What is autism or autism spectrum disorder?
Autism Society defines autism as “a complex developmental disability, typically appearing during childhood [first 2-3 years of life] and affecting a person’s ability to communicate and interact with others.” According to DSM-V, the essential features of autism are (1) Persistent impairment in communication and interaction with others, and (2) Restricted, repetitive patterns of behavior, interests, and activities. These symptoms are present from early childhood and limit or impair everyday functioning in school, work, and other areas of life (American Psychiatric Association, 2013).
Autism is also known as autism spectrum disorder (ASD) because there is a wide variation in the type and severity of symptoms people experience. Thus, each person with autism has a distinct set of strengths and challenges. There is no known single cause of autism, but increased awareness and early diagnosis and intervention with access to appropriate services/supports lead to significantly improved outcomes (Autism Society, n.d.).
Autism is the fastest-growing developmental disability. About 1 percent of the world population has autism spectrum disorder. It affects around 1 in 59 children in the US today. More than 3.5 million Americans live with an autism spectrum disorder. Autism is four times more common in boys than in girls. Autism occurs in all ethnic, racial, and economic groups.
Autism is often accompanied by sensory sensitivities and medical issues such as gastrointestinal disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression and attention issues. Autism can be a minor problem with the person needing less support and, in some cases, able to live entirely independently, or it can be a disability that needs significant full-time care in their daily lives (Autism Speaks, n.d.).
ASD includes disorders previously referred to as these (WebMD Medical Reference, 2019):
- Asperger’s syndrome.These children are more or less fluent with language, and even score average to above-average on IQ tests. But they have social problems and a restricted range of interests.
- Autistic disorder.This is what usually gets referred to as “autism.” It refers to problems with social interactions, communication, and play in children younger than 3 years.
- Childhood disintegrative disorder.These children lose some or most of their communication and social skills, after having had typical development for at least 2 years.
- Pervasive developmental disorder (PDD or atypical autism).The child displays some autistic behavior, like delays in social and communications skills, but doesn’t fit into another category.
Autism Symptoms and Signs
The onset of symptoms is usually by age 3. Autism is characterized by:
- Lack of or delay in spoken language
- Little or no eye contact
- Tending not to look at or listen to people
- Repetitive use of motor mannerisms (e.g., rocking back and forth, hand-flapping, twirling objects), and/or repeating words or phrases, a behavior called echolalia
- Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
- Persistent fixation on parts of objects
- A narrow range of interests or intense interest in certain topics, such as numbers, details, or facts
- Unusual and intense reactions to sounds, smells, tastes, textures, lights and/or colors
- Problems understanding or using speech, gestures, facial expressions, or tone of voice
- Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
- Having an unusual tone of voice that may sound sing-song or flat and robot-like
- Having facial expressions, movements, and gestures that do not match what is being said
- Lack of interest in peer relationships
- Persistent preference for solitude
- A lack of pointing, showing, or bringing objects to share interest with others, or failure to follow someone’s pointing or eye gaze
- Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions
- Difficulty understanding other people’s feelings
- Having difficulties with the back and forth of conversation
- Lack of spontaneous or make-believe play
- Getting upset by slight changes in a routine
- Sleep problems and irritability
- Some may also have seizures, usually starting in adolescence
- Being strong visual and auditory learners
- Being able to learn things in detail and remember information for long periods of time
- Excelling in math, science, music, or art
The cause of autism is not known. It could be multifactorial in origin, with more than one cause, with contributions from both genetics and environmental influences. It is thought to be caused by abnormalities in brain structure or function. In fact, brain scans show differences in the shape and structure of the brain in children with autism compared to that in neurotypical children.
Although for some families an autism diagnosis corresponds with the timing of their child’s vaccinations, it is now known through extensive research over the last two decades that vaccines do not cause autism. Certain risk factors are well-known. There is an increased risk of autism in the following cases:
- Family history of autism, such as a sibling with autism, pointing to the influence of genetic factors
- Having older parents
- Pregnancies spaced less than one year apart
- Folic acid deficiency in pregnancy
- Maternal exposure to certain drugs or chemicals, like alcohol or anti-seizure medications, in pregnancy
- Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])
- Metabolic conditions such as diabetes and obesity
- Individuals with Down syndrome, Rett syndrome, fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria
There’s no cure for autism as of now. However, treatment for autism should begin as soon as possible after diagnosis because it can make a big difference in development for a child with autism. Early treatment for ASD is important as proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.
There is no one-size-fits-all approach to autism treatment and intervention. Each autism intervention or treatment plan should be tailored to address the person’s specific needs. The main types of treatments are behavioral and communication therapy, and medications, or both.
Behavioral and Communication Therapies
You may be referred to programs that are typically highly structured and intensive, and specializing in providing behavioral, psychological, educational, or skill-building interventions. Some of these are:
- Applied Behavior Analysis (ABA)
- Early Start Denver Model (ESDM)
- Occupational Therapy (OT)
- Pivotal Response Treatment (PRT)
- Relationship Development Intervention (RDI)
- Speech Therapy
- Verbal Behavior
These programs typically involve parents, siblings, and other family members, and help people with ASD by:
- Teaching life-skills necessary to live independently, like dressing, eating, and relating to people, through occupational therapy
- Promoting positive behavior and discouraging negative behavior, through applied behavior analysis
- Increasing or building upon strengths
- Helping someone who has problems with being touched or with sights or sounds, through sensory integration therapy
- Teaching social, communication, and language skills, through speech therapy
Medications may help with the following symptoms of autism:
- Attention problems
- Anxiety and depression
- Repetitive behavior
- Gastrointestinal distress
- Sleep disturbances
Coping with a Child with Autism
- Contact your healthcare provider, health department, or autism advocacy group to learn about special programs or local resources that help you cope with a child with autism.
- Join an autism support group.
- Record conversations and meetings with health care providers and teachers to enable you to make decisions in the future about which programs might best meet an individual’s needs.
- Keep copies of doctors’ reports and evaluations, to help qualify in future for special programs.
Prognosis of Autism
Typically, the earlier a child is treated, the better the prognosis will be. In many cases, the symptoms of autism become less pronounced as a child gets older, with some children improving at 4-6 years of age especially those with mild autism who have been treated at an early age.
Not every adult with autism gets better. Some – especially those with mental retardation – may get worse. Many remain stable. Most teens and adults, even those with severe autism, may see improvement over time. Some people with autism go on to live typical lives, though continuing to need services and support as they age.
Surveys show about 50% of adults with autism still living with parents and only around 12% having full-time employment. Prognosis also depends on diseases that co-exist with autism, such as fragile X syndrome, Down’s syndrome, etc.
American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.
Autism Society, n.d. What is Autism?. [Online]
Available at: https://www.autism-society.org/what-is/
[Accessed 14 Nov 2019].
Autism Speaks, n.d. What Is Autism?. [Online]
Available at: https://www.autismspeaks.org/what-autism
[Accessed 14 Nov 2019].
NIMH Information Resource Center, 2018. Autism Spectrum Disorder. [Online]
Available at: https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
[Accessed 14 Nov 2019].
WebMD Medical Reference, 2019. Autism. [Online]
Available at: https://www.webmd.com/brain/autism/understanding-autism-basics#1
[Accessed 14 Nov 2019].