Autism Spectrum Disorder.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that, at its core, affects how one perceives and socializes with others. DSM-5 combined most of the disorders previously included under the umbrella term “pervasive developmental disorders”. (e.g., autistic disorder, Asperger’s disorder, and childhood disintegrative disorder) and included them into this one category. Moreover, Rett disorder, a genetic condition that affects mostly females, is diagnosed as ASD with the qualifier “associated with Rett syndrome” or “associated with MeCP2 mutation”.
Two major characteristics of ASD are expressed in DSM-5:
- Impairments in social communication and social interaction, and
- Restricted, repetitive patterns of behavior, interests, or activities.
DSM-5 introduced three levels of severity:
- Level 1— “Requiring support,”
- Level 2- “Requiring substantial support,” and
- “Level 3- “Requiring very substantial support.”
Difficulties with social communication and interaction are further defined by the inclusion of three aspects- problems with social reciprocity (a failure to engage in back-and-forth social interactions), nonverbal communication, and initiating and maintaining social relationships- all three of which must be present to be diagnosed with Autism Spectrum Disorder. Social reciprocity for individuals with more severe symptoms of ASD (previously diagnosed with autistic disorder) involves the inability to engage in joint attention.
Diagnostic Criteria for Autism Spectrum Disorder.
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity; ranging, for example from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, and affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects or, speech; (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
C. 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).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. The disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Causes: Psychological and Social Dimensions of Autism Spectrum Disorder.
ASD is a complex condition that does not appear to have a single cause. Instead, a number of biological contributions may combine with psychosocial influences. The origins of ASD were based on the unusual speech patterns of some individuals- namely, their tendency to avoid first-person pronouns such as I and me and to use he and she instead. For example, if you ask a child with ASD, “Do you want something to drink?” he might say, “He wants something to drink” (meaning “I want something to drink”). Thus this observation led some theorists to wonder whether ASD involves a lack of self-awareness.
Some people with Autism Spectrum Disorder do seem to have self-awareness and that it follows a developmental progression. Just like children without a disability, those with cognitive abilities below the level expected for a child of 18 to 24 months show little or no self-recognition, but people with more advanced abilities do demonstrate self-awareness. Self-concept may be lacking when people with ASD also have cognitive disabilities or delays, not because of the disorder itself.
Causes: Biological Dimensions.
Deficits in such skills as social communication and the characteristic restricted and repetitive behaviors and interests appear to be biological in origin.
ASD has a significant genetic component. What is also evident is that the genetics of ASD is highly complex with a moderate genetic heritability. Numerous genes on a number of our chromosomes have already been implicated in some way in the presentation of ASD. And also as with other psychological disorders such as schizophrenia, many genes are involved but each one has only a relatively small effect.
Families that have one child with ASD have about a 20% chance of having another child with the disorder. This rate is more than 100 times the risk in the general population, providing strong evidence of a genetic component in the disorder. Whereas, the exact genes involved in the development of ASD remain elusive.
Attention-Deficit/ Hyperactivity Disorder (ADHD)
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.
Attention-deficit/hyperactivity disorder (ADHD), one of the most common reasons children are referred for mental health services. The primary characteristics of such people include a pattern of inattention, such as being disorganized or forgetful about school or work-related tasks, or of hyperactivity and impulsivity. These deficits can significantly disrupt academic efforts, as well as social relationships.
Diagnostic Criteria for Attention Deficit/Hyperactivity Disorder.
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
1. Inattention:
Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort. (For example., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
2. Hyperactivity and impulsivity:
Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected. (For example leaves his or her place in the classroom, in the office or other workplace, or in other situation that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
d. Often unable to play or engage in leisure activities quietly.
e. Often talks excessively.
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings. (For example., at home, school or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder. (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
Specify whether:
Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.
Causes.
Important information about the genetics of ADHD is beginning to be uncovered. Researchers have known for some time that ADHD is more common in families in which one person has the disorder. For example, the relatives of children with ADHD found to be more likely to have ADHD themselves than would be expected in the general population. It is important to note that these families display an increase in psychopathology in general. It includes conduct disorder, mood disorders, anxiety disorders, and substance abuse. Moreover, ADHD is considered to be highly influenced by genetics.
Treatment of ADHD
Treatment for ADHD has proceeded on two fronts: psychosocial and biological interventions.
- Psychosocial treatments generally focus on broader issues such as improving academic performance, decreasing disruptive behavior, and improving social skills.
- Typically, the goal of biological treatments is to reduce the children’s impulsivity and hyperactivity and to improve their attention skills.
Reference,
David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).