Tokyo Mental Health is here to support you and provide you with the help you need.
Autism Spectrum Disorder (ASD) covers a series of neurological and developmental disorders that begin in childhood and last a lifetime. It affects the way a person communicates, understands communication, relates and views the world and people around them. Following the publication of DSM-5, Autism is considered to be a spectrum disorder because it varies from person to person, and therefore affects people on different levels. For instance, one person may have above average intelligence and be highly skilled, but still struggle with communication and social skills. Asperger syndrome is now included within ASD. A person with ASD can be recognized by the way they behave and interact with other people and not by their physical appearance. Although ASD was considered a childhood disorder, it is now accepted that it continues into adulthood and, especially in cases of mild severity, it is sometimes diagnosed during adolescence or adulthood.
ASD is characterized by difficulties in three main areas typically observed before three years of age:
1. Social Interactions:
People with ASD may have differences in the way they interact, develop and maintain relationships.
2. Verbal and non-verbal communication:
People with ASD may have differences in the way they communicate, understand and use language as well as how they integrate these – this includes words, facial expressions, tone and sound of the voice and body language.
3. Restricted, repetitive and stereotyped interests, activities or behaviours:
People with autism may have differences in their interests and how they learn. They might prefer activities or events to be predictable and therefore tend to like routine and structure, and to do the same things repeatedly. Some people with autism may also have a specific interest or they may enjoy ordering and categorizing objects and facts. Other people with autism may respond differently to sensory information – any of the senses may be over- or under-sensitive, or both, at different times.
People with ASD can also find it hard to use their imagination and may find imaginative play such as pretend play or imagining unrealistic or unlikely scenarios difficult. Instead, they may prefer more repetitive activities that they can repeat and pursue rigidly. People with autism may also have a specific interest or they may enjoy ordering and categorising objects and facts. Some individuals with autism may find it hard to cope with changes in routine or rule breaking.
It is also important to highlight some strengths related to ASD. For example, individuals with autism often have a strong attention to details, and therefore are often able to learn things in detail and remember information for long periods of time. People with ASD may also be able to persevere or hyperfocus in their effort to master a skill or search for knowledge, and therefore develop above average skills or expertise, particularly in technical or creative skills, for example, they may excel in math, science, music or art. Many are strong visual and auditory learners, which means that they learn by seeing or hearing new information. Other individuals may have specific character strengths, such as punctuality, honesty and loyalty.
There are no biological or medical tests that can diagnose ASD. Concerns about an autism diagnosis are primarily raised by parents, but may also be flagged by health visitors, family physicians or other practitioners, and education staff. Health professionals will make a diagnosis by gathering information from multiple sources about how a person behaves and communicates, as well as gathering family and developmental history. Generally, an autism evaluation is undertaken by a multidisciplinary team, including psychologists, pediatrician, psychiatrist, speech and language therapists and occupational therapists. A comprehensive evaluation may involve behavioural observations (e.g., in school or from school), family and/or school interview, behavioral assessment using structured and unstructured tools, report writing and feedback.
It is perhaps worth noting that the recognition and diagnosis of autism can be delayed due to ‘social camouflaging’ (the intentional or unintentional masking, hiding, compensating, copying, and mimicking of neurotypical behaviours or traits to minimise autistic traits and to appear ‘non-autistic’). Research has indicated that people, especially women, with autism, and particularly those with greater insight and social sensitivity, may use such strategies in order to “fit in”.
Intervention and support for individuals with ASD are typically aimed at maximising quality of life and functional independence to help the person to reach their full potential. Interventions or support can be grouped into three main categories – pharmaceutical, psycho-social/lifestyle and specific targeted interventions.
Pharmaceutical interventions utilize medication to typically minimize specific symptoms or comorbidities associated with ASD (or other neurodevelopmental conditions), such as depression, anxiety, and compulsions. There are no medications specifically to target signs or features of ASD.
Psycho-Social/Lifestyle interventions include psycho-educational interventions and behavioral intervention programmes, such as Positive Behavior Support (PBS)/Applied Behavioral Analysis (ABA). These interventions take a value-driven, person-centred and systemic approach. This means that they are guided by the person’s values, needs, wishes and requests, whilst involving all relevant people and agencies around the individual, such as parents, school, work place, health professionals and other support systems. More specifically, they emphasize that reducing and replacing problem behaviour is now a secondary concern and improving quality of life is primary. Gert’s (2005) discussion of the moral ideals offers a useful tool for thinking through the rationale for these interventions to aim at actively improving lives; “A good life for most people consists of more than just not being immoral. It includes active efforts to do what is good in addition to doing no harm”. Within this philosophy, the interventions involve targeted interventions outlined below as well as skill acquisition and practical application across different real life settings, reinforcing desirable behaviors, and decreasing behaviors of concern. Thus, the focus is on an effective and sustainable lifestyle change with positive impact on quality of life, and a meaningful life.
Targeted interventions can include speech and language or occupational therapy, social skills training and mCBTs. Speech and language therapy addresses communication needs, and teaches skills or tools to improve communication (e.g., using gestures or picture boards). Occupational therapy targets activity of everyday living skills, dressing, eating, and bathing to improve independence. Social skills training facilitates skills needed to interact with others, such as conversation and reciprocity. mCBTs, whilst targeting cognitions and feelings as traditional CBT, can also help the person to better understand themselves and their autism. The structured, educational and concrete approach inherent in this model typically further facilitates engagement in people with ASD.