Abstract
The dramatic rise in the diagnosis of autism spectrum disorders (ASDs) has resulted in a significant explosion in visibility and a substantial increase in the understanding of this complex group of disorders. Over the last decade, what was once defined only as “autism” has become a spectrum of neurodevelopmental disorders, with variable presentations and levels of impairment that requires an equally broad continuum of care. A wealth of research has not discovered a single “cause” for ASDs, but rather has found a range of genetic/genomic variations that likely play a significant role in the etiology of these disorders. Routine screening for autism is becoming more common, allowing for more timely diagnosis, and hopefully for earlier entry into appropriate and effective treatment. Although there remains no single ‘‘cure’’, there are treatments available that can improve overall functioning and decrease problematic or interfering symptoms across the full spectrum of this disorder. The wide spectrum of ASD presentations complicates treatment planning, with overall ASD severity a factor in determining type, intensity, and duration of interventions and services. This article presents a two-dimensional model of “ASD severity” that considers both the level of specific ASD symptoms/deficits and the level of cognitive resources/limitations as a framework for understanding needs, challenges, and potentially effective interventions for individuals across the ASD spectrum.
Similar content being viewed by others
References
Akins, R. S., Angkustsiri, K., & Hansen, R. L. (2010). Complementary and alternative medicine in autism: An evidence-based approach to negotiating safe and efficacious interventions with families. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics, 7, 307–319.
American Academy of Pediatrics (AAP). (2006). Identifying infants and young children with developmental disabilities in the medical home: An algorithm for developmental screening and surveillance. Pediatrics, 118(1), 405–420.
American Academy of Pediatrics, & Committee on Children with Disabilities. (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102(2), 431–433.
American Hippotherapy Association. (2007). Retrieved from http://www.americanhippotherapyassociation.org/.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.), Text Revision. Washington D.C.: American Psychiatric Association.
Bauman, M. L. (2010). Medical comorbidities in autism: Challenges to diagnosis, treatment. NeuroTherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 7, 320–327.
Brachlow, A. E., Ness, K. K., McPheeters, M. L., & Gurnay, J. G. (2007). Comparison of indicators for a primary care medical home between children with autism or asthma and other special health care needs. Archives of Pediatric and Adolescent Medicine, 161, 399–405.
Carbone, P. S., Behl, D. D., Azor, V., & Murphy, N. A. (2010). The medical home for children with autism spectrum disorders: Parent and pediatrician perspectives. Journal of Autism and Developmental Disorders, 40(3), 317–324.
Centers for Disease Control and Prevention (CDC). (2009). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2006. Morbidity and Mortality Weekly Report, 58, SS-10, 1–20.
Cohen, D., Pichard, N., Tordjman, S., Baumann, C., Burglen, L., et al. (2005). Specific genetic disorders and autism: Clinical contribution towards their identification. Journal of Autism and Developmental Disorders, 35(1), 103–116.
Committee on Children with Disabilities, & American Academy of Pediatrics. (2001). Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Committee on Children with Disabilities. Pediatrics, 107(3), 598–601.
Croen, L. A., Najjar, D. V., Ray, T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118, 1203–1211.
Eikeseth, S. (2009). Outcomes of comprehensive psycho-educational interventions for young children with autism. Research in Developmental Disabilities, 30(1), 158–178. doi:10.1016/j.ridd.2008.02.003.
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7 year-old children with autism. A 1 year comparison controlled study. Behavior Modification, 26(1), 49–68.
Eldevik, S., Hastings, R. P. Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta-analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child and Adolescent Psychology, 38(3), 439–450.http://www.informaworld.com/smpp/title~db=all~content=t775648094~tab=issueslist~branches=38-v38
El-Ghoroury, N. H., & Krakow, E. (2010). A developmental-behavioral approach to outpatient psychotherapy with children with autism spectrum disorders. Journal of Contemporary Psychotherapy (in press).
Feinberg, E., & Vacca, J. (2000). The drama and trauma of creating policies on autism: Critical issues to consider in the new millennium. Focus on Autism and other Developmental Disabilities, 15(3), 130–137. doi:10.1177/108835760001500301.
Filipek, P. A., Accadardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., et al. (2000). Practice parameter: Screening and diagnosis of autism: Report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55, 468–479.
Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591–598.
Ganz, M. L. (2007). The lifetime distribution of the incremental societal costs. Archives of Pediatric and Adolescent Medicine, 161, 343–349.
Gaus, V. L. (2007). Cognitive-behavioral therapy for adult Asperger syndrome. New York: Guilford Press.
Gaus, V. L. (2010). Adult Asperger Syndrome and the utility of cognitive-behavioral therapy. Journal of Contemporary Psychotherapy (in press ).
Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism. Archives of Pediatric and Adolescent Medicine, 160(8), 825–830.
Hanson, E., Kalish, L. A., Bunce, E., Curtis, C., McDaniel, S., Ware, J., et al. (2007). Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(4), 628–636.
Harrington, J. W., Rosen, L., Garnecho, A., & Patrick, P. A. (2006). Parental perceptions and use of complementary and alternative medicine practices for children with autistic spectrum disorders in private practice. Journal of Developmental and Behavioral Pediatrics, 27(2), S156–S161.
Harris, S. L., & Handelman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four- to six-year follow-up. Journal of Autism and Developmental Disorders, 30(2), 137–142.
Hildebrand, D. (1999). Cost-benefit analysis of “Lovaas” treatment for autism and autism spectrum disorder (ASD). Preliminary report prepared for Harper Grey Easton, Barristers and Solicitors. Vancouver: Columbia Pacific Consulting.
IDEA. (2004). Individuals with Disabilities Education Act, 20 U.S.C. § 1400 et seq.2004.
Jacobson, J. W., Mulick, J. A., & Green, G. (1998). Cost-benefit estimates for early intensive behavioral intervention for young children with autism: A general model and single state case. Behavioural Interventions, 13, 201–226.
Jensen, V. K., & Sinclair, L. V. (2002). Treatment of autism in young children: early intensive behavioral intervention and applied behavioral analysis. Infants and Young Children, 14(4), 42–52.
Johnson, C. P., Myers, S. M., & Council of Children with Disabilities. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
Koenig, K., & Levine, M. Psychotherapy for Individuals with Autism Spectrum Disorders. Journal of Contemporary Psychotherapy (in press).
Kohler, F. W. (1999). Examining the services received by young children with autism and their families: A survey of parent responses. Focus on Autism and other Developmental Disabilities, 14(3), 150–158.
Kumar, R. A., & Christian, S. L. (2009). Genetics of autism spectrum disorders. Current Neurology and Neuroscience Reports, 9, 188–197.
Leslie, D., & Martin, A. (2007). Health care expenditures associated with autism spectrum disorders. Archives of Pediatric and Adolescent Medicine, 16, 350–355.
Liptak, G. S., Benzoni, L. B., Mruzek, D. W., Nolan, K. W., Thingvoll, M. A., Wade, C. M., et al. (2008). Disparities in diagnosis and access to health services for children with autism: Data from the National Survey of Children’s Health. Journal of Developmental Behavioral Pediatrics, 29, 152–160.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Mandell, D., & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews, 11, 110–115.
Matson, J. L., & Neal, D. (2009). Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: An overview. Research in Developmental Disabilities, 30(3), 572–586.
Mendelsohn, N. J., & Schaefer, G. B. (2008). Genetic evaluation of autism. Seminars in Pediatric Neurology, 15(1), 27–31.
Myers, S. M., Johnson, C., & The Council on Children with Disabilities. (2007). Management of children with autism spectrum disorders. Pediatrics, 29, 1162–1182.
Nevels, R. M., Dehon, E. E., Alexander, K., & Gontkovsky, S. T. (2010). Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: A review of current and potentially promising treatment options. Experimental and Clinical Psychopharmacology, 18(2), 184–201.
New York State Department of Health Early Intervention Program. (1999). Clinical practice guideline: Technical manual. New York: New York State Department of Health.
Ozonoff, S., Iosif, A., Baguio, F., Cook, I. C., Hill, M. M., et al. (2010). Prospective study of the emergence of early behavioral signs of autism. Journal of the American Academic of Child and Adolescent Psychiatry, 49(3), 258–268.
Paciorkowski, A., & Fang, M. (2009). Chromosomal microarray interpretation: What is a child neurologist to do? Pediatric Neurology, 41(6), 391–398.
Palmieri, L., & Persico, A. M. (2010) Mitochondrial dysfunction in autism spectrum disorders: Cause or effect? BBA-Bioenergetics. doi:10.1016/j.bbabio.2010.04.018.
Rosenberg, S. A., Zhang, D., & Robinson, C. C. (2008). Services for young children: prevalence of developmental delays and participation in early intervention. Pediatrics, 121, 1503–1509.
Schreibman, L., & Koegel, R. L. (2005). Training for parents of children with autism: Pivotal responses, generalization, and individualization of interventions. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatment for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 605–631). Washington, D.C.: American Psychological Association.
Shen, Y., Dies, K. A., Holm, I. A., Bridemohan, C., Sobieth, M. M., et al. (2010). Clinical genetic testing for patients with autism spectrum disorders. Pediatrics, 125, 727–735.
The Committee on Educational Interventions for Children with Autism of the National Research Council, Committee on Children With Disabilities. (2001). Developmental surveillance and screening of infants and young children. Pediatrics, 108, 192–195.
US Department of Health, Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services.
Volkmar, F., Cook, E. H., Jr, Pomeroy, J., Realmuto, G., & Tanguay, P. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues. Journal of American Academy of Child and Adolescent Psychiatry, 38(12), 32S–54S.
Weber, W., & Newmark, S. (2007). Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism. Pediatric Clinics of North America, 54(6), 983–1006.
Weissman, J. R., Kelley, R. I., Bauman, M. L., Cohen, B. H., Murray, K. F., et al. (2008). Mitochondrial disease in autism spectrum disorder patients: A cohort analysis. PLoS ONE, 3(11), e3815. doi:10.1371/journal.pone.0003815.
Wink, L. K., Erickson, C. A., & McDougle, C. J. (2010). Pharmacologic treatment of behavioral symptoms associated with autism and other pervasive developmental disorders. Current Treatment Options in Neurology, 12(6), 529–538. doi:10.1007/s11940-010-0091-8.
Wise, M. D., Little, A., Holliman, J. B., Wise, P. D., & Wang, C. J. (2010). Can state early intervention programs meet the increased demand of children suspected of having autism spectrum disorders? Journal of Developmental and Behavioral Pediatrics, 31(6), 469–476.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jensen, V.K., Spannagel, S.C. The Spectrum of Autism Spectrum Disorder: A Spectrum of Needs, Services, and Challenges. J Contemp Psychother 41, 1–9 (2011). https://doi.org/10.1007/s10879-010-9161-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-010-9161-1