The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders is the most widely acknowledged nomenclature used by psychologists and researchers for the classification of mental disorders. It consists of three main sections. Section 2 contains diagnostic criteria and codes for routine clinical use. It lists the variety of disorders, disabilities, and dysfunctions. Among them are neurodevelopmental disorders, which occurs in the child’s developmental period and are characterized by different developmental disabilities and deteriorate normal activity. According to the manual, these disabilities are divided into intellectual ones (impair normal intellectual and every day adaptive functioning), communication ones (disabilities concerning deficits in verbal and nonverbal communications), autism spectrum disorder (characterized by communication disabilities, deficits in social habits and limited imaginativeness), attention deficit hyperactivity disorder (difficulties of staying focused and controlling behavior, over-activity), specific learning disorder (difficulties of learning, acquiring new academic knowledge and skills), motor disorders (result in abnormal and inadvertent movements) and other neurodevelopmental disorders (American Psychiatric Association, 2013, pp. 31-86).
One of the most severe childhood neurodevelopmental disorders is autism spectrum disorder, which was first identified and described by Leo Kanner in 1943 as “early infantile autism” (Schreibman, 1988, p. 57). Despite each autistic individual has his or her own pattern of autism, the disorder is characterized by common features. They are deficits in social habits and behaviors, communication disabilities, mental retardation, self-stimulation, self-injurious behavior, perseverance for the preservation of sameness (Schreibman, 1988, p. 57). What follows is more detailed discussion of three last above-mentioned features.
Self-stimulatory behavior, or sensory stimulation, is considered to be one of the defining characteristics of the autism spectrum disorder. It can be described as repetitious, incessant, stereotyped activity with no other purpose than to provide sensory or kinesthetic feedback. Self-stimulatory behavior can manifest itself at the motor level through body swinging, extremities twitching, jumping, lunging, head-bobbing etc. As to more subtle level, autistic individuals might gaze and stare at different things for a long time, wiggle and wave fingers or engage in facial grimacing (Schreibman, 1988, pp. 59-60).
It is significant to understand, that self-stimulatory behavior is not only absolutely normal for children with autism, but is also very important and indispensable to life. Autistic individuals often suffer from sensory overload. And “sensory” here not necessarily relates to the five basic senses, but also to some bad news or sudden change of plans. All these can seriously distress individuals with autism. Self-stimulation helps to relieve the stress, provides feedback to distract, calm or cheer autistic individual. Moreover, self-stimulation is often unconscious and arises naturally. It can even provoke pleasant feelings for autistic children. Using self-stimulation, child incites manifestation of his or her senses by certain activities. For example, mumbling stimulates the work of the organs of hearing and touch; body swinging stimulates the work of the vestibular apparatus etc.
Self-injurious behavior is one of the most dramatic features of autism spectrum disorder. The most common forms of such behavior are head-banging, self-biting, hair-pulling and face-scratching. The reasons for the self-injurious behavior of autistic individuals is lowered pain sensitivity or desire for unusual feelings. Sometimes the sense of danger is inadequate. Therefore, a child with autism might not recognize situations, requiring caution, as if he or she has no instinct of self-preservation. It can lead to severe injuries such as fractured skulls, fractured extremities, horrible open wounds with possible further infection. As a consequence, to prevent aforementioned injuries, an autistic individual should be restrained for his or her protection. It might require tying child down to the bed, or place in special clothes like a camisole etc. (Schreibman, 1988, pp. 60-61).
Preservation of sameness
Preservation of sameness is one of the most interesting, unusual and poorly understood characteristics of the autism spectrum disorder. This feature means that an autistic individual is highly sensitive to changes in the arrangements of his or her environment and, therefore, has a strong desire for the preservation of its sameness. Moreover, the changes in a familiar environment or situation may cause serious stress and severe reaction from individuals with autism. Preservation of sameness is typically manifested in several areas. One area is routes of travel and daily routine. The autistic child might become very upset in case of change of usual travel route or usual daily routine. Another area concerns the peculiar disposition of objects. Autistic children often put different objects in a stereotypical manner (by shape, color, size), and doesn’t like when his or her ordered belongings are disturbed. The persistent demand for sameness can also be exhibited in a variety of rituals regarding foods, clothes, and different other objects. Generally, preservation of sameness as the feature of the disorder is one of the essential ones and can be requisite for a diagnosis of autism (Schreibman, 1988, pp. 58-59).
Pursuant to the above-mentioned peculiarities of autism spectrum disorder, the finding of the efficient treatment of autism is one of the most difficult problems of modern medicine. A significant number of psychological researches are dedicated to this problem. The main aim of the researchers is to find the ways to improve problem behaviors of autistic individuals through the variety of interventions. Moreover, it is important to take into consideration different conditions, such as age, gender and mental development (factors, that form the distinctive pattern of autism) of the individual with autism, just as the features of possible treatment methods (Ma, 2009, pp. 342-343). It is also crucial to identify, that an autistic individual has recovered. Usually, concerning the autism, recovery means the achievement of intelligence level, which meets age-related standards and requirements, and absence of behavioral signs of autism.
The main findings of the studies can be summarized into five highly efficient intervention strategies. They are: training of essential skills, self-control (includes self-reinforcement, self-instruction and self-recording), priming (helping autistic individuals prepare for forthcoming activities and assignments), presenting preferential activities in order to engage autistic individuals in social interaction, positive reinforcement and punishment (praise and rewards for desirable behaviors and punishment for undesirable ones) (Ma, 2009, pp. 343-345). Presumably, the best results could be achieved by combining the strong sides of each strategy. Moreover, it is established, that mentioned intervention strategies are very effective in improving communication abilities and conversational skills, social habits and interaction skills, attentiveness and listening skills of autistic individuals. The significant discovery is that it is preferable and more efficient to train social interaction as a whole in individuals with autism spectrum disorder rather than to develop single components separately (Ma, 2009, p. 357). Nevertheless, the choice of the treatment method is a complete prerogative of autistic child’s parents, and usually it is a very important dilemma.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing.
Ma, Hsen-Hsing (2009). The Effectiveness of Intervention on the Behavior of Individuals With Autism: A Meta-Analysis Using Percentage of Data Points Exceeding the Median of Baseline Phase (PEM). Behavior Modification, 33 (3), 339-359. Web.
Schreibman, L. (1988). Diagnostic Features of Autism. Journal of Child Neurology, 3 (1), 57-64. Web.