Autism Spectrum Disorder - One Size Fits All ...?

Abstract: We know ASD is a specific diagnosis with specific qualifying criteria. We know skills with which individuals with ASD tend to have difficulty. What about when the person has higher-level skills and/or social interest, but still has significant difficulty in ASD-related areas?

Description: In 2013, the DSM-V made some significant changes to the diagnostic picture for autism spectrum disorder (ASD), combining a number of related disorders into a single heading. Further, social communication disorder (SCD) shares a number of characterisitics with ASD. All this has led to new challenges in diagnosing ASD. When individuals fit the traditional picture, we tend to know what to do. However, with those changes, higher-functioning individuals must now meet the same criteria, but deciding whether or not they do may not be so straightforward. There may be discrepancies in what different professionals and caregivers think as to whether or not an individual qualifies for the diagnosis and/or services, or what is best to do in treatment/education once diagnosed. As speech-language pathology professionals, we regularly hear how no single evaluative measure should be used to make diagnostic decisions, but we also know that the level of emotional investment displayed by individuals in the diagnostic/treatment equation can be quite high, as well. So, how do we navigate all of this data to come to a solid clinical decision? For example, a common misconception regarding individuals with ASD is that they do not have interest in establishing/maintaining interaction/relationships with others. The new diagnostic criteria highlight that this is not a good assumption. Additionally, as the ASHA practice portal has shared, the kinds of activities/interests female children gravitate toward tend to be more social in nature than those engaged in by males. Have these trends contributed to the lower identification of ASD in females than males?

As is often the case to solving difficult problems, the answers may lie in the balance between firm diagnostic criteria and reminding ourselves that there are different ways those characteristics can manifest. For example, in an individual with ASD, challenges with interactions and relationships will occur, but not necessarily due to lack of interest. Further, we must remember that ASD is a pervasive diagnosis, so while we may not readily see difficulties in one setting, we may see related behaviors to a lesser degree in one environment that are severely impacting function in one or more other settings. Therefore, as is always the case in diagnosing ASD, input from multiple sources and environments and open but accurate thinking is critical to making an accurate diagnosis and the best clinical treatment plans/decisions.

This presentation will utilize the diagnostic criteria and reviews of literature to share information to assist speech-language pathology professionals in making decisions regarding diagnosis and treatment of higher-functioning individuals with ASD, with particular attention paid to what that might look like in females.

Supporting Research: Reference 1: 1. Belcher, H., Morein-Zamir, S., Mandy, W., & Ford, R. (2022). Camouflaging intent, first impressions, and age of ASC diagnosis in autistic men and women. Journal of Autism and Developmental Disorders, 52, 3413-3426.
2. Cummins, C., Pellicano, E., & Crane L. (2020). Supporting minimally verbal autistic girls with intellectual disabilities through puberty: perspectives of parents and educators. Journal of Autism and Developmental Disorders, 50, 2439-2448.
3. Grandin, T., & Barron, S. (2016). Unwritten Rules of Social Relationships – Decoding Social Mysteries Through the Unique Perspectives of Autism. Arlington, TX: Future Horizons, Inc.

Supporting Research: Reference 2: 4. Gray, C. & White, A. (2002). My Social Stories Book. Philadelphia, PA: Jessica Kingsley Publishers.
5. Klimas, N. (2001). Learning in disguise, using music to foster communication in children with autism. ADVANCE for Speech-Language Pathologists & Audiologists, 11(48), 7-8.
6. Knight, V., Sartini, E., & Spriggs, A. (2015). Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 157-178.

Supporting Research: Reference 3: 7. Kranowitz, C. (2005). The Out-of-Sync Child. New York: Skylight Press, Penguin Group.
8. McFayden, T., Albright, J., Muskett, A., & Scarpa, A. (2019). Brief report: sex differences in ASD diagnosis-a brief report on restricted interests and repetitive behaviors. Journal of Autism and Developmental Disorders, 49, 1693-1699.
9. Prelock, P. & McCauley, R. (2012). Treatment of Autism Spectrum Disorders: Evidence-Based Intervention Strategies for Communication & Social Interactions. Baltimore, MD: Paul H. Brookes Publishing Co.

Supporting Research: Reference 4: 10. Song, A., Cola, M., Plagte, S., Petrulla, V., Yankowitz, L., Pandey, J., Schultz, R., & Parish-Morris J. (2021). Natural language markers of social phenotype in girls with autism. The Journal of Child Psychology and Psychiatry, 62(8), 949-960.
11. Trott, M. (2002). Oh Behave: Sensory Processing and Behavioral Strategies. San Diego: Harcourt Education.
12. Tsirgiotis, J., Young, R, & Weber, N. (2022). A mixed-methods investigation of diagnostician sex/gender-bias and challenges in assessing females for autism spectrum disorder. Journal of Autism and Developmental Disorders, 52, 4474-4489.

Supporting Research: Reference 5: 13. Tubio-Fungueiriño, M., Cruz, S., Sampail, A, Carracedo, A., & Fernández-Prieto, M. (2021). Social camouflaging in females with autism spectrum disorder: a systematic review. Journal of Autism and Developmental Disorders, 51, 2190-2199.
14. Williams, M., & Shellenberger, S. (1996). How Does Your Engine Run? Albuquerque, NM: TherapyWorks, Inc.
15. Winner, M. (2007). Thinking About YOU Thinking about ME – 2nd Ed. Think Social Publishing.
16. Winner, M. & Crooke, P. (2009, rev. 2011). Socially Curious and Curiously Social: A Social Thinking Guidebook for Bright Teens and Young Adults. Think Social Publishing.
17. Yack, E., Aquilla, P., & Sutton, S. (2015). Building Bridges Through Sensory Integration – 3rd edition – Therapy for Children with Autism and Other Pervasive Developmental Disorders. Arlington, TX: Sensory