Autism Spectrum Disorder

Autism spectrum disorder is not an illness but a neurodevelopmental disorder. This notion implies that these characteristics are present from a very young age and that the person will evolve with them throughout their life. This disorder causes very variable difficulties from one person to another which are felt on a daily basis and hinder the person's integration into society. 

In France, it has been considered a handicap since 1996.

The characteristics and difficulties associated with it affect the functioning of the person on several levels: 

• social interactions, 
• communication, 
• behaviors 
• interest.

 

Different treatment methods can reduce certain symptoms, but a person with ASD will never be able to “cure” the way one would cure an illness.

The etiology of autism is not yet very well known, but we now know that there is a set of factors and not a single cause. 

Research has recently revealed that autism is a disorder that appears to have a strong genetic component: genetic markers have been associated with an increased risk of developing ASD and it is observed that parents (autistic or not) carrying these markers can pass them on to their child. In addition, we sometimes observe siblings with several people on the autism spectrum. 

Scientists are also exploring potential environmental causal factors, but these are still unclear: it seems that exposure to certain chemicals in utero or certain pre-natal infections increase the risk for children of developing ASD.

Do you know?

As autism is not yet well understood, the classification of the disorder is changing rapidly. For example, in the DSM-4, Rett syndrome was classified as autism, but not in the DSM-5.

Here are the diagnostic criteria defined by the DMS-V:

1. Persistent deficits in social communication and social interactions across multiple contexts
2. Patterns of Restricted and Repetitive Behaviors, Interests and Activities

• difficulty interpreting emotions (one's own and those of others) and facial expressions,
• Difficulty grasping pictorial expressions,
• Difficulty understanding the second degree or tacit social rules,
• An inability or difficulty to modulate one's communication in relation to the context or the interlocutor
• An inability to adapt to a conversation by restarting it, reformulating it, etc.,
• A deficit in non-verbal communication,
• Difficulty developing, maintaining and understanding age-appropriate social relationships.

When it comes to behavior, autistic people are intolerant of change:

• They need routines and daily repetitions, such as motor stereotypies (repetitive behaviors that are reassuring for autistic people; rocking, making hand movements, etc.).
• Many autistic people have a particular sensory perception:
• hypersensitivity to certain stimuli and hyposensitivity to others
• sometimes an unusual interest in sensory elements of the environment (a fascination with lights or rotating objects for example).
• People with ASD are more often subject to synesthesia (which is the act of associating two or more senses with each other: associating colors with musical notes or numbers for example) than the rest of the population.

Symptoms must be present in early childhood (but may not be fully evident until social demands exceed limited capacity). This set of symptoms leads to clinically significant limitations in the social domain, that of occupations or other spheres of functioning in daily life.

The etiology of autism is not yet very well known, but we now know that there is a set of factors and not a single cause.

Autism spectrum disorder being a spectrum, it is therefore extremely broad. This is why the DSM-V diagnostic criteria include three “levels of functioning” each defining the support necessary for a child or adult diagnosed with an autism spectrum disorder: 

• Level 1: requires support.
• Level 2: requires significant support.
• Level 3: requires very significant support.

 

These levels of support reflect differences in the daily difficulties encountered by autistic people.

Level 1 corresponds to what we used to call “high-functioning autism”

These are people who will develop speech in a classic way, or even more quickly than children their age. Furthermore, the language quality may be more sustained and developed than the norm for their age group. Asperger Syndrome falls into this category. 

This type of autism is characterized by having no intellectual deficit (i.e. an intelligence quotient greater than 70). As a result, there may therefore be people with high or very high intellectual potential among them. The person is therefore able to manage daily tasks, such as eating and dressing independently.

On the other hand, repetitive and restricted behaviors, difficulties adapting to change, social difficulties are significant and disabling.

In this type of autism, however, these difficulties may not be identified immediately. However, we note dysfunctions in executive functions (planning, organization, etc.)

People with Level 2 ASD will have greater or more obvious verbal and social communication problems than those diagnosed with Level 1

Executive function disorders are also present, learning disorders (dys disorders) are often noted. Children with Level 2 autism tend to have very narrow interests and engage in repetitive behaviors that can prevent them from functioning in certain situations. 

At level 3, we find what we called “Low-functioning autism”, which includes, for example, Kanner type autistic people. It is the heaviest type of autism and the one that is most present in the collective imagination when we talk about autism.

People at this level need the most support, including full-time supports or intensive therapy. Some autistic people on this level of the spectrum are non-verbal and sometimes completely incapable of any social interaction. situations. 

The comorbidities of ASD are numerous:

• ADHD
• Mood disorders (Depression, bipolarity)
• Anxiety disorders (Generalized Anxiety Disorder****, Social anxiety**,** OCD)
• Intellectual disability (IQ <= 70)
• Retard global de développement, troubles psychomoteurs

Bien que l’autisme ne soit pas une maladie, certain types of therapies/medications can help manage specific symptoms or comorbidities. Note, among other things: 

• Medication treatment (can help with ADHD, mood or anxiety disorders)
• Psychological therapy adapted to the specificities of autistic people
• Psycho-motor skills or occupational therapy sessions
• Speech therapy sessions, which can be very important in the event of associated dys disorder, attacks of selective mutism or even in the case of a non-verbal autistic child.

Each child develops at their own pace and does not always follow general medical curves and predictions: this is not necessarily worrying or predictive of any disorder. If you are a parent, you are in the best position to see a persistent failure to acquire behaviors or skills or a regression (a skill that was acquired and is no longer acquired; this often happens in autistic children). 

Here are the main signs of autism in very young children (under 2 years old). If you notice these signs in your child, it is important to discuss your concerns with a pediatrician: the earlier autism is diagnosed, the more effective the child's care will be and will allow him or her better integration into society.

In France, diagnoses can be made by the CRA (Autism Resource Center), they are free and specialized but the wait is often very long. The other solution is to go see a psychiatrist, either privately or in a center specializing in the care of autistic people.

Decrease/absence of eye contact

Researchers have found that infants/children with ASD have, very early on, a decrease in eye contact, shifty gaze

Decrease/absence of non-verbal communication

Infants/children with ASD have limited nonverbal communication (no waving, pointing at objects or people, little or no reaching, etc.).

Mimics

Facial expressions are not very marked, the child has few facial expressions.

Emotional state

Very (too) calm infant or, on the contrary, too agitated. Infant who cries all the time or never cries.

Difficulty sleeping

The child has difficulty sleeping, he sleeps very little for an infant/child of his age.

Limited imitation

Children often diagnosed with autism are often impaired in imitation.

First name

The child responds little or not to his first name.

Sensitivity

Sensory hypersensitivity and/or sensory Hyposensitivity.

Regressions in children are typical of autism: they generally occur before the age of 2. The child then loses one or more previously acquired skills (loss of speech for example). 

Here are the main signs of autism in children:

• Seems not to be interested in other children: preference for solitary play, limited socialization attempts, limited response to others' socialization attempts, avoidance of social situations
• Difficulty understanding and managing one's emotions, difficulty understanding the emotions of others (this sign is often taken for a lack of empathy, but this is often not the case)
• Uses little body language
• Does little or no response to his first name
• Plays inappropriately with his toys (for example, lines up his cars instead of playing with rolling them)
• Stereotypies (repetitive movements such as hand flapping for example)
• Intolerance of change, need for routines
• Intense tantrums, aggression
• Language delay or above average language development
• Lack of social reciprocity (does not respond to people, does not bounce back in conversations, etc.)
• Marked clumsiness
• Difficulty playing “pretend” games or group games
• Does not like to be touched and/or cuddled
• Difficulty understanding irony, second degree, humor
• Implicit social codes are not acquired
• Wants to impose his rules all the time (reassuring for autistic people)
• Attaches strongly to objects

Here are the main signs of autism in adolescents (in addition to the signs already mentioned above):

• May be obsessively interested in a specific topic and spend hours talking about it and searching for information on it.
• Does not seem to notice when the person he is talking to is not interested in what he is saying
• Has a very good vocabulary
• Speaks too formally
• Difficulty of organization, planning
• Difficulty making friends your own age, prefers younger people or adults
• Does not know how to adjust his vocabulary or behavior to social situations
• Difficulty sleeping
• Anxiety
• TCA (Eating Behavior Disorder)
• School phobia

If you notice these signs yourself, do not hesitate to consult your doctor: autistic parents are more often subject to parental burnout.
In children and adolescents, their differences and their difficulty in communicating with other children and making themselves understood as well as their hypersensitivities can lead to school phobia.

Different methods can help support autistic children and adults to make them more independent. We will note the methods recommended by the High Authority of Health (HAS):

• Educational therapies, based on applied behavior analysis: ABA (Applied Behavior Analysis), which is based on behavioral sciences. The principle is to develop or reinforce a behavior using different techniques (chaining, etc.) and to modify inappropriate behavior. Appropriate behaviors are the subject of rewards and praise, inappropriate behaviors are not, which will encourage the child to abandon them.
• The developmental treatment and education program for children with autism or communication disabilities: TEACCH (Treatment and Education of Autistic and related Communication disabled Children). The aim of this learning method is to promote the autonomy of the autistic person, by offering them an environment structured into zones and personalized teaching using different scenarios. The scenarios are often in images, structured with start and end times.

To be effective, these interventions must be personalized, that is to say defined according to an initial assessment of the child and constantly reassessed and adapted. These are intensive methods: you need at least 20 hours per week of practice, the time recommended by the HAS being even 25 hours minimum per week.
However, it is actually quite complicated for families to have access to care because there is a lack of professionals trained in these methods in France. The specialized centers and professionals therefore find themselves overloaded and the waiting lists to access them are very long. The place of parents is preponderant: parents and professionals are co-actors. Indeed, at home, learning methods must be maintained

• Exchange and development therapies (TED) which aim to develop functions in autistic children that they lack through stimulation through play: the idea being not to impose but to offer interactions and to encourage and congratulate the child when he participates in an exchange.
• Cognitive-behavioral therapies (CBT): CBT can help identify specific behaviors that are not socially appropriate and implement strategies to reduce them or replace them with more appropriate behaviors. Likewise, they help teach autistic people to better understand and manage their emotions and anxiety, for example with the AWARE method