Students Diagnosed with Autism Spectrium Disorder (ASD) 

Autism Spectrum Disorder | Attention Deficit/Hyperactivity Disorder

Asperger Syndrome (AS) was first recognized as “a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior” by the American Psychiatric Association (APA) in 1994(1).   According to the fact sheet on AS, published by the National Institutes of Health, “experts in population studies conservatively estimate that two out of every 10 out of every 10,000 children have the disorder.  Boys are three to four times more likely than girls to have AS.”(2)   New data on Autism Spectrum Disorders (ASD), however, published by the Centers for Disease Control and Prevention, estimates that “between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have ASD.”(3)  Data collection designed to estimate the prevalence of Asperger Syndrome and ASD is confounded by ongoing debate about the nature of the diagnoses. 

Asperger’s Syndrome is currently described as a neurodevelopmental disorder on the autism spectrum.  Proposed revisions for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to be released by the American Psychological Association (APA) in May 2013, however, eliminate Asperger’s Syndrome, as well as autistic disorder (autism), childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified as diagnostic categories that are distinct from Autism Spectrum Disorder (ASD)(4).  The proposed revisions are a result of a growing body of psychological research describing autism as a neurodevelopmental disorder marked by peculiarities and deficiencies, on a spectrum ranging from mild to severe, in communication, socialization, movement, interests, and other forms of thought and behavior.  The proposed revisions are also a result of a growing body of research in neurobiology that identifies specific deficits in the brain system that characterizes individuals who are diagnosed with ASD.

Proposed diagnostic criteria for ASD in DSM-V is described as follows.     

Must meet criteria A, B, C, and D:

A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

  1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
  2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
  3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and  in making friends  to an apparent absence of interest in people

B.    Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

  1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 
  2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
  4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C.    Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
 
D.    Symptoms together limit and impair everyday functioning.(5)

About 75% of our students diagnosed with ASD are also diagnosed with ADHD.  
 
Attention Deficit/Hyperactivity Disorder(6)

The disorder consists of a characteristic pattern of behavior and cognitive functioning that is present in different settings where it gives rise to social and educational or work performance difficulties. The manifestations of the disorder and the difficulties that they cause are subject to gradual change being typically more marked during times when the person is studying or working and lessening during vacation.

Superimposed on these short-term changes are trends that may signal some deterioration or improvement with many symptoms becoming less common in adolescence. Although irritable outbursts are common, abrupt changes in mood lasting for days or longer are not characteristic of ADHD and will usually be a manifestation of some other distinct disorder.

In children and young adolescents, the diagnosis should be based on information obtained from parents and teachers. When direct teacher reports cannot be obtained, weight should be given to information provided to parents by teachers that describe the child’s behavior and performance at school. Examination of the patient in the clinician’s office may or may not be informative. For older adolescents and adults, confirmatory observations by third parties should be obtained whenever possible.

A. Either (1) and/or (2).

  1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities.
    Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.
     
    (a)  Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (for example, overlooks or misses details, work is inaccurate).
     
    (b)  Often has difficulty sustaining attention in tasks or play activities (for example, has difficulty remaining focused during lectures, conversations, or reading lengthy writings).
     
    (c)  Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distraction).
     
    (d)  Frequently does not follow through on instructions (starts tasks but quickly loses focus and is easily sidetracked, fails to finish schoolwork, household chores, or tasks in the workplace).
     
    (e)  Often has difficulty organizing tasks and activities. (Has difficulty managing sequential tasks and keeping materials and belongings in order. Work is messy and disorganized. Has poor time management and tends to fail to meet deadlines.)
     
    (f)   Characteristically avoids, seems to dislike, and is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework or, for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
     
    (g)  Frequently loses objects necessary for tasks or activities (e.g., school assignments, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
     
    (h)  Is often easily distracted by extraneous stimuli. (for older adolescents and adults may include  unrelated thoughts.).
     
    (i)   Is often forgetful in daily activities, chores, and running errands (for older adolescents and adults, returning calls, paying bills, and keeping appointments).
     
  2. Hyperactivity and Impulsivity : Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities.
    Note : for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.

    (a)  Often fidgets or taps hands or feet or squirms in seat.
     
    (b)  Is often restless during activities when others are seated (may leave his or her place in the classroom, office or other workplace, or in other situations that require remaining seated).
     
    (c)  Often runs about or climbs on furniture and moves excessively in inappropriate situations. In adolescents or adults, may be limited to feeling restless or confined.

    (d)  Is often excessively loud or noisy during play, leisure, or social activities.
     
    (e)  Is often “on the go,” acting as if “driven by a motor.” Is uncomfortable being still for an extended time, as in restaurants, meetings, etc. Seen by others as being restless and difficult to keep up with.
     
    (f)   Often talks excessively.

    (g)  Often blurts out an answer before a question has been completed. Older adolescents or adults may complete people’s sentences and “jump the gun” in conversations.
     
    (h)  Has difficulty waiting his or her turn or waiting in line.
     
    (i)   Often interrupts or intrudes on others (frequently butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission, adolescents or adults may intrude into or take over what others are doing).

    (j)   Tends to act without thinking , such as starting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.
     
    (k)   Is often impatient , as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.
     
    (l)   Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.
     
    (m) Finds it difficult to resist temptations or opportunities , even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).

B.   Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12.

C.   The symptoms are apparent in two or more settings (e.g., at home, school or work, with friends or relatives, or in other activities).

D.   There must be clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.

E.   The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Specify Based on Current Presentation

  • Combined Presentation: If both Criterion A1 (Inattention) and Criterion A2 (Hyperactivity-Impulsivity) are met for the past 6 months.
  • Predominately Inattentive Presentation : If Criterion A1 (Inattention) is met but Criterion A2 (Hyperactivity-Impulsivity) is not met and 3 or more symptoms from Criterion A2 have been present for the past 6 months.
  • Predominately Hyperactive/Impulsive Presentation: If Criterion A2 (Hyperactivity-Impulsivity) is met and Criterion A1 (Inattention) is not met for the past 6 months.
  • Inattentive Presentation (Restrictive): If Criterion A1 (Inattention) is met but no more than 2 symptoms from Criterion A2 (Hyperactivity-Impulsivity) have been present for the past 6 months.


(1)National Institute of Neurological Disorders and Stroke.  “Asperger Syndrome Fact Sheet,” January 2005 (Bethesda, MD:  OCPL: NIH Publication No. 05-5624).  Retrieved from http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm .
(2)National Institute of Neurological Disorders and Stroke.
(3)Centers for Disease Control and Prevention.  “Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, United States, 2006.”  (Atlanta, GA).  Retrieved from
http://www.cdc.gov/ncbddd/autism/data.html
(4) American Psychological Association, “Proposed Revisions/Neurodevelopmental Disorders/A09 Autism Spectrum Disorder/Rationale,” last modified January 26, 2011. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94
(5)American Psychological Association, “Proposed Revisions/Neurodevelopmental Disorders/A09 Autism Spectrum Disorder/Proposed Revision,” last modified January 26, 2011.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=94 #.
(6)American Psychological Association, “Proposed Revisions/Neurodevelopmental Disorders/A 10-11 Attention Deficit/Hyperactivity Disorder/Proposed Revision,” last modified May 20, 2010.
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=383