hunger, thirst, danger, etc. This is, as you can see, is a potentially very long list (p.4).
Dr. Julie Buckley offers a biomedical definition of the autism diagnosis by discussing what causes autism, and how it is most effectively treated. She proposes the “five brave, basic truths” of autism:
1. Autism is a medical illness. It only looks like a psychiatric disorder.
2. [Disorders on the Autism Spectrum] are treatable. The foundation of treatment rests in proper diet and nutritional supplementation.
3. Autism is a series of vicious biological and chemical cycles gone awry within the child’s body. These cycles interact, impacting immune function, gut function, and methylation chemistry, among other biological symptoms.
4. Breaking the vicious cycles at the cellular level and normalizing the function of your child’s systems is what biomedical intervention is all about.
5. There are safe and effective starting points for each step of the biomedical intervention process.
(Buckley, 2010, p. 7).
2. If Autism is a physiological illness, what does that mean for diagnosis and treatment?
As outlined in Dr. Buckley’s beliefs about autism (2010, p. 8), the biomedical approach offers the opportunity to find the specific biological and chemical markers that are correlated with the behavior and social ability of autistic children. Rather than focusing on observable deficits in communication or behavior, biomedical doctors are concerned with the underlying causes of those symptoms. Dr. Dan Rossignol has established laboratory testing helps to further define what is causing autistic behavior:
We find that some of the core problems in autism include toxicity (including elevated levels of heavy metals, pesticides, and other chemicals), inflammation (potentially in the gastrointestinal tract and brain), oxidative stress (damage to tissue caused by free radicals, which are neutralized by antioxidants such as vitamins C and E), impaired glutathione production (which is the body’s main natural detoxifier and antioxidant), and impaired mitochondrial function (which are responsible for producing energy)
(Autism File, issue 32, p. 8)
When biochemical data of this nature is collected from a suffering child, the treating physician is able to pin-point where the child’s systems are most broken. It is established that ASD children have major deficits in their ability to make glutathione and methionine- primary implications of the deficits are an inability to effectively detoxify the body, and most importantly to make a healthy amount of dopamine. This leads to ASD children’s general disinterest in interacting with other people, and the physiological response of increased inflammation and oxidative stress (Buckley, 2010, p. 20).
3. What is the process of diagnosis like?
A friend who has an autistic son describes the experience of “cyclical grief.” The nature of autism is that the only thing constant is change. Children regress and improve on a regular basis. Referring to a childhood illness as a spectrum is advantageous because it conveys to parents that their child can improve. The grief and pain of a diagnosis is easier to swallow when it is fluid, and parents are able to understand that there are lots of tools in the medical toolbox, especially for biomedical doctors, to make major changes in the health of their children. For adults on the spectrum, it is a process of normalizing the diagnosis and finding a narrative that serves them well.
go to: puzzlepeacecounseling.com
4. What does the DSM say (concerning diagnostic codes for ASD)?
It is most clear to cover the diagnostic criteria for Autistic Disorder/Autism Spectrum Disorder by combining the most effective information from both The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) and DSM-5 because both manuals are clinically relevant at this time. See below to review the diagnostic criteria for Autistic Disorder provided in the DSM-IV-TR, followed by the DSM-5 explanation of the levels of severity along the Autism Spectrum.
299.00 Autistic Disorder
DSM IV-TR Diagnostic Criteria
Qualitative impairment in social interaction- manifested by at least 2 of the following:
a. Marked impairment in the use of multiple nonverbal behaviors (ex) eye-to-eye gaze, facial expression, body postures, and gestures that facilitate social interaction
b. Failure to develop peer relationships appropriate to developmental level
c. Lack of spontaneous seeking to share enjoyment, interests or achievements with others (ex) showing someone an object of interest
d. Lack of social or emotional reciprocity
Qualitative impairment in communication- manifested by at least 1 of the following:
a. Delay or total lack of development of spoken language (not accompanied by an attempt to compensate non-verbally)
b. In those with adequate speech- marked impairment in the ability to initiate or sustain a conversation with others
c. Stereotyped and repetitive use of language or idiosyncratic language
d. Lack of spontaneous, pretend, imitative play appropriate to age development
Restricted repetitive and stereotyped patterns of behavior, interests, and activities- manifested by at least 1 of the following:
a. Encompassing preoccupation with 1 or more restricted patterns of interest that is abnormal in either intensity or focus
b. Apparently inflexible adherence to specific, nonfunctional routines or rituals
c. Repetitive motor activity (ex) hand or finger flapping or twisting, or complex whole-body movements
d. Persistent preoccupation with parts of objects
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.
(American Psychiatric Association, 2000)
DSM-5 Severity Levels
The DSM-5 offers clarification of the autism diagnosis by diagnosing children with a severity level based on the child’s ability in social communication as well as the types and severity of repetitive or restricted behaviors. The levels of severity are described as:
• Level 1: Requiring support.
• Level 2: Requiring substantial support.
• Level 3: Requiring very substantial support.
(American Psychiatric Association, 2013)
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association, 2012.
“Healing and Preventing Autism” By: Jerry Kartzinel, M.D
“Healing our Autistic Children” By: Julie Buckley, M.D.
http://www.autismmediachannel.com – Autism File Magazine