Autism spectrum disorder (ASD/ASD) is a neurodevelopmental disorder characterized by deficits in social communication, limited interests and repetitive behaviors that are either congenital or appear in the first years of life. The diagnostic criteria for autism have been modified many times since it was first included in the ICD-8 in 1967 in international classification systems until the DSM-5 published in 2013. Although it is the most frequently used diagnostic system, DSM-IV has been criticized by some authors for reasons such as the ambiguity of the boundaries between autism subcategories, different diagnoses of the same patient by different clinics, the lack of specific treatments for subtypes, and the fact that someone who was initially diagnosed with typical autism may meet the diagnostic criteria for Asperger’s Disorder (AB) in adulthood due to changes in the disorder over the years (Gibbs et al. 2012, Aldridge et al. 2012, Wing et al. 2011, Worley and Matson 2012). In line with the criticisms, radical changes were made in the DSM-IV Pervasive Developmental Disorder criteria (Kaba, 2019). In DSM-5, the term “Autism Spectrum Disorder” was used instead of “Pervasive Developmental Disorder”, “Rett Syndrome” was removed from this category and other subgroups were combined in this definition (Kaba, 2019).
Diagnostic Criteria and Symptoms
According to the DSM-5 Definition;
Autism spectrum disorder is characterized by persistent deficits in social communication and social interaction in multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors used for social interaction, and skills to develop, maintain, and understand relationships (American Psychiatric Association DSM-5 2013). In addition to social communication deficits, the diagnosis of ASD requires the presence of restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric Association DSM-5 2013). In DSM-5, ASD is evaluated in two main groups: limitations in social communication and interaction (A) and limited, repetitive interests and activities (B) (American Psychiatric Association DSM-5 2013). TABLE 1 **
According to DSM-5, all criteria A and at least two of criteria B must be met for the diagnosis of ASD (American Psychiatric Association DSM-5 2013).
TABLE**2
According to DSM-5, all criteria A and at least two of criteria B must be met for the diagnosis of ASD (American Psychiatric Association DSM-5 2013).
Epidemiology & Etiology
According to 2014 data from the Centers for Disease Control Prevention (CDC), one out of every 68 children worldwide is diagnosed with autism and it is 4 times more common in boys than in girls. Although there is no epidemiological data showing the prevalence of autism in our country, it is estimated that there are approximately 1,142,586 individuals diagnosed with autism and 4,568,000 family members affected by this condition Dertli, S., & Başdaş, Ö. (2022). Using the human-to-human relationship model in the adaptation process of parents whose child is diagnosed with autism. Journal of Archival Resource Search, 31(3), 237-242.
While symptoms gradually become apparent in 70% of individuals with autism, 30% have a regressive clinical course between 18-24 months. In 50-70% of cases, intellectual deficiency is found in non-verbal IQ tests, and approximately 25% have epilepsy (Yosunkaya, E. (2013). Genetics and current perspective in the etiology of autism. Journal of Istanbul Faculty of Medicine, 76(4), 84-88).
Approximately 25% of children aged 2-3 years diagnosed with ASD later develop the ability to speak and communicate, and by the age of 6-7 years, they can socialize with their school-age peers at different levels. However, 75% of patients require lifelong educational and social support (Yosunkaya, E. (2013). Genetics and current perspective in the etiology of autism. Journal of Istanbul Faculty of Medicine, 76(4), 84-88)
Cognitive Flexibility
Cognitive flexibility is one of the main components of executive function (EF) and can be defined as the ability to switch from one task to another and to adapt quickly to changes in the environment (Diamond, 2013).
Executıve Functıon
Executive Function is three cognitive processes that work together to allow us to plan, focus and multitask to successfully complete daily tasks.
TABLE3
Cognitive Flexibility
Cognitive flexibility refers to the ability to adapt cognitive behavior in response to changing concepts, tasks, or types of information (Ionescu, 2012). Although cognitive flexibility is an “umbrella” term that includes a range of executive functioning skills, it has been recognized as analogous to cognitive ability, as both involve the ability to switch flexibly between mental states and take multiple simultaneous perspectives in response to changing context. Cognitive flexibility is particularly important for early academic and social success, as it has been shown to be associated with reading comprehension (Cole et al., 2014), abstract math skills (Purpura et al., 2017), and social understanding (Bock et al., 2015).
EF is often associated with the prefrontal lobe structures of the human brain. Cognitive flexibility is considered one of the key components of executive functioning that enables individuals to freely engage and disengage from one activity, concept or action to another. Cognitive flexibility refers to the capacity to quickly adapt between different ideas and courses of action and allows a person to perceive updated environmental information and transform their behavior to adjust to changes in the environment.
- Children with ASD have significant impairments in critical developmental areas such as motor development/physical activity (Berkeley, Zittel, Pitney, & Nichols, 2001; Memari and Ghaheri et al., 2013, Memari and Ghanouni et al., 2013, Memari and Ziaee et al., 2013). In their 2009 study, Pan et al. argued that in addition to the basic features of ASD such as impairments in social communication and interaction skills, repetitive behaviors and limited interests, limited participation in physical activity and recreational programs in social life leads to inactivity.
Previous studies have found that physical activity is linked to cognitive functions (Kramer & Hillman, 2006). Themanson, Pontifex, and Hillman, 2008 study of typically developing children showed that physical activity was positively associated with executive function skills such as cognitive flexibility and planning.
There is also sufficient theoretical basis to think that there is a link between EF skills and FA. Temporal Self-Regulation Theory argues for a reciprocal relationship between FA and EF (Hall and Fong, 2015). Voss et al. (2013) showed that a number of brain regions involved in both self-regulation skills and EF abilities, including the prefrontal cortex, cingulate and temporal cortices, as well as subcortical brain networks, are activated in relation to physical activity. In other words, children with a higher capacity for self-regulation and the ability to flexibly maintain goals over an extended period of time will engage in physical activities more frequently (Todd, Reid, & Butler-Kisber, 2010). As children with ASD have difficulty adapting to changes in routine, we expect cognitive flexibility in children to influence physical activity behaviors that often involve complex stimuli and interaction with others (Sorensen and Zarrett, 2014). Furthermore, Memari et al. (2015) showed that children with ASD were less likely to initiate social interactions with peers during an association-based physical activity. In ASD, communication and motor impairments as well as social dysfunctions may reduce opportunities for participation and interaction in physical activities (Memari and Ghaheri et al., 2013, Memari and Ghanouni et al., 2013, Memari and Ziaee et al., 2013).
This is confirmed by reports that children with ASD are prevented from participating in activities such as group walks, team sports or games (Pan, 2009). Considering that the most effective forms of physical activity are social activities, the low motivation of children with ASD for such activities may put them at risk of inactivity (Wehmeyer & Garner, 2003).
Author: Çağla Boral
