Autism spectrum disorder (ASD) is a life-long condition that is characterized by issues in social interaction and diminished communication skills. ASD is noticeable in children as young as less than a year old and can significantly interfere with their growth and development. A child with ASD seems detached from reality and might not respond to their name when called. In addition, they may resist holding or cuddling and may prefer to spend time alone. Therefore, people with autism experience several complications due to developmental differences that prevent them from living normal life. As a result, it is critical to study the etiology of the disease and establish better solutions to curb its implications.
The Diagnostic and Statistical Manual of Mental Disorders (DSM 5), published by the American Psychological Association defines autism spectrum disorder as a complex developmental condition associated with two distinct areas. These include repetitive or restricted sensory behaviors or interests and diminished social communication (American Psychiatric Association, 2013). Thus, an individual should satisfy each of the three stipulated areas of social communication and interactions, including difficulties in social-emotional reciprocity, non-verbal communication, and developing, maintaining, and understanding social relationships (Campisi et al., 2018). In addition, a patient should exhibit two of four restricted and repetitive behaviors. However, the manifestation of ASD varies and is classified under levels one to three, with three being the most severe.
ASD can significantly interfere with a person’s life quality as it prevents them from engaging with others, carrying out daily activities, and satisfying their personal needs. Hence, understanding the development and implications of the disease can help clinicians adopt evidence-based solutions for its management. The following passages describe the differential diagnoses, prevalence, etiology, interventions, and community resources set aside to counter ASD.
Differential Diagnoses of ASD
Many medical conditions share general signs and symptoms like fatigue, headaches, and diminished body functions. However, some diseases have striking similarities, often resulting in a misdiagnosis if clinicians do not take all signs and symptoms into account. Thus, a differential diagnosis is a technique used to contrast two conditions exhibiting similar attributes and features to ensure that one condition is not mistaken for the other. The illnesses occasionally used as a differential diagnosis for Autism Spectrum Disorder are Avoidant Personality Disorder and Obsessive Compulsive Disorder (OCD) (Stavropoulos & McPartland, 2022). Like Autism Spectrum Disorder, these conditions interfere with an individual’s social skills and also interfere with their normal activities resulting in distress. However, these two conditions have notable differences that can be used to rule them out or confirm the initial diagnosis.
Avoidant Personality Disorder (AVPD) is a condition that pushes individuals toward self-aversion and isolation. The condition is characterized by restrained behavior when in the presence of others because of a fear of disapproval. According to the DSM 5, Avoidant Personality Disorder is a pervasive and chronic maladaptive behavioral condition that meets four out of six criteria (American Psychiatric Association, 2013). The individuals should exhibit reluctance to engage in activities associated with interpersonal contact and socialization because of fears of rejection, disapproval, or criticism. In addition, they have restrained intimate relationships and obsession with being criticized or rejected in ordinary social situations. Moreover, these individuals avoid getting involved with people because they assume others don’t like them and inhibit new interpersonal scenarios because of feeling inadequate (Lampe & Malhi, 2018). In addition, individuals with AVPD perceive themselves as socially incapable, inferior to others, and unappealing. Thus, they are reluctant in engaging in new activities or taking personal risks as they may turn out to be embarrassing.
On the other hand, Obsessive Compulsive Disorder (OCD) is a chronic mental illness that traps its victims in a constant state of anxiety. Individuals with OCD experience distressing and repetitive fears or urges they cannot control. As a result, they turn to certain behaviors or develop a routine to carry out activities, thus limiting them from living a normal life. According to the DSM 5, OCD is characterized by persistent urges, thoughts, or images that individuals perceive during their upset (American Psychiatric Association, 2013). These feelings are usually unwanted and intrusive, thus resulting in increased distress and anxiety. Consequently, individuals try to suppress or ignore these emotions by neutralizing them with particular actions or thoughts (Kracker Imthon et al., 2020). Hence, a person can develop a routine, actions, or mental acts that they are obligated to perform. As a consequence, Individuals with OCD are also presumed to suffer from drug addiction and compulsive behaviors that do not constitute normal living.
Although OCD, AVPD, and ASD are disorders that influence individuals’ ability to concentrate, socialize, and sustain interpersonal relationships, ruling out these conditions based on the signs and symptoms of an individual through a differential diagnosis can assist clinicians to obtain accurate results. The criterion for diagnosing ASD is based on two factors, i.e., difficulties in social communication, which involves rarely using language, difficulty communicating, not sharing personal interests, not valuing friendships, and limited understanding of gestures like waving. In addition, a person should exhibit restricted or repetitive sensory behaviors and interests (Campisi et al., 2018). Apart from exhibiting difficulties in both areas, an individual should have developed these signs and symptoms from early childhood. Thus, a clinician can rule out ASD and diagnose AVPD if the only reason why an individual avoids social relationships is feelings of inadequacy and low self-worth. On the other hand, a doctor can determine that a condition is OCD and not ASD if the individual engages in repetitive actions in response to an obsession or fear.
The Prevalence Rates of ASD
Research on the epidemiology of autism spectrum disorders suggests that their prevalence is associated with various social determinants, including demographic, socio-economic, and racial factors. Generally, the CDC reported that about one in forty-four children were diagnosed with ASD in 2018. Out of this population, one in twenty-seven boys and one in 116 girls were identified with ASD (Chiarotti & Venerosi, 2020). Thus, the report suggests that boys are 4 times more likely to develop the disorder compared to girls. However, more children are diagnosed after four years old but diagnosis is possible when an individual is as young as two years. ASD results in intellectual disabilities in about 31% of diagnosed children, while about 25% develop borderline range intellectual disability. 44% of children diagnosed with ASD showcase high levels of intellectual ability with IQ scores of more than 85, which is above average (Zeidan et al., 2022). Thus, although the condition can limit progressing normally, it does not interfere with their learning abilities.
The prevalence of autism in the US is also reflected along racial lines, especially after the consideration of minority groups that were initially misdiagnosed. In 2010, studies suggest that white non-Hispanic children were about 2.5 times more likely to be diagnosed with ASD compared to other races. However, in 2016, the prevalence rates of white, non-Hispanic, Asian, and Black children were almost identical, with the lowest number of diagnoses being recorded in Hispanic children (Chiarotti & Venerosi, 2020). In 2018, records point to an increase in the number of Black children diagnosed with autism but researchers associate these differences with increased diagnosis of the condition at an early age due to improved access to healthcare services. Studies conducted outside the US show that Ultra-orthodox Jews and Arabs have relatively low levels of ASD compared to other populations (Zeidan et al., 2022). Nevertheless, racial differences, ethnicity, and nativity influence the presentation of ASD due to variations in etiological factors
Implications of ASD on Social Functioning
Individuals with ASD suffer from cognitive, functional, and social deficits that impact their relationship with others and quality of life. Researchers suggest that children with ASD develop social functioning issues because of social deficits. These social deficits include lack of attention, difficulty in initiating and sustaining social conversations, odd speaking patterns, challenges in body language interpretation, lack of empathy, and diminished problem-solving abilities (Solomon, 2020). Nevertheless, their inability to associate their emotions with facial expressions presents a barrier to social interactions. Both children and adults with ASD struggle to recognize facial expressions and display facial expressions to match what they feel (Campisi et al., 2018). Instead, ASD victims may not show any expressions or may use expressions that do not resemble their emotions. Therefore, social interactions become challenging for these individuals as many people are not familiar with the condition and may not understand their reactions.
People with autism also experience increased challenges with learning language skills, which involves understanding what they hear and articulating their thoughts. According to Campisi et al. (2018), the two emotions that children with ASD find difficult to recognize and control are fear and anger. Subsequently, their inability to discern these emotions from other emotions may persist until adulthood. Thus, these people exhibit queer behaviors when angry or fearful which may include harming themselves, being aggressive, and throwing tantrums. Consequently, these factors substantially limit the quality of their social relationships and erode their appeal to social interactions. Consequently, they may experience problems with living normally, achieving high education levels, sustaining employment, and being independent (Solomon, 2020). Therefore, people with ASD have fewer friends, hardly support themselves, and find it difficult to live alone, thus obligating them to depend on others to ensure their well-being.
Theories that Explain the Etiology of ASD
Although there is no known cause of autism, researchers and scientists link its development to the interaction of human and environmental factors, explained using theoretical concepts. The extreme male brain theory and the theory of the mind are two ideologies that attempt to explain the etiology of autism disorders. The extreme male brain theory is a highly criticized concept that associates autism with an abnormally developed male brain. Autism is characterized by diminished social interaction and limited communication abilities. Thus, the theory proposes that male brains are inclined toward systemizing, while, the female brain has an opposite cognitive profile that leans towards empathizing (Beckerson et al., 2022). Therefore, autism spectrum disorder is considered a condition that occurs when its victims develop an extreme male brain profile due to potential exposure to testosterone in the womb. Nevertheless, its critics argue that sex differences are not notable in the condition, meaning that they may be insignificant or inexistent.
The theory of the mind is also another explanation of why some people develop autism spectrum disorders. According to its concepts, an individual’s mind gives them the ability to understand others and reason about mental states. Subsequently, brain systems develop from about 18 months of age and advance through adulthood, allowing a child to realize their mental state and differentiate it from others. However, autistic children suffer from a condition known as mind-blindness, which is a mind-reading impairment (Beckerson et al., 2022). Thus, they do not develop the cognitive capacity to communicate with others, read emotions, and interact socially. Theories that attempt to explain autism suggest that these individuals perceive the world differently and speak a different language. Hence, providing these individuals with the assistance they require in interpretation and giving them access to various resources can help them improve their living standards and advance like their peers.
Therapeutic Interventions used to Manage ASD
Although autism is not curable, there are several psychosocial and pharmacological solutions to manage the disease and help an individual to live a better life. Psychosocial interventions refer to solutions based on social and psychological components. These techniques are non-intrusive and do not involve the use of drugs or medicine. Cognitive behavioral therapy is a recommended treatment solution for children with ASD. CBT, when used to treat autism focuses on altering thought processes or beliefs and their behaviors to limit negative emotions and adverse outcomes. CBT teaches children with autism how to cope with the condition (Perihan et al., 2020). Generally, therapists reinforce positive and targeted behaviors by taking patients through a step-by-step process and rewarding each achievement continuously. Subsequently, practitioners can adopt solutions like differential reinforcements, stimulus-control environmental modification, extinction, and task analysis to guide individuals with autism towards conforming to particular behaviors. Seemingly, this technique has proved effective because of its simple approaches, no side effects, and efficiency.
CBT to treat autism has several benefits over other techniques. Researchers suggest that the method is as effective as medication and is recommended in cases where drugs are ineffective or might present issues. In addition, the treatment can be completed in a short time depending on the patient’s capabilities and improvement. Perihan et al. (2020) suggest that the structure of CBT is practical and can be provided in varying formats, including in computer programs, books, and self-help groups. Similarly, the strategies learned in the program are easily applicable to real-life situations, thus allowing patients to develop comprehensive life skills. However, the sessions carry extra work and an individual must commit themselves to achieve results. Thus, the solution cannot be used on children with less developed cognition, people with complex mental comorbidities, and those not willing to complete the program.
Pharmacological solutions to autism spectrum disorder help patients function normally in their day-to-day activities. Risperidone is one of the most effective second-generation antipsychotics recommended by physicians and approved by the FDA to treat irritability and aggression in autistic children. A study conducted by Kloosterboer et al., (2021) on 101 children between 5 to 17 years with signs and symptoms of autism showed notable improvements and limited occurrence of aggressive episodes, self-injurious habits, and tantrums in children when treated using risperidone. In addition, the literature review by Maneeton et al., (2018) suggests that various studies confirm the effectiveness of risperidone in decreasing irritability, inappropriate speech, and hyperactivity in children with ASD compared to most solutions. As a result, the drug is recommended to manage the implications of ASD in adults and children.
Despite being effective, risperidone has several side effects as observed by most researchers. The drug is presumed to lead to weight gain, fatigue, and anxiety. In addition, it can result in increased appetite, drooling, dizziness, and headaches. The main benefits of risperidone are that it can be administered with or without food, it is available in liquid, pill, and dissolving tablet forms, it is effective in children and adults, and it is helpful where other treatments are ineffective (Maneeton et al., 2018). Nevertheless, it makes children feel sleepy, can raise cholesterol and blood sugar levels, and increase the risk of hormonal changes which can result in enlarged male breasts, fertility issues, weak bones, and irregular periods (Kloosterboer et al., 2021). As a result, its administration requires professional guidance and should only be authorized by certified clinicians. Moreover, parents should ensure occasional clinical evaluations for their children to limit adverse outcomes.
Community Resources Set Aside to Aid in Autism Management
There are several community resources designed to help manage the conditions of people living with autism and assist their caregivers to deliver high-quality care in New Jersey. The POAC support network is a highly recommended forum, comprised of dedicated teams of individuals and parents dealing with autistic people every day. POAC, which stands for Parents of Autistic Children, is a non-profit organization whose mission is to make a difference in the lives of individuals living with autism in New Jersey. The organization has amassed a vast online community that facilitates the exchange of information and access to a wealth of resources for its members. The organization organizes various forms of training for parents and caregivers with autistic children and works with several other organizations on initiatives aimed at alleviating their issues. Their membership is free and anyone is allowed to donate through their website. Moreover, they are easily accessible at their offices, whose address is POAC Autism Services, 1989 Route 88, Brick, NJ 08724 but interested parties can reach them via telephone on 732-785-1099.
The Booklet for Siblings and Younger Children is also a resource that is readily available online for parents and caregivers. The organization offers a wealth of publications that provide access to vital information for individuals living with autism. Through its website, anyone seeking information can access webinar videos, research articles, published journals, and other forms of information to offer guidance. In addition, the website shares the organization’s helpline which allows individuals to speak to assistants who guide them through the latest practices in autism, facts, and findings about the condition. Its staff and telephone service providers are certified, trained, and experienced meaning that they provide high-quality support. Moreover, anyone seeking their services can reach them at 500 Horizon Drive, Suite 530, Robbinsville, NJ 08691 call the phone number 609.588.8200 or access their website for prompt services.
Conclusion
Autism spectrum disorder is a developmental condition characterized by diminished social skills, poor communication, and repetitive patterns of action or behaviors. However, it manifests differently in people as others can live a productive life with the illness. Although ASD shares similarities to conditions like avoidant personality disorder and obsessive-compulsive disorder, clinicians can use the DSM 5 to ensure that they diagnose the condition appropriately. ASD has significant social implications on the lives of individuals as it limits them from sustaining relationships and taking care of themselves. The theories that attempt to explain ASD are the extreme male brain theory and the theory of the mind. However, they do not provide guidelines on how to rectify associated issues. The most widely adopted non-pharmacological solution to manage ASD is Cognitive Behavioral Therapy, while the preferred pharmacological method is risperidone. In addition, there are several public community resources in New Jersey to assist parents, caregivers, and people living with ASD to manage its effects using the latest solutions.
References
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