Aspergers Syndrome

Diagnosis, Assessment, and Treatment of Level 1 Characteristics of Autisms

Introduction

Autism Spectrum Disorder (ASD) is often described as a multifaceted, multifactorial, and pervasive neurodevelopmental condition. As the definition presents itself, the condition characterizes itself with developmental difficulties. To diagnose the condition, aberrant behavior forms and characteristics are prioritized. The criteria focus on problems or deficiencies in societal communication, restricted relations, repetitive types of behavior, and lack of interest in some activities.  The condition presents itself in different forms leading to the current reports on morbidity and psychiatric comorbid frequencies. The commonly identifiable mental and psychiatric conditions include oppositional defiant disorder, social anxiety, hyperactivity, and intellectual disability. Medically related conditions that have been on the rise and frequently reported include sleep disorders, epilepsy, dysfunction of mitochondria, abnormalities in the immune system, and gastrointestinal disorders. The effect of this condition is massive and extends across various sectors such as education, health, labor markets, employment, welfare, and social care. Due to the extended effects, there are high chances of individuals suffering from economic burdens, especially into adulthood. If the focus is on the cost of medicine or treatment, it is surprising to note that the annual direct productivity and medical expenses are likely to hit $ 500 billion per annum by 2025 in the United States. Because of this, there is a call for adequate care, efficacious treatment, and support structures for the affected families. Effective treatment is likely to improve the functioning of individuals with this disorder, especially considering that the outcomes cannot be underestimated. The research brings on board a literature review of individuals with level one autism disorder. Studies have demonstrated that these people have issues with socializing and communication. Even though they may develop a conversation, it is often difficult to maintain. Because of the nature of this level of Autism, the paper sheds more light on the diagnosis, assessment, and treatment of persons with level one characteristics of Autism.

Literature Review

Individuals with level one autism disorder have noticeable conditions ranging from communication difficulties to socialization. Other people at this level find it difficult to reach out and make friends (Masi, DeMayo, Glozier, & Guastella, 2017). As the DSM-5 reports, individuals who are diagnosed with this level demands immediate social support. Symptoms of level-one Autism include the following:

ü  Lack of or decreased interests in social interaction

ü  Difficulty to maintain social interactions, for instance, talking to friends

ü  Signs of communication challenges and problems

ü  Inability to give and take a constructive conversation, even though there are abilities to engage

ü  Difficulties in organizing and planning

ü  Troubles in adapting to the changing behaviors (Masi et al., 2017)

Theoretical Framework

The study by Masi et al. (2017) demonstrates that the first time when autism spectrum disorder was reported dates to 1943 when Leo Kanner published a report about the stubborn nature of sufficient contact. In the report, Kanner included a study of eleven children aged between two years and eleven. He describes the observations of these children after the visit and diagnosis at his clinic as a devising and thrilling incapacity to interact or relate to others who were present. Kanner brought on board a distinction between this disorder and that of people with schizophrenia. He managed to differentiate the two by use of various factors such as time of onset. Kanner described childhood schizophrenia as the process of withdrawal from healthy development (Masi et al., 2017). In addition to the desire to remain alone, Kanner also observed that children who had acquired this disorder recently (the earliest level) had unusual language development with an ability to learn nursery rhymes and nouns. There were also problems with developing communicative aspects of speech, interpretation of things literally, and repetitive sensory actions.

In 1944, a researcher, Hans Asperger, printed an article concerning what he thought was autistic psychopathy. In the article, he provided more insights about children experiencing issues with non-verbal communiqué and public skills. This report was important because it formed the foundation of Kanner’s effort in the description of the notion and levels of Autism (Manouilenko & Bejerot, 2015). The signs proposed by Hans were similar to those of Kanner. It was not until the 1970s when the article penetrated the whole world after the end of the Second World War. In 1981, Lorna Wing provided more insightful remarks and thoughts about the history of the syndrome, which was proposed by Asperger. In the new study, the condition was amended by the removal of the term "psychopathy" and renaming it as "Asperger syndrome." In her acknowledgment, Wing agrees that there are three levels of Autism, with the first one being level one or the initial phase. Wing re-evaluated the initial diagnostic criteria by highlighting a wide range of criteria ranging from "Kanner’s Autism” (lower functioning) to the common “Asperger’s syndrome” and evolving individuals who demonstrate some characteristics of this condition.  The current inherent nature of autism and its differentiating characteristics among people calls for more advanced diagnostic criteria.

Diagnosis and Assessment of Level One Characteristics of Autism

The diagnosis of level one autism first appeared in the Diagnostic and Statistical Manual of mental Disorder, third edition (DSM-III) (Grenyer, 2018). The description was primarily based on an inactive group of people with the developmental mental disorder. The discussion by the author suggests that this level occurs during the first thirty months of development and is characterized by lack of responsiveness to others, slow or lack of responses to the varying environmental stimuli, deficits in language development, and lack of schizophrenic signs. Another study by Barlati, Deste, Ariu, & Vita (2016) expanded on these diagnostic criteria by use of the DSM-III-R to bring on board the inescapable landscape of the condition with the elaboration that the disorder was not just limited to children as initially thought. The criteria used in the analysis did not include those individuals with higher functioning that only displayed the deficits after a certain time in life, other than the early stages of development. The literature by Barlati in the DSM-III-R diagnostic criterion recognizes eight out of sixteen possible methods for diagnosis of this level of Autism. The age of onset is specific in demonstrating the period when the condition appeared, for instance, during infancy or early childhood. 

The DSM-IV was also released in 1994 with similar criteria as those used in DSM-III-R of Autistic Disorder. However, the onset period was detached. This criterion established the foundation of set strategies for Autism Disorder using the outline by Wing. The approach simply involved the description of the condition as that characterized by impairments in imagination, communication, and interaction (Nicolaidis, Raymaker, Ashkenazy, McDonald, Dern, Baggs & Boisclair, 2015). Nicolaidis et al. (2015) and the use of the DSM-IV marked the increased clarification and the specifics in Autism related symptoms. The diagnosis of ASD, Pervasive Development Disorder (PDD), and the Asperger's Syndrome was altered by being reduced into two main criteria, the Autism Spectrum Disorder and Communication Difficulty. The growing and increased modification provided more insights about level-one Autism in totality to the validity of the diagnosis of Asperger's syndrome. Similar research by Duvekot, van der Ende, Verhulst, Slappendel, van Daalen, Maras, & Greaves-Lord (2017) reflected the growing concerns about diagnostic criteria used. Individuals with Asperger's syndrome were believed to take a diagnosis of ASD without cognitive or language impairment. The current diagnostic tests used for Autism Spectrum Disorder (level one) are recorded in table one. Concerning DSM-IV, it is vital to introduce pragmatic communication disorder as a request for the persistent problems in the frequent use of nonverbal communiqué without limitation to monotonous and restricted behavior. It is expected that individuals initially diagnosed with PDD do not meet the DSM-IV criteria for level-one autism disorder, and will quite often be identified with SCD (Duvekot et al., 2017). The new standards were meant to offer more significant and advanced methods for diagnosis and assessment of level one characteristics of Autism. Previously, studies discussed demonstrated that there was a considerable variation between clinical diagnoses of level-one ASDs, even though there were comparable standardized measures and scores across the facilities in support of the use of DSM-IV as a dimensional descriptor of common communication, restricted interaction and repetitive behaviors. With the current evolution of DSM-V, it is evident that some of the diagnostic criteria proposed by Asperger, Wing, and Kanner remain ideal for level-one Autism (Garg, Plasschaert, Descheemaeker, Huson, Borghgraef, Vogels, & Green, 2015). There is still a lot of controversy concerning the different levels of Autism Spectrum Disorder, and lack of a clear guideline about the association between the functioning of Autism, diagnostic relevance, cognitive working and the need for treatment of individuals who appear to have recently contracted the condition, especially at their current occupational places.

	Social Communication	Restricted Repetitive Behavior
Standards	Problems in social communication and interaction across different sectors, by history or currently	Limited, monotonous aspects of behavior, activities, and interests.
Descriptive examples	·         Lack of social mutuality such as abnormal approaches, failed conversations, lack of interests in interaction, frequent emotions and lack of response to mass connections ·         Lack of good nonverbal communication behaviors meant for social bonding, such as non-developed verbal and nonverbal conversations, irregularities in eye contacts and usage of signs, and total absence of facial languages or messaging cues ·         Shortfalls in evolving, upholding and appreciative relations, problems in altering conduct to suit the social contexts, inability to make friends or share imaginative plays and lack of interests in friends (Masi et al., 2017)	·         Ritualized patterns ·         Insistence ·         Monotonous motor actions ·         Stereotyped usage of objects ·         Fixed interests and restrictiveness ·         Hyperactivity ·         Lack of interests in facets of the setting
	v  These signs must be present at level one. However, these symptoms may not manifest unless the social demand overcome the limited capability or concealed by the adopted strategies in later stages of development v  The signs may lead to significant social impairments, current functioning, and technical issues if not well managed (Nicolaidis et al., 2015).  v  The symptoms cannot be well demonstrated in terms of intellectual disabilities or developmental delays
Specifiers	v  Presence of absence of intellectual impairments v  The environment or genetic composition trigger this medical condition v  Presence or absence of verbal and linguistic impairment v  Linked to behavioral, mental and neurodevelopmental conditions

Table 1: Diagnostic Criteria for Level 1 Characteristics of Autism Spectrum Disorder

Level 1 Necessitating sustenance

v  With the absence of social support, problems in mass communication contribute to major impairments. These may include issues with interaction with friends, unsuccessful responses to social conversations and many more v  Lack of interests in social interactions and making friends

·         Intransigence in behaviors may necessitate interference with the normal functioning of the brain ·         Problems altering or varying between activities ·         Issues with organizing and planning, affecting independence (Duvekot et al., 2017)

Table 2: Current Severity Specifiers for Level One Characteristic Autism Spectrum Disorder

The western participants have prioritized the diagnostic methods discussed above for level one characteristics of Autism. Even though the patterns are highlighted to be affected upon by developmental conditions and biological factors majorly, research conducted by Hobson (2019) agrees that both the cultural and social factors are critical in influencing cultural acceptability and diagnostic rates. An example would be the case of the United States, where extensive delays in the developmental call for diagnosis, which is also the case for impaired language skills. Therefore, given that the diagnosis process is dependent upon contextual and social observations, it is not astonishing that tools and phenotypes are not transferable to other cultures. In India, language is not used as a diagnostic criterion for level-one Autism as quite often, boys develop their language skills in life later when compared to girls (Curdt-Christiansen, 2016). Similarly, in a majority of Asian countries, direct eye contact is not applicable or a call for a level-one autism diagnosis, as this is regarded as a lack of respect. Thus, a reduced eye contact would not necessarily be viewed as a typical diagnostic feature in this culture.

Treatment/Interventions Relating to Individuals with Level One Characteristics Autism

Irrespective of the high costs and severe economic conditions, there are incomplete possibilities for treating the symptoms related to level-1 Autism. Both signs linked to being a function of a comorbid mental and medical condition and the diagnostic criteria are known to worsen the ruthlessness of the appearance. While there are hopeful advancements for the treatment of the disease, a recent report that involved methodical review identified that many offspring with level-1 Autism were treated with medical interventions (Khalifeh, Yassin, Kourtian, & Boustany, 2016). However, little evidence is available to suggest the importance and effectiveness of most treatments. According to Fakhoury (2015), there are many challenges associated with the identification of the most effective treatment for ASD. A systematic review of the literature indicates that cognitive, environmental, genetic, and social aspects of autism phenotypes produce different samples which reduce the efficiency of a possible intervention. Other factors inherent in contributing to the technical nature of identifying the best treatment include the absence of impaired study participants, non-uniform outcome measures, and small sample sizes (Masi et al., 2017). Cross-cultural variations such as deviation from acceptable or normal behavior from one culture to another further complicate the need for better or uniform treatment options in the ASD population with level-1. 

Behavioral interventions engaged in during the early stages of life are considered typical in setting standards for the treatment of symptoms associated with level-one Autism (Masi et al., 2017).  According to the U.S. Food and Drug Administration (FDA), Risperidone and aripiprazole are considered as the most effective forms of treatment of the symptoms associated with the disorder. In adults, the FDA approved the use of Risperidone that helps in blocking brain receptors for serotonin and dopamine. This medicine was found to be active and the most effective, especially in dealing with the short-term effects of level-one Autism. Despite, it is critical to understand that there are significant side effects associated with this form of medication, including drowsiness, increased appetite, and high levels of prolactin hormone (Masi et al., 2017). In 2009, the FDA also approved aripiprazole (a form of antipsychotic) that helps in dealing with ASD irritability in both children and adults. Aripiprazole, even though known for significant side effects such as sedation, tremor, somnolence, and vomiting, is a dopamine system stabilizer because it indices extrapyramidal symptoms when compared to Risperidone (Masi et al., 2017). Therefore, the treatment response for level-1 Autism continues to be primarily based on observable clinical behaviors. The focus is basically on phenomenological approaches that have multi-dimensional aspects, especially in their presentations.

Discussion

The research supports the shift towards a more sophisticated and advanced analytic system based on a profounder thoughtful of psychosocial and biological bases of level-1 autism disorder. There is also a requirement across the research for the analysis of many neural circuits, behavior, and genes. Even though level-1 Autism is still in its developmental phase, there is a need for a more advanced and developed precision that prioritizes pathophysiology and etiology. Ultimately, it is anticipated that the approach will recognize the importance of aligning both the diagnosis and treatment to care and support of individual needs. People with level-1 autism demand career support to improve signs of ASDs. While the different dimensions of ASDs may appear as the main causative factor, it has no potential to hamper the understanding of different groups or sub-levels of Autism. The diagnosis of ASDs continues to be dependent on observable behaviors or the phenotype of individuals. Currently, there is a greater acknowledgment of the technical nature of symptoms, including health comorbidities and medical conditions, because of the recent identification of the relationships. The realization of objective measures of reaction will help to contribute to the definition of subgroups of ASDs while at the same time advancing the expedition for medicine and treatment models in varied individuals. Thus, the psychiatric and comorbidity of the condition necessitates this study. There is a need for advanced and more sophisticated methods of diagnosis and treatment when dealing with ASDs. The substantial effects of the condition are massive, touching across educational, labor markets, occupational, and health facilities. Due to these reasons, there are the quests for a growing body of investigation that would provide more insights about the cross-cultural issues applicable in the diagnosis of level-1 Autism and the other sub-groups. Perhaps, this research has played roles in addressing specific symptoms, signs, and treatment of level-1 Autism. More elaborate information about contextual factors in diagnosis are also discussed. Future research should aim at providing a more detailed of the relationship between sublevels of Autism and cross-cultural factors affecting the treatment of the condition.

References

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Curdt-Christiansen, X. L. (2016). Conflicting language ideologies and contradictory language practices in Singaporean multilingual families. Journal of Multilingual and Multicultural Development, 37(7), 694-709.

Duvekot, J., van der Ende, J., Verhulst, F. C., Slappendel, G., van Daalen, E., Maras, A., & Greaves-Lord, K. (2017). Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism, 21(6), 646-658.

Fakhoury, M. (2015). Autistic spectrum disorders: A review of clinical features, theories, and diagnosis. International Journal of Developmental Neuroscience, 43, 70-77.

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Khalifeh, S., Yassin, W., Kourtian, S., & Boustany, R. M. (2016). Autism in a review. Lebanese Medical Journal, 103(3431), 1-6.

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Masi, A., DeMayo, M. M., Glozier, N., & Guastella, A. J. (2017). An overview of autism spectrum disorder, heterogeneity, and treatment options. Neuroscience Bulletin, 33(2), 183-193.

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