When discussing populations with diagnoses in general, it is important to use person-first language. This means that we refer to an individual or group as having a specific condition, disorder, etc., rather than being that label.
|Examples to Practice||Examples to Avoid|
Person with autism
Person with Asperger syndrome
Person with catatonia
Person with depression
Person with schizophrenia
We put the person first, followed by any additional information that allows us to appropriately identify their unique needs. However, some individuals consider their diagnosis to be an integral part of their identity. We cannot assume a personal preference, so it is appropriate to ask patients with a diagnosis or their caregivers how they wish to be identified if you are unsure. If you are speaking about a group or population in general, it’s most appropriate to use person-first language (e.g., individuals with autism may experience difficulty with social communication, or parents of children with autism often report that…).
We always want to keep patient dignity at the forefront. When speaking directly to individuals, we use their names and preferred pronouns. When speaking to their families and support systems, we use the terms “children,” “teens,” “adults,” “students,” etc., in addition to their names and pronouns.
When discussing individuals with autism spectrum disorder with other professionals, we often use the term “patients.” This is because ABA is deemed medically necessary treatment for this population. Before the surgeon general made this distinction, the field of ABA typically used the term “clients.” These terms are now interchangeable, but “patients” is preferred. When discussing teen and adult patients, “learner” has become the preferred term based on direct feedback from these individuals.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a range of symptoms, including social communication and social interaction deficits and the presence of restrictive, repetitive patterns of behavior, interests, or activities.
EXAMPLE“Mom, I’m hungry.”
EXAMPLE“I don’t like that.” or “I don’t want to do that.”
EXAMPLEA parent tells their child, “Come here, pick up your trash, and throw it away,” and the child follows those instructions.
You want pretzels or Goldfish? What is it?
Tell me what it is.
Can I have Goldfish? Yeah, you can have Goldfish! Thanks for asking!
Who wants to start the conversation? OK. Go ahead.
Do you like-- do you like cool toys?
Who are you talking to?
Calen. Calen, do you like cool toys?
Can you say "do"?
Can you say "do you"? Calen.
Do you like-- you like it?
Do you like--
Do you like cool toys?
Calen. Ask AJ.
Do you like cool toys?
Cool. So what else could you say? You could say, what kind of cool toys?
What kind of--
EXAMPLEKids watching friends play outside with toys and imitating them to learn how to play.
EXAMPLEA baby picking up a toy and holding it out towards their mother while smiling.
EXAMPLEWhen someone walks in the room, you look up at them and say, “Hey.”
[CHILDREN PLAYING] You are a silly goose.
Good try. Right here. Like this. Can you try? Do this. There you go! All right. There you go.
What's on our schedule now? Look. Hey. What's on our schedule?
That's what she reminds me of.
Puzzle. Do you want to do a princess or Doc McStuffins puzzle?
Which one? Doc McStuffins or princess?
Repetitive motor mannerisms or stereotypy involve non-vocal behaviors such as body rocking, spinning, pacing, jumping, hand flapping, or peripheral gazing.
EXAMPLETensing of hands or fingers when excited
EXAMPLETurning head to look out of the corner of their eye at toys
EXAMPLELaying their head on the floor while playing with toys
Houston, touch D. Good. Nice job. Tucker, touch D. D. --would be an F. It was like a P-H mixed up sound. So we-- Yeah. She did a wonderful job. When she came in the classroom she sat there for a little bit with her blanket, and was just kind of just really calm. And then we just started talking. She was fine. Yeah. If you ever [INAUDIBLE] OK. Jacob. Oh, yeah. [INAUDIBLE] Go wash your hands. Thanks for standing up. You gotta look at the paper.
Repetitive vocal behaviors or stereotypy involve humming, echolalia (repeating sounds, words, phrases), and other non-speech related vocal sounds.
EXAMPLEMaking train crossing sounds
EXAMPLE“Scripting” lines from their favorite Disney princess movie in a non-functional way
EXAMPLE“What’s your name? What’s your name? What’s your name? What’s your name?”
Dinosaur. Dasher. Dasher.
Yeah, it is a dinosaur. Dinosaur starts with D.
Dasher. Dasher. Dasher. Dasher. Dasher.
All right, what is this?
You did an awesome job matching.
Neurodevelopmental disorders are characterized by the presence of deficits that produce impairment in personal, social, academic, or occupational functioning. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
The prevalence of ASD has increased dramatically over the past several decades. This table below shows the CDC 2020 estimates of the prevalence of ASD based on 2016 data (Autism Speaks, 2020).
|Year||Estimated Autism Prevalence|
|2004||1 in 166*|
|2006||1 in 150*|
|2008||1 in 125*|
|2010||1 in 110*|
|2012||1 in 88*|
|2015||1 in 68*|
|2018||1 in 59*|
|2020||1 in 54*|
|✳ Centers for Disease Control and Prevention (CDC) prevalence estimates are for 4 years prior to the report date (e.g. 2020 figures are from 2016).|
Developmental pediatricians, neurologists, and psychologists can diagnose ASD. Pediatricians can make a preliminary diagnosis but must refer the individual for more intensive assessment. School psychologists may give the diagnosis for purposes of classification by schools, but a diagnosis must come from one of the above professionals to be recognized outside of the school setting. No formal testing is required, but it is recommended.
Similarly, no medical assessment or blood test can clearly determine if a student has autism or another disorder or is developing typically. The diagnosis is based on the observations and judgments of a psychologist or other trained professional. These individuals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA).
The DSM is a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders. With successive editions over the past 60 years, it has become a standard reference for clinical practice in the mental health field (APA, 2013). It is used to diagnose mental and behavioral conditions. In May 2013, APA released the fifth edition, or DSM-5, which is the current version used for diagnosis.
Here is the DSM-5 Diagnostic Criteria Set for Autism Spectrum Disorder (299.00):
Finally, most applied behavior analytic service providers are unfamiliar with the diagnostic process. Greater familiarity with this process will likely provide treatment providers with a richer source of information about their learner’s history and functioning level. This increased understanding will provide opportunities for more finely customizing treatment programs.