Intellectual disability and its relationship to autism spectrum disorders

Autism Spectrum Disorder | Intellectual Disability and Health

intellectual disability and its relationship to autism spectrum disorders

Intellectual disability and its relationship to autism spectrum disorders. This page provides detailed information about this publication. Please click on any text. My four-year-old child is diagnosed with autism spectrum disorder (ASD). His evaluator said that my son was “intellectually disabled in addition to having Intellectual Disability: previous editions of the DSM used the term mental retardation. Res Dev Disabil. Nov-Dec;30(6) doi: /acryingshame.info Epub Jul Intellectual disability and its relationship to autism spectrum.

Theories about the causes of autism have changed markedly over the years. When the condition was first described Kanner, inadequate parenting was often considered to be the primary cause. However, it is now evident that families with one autistic child have a significantly increased risk of having other children with ASD. Family genetic studies have also identified very high concordance rates among monozygotic twins, and increased rates of social and communication difficulties and circumscribed interests or repetitive behaviours among relatives Bolton et al.

In addition, there is an increased familial risk of depressive disorders. Currently ASD is recognised as a highly heritable genetic disorder that may be caused by multigene interactions or arise from spontaneous mutations in genes with major effects. A wide range of common and rare variants associated with ASD has been identified but these can differ from one individual to another.

Many of the ASD-risk genes that have been identified are involved in chromatin remodeling, regulation of protein synthesis and degradation, or synaptic plasticity Bourgeron, Possible environmental factors linked with an increased risk of autism include higher parental age and a history of sub-optimal pre-or perinatal development e. While there is no evidence that vaccination notably the MMR vaccine is associated with an increased risk of ASD, the potential impact of other environmental influences is still a focus of ongoing research.

It is now generally accepted that autism is not due to impairment in a specific brain region or system but to widespread and diffuse effects on brain connectivity that affect perceptual, attentional, motor and social systems from the first year onwards. Individual differences in sensitivity to the environment and different learning styles can subsequently result in very different developmental trajectories and may explain the very heterogeneous profiles of skills and deficits that characterise autism.

Cognitive and language ability Estimated rates of intellectual disability in ASD vary widely and are influenced by the intelligence tests used and the samples of children involved.

However, language comprehension, particularly related to more complex or abstract language is typically poorer than expressive language. This can give rise to difficulties since the relatively good spoken vocabulary of many individuals with ASD often gives a misleading impression of their true level of competence and understanding. Interventions for autism There is no evidence for treatments that claim to result in cures or recovery from autism.

Moreover, many widely used interventions such as dietary and vitamin treatments, music therapy and sensory therapies have very limited evidence of effectiveness NICE, NICE guidelines also discourage the use of a number of specific treatments see Table 4. NICE recommendations for interventions that should be avoided 1. Do not use the following interventions to manage autism in any context in children and young people.

Secretin Chelation Hyperbaric oxygen therapy 2. Do not use neurofeedback or auditory integration training to manage speech and language problems in children and young people with autism. There is also moderate evidence for a number of programmes based on Applied Behaviour Analysis.

For older children, various social skills interventions have been found to improve social competence and understanding Ke et al. Cognitive behavioural interventions to reduce anxiety also report moderate to high effect sizes Lord et al.

High quality intervention research for adults is much more limited, although there is some evidence for the effectiveness of cognitive behaviour therapies including mindfulness for reducing anxiety and depression Spain et al. However, pharmacological interventions can be important in treating common co-occurring disorders such as irritability, agitation, ADHD, epilepsy, anxiety and mood disorders, ASD in adulthood Despite the fact that ASD is a life-long condition, much past research into diagnosis and treatment has focused on children.

However, more recent studies have begun to highlight the needs and skills of adults. Diagnosing ASD in adulthood For individuals who remain undiagnosed during childhood but continue to show difficulties as they move through adolescence and into adulthood, NICE highlights a number of characteristics that should alert clinicians to the need for a full assessment of possible ASD See Table 5. Symptoms in adulthood suggesting the need for a full autism diagnostic assessment 1.

Adults of higher IQ One or more of the following: ADI-R can be used reliably with adults. Although there may be problems in finding an appropriate informant if parents are deceased or very elderly, a satisfactory developmental history can frequently be obtained from siblings or other relatives. The ADOS also has a module that is specifically designed for adolescents and adults. Outcome in adulthood Among the strongest predictors of a positive outcome are the development of language and having a non-verbal IQ in or around the average range Lord et al.

intellectual disability and its relationship to autism spectrum disorders

Most people with ASD show improvements in many aspects of their development as they grow older and the severity of autism symptoms also tends to decrease over time. Nevertheless, access to higher education and employment is limited and follow-up studies suggest that fewer than a third of adults are in full-time employment.

There are few evidence-based interventions for adults and specialist help and support is particularly limited for individuals of average or above intelligence disability. Physical problems and chronic health disorders are also more common than in the general population Croen et al. Premature mortality is particularly high in adults with intellectual disability and epilepsy.

In individuals of average or above average IQ suicide is a significant cause of premature death. ASD in older adults Very little is known about the lives of older individuals i. Conclusion Understanding of ASD has improved significantly over recent decades.

It is now accepted that this condition is far more common than was once thought, that it can affect individuals of all cognitive levels, and that, in the majority of cases, it is genetically determined. However, more is still to be learned about the genetic mechanisms involved, and how these affect brain development and brain function throughout the life-span.

Finally, thanks to a growing movement among individuals with ASD themselves, it is becoming increasingly recognised that ASD can be associated with many positive skills and potential benefits. Journal of Autism and Developmental Disorders 43, — The autism-spectrum quotient AQ: Epilepsy in patients with autism: From the genetic architecture to synaptic plasticity in autism spectrum disorder.

Psychological assessment in the clinical context. The health status of adults on the autism spectrum.

Autism Spectrum Disorder

Explaining differences in age at autism spectrum disorder diagnosis: Autism and the social brain: The rising prevalence of autism. Differences in verbal and nonverbal IQ test scores in children with autism spectrum disorder.

A systematic review of screening tools in non-young children and adults for autism spectrum disorder. Premature mortality in autism spectrum disorder. Autistic disturbances of affective contact. Social skill interventions for youth and adults with Autism Spectrum Disorder: What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. The Lancet, ,11—17 AugustLord C. The changing epidemiology of autism spectrum disorders. A Systematic Evidence Review for the U.

Preventive Services Task Force. Autism, 18 8 Environmental risk factors for autism: Clinical guideline [CG] Published date: August Reichow, B.

Cochrane Database of Systematic Reviews, 5. Prevalence of autism spectrum disorder phenomenology in genetic disorders: London, Jessica Kingsley Publications. The Social Communication Questionnaire. Psychiatric disorders in children with autism spectrum disorders: The developmental, dimensional and diagnostic interview 3di: A novel computerized assessment for autism spectrum disorders. In most cases, a detailed developmental and family history, together with careful physical, psychometric and linguistic assessments will avoid diagnostic confusion.

Theories about the causes of autism have changed markedly over the years. When the condition was first described Kanner, inadequate parenting was often considered to be the primary cause. However, it is now evident that families with one autistic child have a significantly increased risk of having other children with ASD.

Family genetic studies have also identified very high concordance rates among monozygotic twins, and increased rates of social and communication difficulties and circumscribed interests or repetitive behaviours among relatives Bolton et al. In addition, there is an increased familial risk of depressive disorders. Currently ASD is recognised as a highly heritable genetic disorder that may be caused by multigene interactions or arise from spontaneous mutations in genes with major effects.

A wide range of common and rare variants associated with ASD has been identified but these can differ from one individual to another. Many of the ASD-risk genes that have been identified are involved in chromatin remodeling, regulation of protein synthesis and degradation, or synaptic plasticity Bourgeron, Possible environmental factors linked with an increased risk of autism include higher parental age and a history of sub-optimal pre-or perinatal development e.

While there is no evidence that vaccination notably the MMR vaccine is associated with an increased risk of ASD, the potential impact of other environmental influences is still a focus of ongoing research. It is now generally accepted that autism is not due to impairment in a specific brain region or system but to widespread and diffuse effects on brain connectivity that affect perceptual, attentional, motor and social systems from the first year onwards.

Individual differences in sensitivity to the environment and different learning styles can subsequently result in very different developmental trajectories and may explain the very heterogeneous profiles of skills and deficits that characterise autism. Cognitive and language ability Estimated rates of intellectual disability in ASD vary widely and are influenced by the intelligence tests used and the samples of children involved.

However, language comprehension, particularly related to more complex or abstract language is typically poorer than expressive language. This can give rise to difficulties since the relatively good spoken vocabulary of many individuals with ASD often gives a misleading impression of their true level of competence and understanding.

Interventions for autism There is no evidence for treatments that claim to result in cures or recovery from autism.

Moreover, many widely used interventions such as dietary and vitamin treatments, music therapy and sensory therapies have very limited evidence of effectiveness NICE, NICE guidelines also discourage the use of a number of specific treatments see Table 4. NICE recommendations for interventions that should be avoided 1.

Intellectual disability and its relationship to autism spectrum disorders.

Do not use the following interventions to manage autism in any context in children and young people. Secretin Chelation Hyperbaric oxygen therapy 2. Do not use neurofeedback or auditory integration training to manage speech and language problems in children and young people with autism.

There is also moderate evidence for a number of programmes based on Applied Behaviour Analysis. For older children, various social skills interventions have been found to improve social competence and understanding Ke et al. Cognitive behavioural interventions to reduce anxiety also report moderate to high effect sizes Lord et al. High quality intervention research for adults is much more limited, although there is some evidence for the effectiveness of cognitive behaviour therapies including mindfulness for reducing anxiety and depression Spain et al.

However, pharmacological interventions can be important in treating common co-occurring disorders such as irritability, agitation, ADHD, epilepsy, anxiety and mood disorders, ASD in adulthood Despite the fact that ASD is a life-long condition, much past research into diagnosis and treatment has focused on children. However, more recent studies have begun to highlight the needs and skills of adults. Diagnosing ASD in adulthood For individuals who remain undiagnosed during childhood but continue to show difficulties as they move through adolescence and into adulthood, NICE highlights a number of characteristics that should alert clinicians to the need for a full assessment of possible ASD See Table 5.

Symptoms in adulthood suggesting the need for a full autism diagnostic assessment 1. Adults of higher IQ One or more of the following: ADI-R can be used reliably with adults. Although there may be problems in finding an appropriate informant if parents are deceased or very elderly, a satisfactory developmental history can frequently be obtained from siblings or other relatives. The ADOS also has a module that is specifically designed for adolescents and adults.

Outcome in adulthood Among the strongest predictors of a positive outcome are the development of language and having a non-verbal IQ in or around the average range Lord et al.

intellectual disability and its relationship to autism spectrum disorders

Most people with ASD show improvements in many aspects of their development as they grow older and the severity of autism symptoms also tends to decrease over time. Nevertheless, access to higher education and employment is limited and follow-up studies suggest that fewer than a third of adults are in full-time employment.

There are few evidence-based interventions for adults and specialist help and support is particularly limited for individuals of average or above intelligence disability. Physical problems and chronic health disorders are also more common than in the general population Croen et al. Premature mortality is particularly high in adults with intellectual disability and epilepsy. In individuals of average or above average IQ suicide is a significant cause of premature death.

ASD in older adults Very little is known about the lives of older individuals i. Conclusion Understanding of ASD has improved significantly over recent decades. It is now accepted that this condition is far more common than was once thought, that it can affect individuals of all cognitive levels, and that, in the majority of cases, it is genetically determined. However, more is still to be learned about the genetic mechanisms involved, and how these affect brain development and brain function throughout the life-span.

Finally, thanks to a growing movement among individuals with ASD themselves, it is becoming increasingly recognised that ASD can be associated with many positive skills and potential benefits. Journal of Autism and Developmental Disorders 43, — The autism-spectrum quotient AQ: Epilepsy in patients with autism: From the genetic architecture to synaptic plasticity in autism spectrum disorder. Psychological assessment in the clinical context.

The health status of adults on the autism spectrum. Explaining differences in age at autism spectrum disorder diagnosis: Autism and the social brain: The rising prevalence of autism. Differences in verbal and nonverbal IQ test scores in children with autism spectrum disorder. A systematic review of screening tools in non-young children and adults for autism spectrum disorder. Premature mortality in autism spectrum disorder. Autistic disturbances of affective contact. Social skill interventions for youth and adults with Autism Spectrum Disorder: What is the male-to-female ratio in autism spectrum disorder?

A systematic review and meta-analysis. The Lancet, ,11—17 AugustLord C. The changing epidemiology of autism spectrum disorders. A Systematic Evidence Review for the U. Preventive Services Task Force. Autism, 18 8 Environmental risk factors for autism: Clinical guideline [CG] Published date: August Reichow, B.

Cochrane Database of Systematic Reviews, 5.

Intellectual Disability and ASD

Prevalence of autism spectrum disorder phenomenology in genetic disorders: London, Jessica Kingsley Publications. The Social Communication Questionnaire. Psychiatric disorders in children with autism spectrum disorders: The developmental, dimensional and diagnostic interview 3di: