- Difficulty with communication and interaction with other people
- Restricted interests and repetitive behaviors
- Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life
The fifth version of the Diagnostic and Statistical Manual (DSM-5) was published in 2013. The manual reflects the state of knowledge of mental and emotional disorders. Changes in the newest edition include combining the previously distinct Pervasive Developmental Disorders (Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder – Not Otherwise Specified) into one new disorder:
Autism Spectrum Disorder.
However, due to changes in criteria, not all people diagnosed with a Pervasive Developmental Disorder in the previous edition of the DSM will receive a diagnosis of Autism Spectrum Disorder in the new criteria. In addition to the changes in criteria, a 3-level severity scale has been added to the manual. Those who no longer meet the diagnostic criteria may qualify for Social Communication Disorder.
|Diagnostic Criteria (2 Domain)|| • Impaired Social Communication and Interaction|
• Restrictive Repetitive Behavior, interest or activities
|Three Required Symptoms:|| • Deficits in social interaction|
• Deficits in social communication
• Deficits in play or friendship
|Restricted, repetitive behavior, interests, or activities:(Must have a symptom in 2 of the 4 areas)|| • Repetitive motor movements, use of objects, or speech.|
• Rigidity related to routines or rituals.
• Restricted interest abnormal in intensity or focus.
• Over or under sensitivity or interest in sensory stimuli (pain, temperature, light, sound, etc.)
|Severity Indication:|| • Level 1 (“Requiring support”)|
• Level 2 (“Requiring substantial support”)
• Level 3 (“Requiring very substantial support”)
|Implications:|| • Well established diagnosis ⇨ ASD diagnosis|
• No longer meet criteria ⇨ Social Communication Disorder
Fact: Individuals on the autism spectrum are often keen to make friends but may find this difficult.
Fact: Given appropriate education, many will grow up to be successful contributors to society.
Fact: There is clear evidence from research that autism is not caused by bad parenting but from a difference in the way the brain develops before the child is born
Fact: When individuals on the autism spectrum feel relaxed and confident with the communication partner, eye contact can be quite spontaneous. It is NEVER a good idea to force a person on the spectrum to have eye contact with you.
Fact: It is estimated that 10% of individuals on the autism spectrum may have special abilities in areas like music, art, mathematical calculations, memory and manual dexterity. The majority however, may have areas of high performance that relate to their special interests or obsessions. These skills are often referred to as 'splinter skills', as they are often not consistent with skills in other areas of development.
Fact: Children do not 'outgrow' autism but symptoms may lessen or change as the child develops and receives appropriate interventions.
Fact: Individuals on the autism spectrum can and do give affection. However, due to differences in sensory processing and social understanding, the display of affection may appear different from typical people. Understanding and acceptance of these differences is the key.
What are the causes and risk factors for ASD?
At this point, the cause of autism remains unknown, however, the one theory that has strong scientific evidence is that genetics play a significant role in contributing to the occurrence of ASD. Studies show the concordance rate for identical twins is much higher than for fraternal twins, and ongoing research is beginning to identify genes that may put an individual at risk.
Additionally, in the last decade, there are more postulations on the relationship between environmental toxins, diets, vaccines and autism, but up till now, there is no convincing scientific evidence that demonstrate a causal link between ASD and these toxins, life-saving vaccines or diets. As a result, adherence to these speculative beliefs is tragic because more children are harmed by not receiving life-saving vaccination.
Finding the answer will require long-term, painstaking, rigorous, and sophisticated scientific investigation. Professional responsibility and ethics demand that care be taken not to over-speculate, misrepresent nor present mere hypotheses as facts for the causes of autism.
In most cases, no cause can be identified. Genetics play an important role, although autism may occur with age, education and social environment. Importantly, parenting styles are NOT responsible. There is also no evidence that vaccines cause autism.
What is the prevalence rate of ASD in the world and in Singapore?
- 1 in 68 children has been identified with autism spectrum disorder (ASD) in the United States, 30 percent higher than previous estimates reported in 2012 of 1 in 88 children (Center for Diseases Prevention and Control, CDC 2014)
- In Singapore, due to the lack of statistical studies to establish the prevalence rate locally, an estimate figure of 1% of the population is diagnosed with ASD.
- 1,100,000 cases of autism in China; 650,000 in the UK; 500,000 in the Philippines; and 180,000 in Thailand (the World Health Organization, WHO, 2009)
- 49 children in every 10,000 is diagnosed with the disorder in Hong Kong (epidemiological study by V. Wong & S. Hui (2007) of The University of Hong Kong)
- 5 times more common among boys (1 in 42) than among girls (1 in 189). (Centers for Disease Control and Prevention, CDC, ASD)
- Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of about 1%. A study in South Korea reported a prevalence of 2.6%. (Centers for Disease Control and Prevention, CDC, ASD)
- Approximately 67 million people worldwide are affected by autism.
It is generally believed that the prevalence is similar across countries and cultures, although the numbers obtained in prevalence studies vary according to the methodology and diagnostic criteria used.
Boys are affected by autism at a much higher rate than girls, for reasons that are not entirely clear. A similar pattern is seen in other childhood disorders such as Attention Deficit Hyperactivity Disorder (ADHD).
The estimated rate of autism in Singapore is about one in 150 children and that is around 1% of the population in Singapore. This is a higher rate than the World Health Organisation’s global figure of one in 160 children. The rise in the number of people with autism are likely due to the nature of the diagnostic testing and also the increase in awareness on special needs in Singapore.
1. Can autism be cured?
According to Singapore General Hospital (2018), “There is no known cure for autism. With appropriate education and support, children with ASD can develop their communication and interaction skills to become independent adults and lead productive lives. Therapies do NOT cure autism, although they bring about marked improvement.”
Many treatment options can help to improve outcomes for children. In a field exploding with alternative treatments, choosing the best course of action for the child with autism can be a daunting task.
Following Singapore’s AMS-MOH Clinical Practice Guideline 1/2010, one of the most scientifically proven treatment methods for autism is Applied Behavior Analysis (ABA). Awarded Grade A in terms of Level of Recommendation and Level 1++ in terms of Level of Evidence. ABA is the highest-rated treatment method by the Ministry of Health, Singapore (MOH).
At Autism Partnership (AP), we adopt our very own unique style of Applied Behavior Analysis (ABA), known as the Autism Partnership Method (APM). APM is a progressive model of ABA that is highly individualised, child-friendly, holistic, and focused on “in the moment analysis” and “clinical judgement”. Our APM has been developed for over 40 years and results from the hundreds of clinicians working around the world.
Learn more about our AP Method today: https://www.autismpartnershipsg.com/our-method-approach
2. Can autism be prevented?
As a parent, noticing signs of possible developmental delay in your child can be overwhelming and difficult to accept. If you think your child is not meeting certain developmental milestones, trust your instincts and consult your Developmental Paediatricians for a screening.
This first step that you are taking can make a huge difference in your child’s life. The earlier a diagnosis is made, the sooner your child can participate in early intervention programmes. Early intervention has been shown to yield benefits in language, academic, behavior, and educational progression.
Learn more about development milestones here: http://bit.ly/whatisASD
Learn more about our AP Method today: https://www.autismpartnershipsg.com/our-method-approach/
3. What causes Autism?
Although there are many theories, no one fully knows the definitive answer to this question. Research shows that autism can be caused by a variety of conditions that affect brain development, which may occur before, during or after birth.
While the cause or combination of causes of autism is not fully understood, research suggests a biological correlation affecting the parts of the brain that process language and information coming in from the senses. Other research findings suggest that there may be an imbalance in certain chemicals in the brain. Genetic factors may sometimes be involved in certain families. In reality, what we know is that autism may develop from a combination of several “causes”.
4. What Is Asperger’s Syndrome (DSM IV)?
Asperger’s Syndrome is a form of autism, a condition that affects the way a person makes sense of the world and relates to others. A number of traits of autism are common to Asperger’s Syndrome including: difficulties in communicating, social relationships, and a lack of social imagination and creative play.
Persons with Asperger’s Syndrome usually have fewer difficulties with language than those with classical autism, often speaking fluently, though their words can sometimes sound formal or ‘unusual’ to the listener. Even though they have few difficulties with language, they do have significant difficulties with social aspects of communication.
Many children with Asperger’s Syndrome are able to adapt to learning in a mainstream school setting. With the right support and encouragement, they are able to make good progress and go on to further education and employment options.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) which was published in May 2013 no longer includes Asperger’s disorder as a separate diagnosis and has homogenized it under autism spectrum disorder, with severity measures within the broader diagnosis.