Autism Spectrum Disorder (ASD)
In the United States, a revision to autism spectrum disorder (ASD) was presented in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 2013.
The new diagnosis encompasses previous diagnoses of autistic disorder, Asperger syndrome, childhood disintegrative disorder, and PDD-NOS
What are the different types of autism?
In the US there traditionally have been three different types of Autism Spectrum Disorders:
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Autistic Disorder (also called "classic" autism) This is what most people think of when hearing the word "autism."
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Asperger Syndrome (no longer referred to by this name)
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Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called "atypical autism")
In the UK there are been 5 recognized different types of Autism Spectrum Disorders:
Autistic spectrum disorder.
- Asperger's syndrome.
- Pathological demand avoidance (PDA)
- Childhood disintegrative disorder.
- Pervasive developmental disorder (not otherwise specified)
As a UK/US/Ireland trained clinician, Nicole Story, Clinical Director is well versed in both UK and US models of thought on ASD and Neurodiversity and offers psychotherapy to clients in Florida, Ireland and the UK.
For more information on PDA please see our page on Pathological Demand Avoidance.
"Advances in Psychotherapy, Evidence Based Practice - Autism Spectrum Disorder" defines ASD as "a lifelong neurodevelopmental disorder, qualitatively different form other behavioral disorders." It arises very early in life, often has associated biological and medical conditions, and is not easily treated. In fact, although clearly some individuals improve over time and even "remit," it is considered controversial even today to discuss a "cure" for the disorder. (Joseph, Soorya & Thurn, 2015)
Contrastly, the term "neurodivergent" is a non-diagnostic term to describe the ASD brain as divergent - not "pathological."
What Does It Mean to Be Neurodivergent?
Judy Singer, a sociologist who has autism, started using the term "neurodiversity" in the late 1990s. It refers to the concept that certain developmental disorders are normal variations in the brain and people who have these features also have certain strengths.
For example, people with ADHD may have trouble with time management. But they often show high levels of passion, drive, and creative thinking.
"Even their impulsivity can be an advantage," says Sarah Cussler, assistant director of Undergraduate Writing and Academic Strategies at Yale Poorvu Center for Teaching and Learning. "Because they’ll say things other people are afraid to say."
Neurodiversity isn’t the same thing as disability. Though, people who have neurodivergent features may need accommodations at work or school.
"Neurodiverse students are wonderful students," Cussler says. "They can be really creative, big-picture, out-of-the box thinkers. But with some classic kinds of assessments, they have more difficulty."
Besides ADHD, neurodiversity commonly refers to people with:
Autism spectrum disorder
Dyslexia
Dyspraxia
Other learning disabilities (Wiginton & Bhandari, MD, 2021)
In the field of mental health it is necessary to use clinical and medical terminology and formal assessments to diagnose, and when speaking with other clinicians, however, it can be more therapeutic and less controversial to use non-pathologizing terms with patients/clients in "treatment" or assessment.
In the field today there are contrasting viewpoints - one is clinically that children and people with ASD have limitations that need to be addressed and "treated" to increase functioning (academically, socially, occupationally, at home, etc.) and overall mood and successful living in society.
The other viewpoint is more parent or person driven - that neurodivergence is a diversity that should be recognized as such and accommodated (not "treated").
As a highly trained, experienced clinician with over 20 years working with children, parents and adults; and as a mother experienced in raising her own children and navigating the school systmen - this clinician is open to and well versed in both viewpoints.
The main features of autism spectrum disorder (ASD) are problems with social communication and interaction.
Signs of ASD in pre-school children Spoken language
delayed speech development (for example, speaking less than 50 different words by the age of two), or not speaking at all
frequent repetition of set words and phrases
speech that sounds very monotonous or flat
preferring to communicate using single words, despite being able to speak in sentences
Responding to others
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not responding to their name being called, despite having normal hearing
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rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
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reacting unusually negatively when asked to do something by someone else
Interacting with others
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not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
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little interest in interacting with other people, including children of a similar age
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not enjoying situations that most children of their age like, such as birthday parties
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preferring to play alone, rather than asking others to play with them
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rarely using gestures or facial expressions when communicating
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avoiding eye contact
Behavior
having repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something
preferring to have a familiar routine and getting very upset if there are changes to this routine
having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately
Signs and symptoms of ASD in school-age children
Spoken language
preferring to avoid using spoken language
speech that sounds very monotonous or flat
speaking in pre-learned phrases, rather than putting together individual words to form new sentences
seeming to talk "at" people, rather than sharing a two-way conversation
Responding to others
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taking people’s speech literally and being unable to understand sarcasm, metaphors or figures of speech
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reacting unusually negatively when asked to do something by someone else
Interacting with others
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not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
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little interest in interacting with other people, including children of a similar age, or having few close friends, despite attempts to form friendships
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not understanding how people normally interact socially, such as greeting people or wishing them farewell
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being unable to adapt the tone and content of their speech to different social situations – for example, speaking very formally at a party and then speaking to total strangers in a familiar way
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not enjoying situations and activities that most children of their age enjoy
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rarely using gestures or facial expressions when communicating
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avoiding eye contact
Behavior
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repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
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playing in a repetitive and unimaginative way, often preferring to play with objects rather than people
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developing a highly specific interest in a particular subject or activity
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preferring to have a familiar routine and getting very upset if there are changes to their normal routine
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having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
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unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately
Other conditions associated with ASD
People with ASD often have symptoms or aspects of other conditions, such as:
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a learning disability
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attention deficit hyperactivity disorder (ADHD)
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Tourette's syndrome or other tic disorders
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epilepsy
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dyspraxia
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obsessive compulsive disorder (OCD)
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generalized anxiety disorder
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depression
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bipolar disorder
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sleep problems
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sensory difficulties
If your child has any of these symptoms, they may benefit from separate treatment, such as medication (eg. melatonin for insomnia, etc), animal assisted therapy or cognitive behavioral therapy (CBT), in addition to their treatment for ASD.
If you would like to confidentially assess your child for ASD or other issues, contact our office to schedule an evaluation.
This office does not provide ABA therapy, but seeks to provide support to parents seeking support.
We offer a variety of assessments and can, at your request, convey the results to school or court as requested.
About
Nicole Story, EDS, MED, LMFT, LMHC, NCC
Psychotherapist, Clinical Director
A highly trained clinician (both US and UK/Ireland) for 20 years and Clinical Supervisor to over a dozen nonprofit agencies, military and veterans administration clinical staff, training therapists how to recognize, diagnose and treat autism, ADHD, AuDHD and PDA.
Mother of 2, familiar with the familial, emotional, social, behavioral and academic issues surrounding PDA for the child and the family.
