Description of the Autism Spectral Disorder - Literature Review Example

Autism Spectral Disorder (ASD) is a type of heterogeneous neurodevelopment disorder with broad, varying levels and manifestations that are not only associated with genetic but also environmental causes (Morrison, 2014). ASD is usually identified in the stage of early childhood, where it continues to adult life. However, it has been found that the form may be largely modified through education and experience. In the DSM-5, ASD has been described as a condition with symptoms that can be categorized into three forms where the two has been lumped together. The three broad categories of ASD are communication, socialization, and motor behavior.

Communication. Although their hearing is normal, patients with ASD may have their speech delay for several years. Their deficits vary greatly not only in scope but also in severity. The severity range from a mild condition that was previously known as Aspergers disorder to severe conditions where the affected patients hardly communicate at all. Aspergers disorder is a condition where the patients affected can speak clearly and also have normal, or even superior intelligence. Other patients, however, may exhibit unusual speech problems as well as idiosyncratic utilization of phrases. While some patients may speak too loudly, others are devoid of the prosody or lilt that facilitates the music of the normal speech. In some cases, the patients may have challenges in using the body language or other non-verbal behavior when they are communicating. For example, they may have challenges using head nods or smiles which normal people often use. The affected patients may have lack of understanding on the basis of humor. Often, Children with ASD have trouble in the not only beginning but also sustaining their conversation. Rather, the children may talk to themselves or even hold monologues on any subject they found interesting to them, but not other people. ASD children also usually ask questions frequently even after they have been given repeated answers.

Socialization. Unlike normal children, the social maturation of ASD patients occurs at a slower pace. Unlike normal children. Further, the developmental phases may take place outside the normal sequence. Parents with ASD children often become concerned during the second 6 months. That is when they notice that their child does not make eye contact, cuddle, or even smile reciprocally but instead, the baby turns away from the embrace of the parent and stare into space. Additionally, toddlers with ASD do not play with other children or point to objects. Further, when they are being picked, they may not stretch their arms or exhibit anxiety that is common among children when they separate with their parents. As a consequence of their inability to communicate effectively, children with ASD often display tantrums as well as aggression. Since they do not desire closeness, older children do not have many friends and have little interest sharing joys, sorrows or fears with other people. In the adolescent stage and further in life, this can occur as almost absent desire for sex.

Motor Behavior. While the motor milestones of ASD patients often occur in time, the nature of the behavior they choose set them apart. Such behaviors include ritualistic or compulsive actions, also known as stereotypes such as rocking, head banging, twirling, hand flapping, and also maintaining unique body postures. Rather than utilizing the toys as items of imaginative play, the children often suck them. Their little interests make them to be so much preoccupied with parts of objects. Further, they tend to adhere rigidly to routine and resist anything that seems to upset the routine. While they exhibit low concern to extremes of temperature or pain, the patients often get preoccupied with touching or smelling things. Owing to their unique motor behavior, many of such patients often injure themselves through various ways including skin picking, head banging, and other repetitive motions.

Diagnosis of ASD

ASD is usually linked to intellectual disability. Therefore, discriminating the two disorders can be a very difficult. However, 90% of the patients with ASD often exhibit sensory abnormalities (Morrison, 2014) which manifest in many forms. For example, some children hate phenomena such as loud sounds, bright light, Sensory abnormalities occur in perhaps 90% of patients with ASD; some children hate bright lights, the prickly texture of certain materials and other surfaces, or loud sounds. A small minority of the patients, however, display cognitive splinter skills: those special abilities associated with role memory, music, and computation. Certain physical conditions linked with ASD include fragile X syndrome, history of perinatal stress, phenylketonuria, and tuberous sclerosis. Additionally, mental health comorbidity conditions include seizures (affect 25-50%), attention-deficit/hyperactivity disorder (over 50%), obsessive-compulsive behavior (in about 30%), and depression and anxiety disorders (especially prevalent) (230%). Some patients have been found to complain of reduced need for sleep or insomnia with a few even sleeping during the day and remaining awake at night. Recently, researchers have reported a link between a certain form of autism with a gene that is associated with colon, kidney, breast, skin, and brain cancer. Other than physiological warning signs, it has also been found that the circumference of the head during the infancy stage is a strong predictor of ASD (Boyd, Odom, Humphreys, and Sam, 2010). Evidence shows that infants who were later diagnosed with ASD initially had their head circumferences not enlarged but underwent rapid enlargement within their first two years in life.

ASD in Children/Adolescents versus Adults

Investigations conducted by Anderson, Maye, and Lord (2011) revealed that patients with ASD take different trajectories of change in symptoms from childhood, adolescence, and adult stages. Noticeable change in symptoms includes social withdrawal, hyperactivity, and irritability. The researchers found that children with severe core characteristics of ASD exhibit consistently higher levels of hyperactivity and irritability score over time as compared with those with wider delays in nonspectrum and ASD. In all diagnoses, behaviors associated with hyperactivity have been found to show the greatest improvement over time. However, the researchers also showed that social withdrawal become worse with age for a great percentage of youths with ASD, but it is not the case for the nonspectrum comparison group. A comparison of children with ASD and nonspectrum youths indicate that the former indicates a greater heterogeneity in trajectories for maladaptive behaviors. Previous studies showed that as many as 30% of children with ASD are affected by deteriorating functioning for many years and is more likely to increase with the onset of puberty where the condition is marked by heightened levels of destructiveness, obsessions aggression, and repetitive behaviors. Additionally, a decrease in cognitive as well as language skills have also been observed. Further, the heightened maladaptive behaviors appearing at the time of puberty appear to be associated with more severe intellectual epilepsy and disability. Unlike boys, girls have been found to be affected by deterioration for an extended period. At age 9, children with ASD display more social withdrawal, and more externalizing problem behaviors linked to hyperactivity and irritability as compared with those with DDs and Broader Autism Spectrum Disorder (BASD). Overall, it has been found that there are a decreasing hyperactivity and irritability problems with age, especially for youths who have been diagnosed with autism. While the researchers found that withdrawal increase with age for a large majority in both spectrum and autism groups, it was not the case for spectrum group. The onset of puberty is linked to increased social withdrawal.

Other Diagnostic Criteria for ASD

Other than diagnostic criteria employed for ASD, there are psychological tests that are used. One psychological test involves the use of screening instruments designed for children who over 16 months. However, all children aged over 16 months can be effectively and efficiently screened suing Modified-Checklist for Autism in Toddlers (M-CHAT) (Toth and Stobbe, 2011). M-CHAT is 23-item checklist comprising of yes/no parent statements. Children aged four years and older are screened using Social Communication Questionnaire (SCQ). SCQ is a short questionnaire answered by the parent.

Psychological Theories

The Theory of Mind (ToM) Hypothesis of autism

According to Romero-Munguia (2013), the capacity to recognize thoughts and feelings is one of the two critical elements of empathizing. This capacity is referred to as ToM. The ToM posits that people with autism fail to impute mental states to themselves and others and that this deficiency depicts lack of capacity to mentalise or inability to consider other peoples mental states. Children with ASD have been shown to have underdeveloped ToM. This means that they have a problem decoding the cognitive and affective states of other individuals and may also have a difficulty being empathetic and usually feel confused by other individuals behaviour (Ozonoff & Miller, 1995). Neuroimaging studies have shown that individuals with higher-functioning ASD manifest less activation in the brain regions that are crucial for mentalising in neurotypical individuals (Kidd, 2008).

Deficit in ToM was first tested using the unexpected transfer test of false belief. In this test, the child is required to watch a story about two dolls. One of the dolls (named Sally) possesses a marble which she places in a basket and exit the scene. While Sally is away, Anne (a second doll) transfers the marble from the basket to a box. After watching the story, the investigator asks the child to deduce where Sally will search for the marble. The child passes the test if he or she points to the basket by considering the knowledge (false belief) from Sally. Studies have reported that 85% of children undergoing normal development pass unexpected transfer test of false belief while 80% of children with ASD fail (Romero-Munguia, 2013). ToM deficit is not related to intellectual ability, since children with ASD have been reported to have normal verbal mental age (VMA). In one study, children with ASD were found to have a mean VMA of 5 years 5 months while their counterparts with normal development had a mean chronological age (CA) of 4 years 5 months (Baron-Cohen, Leslie, & Frith, 1985). Even though the mental age children with ASD was higher than that of normal children and those with Down's syndrome, only children with ASD failed to impute beliefs to others. This shows that ToM dysfunction is not linked to mental retardation and specific to autism (Baron-Cohen, Leslie, & Frith, 1985).

Happe (1994) question the validity of ToM hypothesis in explaining ASD because 20% of children with the disorder are capable of passing unexpected transfer test of false belief and so, he argued, the deficit may not be universal. Rajendran and Mitchell (2007) provided three ways in which this phenomenon can be explained. First, passing the test needs a multiplicity of skills and even though some children pass the test, their approach is quite distinct from that of non-ASD children. Therefore, the most important thing is not passing or failing of the test, but the way in which a participant tackles the test is critical. Second, Rajendran and Mitchell (2007) argued that ToM may be flawed because it cannot explain the possibility of some individuals with ASD passing the test yet autism is regarded as deficit in ToM. Thirdly, Rajendran and Mitchell (2007...