Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a developmental and brain condition that causes symptoms very early in life. Those symptoms may improve as a child ages, but many people with ASD continue to face challenges as adults. ASD causes impairments in social function, communication, and normal behaviors. Early diagnosis is important, but regardless of when a diagnosis is made, individuals with ASD can benefit from behavioral therapies, specific therapies, educational interventions, medications, and alternative therapies.

What Is Autism Spectrum Disorder?


Autism spectrum disorder, or ASD, is a developmental disorder related to the brain that causes issues with perception, socialization, communication, and behaviors. ASD is referred to as a developmental disorder because it typically begins to show signs in the first years of a child’s life, although it is also lifelong. This is a spectrum disorder because there is a wide variety in severity and symptoms from one person to another.

ASD collects together several conditions that were previously categorized separately, including Asperger’s syndrome and pervasive developmental disorder. ASD can be diagnosed based on a child’s symptoms, behaviors, and development, and early diagnosis is important for starting interventions and treatments at as young an age as possible. While ASD is a lifelong condition, most children’s symptoms lessen as they get older and learn how to manage them.

Types of Autism Spectrum Disorder


Previously, there were several similar conditions grouped together, including autism, Asperger’s syndrome, pervasive developmental disorder, and childhood disintegrative disorder. These have all been replaced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with autism spectrum disorder. There are no separate types of ASD, but the DSM-5 does have specifiers and severity levels that help distinguish differing characteristics among children. Specifiers include ASD with:

  • An intellectual impairment, or a lower IQ
  • A language impairment, with difficulty talking and communicating
  • An associated medical or genetic condition
  • An associated developmental, mental or behavioral condition
  • Catatonia, which is a state of limited mobility

There are three severity levels of ASD as outlined by the DSM-5:

  • Level 1 ASD requires some degree of support, because the condition causes impaired function and a limited ability to be independent.
  • Level 2 requires substantial support. A child at level 2 has inflexible behaviors, distress when changing activities or focus, significant social impairment, and difficulty communicating.
  • Level 3 ASD causes severe impairments in communication, social skills, and normal functioning. iI requires very substantial support.

Facts and Statistics


ASD affects millions of children, and the prevalence of this developmental disability has been on the rise for years.

Symptoms and Diagnosis of Autism Spectrum Disorder


ASD is often diagnosed later than it should because it can be difficult to determine when deviations from normal development at a young age are truly signs of this condition. Another difficulty is that symptoms of ASD vary widely. The first step in getting a diagnosis is to talk to a pediatrician who will evaluate a child’s development and behaviors and can recommend a specialist.

A specialist, such as a developmental psychologist or pediatrician, a pediatric neurologist, or a child psychiatrist can make a diagnosis by observing the child and interviewing parents and caregivers about development and symptoms. Specialists use the criteria in the DSM-5 to make a diagnosis. These include issues with social interactions and communication, including:

  • Abnormal interactions with others, difficulty having a conversation, and deficits in emotional reciprocity
  • Inability to recognize or use nonverbal communication, such as eye contact and body language
  • Difficulty developing interpersonal relationships or making friends

The criteria also include symptoms related to repetitive behaviors, activities, and interests:

  • Repetitive movements, such as rocking back and forth, or repetitive speaking.
  • Difficulty being flexible or changing routine, distress at even small changes, and ritualized actions and behaviors
  • Fixated interest in specific topics
  • Unusual sensitivity to sound, touch, or smell, or a fascination with certain senses

To make a diagnosis using these criteria a child must exhibit the symptoms in early development. The symptoms also must cause significant impairment in a child’s functioning and cannot be better explained by another type of disability.

These guidelines for diagnosis can take many different forms and range in severity depending on the individual child. Some signs and symptoms parents may see in young children with ASD include:

  • Delayed speech or unusual ways of speaking
  • Delayed or unusual motor skills and coordination
  • Failure to respond to name or attempts at affection
  • Poor eye contact and facial expressions
  • Repeating words or phrases
  • Lack of awareness of other people’s feelings
  • Inappropriate social behaviors, such as aggression or disruption
  • Inability to recognize other people’s facial cues or tone of voice
  • Engagement in repetitive movements
  • Unusual sensitivity to light or touch, or specific smells
  • Fixations on specific objects or activities
  • Development of rigid routines and getting upset if they are not followed
  • Development of very specific preferences for clothing, food, and other objects

In some cases a child with ASD will have many of these symptoms but also unusual strengths or talents. These could include math, music, art, or memory, among many other things.

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Causes and Risk Factors


Researchers have not yet been able to pinpoint a single cause of ASD, but genetics are thought to be important. In sets of identical twins, for example, if one child is diagnosed with ASD there is a strong chance that the other will be as well. There are also known connections to specific genetic and chromosomal conditions, including fragile x syndrome and Down syndrome. There is also some evidence that environmental factors play a role in ASD. Infections, drugs, or pregnancy complications may contribute to the development of ASD.

While the causes are not yet well understood, there are known risk factors for ASD, including family history and genetic conditions. Other factors that increase the risk a child will have ASD include being a boy, very early preterm delivery (26 weeks or earlier), being born with a low birth weight, and having parents that are older.

Co-Occurring Disorders


Some of the most common disorders that co-occur with ASD are genetic. Approximately 10 percent of children with specific genetic abnormalities, such as fragile x syndrome, Rett syndrome, and tuberous sclerosis, as well as Down syndrome, will also be diagnosed with ASD. The connection is not fully understood, but it is thought that there are some genetic mutations that cause these conditions and may trigger abnormal brain development that leads to ASD. Other conditions or complications that can co-occur with ASD include intellectual disability, epilepsy, and mental illnesses like depression or anxiety disorder.

Treatment and Prognosis of Autism Spectrum Disorder


The prognosis for ASD depends on many factors: the age of diagnosis, when interventions began, the quality of interventions and treatments, and the severity of symptoms. Most children who are diagnosed early and get treatment will be able to manage their symptoms as they become adults. Those who struggle more as they get older are children with severe symptoms and those who did not receive adequate treatment.

The treatment for ASD varies by individual needs but generally includes behavioral therapies, educational interventions, medications, alternative therapies, and dietary changes. Therapy can help someone with ASD learn to manage problematic behaviors, be more flexible, understand social cues, develop and maintain relationships, and communicate more effectively. Children can benefit from educational interventions to improve social interactions and to improve academic performance.

Additional and alternative therapies that may help include speech and language therapy, occupational therapy, and physical therapy. Creative therapies with music, art, or drama or sensory therapies can help improve communication and behaviors, while animal therapy offers help with social interaction, emotional expression, and recreation.

Medications may be useful depending on the individual. There is no specific medicine for ASD, but antipsychotics can help treat severe symptoms, antidepressants manage anxiety, and other types of drugs can help manage aggression, hyperactivity, or depression. Diet has only recently been shown to potentially be effective in managing symptoms of ASD. Working with a dietician may be useful in finding the right foods and supplements for a particular individual without creating nutritional deficiencies.

ASD is a difficult developmental condition that, while most prominent in childhood, continues on into adulthood. Adults with ASD, even if they did not get sufficient treatment as children, can benefit from therapies, medications, and lifestyle changes. Depending on the severity of symptoms, individuals with ASD may be able to live independent and fulfilling lives.