The Various Facets of Autism Spectrum Disorder

The Various Facets of Autism Spectrum Disorder: Implications on Children
Lamin Dainkeh
St. Mary’s College of Maryland

Autism has become an area increasing area of interest to medical professionals, educational institutions, child developmental researchers, and parents. The increase in prevalence is attributed to various reasons such as an increase in awareness of children identified with autism, expanding in diagnostic criteria and diagnostic substitution. The purpose of this literature review is to provide a comprehensive review of autism, provide symptoms of this disorder, explore possible causes and risk factors, and various methods of treatments.
Keywords: autism, risk factors, method of treatments, diagnostic criteria

The Various Facets of Autism Spectrum Disorder: It Implications on Children
Autism spectrum disorder has become a recognized field of research due to its increase in recognition, definition, and public knowledge. In the last ten years, the amount of research done on autism has increased significantly (Field, 2017; Howlin ; Asgharian, A. 1999; Kogan et al., 2009). Prevalence figures have suggested that ASD is now recognized as a signigifcant problem that demands further research and intervention (Kim et al., 2000; Kogan et al., 2009). Numerous studies have suggested that the number of children diagnosed with ASD has increased dramatically in the past decades (Kogan et al., 2009; Simonoff et al.,2008; Ehlers ; Gillberg,1993). In 2007, the prevalence estimate rate was 110 per 10,000 (Kogan et al., 2009). The increase in prevalence was attributed to increase awareness of children identified with autism, expanding in diagnostic criteria, and diagnostic substitution (Fombonne, 2008; Keen ; Ward, 2004). According to the Center for Disease Control and Prevention (CDC), 1.5 children were identified with ASD. In 2009, 637,000 children in the United States were diagnosed with ASD (Kogan et al., 2009). ASD was four times more prevalent in boys than girls; Caucasian children are more likely to be diagnosed with this disorder than African Americans and Hispanics (Kogan et al., 2009).
In the United States, 175, 000 children under 15 years of age are diagnosed with Autism (Filipek et al., 1990; Filipek et al., 2000). According to a survey of 1, 300 families in the United Kingdom, showed that the average age of diagnosis was 6 years old (Howlin ; Moore, 1999). Most children are not diagnosed until they are 2 to 3 years of age (Filipek et al., 2000). Researchers have noted that early intervention during preschools years improves outcomes of children diagnosed with autism (Howlin ; Moore, 1999). Filipek et al. (2000) stated that early interventions provided time for educational planning, family support, management of stress, and establishing appropriate medical care and treatments.
The Childhood Autism Scale (CARS) was developed in 1966 by Eric Shopler, Robert Reichier, and Barbara Rochen Reiner (Schopler, Reichler, DeVellis, ; Daly, 1980). This questionnaire was used to examine and score children who exhibited autistic behaviors. These behaviors are observed by an Applied Behavior Analysis (ABA) and reported by teachers, family members, and parents (Schopler et al., 1980). Based on the assessment of ABA, they will access the influences an intervention has on changing autistic behaviors (Simpson, 2001). The behavior analyst was responsible for collecting data, meeting parents, school staff, and various members of the home to analyze and develop programs that will help children with autism (Simpson, 2001).
These programs are individualized based on the needs of the child, and every child with autism has a completely different program (Simpson, 2001; Schopler et al. 1980). The purpose of this literature review is to provide a comprehensive review of autism, such as possible causes and treatments, identifications; learning and teaching implications. The structure of this literature review is as follows. First, we define autism. Second, we discuss the symptoms associated with ASD. Third, we will discuss the various causes of ASD. Next, we will discuss the various treatments options for ASD. Then, will
the two most common approaches of autism, which are Applied Behavior Analysis (ABA) and Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) to provide a theoretical prospective of autism. Next, we evaluate the evidence relating to ABA and TEACCH and whether these approaches are effective treatments for individuals diagnosed with autism. Finally, we address gaps in literature, limitations in research, and future research directions.
Review of Literature
Defining Autism
Autism is defined as a neurodevelopmental disorder characterized by impairment in communication, socialization, and repetition of activities and interest (Ingram, Takahashi, ; Miles, 2007; Kogan et al., 2009; Lord et al., 2000). The phrase spectrum disorder refers to a wide range of symptoms, skills, and levels of disabilities that affect daily functioning (Fombonne, 2002; Keen ; Ward, 2000; Partland, Reichow, ; Volkmar, 2002). The manifestation of this disorder is presented in the early onset of childhood development and has associations with language daily, mental retardation and epilepsy (Fombonne, 2002; Field, 2007). Filipek et al. (2000) noted that individuals have to meet the criteria listed on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in order to be diagnosed with autism. According to the DSM-5, ASD is placed in the category of Pervasive Developmental Disorder (PDD). Currently, there are five disorders included under PDD (Filipek et al., 1990). These disorders are autistic disorder (classic autism), Asperger’s disorder (Asperger’s syndrome), pervasive developmental disorder (PDD-NOS), Rett’s disorder (Rett’s syndrome), and childhood disintegrative disorder (Filipek et al., 1990, Filipek et al., 2000).
Symptoms of Autism Spectrum Disorder
According to the CDC, symptoms among individuals diagnosed with ASD varies from one person to the other, but these symptoms involve three criteria’s. These involve social impairment, communication difficulties, and repetitive and stereotyped behaviors (Fombonne, 2002) Individuals diagnosed with autism find it difficult to involve in everyday social interactions (Kogan et al., 2009; Kim, Szatmari, Bryson, Streiner & Wilson, 2000). Kim et al. (2000) stated that limitations in social interactions may present various obstacles for individuals with ASD, such as making eye contact, listening to others, recognizing emotions, picking up social cues, and reading people’s emotions. In addition, ASD individuals respond differently or inappropriately when others show feelings of distress, sadness, affection, or anger (Kamps, Leonard, Vernon, Dugan, ; Delquadri, 1992; Kim et al., 2000). Various studies have shown that children who suffer from ASD develop language comprehension slower than others, repeated words that they hear from others, and their sentences structure does not make sense to others (Simpson, 2001; Fombonne, 2002).
Causes of Autism Spectrum Disorder
The causes of ASD are still unknown, but various studies have suggested that maternal factors may have an impact on this disorder (e.g. Bolton et al., 1997; Juul-Dam et al., 2001). A study by Lyall, Pauls, Spigelman, Ascherio, and Santangelo (2011) hypothesized that early maternal life factors associated with hormone levels may be correlated with having a child with ASD.
In their study, they focused on maternal early factors, and the whether or not hormonal and reproductive changes impact the chances of having a child with ASD (Lyall et al., 2011). Their sample included prospective cohort of 116,608 females aged 25-42. These prospects were recruited in 1989 through a biennial mailed questionnaire. Also, they collected information about the age of their menstrual cycle, characteristics of their menstrual cycle during adolescence, and their use of any contraceptives or birth control. Furthermore, they asked about their body mass index (BMI) prior to given birth and their body shape (Lyall et al., 2011). They found that women with a history of pregnancy complications were significantly more likely to have a child diagnosed with ASD than women with uncomplicated pregnancies.
Numerous studies have examined the influence of parental, prenatal, and perinatal; the impact it has on having a child with ASD. Parental is characterized by the period before the child was born. Prenatal is characteristics of the parents. Perinatal is characterized by the period after delivery (Zhang et al., 2010). In a study conducted by Zhang et al. (2010), the researchers examined three factors which are parental, prenatal, and perinatal, and their association with ASD. The sample population included a cohort of 190 Han children with and without autism to examine prenatal and perinatal risk factors. They examined numerous parental risk factors such as parental ages at delivery, occupation, education, marriage of close relative, personality, family medical history, and ethnicity (Zhang et al., 2010).
On the other hand, the prenatal risk factors that were examined included alcohol consumption, maternal characteristics, behaviors during pregnancy, emotional state, and medication history. Some of the perinatal factor included newborn complication, infant’s gestational age at birth, abnormal skin conditions, and birth weight. Zhang et al. (2010) found that emotional state during pregnancy was significantly associated with autism. Out of the risk factors studied, seven conditions during gestation increased the chance of having a child with autism. Also, the factors that showed the strongest relationship were emotional state, acute medical conditions, maternal unhappiness, and second-hand smoke exposure (Zhang et al., 2010). Based on their results, Zhang et al. (2010) concluded that the following. First, perinatal risk factors were significantly associated with autism. Second, advanced paternal age at delivery were significantly associated with autism.
Autism is a difficult disorder to cure. Currently, there are no single therapy or method that could cure an individual with autism. But, there are various approaches that have been proven to be effective in treating individuals with this disorder. Also, most approaches used a combination of different methods to improve the skills of individuals diagnosed with autism. In the following section, we are going to discuss the various treatment options for autism and the implication it has on children.
Autism Spectrum Disorder Treatments
There are various treatments used to teach children with autism. Rutter and Bartak (1973) suggested that children with ASD benefited from a structural approach of teaching, and early interventions will improve social interaction, communication, and education of individuals diagnosed with this disorder. Baron-Cohen (2004) acknowledge that individuals with ASD should be supported and their strengths should be recognized. In addition, Baron-Cohen (2004) stated that early intervention can influence individual’s imaginative ability, social skills, and communication, which will enable them to form friendships, build self-esteem, and access to various education and employment opportunities. Although there are concerns about labeling a child with ASD, the earlier the diagnosis, the earlier the intervention can begin (Filipek et al., 2000; Howlin, 1999).
TEACCH is one of the behavioral treatment implmented on children diagnosed with ASD. Schopler et al. (1980) defined TEACCH as a global approach based on the collaboration between parents and professionals that used various intervention methods, different environmental adaptations, and communication training to minimize the difficulties of children with ASD and to accommodate their strength. This type of treatment originated as a state-wide program at the University of North Carolina in 1972. and is now used as a special interevention program for children with ASD. As noted by Simspon (2011), this type of treatment has been implemented throughout various institutions in Europe and the United States. Schopler et al. (1980) notated that the objectives of this approach are modifying and shaping individual behaviors, developing social and communication skills, and teaching children how to interpret emotional meanings. Furthermore, TEACCH is a life-long approach, applicable from pre-school into adulthood, and has been designed to equip children with ASD with skills for independent living and finding employment.
Various studies have indicated the effectiveness of this approach for supporting children with ASD (e.g. Simpson, 2001; Rutter ; Bartak, 1973).

Behavioral approaches are based on the theory of Skinner (1957), which stated that a development is a behavior and all behavior is learned. By using associative leaning and operant conditioning, the behavioral responses of individuals diagnosed with ASD can be modified by positive and negative reinforcement. This concept was developed based on the idea that children diagnosed with ASD have some developmental deficiencies that needed to be altered and conditioned (Lovaas, 1987).
Another behavioral treatment that have been used to help children with autism is Applied Behavioral Analysis (ABA). ABA is an intensive behavior therapy that is initiated as soon the child is diagnosed with autism, usually between the ages of 2 to 3 years old (Filipek et al., 2000). This approach was used by Lovass and colleagues (Lovass, 1981) which involves breaking down a skill into small steps and teaching each step using a discrete trial technique. In this study, Lovass reported that 47% of children in the experimental group achieved normal intellectual and educational functioning (Lovass, 1987).

Occupational therapy is another treatment option for children diagnosed with ASD. This type of therapist is trained in teaching various life skills to help individuals become self-independent. One of the commonly used type of occupational therapy is sensory integration therapy. Various studies have suggested that one of the symptoms of ASD are disturbance in sensory modulation (e.g. Lovaas, 1987; Lyall et al., 2011). Ingram (2007) stated that children diagnosed with ASD have difficulties in communication, language comprehension, and difficulties relating to social clues. Because children with ASD have these difficulties in regulating sensory inputs appropriately, they have problems expressing themselves socially and communicating with others (Kim et al., 2000; Simonoff, 2008). As noted by Filipek et al. (2000), the objective of sensory integration therapy is to stimulate and challenge the sense of children that are being treated. In addition, children with ASD are either over simulated or under stimulated by their environment, and they often have difficulties learning to combine and integrating various senses (Bartak ; Rutter, 1973).
Filipek et al. (2000) suggested that difficulties interpreting sensory inputs may be a result of communication and social problem caused by ASD. In attempt to regulate their sensory systems, children with ASD practice certain stereotyped behaviors, such as lining up toy on a table and moving it back and forth. Simpson (2001) listed three different components included in this approach: helping parents to understand their children behavior, helping parents and teachers to modify and change their children behavior. and helping children to respond to various sensory inputs. Since every child diagnosed with ASD is different, occupational therapist have to consider each individual own unique needs and goals (Simpson, 2001).
Sensory integration therapy is one of the commonly used technique in occupational therapy (Kogan et al., 2009; Case-Smith, 1991). This type of therapy has been used by 95% of occupational therapists because it has been proven to help children improve their social interactions and communication skills (Case-Smith, 1991). Also, they found that sensory integration therapy significantly decreased behaviors where the child was not interacting with the environment. Examples of these behaviors include wandering aimlessly and unfocused staring. A study conducted by Cohn (2001) focused on parent’s perceptions of sensory integration approach as a treatment used on their children. In this study, they found that sensory integration therapy was successful in helping parents understand the benefits of this approach of therapy and their children’s problem.

American Psychiatric Association, ; American Psychiatric Association. (2000). Task force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association, 41-48.
Bartak, L., ; Rutter, M. (1973). Special educational treatment of autistic children: A comparative study–1. Design of study and characteristics of units. Journal of Child Psychology and Psychiatry, 14(3), 161-179.
Case-Smith, J., ; Bryan, T. (1999). The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy, 53(5), 489-497.
Ehlers, S., ; Gillberg, C. (1993). The epidemiology of Asperger syndrome. Journal of child psychology and psychiatry, 34(8), 1327-1350.
Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Dawson, G., … ; Levy, S. E. (2000). Practice parameter: Screening and diagnosis of autism Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55(4), 468-479.
Field, T. (2017). Imitation enhances social behavior of children with autism spectrum disorder: A review. Behavioral Development Bulletin, 22(1), 86-93. doi:10.1037/bdb0000042
Howlin, P., ; Asgharian, A. (1999). The diagnosis of autism and Asperger syndrome: findings from a survey of 770 families. Developmental medicine and child neurology, 41(12), 834-839.
Ingram, D. G., Takahashi, T. N., ; Miles, J. H. (2007). Defining autism subgroups: a taxometric solution. Journal of autism and developmental disorders, 38(5), 950-960.
Keen, D., ; Ward, S. (2004). Autistic spectrum disorder: a child population profile. Autism, 8(1), 39-48.
Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., … ; van Dyck, P. C. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395-1403.
Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., ; Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117-132.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of consulting and clinical psychology, 55(1), 3.
Lyall, K., Pauls, D. L., Santangelo, S., Spiegelman, D., ; Ascherio, A. (2011). Maternal early life factors associated with hormone levels and the risk of having a child with an autism spectrum disorder in the nurses health study II. Journal of autism and developmental disorders, 41(5), 618-627.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., ; Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child ; Adolescent Psychiatry, 47(8), 921-929.
Schopler, E., Reichler, R. J., DeVellis, R. F., ; Daly, K. (1980). Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10(1), 91-103.
Simpson, R. L. (2001). ABA and Students with Autism Spectrum Disorders: Issues and Considerations for Effective Practice. Focus on Autism ; Other Developmental Disabilities, 16(2), 68.
Zhang, X., Lv, C. C., Tian, J., Miao, R. J., Xi, W., Hertz-Picciotto, I., ; Qi, L. (2010). Prenatal and perinatal risk factors for autism in China. Journal of autism and developmental disorders, 40(11), 1311-1321.