Specified (PDD-NOS) are some of the most common Autism Spectrum Disorders.
The autism spectrum is considered a “spectrum” because the individuals who comprise it vary greatly from each other.
Intellectually, some fall in the mentally retarded range while others clearly fall in the superior intellectual range. Asperger’s Syndrome
and High-Functioning Autism involve, by definition, individuals with average to above average intellectual ability and better
communication skills than those with more “classic” autism who tend to have lower intellectual functioning and more communication
difficulties. Those who have symptoms of an Autism Spectrum Disorder but do not meet the full criteria for a specific diagnosis like
autism or Asperger’s Syndrome are typically given the diagnosis PDD-NOS. This actually represents the largest category of individuals
on the spectrum, which means that although we can identify individuals on the spectrum, the diagnostic process is not yet good at
making specific differential diagnoses among Autism Spectrum Disorders.
Current diagnostic criteria describe Autism Spectrum Disorders as involving difficulties in three general areas: (a) qualitative
impairment in social interactions (e.g., impairment in responding to or initiating interactions with others, or failure to form peer
relationships), (b) qualitative impairment in verbal and nonverbal communication (e.g., no mode of communication, or impairment
in the ability to initiate or sustain conversations), and (c) restricted, repetitive, and stereotyped patterns of behavior, interests or
activities (e.g., preoccupation with restricted patterns of interest, or inflexible adherence to nonfunctional routines or rituals) (American
Psychiatric Association, 1994).
Problems with social interaction can include difficulties initiating or responding to conversation, difficulties using or responding
to nonverbal gestures (e.g., pointing out objects), lack of or inconsistent eye contact, impairment in responding to others’ feelings,
difficulties working cooperatively with peers, and subsequent failure to develop peer relationships. Understanding what to do or say in
social situations is a core concern for autistic individuals.
Communication problems range from no ability to communicate and use language to more subtle difficulties with the flow of
conversation and social communication (pragmatic language). Some classically autistic individuals may have difficulties understanding
the meanings of most words and may show little spontaneous language communication. In contrast, those with High-Functioning
Autism and Asperger’s may appear to have excellent command of language in terms of their ability to express themselves and
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understand others, yet they may have great trouble with the flow of social conversation, talking
at
people instead of
with
people,
relaying factual information or phrases memorized from TV shows without responding to what their listener is saying or doing. Thus
individuals with Asperger’s may have extensive vocabularies, but difficulty using it in a fluid way to make conversation in social
situations. High-functioning individuals, like those with more language difficulties, may also have trouble with abstract language and
tend to interpret things literally. For example, if a teacher said, “Don’t let the cat out of the bag,” a literal interpretation would have
a student looking for a cat and a bag. In addition, many students with autism may have trouble processing language when there
are competing sights and sounds. Thus using language alone to explain complicated material may sometimes be less effective than
supplementing the explanation with concrete visual information that supports the verbal explanation (Quill, 1995).
Repetitive and ritualistic behaviors reflect a preference for sameness and repetition with regards to interests, daily routine, and
body movements. Many youngsters with autism develop a fascination with a particular area of interest and elaborate on that interest
to the exclusion of learning about new things. For example, I knew a youngster who became obsessed with vacuum cleaners and
was reluctant to attend to or talk about anything else. Many individuals with autism also exhibit nonfunctional routines that appear
superstitious in nature. One individual I worked with had to hang every picture in the house at a crooked angle before he could use
the toilet. Other students may not have nonfunctional routines, but prefer that their daily routines occur the same way all the time
and may become very anxious or upset when changes or transitions are introduced. Youngsters may also demonstrate repetition in
their use of language (repeating the same phrase over and over) or in their physical movements (e.g., repetitive hand flapping, body
rocking, or twirling around).
Because of the difficulties individuals with Autism Spectrum Disorders have in negotiating social situations and handling
changes in their environment, many students experience stress, frustration and anxiety on an almost constant basis (Kim, Szatmari,
Bryson, Streiner, & Wilson, 2000; Myles & Southwick, 1999). Wanting to interact with another student but not knowing how,
not understanding the change in teacher directions for a new challenging task, hearing other students laugh around them, and
not knowing whether they are the target of the joke—these are all stressful situations that youths with Autism Spectrum Disorders
experience daily.
Despite this level of stress, it is important to point out the emotional variability among students with Autism Spectrum Disorders.
Some students rarely seem to get upset, as they may handle their stress by withdrawal and go virtually unnoticed. Others present
with additional anxiety disorders (e.g., Obsessive-Compulsive Disorder, Social Phobia, or Panic Disorder). Some students seem to be
constantly frustrated, impulsive, and have frequent tantrums. Many
