Autism Spectrum Disorder (ASD)


Fact: About 1% of the world's population has Autism Spectrum Disorder

What is Autism Spectrum Disorder?
Autism spectrum disorder is a serious neurodevelopmental disorder that impairs a child's ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities. These issues cause significant impairment in social, occupational and other areas of functioning.

Autism spectrum disorder (ASD) is now defined by the American Psychiatric Association's Diagnosis and Statistical Manual of Mental Disorders (DSM-5) as a single disorder that includes disorders that were previously considered separate — autism, Asperger's syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

The term "spectrum" in autism spectrum disorder refers to the wide range of symptoms and severity. Although the term "Asperger's syndrome" is no longer in the DSM, some people still use the term, which is generally thought to be at the mild end of autism spectrum disorder.

Symptoms
The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years).

As part of a well-baby or well-child visit, your child’s doctor should perform a “developmental screening,” asking specific questions about your baby’s progress. The National Institute of Child Health and Human Development (NICHD) lists five behaviors that warrant further evaluation:

  • Does not babble or coo by 12 months
  • Does not gesture (point, wave, grasp) by 12 months
  • Does not say single words by 16 months
  • Does not say two-word phrases on his or her own by 24 months
  • Has any loss of any language or social skill at any age


Any of these five “red flags” does not mean your child has autism. But because the disorder’s symptoms vary so widely, a child showing these behaviors should be evaluated by a multidisciplinary team. This team might include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professionals who are knowledgeable about autism.


Causes

There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to in neurotypical children. Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems.

In many families, there appears to be a pattern of autism or related disabilities, further supporting the theory that the disorder has a genetic basis. While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single “trigger” that causes autism to develop.

Other researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may interfere with brain development, resulting in autism. Still other researchers are investigating problems during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances and exposure to chemicals.

Genetic Vulnerability
Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria (PKU). Some harmful substances ingested during pregnancy also have been associated with an increased risk of autism.

Tests & Diagnosis​
Your child's health care provider will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you'll likely be referred to a specialist who treats children with ASD, such as a child psychologist, pediatric neurologist or developmental pediatrician, for a thorough clinical evaluation.

Because ASD varies widely in severity, making a diagnosis may be difficult. There isn't a specific medical test to determine the disorder. Instead, a specialist in ASD may:

  • Observe your child and ask how your child's social interactions, communication skills and behavior have developed and changed over time
  • Give your child tests covering speech, language, developmental level, and social and behavioral issues
  • Present structured social and communication interactions to your child and score the performance
  • Include other specialists in determining a diagnosis
  • Recommend genetic testing to identify whether your child has a genetic disorder such as fragile X syndrome

Signs of ASD often appear early in development when there are obvious delays in language skills and social interactions. Early diagnosis and intervention is most helpful and can improve skill and language development.

Diagnostic criteria for ASD
For your child to be diagnosed with autism spectrum disorder, he or she must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

ASD includes problems with social interaction and communication skills and restricted, repetitive patterns of behavior, interests or activities that cause significant impairment in social, occupational or other areas of functioning.

Impaired social and communication skills
To meet ASD criteria, your child must have problems across multiple situations with:

  • Social and emotional give-and-take in social settings — for example, an inability to engage in normal back-and-forth conversation, a reduced ability to share experiences or emotions with others, or problems initiating or responding to social interactions
  • Nonverbal communication behaviors used for social interaction — for example, difficulty using or understanding nonverbal cues, problems making eye contact, problems using and understanding body language or gestures, or a total lack of facial expressions
  • Developing, maintaining and understanding relationships — for example, difficulty adjusting behavior to suit various social situations, problems sharing imaginative play or in making friends, or a lack of interest in others

Restricted, repetitive patterns of behavior
To meet ASD criteria, your child must experience at least two of these:

  • Odd or repetitive motor movements, use of objects or speech — for example, body rocking or spinning, lining up toys or flipping objects, mimicking sounds, or repeating phrases verbatim without understanding how to use them
  • Insistence on sameness, rigid routines, or ritualized patterns of verbal or nonverbal behavior — for example, extreme distress at small changes, expecting activities or verbal responses to always be done the same way, or needing to take the same route every day
  • Interests in objects or topics that are abnormal in intensity, detail or focus — for example, a strong attachment to unusual objects or parts of objects, excessively limited narrow areas of interest, or interests that are excessively repetitive
  • Extra sensitivity or a lack of sensitivity to sensory input or an unusual interest in sensory aspects of the environment — for example, apparent indifference to pain or temperature, negative response to certain sounds or textures, excessive smelling or touching of objects, or visual fascination to lights or movement

Treatment & Drugs
No cure exists for autism spectrum disorder, and there is no one-size-fits-all treatment. The range of home-based and school-based treatments and interventions for ASD can be overwhelming.

The goal of treatment is to maximize your child's ability to function by reducing ASD symptoms and supporting development and learning. Your health care provider can help identify resources in your area. Treatment options may include:

  • Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with ASD. Some programs focus on reducing problem behaviors and teaching new skills. Others focus on teaching children how to act in social situations or how to communicate better with others. Though children don't always outgrow ASD symptoms, they may learn to function well.
  • Educational therapies. Children with ASD often respond well to highly structured educational programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
  • Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
  • Medications. No medication can improve the core signs of ASD, but certain medications can help control symptoms. For example, antidepressants may be prescribed for anxiety, and antipsychotic drugs are sometimes used to treat severe behavioral problems. Other medications may be prescribed if your child is hyperactive.


Alternative Medicine
Because autism spectrum disorder can't be cured, many parents seek out alternative and complementary therapies, but these treatments have little or no research to show that they're effective. 
You could, unintentionally, reinforce negative behaviors. And some alternative treatments are potentially dangerous.

Talk with your child's doctor about the scientific evidence of any therapy that you're considering for your child. 

Examples of complementary and alternative therapies include:

  • Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy or music therapy, which focuses on reducing a child's sensitivity to touch or sound.
  • Sensory-based therapies. These therapies are based on the theory that people with ASD have a sensory processing disorder that causes problems tolerating or processing sensory information, such as touch, balance and hearing. Therapists use brushes, squeeze toys, trampolines and other materials to stimulate these senses and organize the sensory system. A sensory processing disorder is not an official diagnosis, and it is not clear if this is even the problem experienced by people with ASD. Research has not shown these therapies to be effective, but it's possible they may offer some benefit when used along with other treatments.
  • Special diets. Several diet strategies have been suggested as possible treatments for ASD, but more research is necessary to see if they have any effect on ASD signs and symptoms. To find out more, talk to a registered dietitian with expertise in ASD.
  • Chelation therapy. This treatment is said to remove mercury and other heavy metals from the body. However, there's no known link between mercury and ASD. Chelation therapy for ASD is not supported by research evidence and can be very dangerous. In some cases, children treated with chelation therapy have died.
  • Acupuncture. This therapy has been used with the goal of improving ASD symptoms. However, the effectiveness of acupuncture for ASD has not been supported by research

Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding Autism Spectrum Disorder. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.


American Speech-Language-Hearing Association
Autism Society
Autism Speaks
Mayo Clinic
WebMD

Information on this page taken directly from:
Autism Society
Mayo Clinic