The way in which these alterations appear varies greatly from one child to another, which is why we speak of a “spectrum” or “continuum of disorders”, meaning that there are different ways in which the symptoms of this type of disorder appear and that their severity varies from one case to another. The clinical picture is not uniform nor absolutely clear-cut, and its presentation ranges along a spectrum from greater to lesser impact, varies over time and is influenced by factors such as the degree of associated intellectual ability or access to specialised support.
People with ASD process information in their brain differently from others and develop at a different pace in each area. They are characterised by the presence of clinically significant and persistent difficulties in social communication (marked difficulty in the non-verbal and verbal communication used in interaction, absence of social reciprocity and difficulties developing and maintaining relationships with peers appropriate to their developmental level), stereotyped motor or verbal behaviours, unusual sensory behaviours, excessive adherence to routines and ritualistic behaviour patterns, and restricted interests.
The following criteria are used for current diagnosis:
- Persistent deficits in social communication and social interaction across multiple contexts, currently or by history, manifested in the following way:
- Deficits in social-emotional reciprocity.
- Deficits in non-verbal communicative behaviours used for social interaction.
- Deficits in developing, maintaining and understanding relationships.
- *Severity must be specified.
- Restricted, repetitive patterns of behaviour, interests or activities, manifested by at least two of the following criteria, currently or by history:
- Stereotyped or repetitive motor movements, use of objects or speech.
- Insistence on sameness, inflexible adherence to routines or ritualised patterns of verbal or non-verbal behaviour.
- Highly restricted, fixed interests that are abnormal in intensity or focus.
- Unusual reaction to sensory input or unusual interest in sensory aspects of the environment.
- *Severity must be specified.
- Symptoms must be present in the early developmental period (although they may not become fully manifest until social demands exceed limited capacities, or they may be masked later in life by learned strategies).
- Symptoms cause clinically significant impairment in social, occupational or other areas of functioning.
- Intellectual disability (intellectual developmental disorder) or global developmental delay do not better explain these disturbances.
It is also essential to specify the following points:
- Presence of intellectual impairment
- Presence of language impairment
- Associated with a known medical or genetic condition, or environmental factor
- Associated with another neurodevelopmental, mental or behavioural disorder
- Catatonia
- Loss of acquired skills
A change of paradigm
In recent years, with the publication of DSM-V, there has been a very significant change in the classification of this condition. DSM-IV set out the section “Pervasive developmental disorders”, which included 5 types:
- Autistic Disorder
- Rett’s Disorder
- Childhood Disintegrative Disorder
- Asperger’s Disorder
- Pervasive Developmental Disorder Not Otherwise Specified
DSM-V created the term “Autism Spectrum Disorders” (ASD), in turn included within the category “Neurodevelopmental disorders”, which covers all of them except Rett’s Disorder, which is no longer part of this category. Instead of distinguishing between these subtypes, the DSM-V diagnostic definition specifies three levels of symptom severity, as well as the level of support required, as set out above.
Early Warning Signs
Early identification is key to improving prognosis and quality of life. Although development is variable, there are certain “red flags” or warning signs that can be detected before the age of 2:
- Lack of response to their own name (at around 12 months).
- Not pointing at objects to show interest (at around 14 months).
- Little or no eye contact.
- Delay in the development of spoken language and absence of babbling.
- Hand flapping, body rocking or spinning in circles (stereotypies).
- Unusual reactions to sounds, smells, tastes, textures or lights.
The Neurodiversity approach: Strengths in ASD
It is important to stress that ASD does not only involve challenges, but also a different neurological configuration that can bring notable strengths and abilities. The neurodiversity paradigm invites us to value characteristics such as:
- Exceptional attention to detail and the ability to identify patterns.
- Outstanding memory (visual, auditory or for specific facts).
- Great sincerity, honesty and loyalty in relationships.
- Deep logical thinking and a creative approach to problem solving (thinking “outside the box”).
- High levels of concentration and expert knowledge in their areas of deep interest.
Intervention and Multidisciplinary Support
Autism will accompany the person throughout their life, but early, specialised, evidence-based intervention can make an enormous difference to their development. Support plans must always be individualised and may include:
- Psychological and Behavioural Therapy: To foster social skills, emotional regulation and the reduction of anxiety.
- Speech and Language Therapy: Aimed at improving verbal and non-verbal communication (including Augmentative and Alternative Communication systems, or AAC).
- Occupational Therapy: Essential for working on sensory integration, independence in activities of daily living and psychomotor skills.
- Psychoeducational Support: Methodological adaptations in the school environment to facilitate the pupil’s learning and inclusion.