Autism spectrum disorders (ASDs) are a group of neurodevelopmental disabilities defined by substantial impairments involving social interaction, deficits in communication, and the presence of rigid behaviors and restricted interests. People with ASDs can range in their thinking and learning abilities from gifted to severely limited. ASD most often starts before age 3 and can create lifelong challenges. ASD does not discriminate by race, ethnicity or socioeconomic group. It occurs four times more often in males than females. The primary ASDs include Autistic Disorder (or "autism"), Asperger's Disorder, and Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS). Even though these conditions share many of the same behaviors, they differ as far as onset, severity and pattern of behaviors and problems (Lindgren 2011, pg. 4).

Autistic Disorder or "autism" is defined by qualitative impairments in three areas of function:

• social interaction, (2) communication, and (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities. Common symptoms include poor eye contact, poor "reading" of social cues, failure to develop peer relationships, lack of social or emotional reciprocity, delayed speech development, difficulty sustaining conversation, lack of make-believe play, repetitive motor mannerisms, and rigid adherence to routines. Symptoms are present before 3 years of age. As many as 6075% of children with Autistic Disorder also have intellectual disabilities, but some children with Autistic Disorder can develop average or even superior intellectual abilities. Even in children with intellectual disabilities, there may be isolated skills that are highly developed (such as in music, math, or memory) (Lindgren, 2011, pg. 4).

Although scientists think both genes and the environment play a role in autism, it remains an idiopathic condition. Research shows that autism tends to run in families. It is a brain-based disorder and is not caused by ineffective parenting. It is imperative to recognize that parents can play a key role in planning and implementing interventions once an ASD is identified. Early identification and intervention have been shown to have a very positive effect on long-term outcomes for children with ASD (Lindgren, 2011, pg. 5).

Because each person with ASD is unique, intervention plans must be individualized to meet the specific needs of the individual and family. Early intervention can have a huge impact on cognitive and social development for children with ASD. Intensive, highly structured educational programs based on the principles of applied behavior analysis (ABA) are the gold standard for early autism treatment. Target areas include the child's acquisition of communication, social, play, and academic skills. In order to be effective, the average amount of time spent on ABA is 25 hrs. per week (Lindgren, 2011, pg. 22).

Applied Behavior Analysis (ABA) is defined as the process of applying behavioral principles to change specific behaviors and simultaneously evaluating the effectiveness of the intervention. ABA emphasizes both prevention and remediation of problem behavior. Significant attention is given to the social and physical environment, including the antecedent conditions and consequences that elicit and maintain behavior (Lindgren, 2011, pg. 12).

Medication is another aspect of treatment. Although it cannot cure ASD, it can help provide control over symptoms like aggression, mood disorders, rigid behavior, and attention deficits. Medical care may be needed to manage associated problems with seizures, gastrointestinal problems, dietary imbalances, or disrupted sleep patterns. Targeted therapies (e.g., speech/language, OT) are commonly used to improve communication skills as well independence in activities of daily living. "Sensory" activities are often reinforcing and may aid in them becoming more physically active or enable them to accept a wider range of sensory experiences (Lindgren, 2011, pg. 22).

Some things to keep in mind when working with children with an ASD diagnosis include:

• A lack of efficient organization skills can negatively impact academic or job performance. Having a proactive support strategy is beneficial and could include checklists, picture charts, reminders, direct guidance and instruction. Patients can be taught to develop strategies that work best for them. For a therapy session, I might make a visual schedule with pictures and simple words to show the order of the activities we will be doing. I could involve the patient so they have some control and buy in. People with autism often like structure and routine so it may be important to try to keep the order of our activities the same for each session.
• Many patients with autism have limited communication skills. Behavior can be a form of communication and sometimes can occur in patterns. It can be helpful to pay attention to what occurs right before and immediately after a behavior.
• I need to keep in mind that just because an individual may be nonverbal, he or she still hears and understands a great deal of what is said around them. I need to ensure my statements are positive and not talk about them as if they aren't present.
• Each person's autism is different, so it's important to be aware of how they are impacted by sensory input in their environment. It will be crucial for me to think about the visual input (e.g. fluorescent or bright lights), auditory input (e.g. loud noises), tactile input (e.g. certain surfaces, textures, fabrics), and smell/tastes (strong perfumes or certain food textures) that may be bothering the person. Knowing these things in advance would be most helpful. When sensory issues are not addressed, the patient may resort to repetitive behaviors and a fail to respond to stimuli that may be relevant to their therapy.
• I will probably need to break tasks down into smaller steps.
• When working with children, I may need to provide rewards when goals are reached.
• I will need to try to keep language simple; using minimal words so I don't overwhelm them.
• I should avoid sarcasm and idioms, as they could be taken literally.
• Individuals on the spectrum are sensitive and aware of our emotional level about a situation. I will need to maintain a calm tone of voice and avoid physically touching the individual, even if they are having a behavioral outburst. Many individuals are calmed by compression or weighted vests.