The term “spectrum” refers to the wide variance in symptomology, skill, and levels of impairment in functioning that can occur in people with ASD. This variation can be seen in the amount of independent functioning, as some individuals with ASD manage daily living requirements independently while others require significant amounts of support in basic daily living. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013 includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD, rather than as separate disorders (American Psychological Association, 2013).
As mentioned above, core ASD criteria can be said to fall into two categories: a) Social impairment and communication difficulties and b) Repetitive and characteristic behaviours, see table 2.1.
2.1.1 Social impairment and communication difficulties
Social deficits and communication difficulties were previously presented as separate categories in the DSM-V however have been combined as they are inherently inter-related (DSM-5, American Psychological Association, 2013).
Commonly discussed deficits of ASD are those in the domain of social interaction and understanding. Deficits present in ASD impact the individual’s manner of developing, understanding and maintaining social relationships with others (Van der Merwe, Bornman, Donohue, & Harty, 2017), often impeding appropriate social interaction (Van der Merwe et al., 2017). Social interactions can be considered very difficult for individuals with ASD due to deficits in social comprehension and communicative ability.
Communication abilities vary greatly amongst individuals with ASD, ranging from complete lack of expressive language ability to fluent but possibly inappropriate speech.
Impairments in theory of mind and hypothetical thinking present in children with ASD may impair the individuals’ ability to understand and in turn use, non-verbal language cues and gestures, as well as in their ability to conceptualise the other individuals internal experiences.
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Table 2.1 Showing criteria of Autism Spectrum Disorder and examples (adapted from DSM-5, APA, 2013)
Main category Sub-category Aspects within this Examples
Social
communication
& social interaction deficits
Social-emotional reciprocity
Abnormal social approach Language often one-sided, lacks reciprocity, used to label or request instead of commenting sharing feeling or converse.
Failure of normal back-and-forth conversation Reduced sharing of interests, emotions or affect
Failure to initiate or respond to social interactions Difficulty processing and responding to social cues:
when and how to join a conversation, appropriate things to say
Non-verbal communication behaviours
Poorly integrated verbal & nonverbal
communication Difficulty co-ordinating non-verbal with speech:
present as odd, wooden or exaggerated.
Abnormalities in eye contact & body language Absent, reduced, or atypical
Deficits in understanding/ using gestures Impaired joint-attention: a lack of pointing/showing/
bringing objects to share with others, failure to follow others pointing/ eye gaze.
Total lack of facial expressions & nonverbal
communication May learn a few functional gestures, lack of
spontaneous use of gestures.
Developing, maintaining &
understanding relationships
Difficulties adjusting behaviour to suit social contexts
Difficulties understanding deeper complexities of social behaviour (and language)
Difficulties in sharing imaginative play or in making
friends Preference for solitary play, desire for friendships
but a lack of realistic understanding of what friendship entails.
Absent/reduced/ atypical interest in peers Rejection of others, passivity or inappropriate approaches- seeming aggressive or disruptive.
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Main category Sub-category Aspects within this Examples
Restricted, repetitive patterns of behaviour, interests or activities
Stereotyped or repetitive motor movements, use of objects or speech
Simple motor stereotypies Hand flapping, finger licking Lining up toys or flipping objects Spinning items, lining up toys
Echolalia or repetitive speech Echolalia: delayed or immediate parroting of heard words, use of “you” when referring to self.
Idiosyncratic phrases Stereotyped use of words, phrases or prosodic patterns.
Insistence on sameness, inflexible adherence to routines or ritualised patterns of verbal/ non-verbal behaviour
Resistance to change Extreme distress at small changes: changes in packaging of a favourite food, insistence on adherence to rules, rigid thinking patterns; Need to take same route or eat same food every day, greeting rituals
Difficulties with transitions Ritualised patterns of verbal/ non-verbal
behaviour Repetitive questioning, pacing a perimeter
Restricted, repetitive patterns of behaviour, interests or activities
Highly restricted, fixated interests that are abnormal in intensity or focus
Strong attachment to or preoccupation with
unusual objects Attachment to a pan, or preoccupation with vacuum
cleaners, spending hours writing out timetables.
Excessively circumscribed or perseverative
interests
Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the environment
Apparent indifference to pain/ temperature
Adverse response to specific sounds or textures Extreme responses to specifics; extreme reaction to or rituals involving taste, smell, texture or appearance of food or excessive food reactions.
Excessive smelling or touching of objects Visual fascination with lights or movement
21 The concept of ASD occurring on a spectrum is highly evident in these variances of communicative abilities as well as variations in social understanding and functioning, as a child with ASD may have any number of combinations of the above-mentioned deficits.
2.1.2 Repetitive and characteristic behaviours
Children with ASD may present with repetitive movements and unusual behaviour that can be disruptive. These include “flapping” (flapping their arms), rocking from side to side, or spinning. Some children engage in behaviours that may be self-injurious or difficult to stop.
They may become preoccupied with parts of objects like the wheels on a toy truck. Individuals with ASD may become preoccupied or obsessed with unusual topics or parts of objects.
This rigidity of thought or ‘repetitiveness’ is also seen in the ASD individuals need for routine and familiarity. Many individuals with ASD have great difficulty coping with change or spontaneous activities as they tend to thrive with clear, set routines and daily patterns. Changes to this daily pattern or unexpected deviations can be extremely challenging and may result in emotional outbursts in response.
These are considered the “core” characteristics of ASD however there are a number of other behavioural and emotional difficulties that may present themselves as well as deficits in cognitive ability.