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Autism

Autism

Autism is a complex developmental disability which can impair how an individual communicates, behaves and relates to others. The intensity of symptoms and complications can be different for each sufferer.

What Is Autism?

What Is Autism?
Autism


It is a lifelong neurodevelopmental disorder which impacts a person’s communication, behaviors and social interaction. It is characterized by persistent difficulties in verbal & nonverbal communication, interpersonal interactions, repetitive, limited behavior patterns and stereotyped interests. The condition 1 can not only affect their ability to express their thoughts and feelings through expressions, gestures or speech, but also affect their ability to understand others’ feelings. Sufferers also face challenges with learning and have their own strengths and weaknesses. They may appear highly skilled in certain aspects while lacking necessary skills in certain other aspects. For instance, while someone with autism may have a strong memory, they may have difficulty communicating.

As it affects different people in different ways, it is considered as a spectrum condition. Hence, the condition is widely known as autism spectrum disorder (ASD). This is an umbrella term that involves a wide range of conditions, symptoms & severity associated with communication, behaviors and social skills. “Autism spectrum disorder (ASD) is a behaviorally defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors,” states a 2014 study 2 . Although it is not specifically identified as a disease, ASD can seriously impair an individual’s life. While some people can live independently and have a productive life, others may require lifelong support due to varied symptoms. Moreover, for some the symptoms can be present from their childhood, while for some others the symptoms may become noticeable in their adulthood.

Understanding Autism

According to a recent 2020 study 3 , autism is considered as a spectrum disorder in American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5 4 ) as the ASD diagnosis was formed by merging separate pervasive developmental disorder (PDD) diagnoses into a single condition. These disorders include –

  • Autistic disorder
  • Asperger’s disorder
  • Childhood disintegrative disorder
  • Pervasive developmental disorder not otherwise specified (PDD-NOS)

This neurodevelopmental disorder usually develops during infancy 5 and leads to serious functional impairments in education, career, relationships and social & personal lives. ASD is typically diagnosed in children between 3-6 years of age 6. Moreover, male children are around four times more likely 7 to be affected than females. Although a parent may observe certain symptoms in autistic children 8 from an early age, the child may develop social and communication skills initially and show signs of regression later. They may also show signs of losing previously acquired skills. As it is a lifelong condition, children suffering from this disorder tend to experience symptoms with varying degrees of severity throughout their entire lives. Even though there is no specific cure, early intervention and effective treatment can enable the sufferer to manage their symptoms and live more independently.

As autism involves a spectrum of disorders, some children may have highly noticeable problems while others may not. There are several subtypes of the condition that are influenced by genetics, environment and other factors. ASD can also develop along with sensory sensitivities & other mental health and medical conditions such as attention problems, anxiety, depression, seizures and gastrointestinal (GI) disorders.

Autism At A Glance

  1. Autism is a developmental disability that can cause significant social, communication and behavioral challenges.
  2. ASD has considerably increased globally over the past few years to 6 per 1000 children from 4 per 10,000.
  3. It is typically diagnosed in children between 3-6 years of age.
  4. Boys are four times more likely to be affected than girls.
  5. There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function.
  6. Autism spectrum disorder (ASD) involves impairments in three core domains – communication difficulties, social impairments, and stereotyped & repetitive behaviors.
  7. Even though there is no specific cure, early intervention and effective treatment can enable the sufferer to manage their symptoms and live more independently.

Prevalence Of Autism

According to research, prevalence rates 9 of ASD have considerably increased golabbly over the last few years to 6 per 1000 children from 4 per 10,000. “The reasons for this increase include wider public awareness of these disorders, broadening of the diagnostic concepts, reclassifications of disorders and improved detection,” add the researchers. Another 2003 study 10, found that at educational sources in the United States about 40% of children had autism.

Features & Symptoms Of Autism

Features & Symptoms Of Autism
Autism


Research 11 shows that autism spectrum disorder (ASD) involves impairments in three core domains – communication difficulties, social impairments, and stereotyped & repetitive behaviors. It involves the following characteristics:

1. Communication

Children with ASD have difficulties in communicating, whether using speech or non-verbal languages such as facial expressions, eye contact, tone of voice, and gestures. Typical communication challenges may include –

  • Unique or abnormal speech
  • Difficulties with normal conversations
  • Trouble identifying or reacting to social cues
  • Lack of sharing of emotions
  • Inability to grasp abstract ideas or concepts
  • Slower processing of information
  • Repeating others

2. Social interaction

Autistic children and even adults have trouble understanding others’ thoughts, emotions & intentions. Moreover, they have trouble expressing their own thoughts and feelings. This can cause severe impairments in social interactions. Other difficulties may include –

  • Strong need for spending time alone
  • Seem to lack empathy and be insensitive
  • Perceived to be socially inappropriate
  • Strange or abnormal behaviors in social situations
  • Challenges in building or maintaining relationships

3. Repetitive behaviors

Autistic people tend to exhibit restricted & repetitive behaviors, interests and activities. While some individuals may experience mild or severe cognitive delays, some patients may possess normal intelligence. Here are some of the behavioral challenges of autism and related ASD conditions-

  • Strong need for predictable routines
  • Strong interests in activities uncommon for children of that age
  • Sensory sensitivities
  • Walking or moving abnormally
  • Sleep problems
  • Seizures
  • Psychiatric disorders

Apart from these, an autistic person may also have the following characteristics and symptoms –

  • Repetitive movements
  • Overwhelmed, uncomfortable or stressed by certain things, like strong lights or loud sounds
  • Become sad or anxious in unfamiliar situations
  • Think about the same thoughts repeatedly
  • May not respond to conversations or social interactions but react to sounds
  • Avoid making eye contact
  • Highly passionate about certain objects or topics
  • Repeatedly organize or arrange things, like toys, in lines
  • Outbursts of anger, frustration or sadness when routines are broken or when experiencing sensory overload

People with ASD perceive the world very differently as they may become hypersensitive to external stimuli. This can make normal daily activities and chores difficult for them to perform.

Types Of Autism Spectrum Disorder

ASD involves a number of conditions that were previously considered as separate conditions. Here are the conditions incorporated in this “spectrum” disorder –

1. Autistic disorder

This condition 12 refers to what we primarily understand as autism. It is a developmental disorder observed in children in the first 3 years and is characterized by impairments in communication, social interaction and limited, repetitive behavior.

2. Asperger’s syndrome

“Asperger’s syndrome is a neurodevelopmental disorder which is part of the large family of autism spectrum disorders,” explains a 2019 study 13. Although sufferers 14 may not experience language problems, they have limited interests and social interaction difficulties.

Read More About Asperger’s syndrome Here

3. Pervasive developmental disorder (PDD)

Also known as atypical autism, this condition is marked by social communication & language delays and deficits 15 which can’t be categorized as other conditions. According to a 2011 study 16, “The term PDD is based largely on a developmental view, whereas the term ASD is relatively based on a symptomatic view.”

4. Childhood disintegrative disorder

This rare disorder 17 is also known as disintegrative psychosis and Heller’s syndrome. Marked by a late onset, children with this disorder may experience normal development for about 2 years but may show signs of losing communication & social skills development afterwards. CDD is “a clinical syndrome characterized by disintegration of mental functions and regression of acquired language and intellectual functions after a period of normal development typically of 3 to 4 years,” explains a research paper 18.

Causes Of Autism

The exact cause for the onset of autism is not clearly known. One 2017 study 19 claims that the condition is “hypothesized to result from cerebral dysfunction arising from a complex interaction between genetic, epigenetic and environmental factors.” As the condition tends to run in families, it may have a genetic predisposition 20. Moreover, environmental factors may also influence the development of ASD. Contrary to what some may believe, the disorder is not caused by poor or neglectful parenting, bad diet or any infectious disease. Researchers 21 found that “autism and other neurodevelopmental disorders have a strong genetic component. But environmental factors must also contribute to autism etiology.” Here are some of the most commonly observed risk factors that may influence the onset –

1. Genetics

Research 22 shows autism is a highly heritable neurodevelopmental disorder. If someone has a first degree relative with ASD, then they will have an increased risk of developing the condition. Studies 23 show that “the prevalence of this type of ASD is in approximately 35% of the siblings and about 20% of cases have positive family history for ASD.”

2. Environmental factors

Apart from genetics, a variety of probable environmental factors and challenges, such as prenatal, natal, and postnatal 24 risk factors, can also significantly contribute towards the development of ASD. Moreover, particular environmental exposures tend to play a significant role in patients with specific genetic compositions 25. Research 26 shows that around 40–50% of variance in ASD liability may be influenced by environmental factors. According to a 2012 study 27, some common environmental risk factors may include –

  • Prenatal viral infection
  • Zinc deficiency
  • Abnormal melatonin synthesis
  • Maternal diabetes
  • Prenatal and perinatal stress
  • Toxins
  • Parental age
  • Postnatal risk factors
  • Gastrointestinal or immune system abnormalities
  • Allergies

The study adds that “exposure of children to drugs, infection, certain foods or heavy metals have been proposed as risk factors for autism.” Apart from these, there may be some other risk factors for autism, such as –

  • Preterm birth
  • Early disruption of brain development
  • Brain damage
  • Male gender
  • Substance abuse during pregnancy
  • Anti-seizure medications during pregnancy
  • Maternal obesity
  • Genetic disorders like fragile X syndrome 28
  • Metabolic disparity
  • Low birth weight
  • Exposure to environmental toxins
  • Viral infections

Researchers 29 have not found any evidence that vaccinations, such as the MMR vaccine, can lead to the development of ASD. A 2019 study 30 states that “Several epidemiologic studies have not found an association between MMR vaccination and autism, including a study that found that MMR vaccine was not associated with an increased risk of autism even among high-risk children whose older siblings had autism.”

Complications

Complications
Autism


Children with autism commonly experience difficulties with communication, social interactions and behavior that can lead to different complications such as –

  • Issues with education and learning
  • Problems with career and work
  • Being bullied
  • Social isolation
  • Stressful family dynamics
  • Unable to live independently

Apart from these patients’ with autism spectrum disorder can also suffer from a number of mental health and medical conditions, such as –

  • Anxiety 31
  • Depression 32
  • Sleep disorders 33
  • Obsessive-compulsive disorder (OCD 34)
  • Gastrointestinal problems 35
  • High blood pressure
  • Seizures
  • Diabetes 36
  • Obesity 37

Diagnosis Of Autism

There are no specific medical tests for ASD. Assessment of autism spectrum disorders can be challenging. A proper diagnosis 38 may typically involve a “stepwise approach” that involves the doctor checking the patient’s medical and family history, conducting a holistic exam & observing the child’s behavior, social interaction and play. The doctor will also follow the established DSM-5 diagnostic criteria 39 for ASD. A healthcare professional may also check the patient’s intellectual abilities, language impairment or delays, severity of symptoms and other disorders. They will also check if the symptoms are caused by any underlying medical or mental health condition. Moreover, the patient’s strengths and weaknesses will also be taken into consideration while developing a treatment plan.

A doctor may also conduct the following tests for the assessment of ASD:

  • Developmental screenings 40
  • Visual & audio tests
  • Occupational therapy screening
  • Behavioral evaluation
  • The Modified Checklist for Autism in Toddlers (M-CHAT)
  • DNA testing for genetic mutations and conditions
  • Genetic tests
  • Developmental questionnaires, like Autism Diagnostic Observation Schedule (ADOS 41)
  • Other screenings 42 and tests

Early diagnosis 43 & treatment can significantly help in relieving autism symptoms, enabling the sufferer to live independently & improving the patient and family members’ quality of life. If you believe your child or family member is showing symptoms of ASD, then make sure to seek medical attention immediately.

Treatment Of Autism

Treatment Of Autism
Autism


There is no specific cure for autism spectrum disorder. However, early intervention and treatment 44 can be beneficial. After conducting a proper diagnosis, a doctor may devise a personalized treatment plan depending on the type of ASD and severity of symptoms. The objective of treatment 45 is to relieve symptoms, promote learning & development, and help the patient function independently. The treatment plan may also change over time depending on the specific needs of the patient. A 2016 study 46 suggests that “the treatment for ASD should be individualized. Treatment of disabling symptoms such as aggression, agitation, hyperactivity, inattention, irritability, repetitive and self-injurious behavior may allow educational and behavioral interventions to proceed more effectively.”

Here are some of the most helpful treatment approaches available for autism:

1. Behavioral and communication therapy

This form of therapy can help to improve language, social and behavioral challenges by teaching new skills, organization and reducing unhelpful behaviors. Applied Behavior Analysis (ABA 47 ) is an effective treatment approach for ASD that can teach new skills to autistic children and empower them to utilize those skills in different situations by providing motivation and rewards. It also encourages positive behavior in the patients. Sensory integration therapy (SIT 48 ) can be recommended for patients with issues related to loud sounds, strong lights or being touched. One 2017 study 49 found that SIT can help in “improving occupational performance in children with ASD.”

Moreover, occupational therapy 50 can also be beneficial for learning life skills such as relating to others, eating and dressing, while speech therapy 51 can help to teach better communication skills to improve social interaction. “Paediatric occupational therapy seeks to improve children’s engagement and participation in life roles,” states a 2019 study 52.

2. Educational therapy

Educational programs 53 that are well-structured can be substantially helpful for children with ASD. Educational therapies are generally supported by a team of therapists and specialists. The therapy includes different strategies and activities that aim to improve the symptoms. Research 54 has found that certain behavioral and educational interventions have proven to be effective. One 2017 study 55 found that “Educational interventions form the mainstay of management for children with autism spectrum disorder. Such interventions focus on improving social interaction, communication and challenging behaviors, thereby promoting learning and independence in children.”

3. Family therapy

This can significantly help parents 56 and family members to better understand how to deal with autism in their children. Parents can learn how to encourage positive behavior, improve social interaction skills, better communication skills and other life skills to their autistic children.

4. Other therapy options

Apart from these, physical therapy and play therapy may also be recommended by doctors. Moreover, complementary and alternative treatments (CATs 57) and therapies like relaxing techniques, deep breathing, meditation and massages can also help in the treatment process. Although Complementary and Alternative Medicine (CAM) are widely used in treating individuals with autism spectrum disorder, “there is no conclusive evidence supporting the efficacy of CAM therapies in ASD,” states a 2015 study 58.

5. Medications

There are no specific medications for ASD. Although certain drugs can help to regulate some symptoms, medications are generally “not effective 59 for the core symptoms.” Medications such as antidepressants, anti-anxiety, anticonvulsants, antipsychotic medications or stimulants may be prescribed to manage attention problems, anxiety, depression, hyperactivity and behavioral problems in the patient. According to a 2015 study 60, medications or pharmacological therapies can help patients with daily functioning, but behavioral therapy is considered as the first-line treatment. However, research 61 shows that “There is a marked lack of data on use of medication treatments for adolescents and young adults with ASD.” Moreover, as certain medications can lead to side effects, it is crucial to inform the doctor about any medication the patient may be taking currently.

Coping Strategies For Caregivers

Studies 62 show that behavior problems in autistic individuals may be a coping mechanism to deal with sensory overload and feeling overwhelmed. This is why it is crucial for parents and caregivers to seek medical help and educate themselves about autism spectrum disorder. This can enable them to develop certain coping strategies to support the treatment plan and help in recovery.

Here are some helpful coping tips for parents and caregivers –

  • Seek professional help
  • Learn about ASD, symptoms, treatment and how it affects the sufferer
  • Build a support network
  • Realize that the child or patient has their own strengths and weaknesses
  • Create helpful & structured routines and rules for them
  • Help them hone their skills and focus on interests
  • Be prepared for any changes or complications
  • Keep the patient away from environments that are over-stimulating
  • Provide options and set boundaries to promote positive behavior
  • Have a nutritious 63 diet plan with whole foods for the patient
  • Encourage the patient to engage in physical exercise 64 which they enjoy
  • Reach out to other caregivers or parents with autistic children
  • Practice self-care and avoid ignoring your own needs

A recent 2020 study 65 has found that proper diet and nutrition, along with regular exercise, can play a vital role in managing ASD symptoms in children. “Physical activity helps in weight management and helps release their stresses along with providing social interactions,” adds the study.

Takeaway

Autism spectrum disorder is a group of complex disorders marked by impairments in communication, social interaction & repetitive, restricted behaviors. As it can impact different people in completely different ways, it is best to seek medical attention if you suspect your child is suffering from ASD. Therapies and medication can help to manage symptoms and enable the child to learn crucial life skills and live more independently.

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