(First in a series)
October is Autism Awareness Month, so it’s timely to look at the fastest growing category in special education.
Autism is one of five Pervasive Developmental Disorders signposted in the psychiatric bible. This tome (the Diagnostic and Statistical Manual of the American Psychiatric Association) lays out the criteria used to diagnose people with mental or emotional disorders.
The five Pervasive Developmental Disorders are autism, Asperger’s Disorder (also known as Asperger’s Syndrome), Pervasive Developmental Disorder — Not Otherwise Specified, Rhett’s Syndrome (mainly affecting girls) and Childhood Disintegrative Disorder.
Rhett’s and Childhood Disintegrative Disorder are relatively rare.
The first three, which aren’t as rare as was once thought, are usually referred to as Autism Spectrum Disorder.
So what is a Pervasive Developmental Disorder?
It means the child comes into the world with the disorder already coded into its genes.
The disability reveals itself as the child grows and fails to make typical or usual developmental progress.
Parents of young children celebrate developmental milestones, like the first smiles, the first word, and the first step.
And conversely, parents become worried when their baby or toddler is not developing in the same way as other children.
Autism Spectrum Disorder is called a pervasive disorder because it affects all areas of functioning: language, cognition (thinking), affect (emotion), adaptive behaviour (daily living skills) and social interaction.
How is Autism Spectrum Disorder diagnosed?
Autism, Asperger’s Syndrome and Pervasive Developmental Disorder — Not Otherwise Specified are diagnosed based on the child’s difficulties in communication, social interaction and unusual behaviours.
One of the telltale signs of autism is a delay in language development.
Children with autism may not develop oral language and may need to use an alternate communication system based on pictures.
These babies or toddlers may appear to be deaf and a hearing assessment may be the first step on the road to a diagnosis.
Children with Asperger’s Syndrome have completely normal or typical language development, but their communication difficulties show up in failure to carry on a conversation.
They often have difficulties staying on a topic, instead waxing lyrical about their favourite interests.
Autistic and Asperger’s Syndrome children also have difficulties interacting with peers.
Difficulties range from not making eye contact to not knowing how to play with other children.
Autistic and Asperger’s Syndrome children also display unusual or stereotyped and repetitive behaviours.
These range from rather obvious actions, like hand-flapping, holding hands in front of their face and gazing at them, and preoccupation with spinning objects, to an intense need for order, such as lining up their toys.
So what’s Pervasive Developmental Disorder — Not Otherwise Specified?
Children are identified as Pervasive Developmental Disorder — Not Otherwise Specified when there are some of the characteristics of autism and Asperger’s Syndrome, but not enough to make a definitive diagnosis.
Pervasive Developmental Disorder — Not Otherwise Specified is a diagnosis by exclusion, when autism and Asperger’s Syndrome are ruled out.
By now the savvy reader will understand why these three diagnostic categories are lumped together as Autism Spectrum Disorder.
The defining characteristic of a spectrum is that it has variability with no clear cut demarcations between different parts of the spectrum, but with relatively clear differences at each endpoint.
Sometimes the Asperger’s Syndrome and Pervasive Developmental Disorder — Not Otherwise Specified children are referred to as being at the ‘milder’ end of the spectrum.
Both of these conditions have an enormous impact on the child and the family and are only ‘milder’ in comparison to the very obvious disabilities involved in classical autism.
The discussion so far may seem to be in the realm of specialists and have little relevance for the lay reader.
At one time, this may have been true, but a diagnosis of Autism Spectrum Disorder is no longer rare.
Classic autism is still rare (four to six persons per 10,000) but Asperger’s and Pervasive Developmental Disorder — Not Otherwise Specified is on the rise.
The generally accepted figure for Autism Spectrum Disorder (which includes autism) is 62.5 per 10.000 or 1 in 160.
Discussions are ongoing about whether this represents increased awareness and diagnosis or whether there is an actual increase.
Be that as it may, the numbers suggest that Yukon’s school system will have to accommodate close to 100 children with Autism Spectrum Disorder.
Dr. Webster is an Educational Psychologist who consults locally and internationally on children and youth with special educational needs.