Autism Spectrum Disorder
Consider the range of impairment for individuals whose symptoms are described by autism spectrum disorder (ASD). Address the following using headings to match content in each bullet point:
Compare early behaviors typical of those diagnosed with ASD evident in the description of Temple and Richard.
How have the developments in the field since the time Temple was young changed how we understand Richard’s symptoms and their causes?
Case One: Dr. Temple Grandin, professor of animal sciences at Colorado State University, has designed one-third of the livestock-handling facilities in the United States. She has published dozens of scientific papers and gives lectures throughout the world. Some of her lectures describe her new equipment and procedures for safer and more humane animal handling. Others describe her life with autism. Grandin showed the classic symptoms of autism (now called autism spectrum disorder) during childhood. As a baby, she had no desire to be held by her mother, though she was calm if left alone. As a young child, she seldom made eye contact with others and seemed to lack interest in people. She frequently threw wild tantrums. If left alone, she rocked back and forth or spun around repeatedly. She could sit for hours on the beach, watching sand dribble through her fingers, in a trancelike state.
At age 2, she still had not begun talking and was labeled “brain-damaged” because doctors at that time did not know about autism spectrum disorder. Fortunately, Grandin’s mother was determined to find good teachers, learn ways to calm her daughter, and encourage her to speak and engage with others. Grandin did learn to speak by the time she entered elementary school, although most of her social interaction deficits remained. When she was 12, Grandin scored 137 on an IQ test (which falls in the very superior range) but still was thrown out of a regular school because she didn’t fit in. She persisted, however, and eventually went to college, where she earned a degree in psychology, and then to graduate school, where she earned a PhD in animal sciences. Grandin has been able to thrive in her career and personal life. Still, she finds it very difficult to understand emotions and social relationships.
She does not “read” other people well and often finds herself offending others or being stared at because of her social awkwardness: I have always felt like someone who watches from the outside. I could not participate in the social interactions of high school life. … My peers spent hours standing around talking about jewelry or some other topic with no real substance. What did they get out of this? I just did not fit in. I never fit in with the crowd, but I had a few friends who were interested in the same things, such as skiing and riding horses. Friendship always revolved around what I did rather than who I was. (Grandin, 1995, p. 132) Still, Grandin does not regret that she has autism. She says, If I could snap my fingers and be a nonautistic person, I would not. Autism is part of what I am.
Case Two:.Richard, age 3½, appeared to be self-contained and aloof from others. He did not greet his mother in the mornings or his father when he returned from work, though if left with a baby-sitter, he tended to scream much of the time. He had no interest in other children and ignored his younger brother. His babbling had no conversational intonation.
It was not until age 3 that he could understand simple practical instructions. His speech consisted of echoing some words and phrases he had heard in the past, with the original speaker’s accent and intonation; he could use one or two such phrases to indicate his simple needs. For example, if he said, “Do you want a drink?” he meant he was thirsty. He did not communicate by facial expression or use gesture or mime, except for pulling someone along with him and placing his or her hand on an object he wanted. He was fascinated by bright lights and spinning objects and would stare at them while laughing, flapping his hands, and dancing on tiptoe.
He was intensely attached to a miniature car, which he held in his hand, day and night, but he never played imaginatively with this or any other toy. From age 2 he had collected kitchen utensils and arranged them in repetitive patterns all over the floors of the house. These pursuits, together with occasional periods of aimless running around, constituted his whole repertoire of spontaneous activities. The major management problem was Richard’s intense resistance to any attempt to change or extend his interests.
Removing his toy car, even retrieving, for example, an egg whisk or a spoon for its legitimate use in cooking, or trying to make him look at a picture book precipitated temper tantrums that could last an hour or more, with screaming, kicking, and the biting of himself or others. These tantrums could be cut short by restoring the status quo. His parents had wondered if Richard might be deaf, but his love of music, his accurate echoing, and his sensitivity to some very soft sounds, such as those made by unwrapping chocolate in the next room, convinced them that this was not the cause of his abnormal behavior. Psychological testing gave Richard a mental age of 3 years in non-language-dependent skills (such as assembling objects) but only 18 months in language comprehension.
Source: DSM Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.
DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
First, M. B. (2013). DSM-5 handbook of differential diagnosis. American Psychiatric Pub.
Pizzorno, J. E., Murray, M. T., & Joiner-Bey, H. (2016). The Clinician’s Handbook of Natural Medicine E-Book. Elsevier Health Sciences.
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