What is autism spectrum disorder?
Autism is the name given to a group of similar disorders that vary in severity, so the term autism spectrum disorder (ASD) is now often used rather than autism. Autism is one type of ASD (others include Asperger's and Rett's syndrome) and so (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behaviour and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.
There is a huge range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities.
ASD occurs in every racial and ethnic group, and across all socioeconomic levels. However, boys are four times more likely to develop ASD than girls. Around 1% of children have ASD.
What causes ASD?
The cause remains unknown, although it appears to sometimes be passed down in families as twins and brothers have a higher than expected chance of also being autistic. It is believed that both genetics and environment likely play a role in ASD, but it is not known why rates of autism appear to have been increasing in recent decades.
Some studies suggest that ASD could be a result of disruptions in normal brain growth very early in development, and autism is more common in children born prematurely.
Environmental factors may also play a role in gene function and development, but no specific environmental causes have yet been identified. Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism in the population.
People with ASD also have a higher than average risk of having epilepsy. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. Additionally, people with both ASD and intellectual disability have the greatest risk of developing seizure disorder.
What are the symptoms of ASD?
As infants, children with ASD may seem different, especially when compared to other children their own age. They may constantly focus on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.
There are 4 main differing groups of symptoms in ASD, all of which usually occur in children.
1. Social difficulties
These are often described generally as an inability to get along normally with other children or adults, instead preferring to be alone, having few friends and not understanding other people's emotions.
2. Language and communication problems
People with ASD may have very different verbal abilities ranging from no speech at all to speech that is fluent, but awkward and inappropriate. Some children with ASD may have delayed speech and language skills, may repeat phrases, and give unrelated answers to questions. In addition, people with ASD can have a hard time using and understanding non-verbal cues such as gestures, body language, or tone of voice.
3. Poor imagination
'Pretend' play is very limited in children with ASD and any games that are played are usually done in the same way every time at a level younger children would play.
4. Unusual behaviour
Many children with ASD engage in repetitive movements or unusual behaviour such as flapping their arms, rocking from side to side, or twirling. They may become preoccupied with unusual things such as numbers, lists, timetables or calendars.
How is ASD diagnosed?
Routine health checks occur in the UK to make sure a child is developing normally, and it is often at such checks that early signs of ASD are picked up. There is no specific blood test that diagnoses ASD. If the diagnosis appears possible, a specialist is usually asked to assess the child so that a formal diagnosis can be made.
Early indicators that require evaluation by an expert include:
- No babbling or pointing by age 1
- No single words by age 16 months or two-word phrases by the age of two
- No response to their name
- Loss of language or social skills previously acquired
- Poor eye contact
- Excessive lining up of toys or objects
- No smiling or social responsiveness.
A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD. Because hearing problems can cause behaviour that could be mistaken for ASD, children with delayed speech development should also have their hearing tested.
How is autism treated?
There is no cure for ASD but treatments and behavioural interventions are designed to help improve symptoms. Most health care professionals agree that the earlier the intervention, the better. The mainstay of treatment is specialist educational support, with medication only being considered if other treatments are not helping with symptoms such as agitation, aggression, or obsessive-compulsive disorder.