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Over the past 50 years, autism spectrum disorder (ASD) has gone from a rare disorder that starts in childhood and at the start was narrowly defined, to a strongly advocated, researched, common lifelong condition. ASD is described as a social communication deficit and it has unusual and repetitive sensory-motor behaviors that have not changed since its original delineation (Pathological Demand Avoidance: symptoms but not a syndrome. Green, Jonathan; Absoud, Michael; Grahame, Victoria; Malik, Osman; Simonoff, Emily; et al. The Lancet. Child & Adolescent Health Vol. 2, Iss. 6, (June 2018): 455-464).
Autism is now a spectrum that ranges from very mild to severe. Many people with ASD will require lifelong support. Autism was first discussed by a psychiatrist named Leo Kanner in 1943. He described the disorder as one where children have problems relating to others and experience high sensitivity to changes in their environment (Kanner L. Autistic disturbances of affective contact. Nervous Child. 1943;2:217250).
Signs, symptoms, and diagnosis Diagnostic features of children that have ASD include deficits in social communication and restricted, repetitive patterns of behavior, interest, or activities. a reliable diagnosis can be made by 24 months of age. Some of these symptoms are very limited initiation of social interactions, Severe deficits in verbal and nonverbal social communication skills causing severe impairments in functioning, Marked deficits in verbal and nonverbal social communication skills; limited initiation of social interactions, and minimal response to social overtures from others. social impairments apparent even with supports in place; Restricted, repetitive patterns of behavior, interests, or activities, reduced or abnormal responses to social overtures from others, repetitive motor movements, use of objects, speech, simple motor stereotypies, echolalia, lining up toys or flipping objects, idiosyncratic phrases, inflexible adherence to routines, or difficulties with transitions, rigid thinking patterns, ritualized patterns of verbal or nonverbal behavior such as extreme distress at small changes, greeting rituals, Hyper- or hyperreactivity to sensory input or unusual interest in sensory aspects of the environment such as apparent indifference to pain/temperature, need to take same route or eat same food every day, adverse response to specific sounds or textures, touching of objects, excessive smelling, visual fascination with lights or movement. Highly restricted, fixated interests that are abnormal in intensity or focus such as a strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.).
There are many ways to be screened when someone, like a parent or professional, is concerned that a child might have ASD, the most common of which is the Modified Checklist for Autism in Toddlers (M-CHAT) and the least common is by using the Communication and Symbolic Behavior Scales (CSBS). Most of the children that are identified by these screening instruments have developmental difficulties, although not all have ASD (Weiner, Daniel J; Wigdor, Emilie M; Ripke, Stephan; Walters, Raymond K; Kosmicki, Jack A; et al. Nature Genetics; New York Vol. 49, Iss. 7, (Jul 2017): 978-985D). ASD can be diagnosed by various professionals such as pediatricians, psychiatrists, or psychologists. Standardized diagnostic instruments are available, including the Screening Tool for Autism in Toddlers and Young Children (STAT) this is a 20-min observation for young children, Autism Diagnostic Observation Schedule (ADOS)which is a 45-min observation done by a skilled professional, which is performed on people whose ages are from 12 months to adulthood. These allow the person conducting the test to observe and characterize the behaviors of the person suspected to have ASD (Brown, Hilary K; Ray, Joel G; Wilton, Andrew S; Lunsky (Apr 18, 2017): 1544-1552.). Etiology Studies of genetic heritability of ASD range anywhere from 40-90%, the most recent estimates are around 50% genetic liability. This genetic contribution occurs because of mutational mechanisms along biological pathways. (Green, Jonathan; Absoud, Michael; Grahame, Victoria; Malik, Osman; Simonoff, Emily; et al. The Lancet. Child & Adolescent Health Vol. 2, Iss. 6, (June 2018): 455-464.)
Some additional risks are associated with environmental factors. These include in-utero risks such as traffic-related air pollution, pesticide exposure, parents’ age, maternal infections, low birth weight, and preterm delivery. A preterm delivery can increase the risk of ASD because of the decreased brain development. There have been some previous concerns related to thimerosal-based vaccines, but those concerns have been conclusively disproven (Centers for Disease Control and Prevention. Vaccine safety: vaccines do not cause autism. http://www.cdc.gov/vaccinesafety/concerns/autism.html. Accessed October 13, 2019). Stigmas associated with Autism spectrum disorder. Public stigma refers to stereotypical beliefs, prejudicial attitudes, and discriminatory behaviors endorsed by a group in society toward a person or a subgroup (Corrigan and Watson 2002). Public stigma has been known to affect individuals with psychiatric disorders, including ASD (Ling et al. 2010; Mak and Cheung 2008). Parents of children with autism spectrum disorder as well as children with this disorder have stated that they have experienced shame and social exclusion (Gray 1993, 2002) Scambler and Hopkins (1986) identify a distinction between felt and enacted stigma, describing feelings of worthlessness and inferiority, and social exclusion.
Their children are now seen as distracting and are no longer accepted by the community therefore making the family no longer accepted. Because of the stigmas placed on families, many parents have restricted their daily activities to avoid public situations with their children, also avoiding enacted stigma, Due to the family restrictions these actions also contribute to the separation from the wider community. Stigmas may also prevent a person from seeking treatment for themselves or a loved one. Treatments involve Behavioral treatment; this treatment teaches new skills by reinforcing the desirable behaviors and decreasing undesirable behaviors. There is strong evidence that shows behavior therapy reduces anxiety in older children.(Weitlauf AS, McPheeters ML, Peters B, et al. 2014). Medical Management is another treatment that helps to manage anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and sleep disorders. Cultural considerations when diagnosing Culture are defined as a set of behavioral norms, meanings, and values or reference points utilized by members of a society to construct their unique view of the world and ascertain their identity. This includes things like language, traditions, values, religious beliefs, morals, gender, sexual orientation, and socio-economic status (Group for the Advancement of Psychiatry, Committee on Cultural Psychiatry. Washington: American Psychiatric Publishing; 2001.
Cultural assessment in clinical psychiatry). Ethical considerations of treatmentLearn More ’ Ethics are a complex series of values that guide human actions. Many individuals are led by ethics in their personal lives, so when it comes to medical treatment that person is typically guided by what they feel is right. This can lead to disagreements in treatment. Medical professionals need to consider a person’s ethics when discussing what the best treatment is for their situation. Conclusion Life for many children and adults with ASD has greatly improved today compared with 50 years ago. More adults who have ASD can talk, drive, read, graduate from school, and live in the community. Research directs attention to individuals who have difficulties and provides pathways to greater independence for more people. Science and public policy both have the potential to contribute to such changes. Families, schools, and communities make a difference in the lives of children and adults by providing support and hope.
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