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What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a complex neurological and developmental disorder that begins early in life and affects how a person acts and interacts with others, communicates, and learns. ASD affects the structure and function of the brain and nervous system. Because it affects development, ASD is categorized as a neurodevelopmental disorder. Although ASD begins in early development, it can last throughout a person's lifetime.
ASD is characterized to varying degrees by difficulties in social interaction, issues with verbal and nonverbal communication, and repetitive behaviors. With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder – not otherwise specified (PDD-NOS) and Asperger syndrome.
It is considered a spectrum disorder because there is a wide range of symptoms, skills and levels of impairment or disability among people with the disorder. Usually first diagnosed in early childhood, ASD causes severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. The disorder also can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art. About 25 percent of those with ASD are nonverbal but can learn to communicate using other means.
How Common Is Autism?
ASD affects more than 3 million individuals in the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10 to 17 percent annually in recent years. A survey by the U.S. Centers for Disease Control and Prevention (CDC) that examined health and school records of 8-year-olds in 11 communities throughout the country found that approximately 1 in 68 children in 2010 was on the autism spectrum. Boys face about four to five times higher risk than girls, with 1 in 42 boys diagnosed with ASD versus one in 189 girls. The CDC report confirms other recent studies that reveal more children are being diagnosed with ASD than ever before – a ten-fold increase in prevalence in 40 years.
Signs and Symptoms
Autism spectrum disorder (ASD) is characterized by the following criteria:
- Persistent deficits in social communication and social interaction across multiple contexts;
- Restricted, repetitive patterns of behavior, interests or activities;
- Symptoms present in the early developmental period (typically recognized in the first two years of life); and,
- Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning.
Autism appears to have its roots in very early brain development. The most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age, however many children show symptoms of autism by 12 months to 18 months of age. These may include:
- Problems with eye contact
- No response to his or her name
- Problems following another person's gaze or pointed finger to an object
- Poor skills in pretend play and imitation
- Problems with nonverbal communication
Many parents are not aware of these "early" signs of autism and don't start thinking about autism until their children do not start speaking at a typical age. Children with autism do not progress through normal stages of child development. Some children show signs of future issues once they’re born. Other children may develop typically until they’re 18-36 months old, and then development stalls: When an affectionate, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong.
People with autism tend to appear indifferent and remote and are unable to form emotional bonds with others. In addition, they will often have unusual responses to sensory experiences, such as certain sounds or the way objects look. Symptoms can range from mild to severe depending on the individual.
Diagnosis of autism spectrum disorder (ASD) is often a two-stage process. The first stage involves general developmental screening during well-child checkups with a pediatrician or an early childhood health care provider. Children who show some developmental problems are referred for additional evaluation. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties. At this stage, a child may be diagnosed as having ASD or another developmental disorder.
Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include brain imaging and genetic testing, along with in-depth memory, problem-solving and language testing.
Currently, there is no proven cure for autism spectrum disorder. However, treating ASD early, using school-based programs, and getting proper medical care can greatly reduce ASD symptoms and increase the child's ability to grow and learn new skills.
Early intervention is crucial. Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young children with ASD. Even though there isn't a single-best treatment package for all children with ASD, they respond well to highly structured, specialized programs.
Applied Behavior Analysis (ABA) uses techniques to increase useful behaviors and reducing those that may cause harm or interefere with learning. Most ABA programs are highly structured and consist of 25-40 hours per week of therapy. A Board Certified Behavior Analyst (BCBA) specializing in autism will write, implement, and monitor the child's individualized program. To find more information on ABA go to ABAInternational.org.
Verbal Behavior Therapy teaches communication using the principles of Applied Behavior Analysis. Verbal Behavior therapy avoids focusing on words as mere labels ( cat, car, etc.) . Rather, the student learns how to use language to make requests and communicate ideas. To put it another way, this intervention focuses on understanding why we use words. Verbal Behavior therapy is provided by VB-trained psychologists, special education teachers, speech therapists and other providers. VB programs usually involve 30 or more hours per week of scheduled therapy. Families are encouraged to use VB principles in their daily lives. To find more information on VB, go to the Cambridge Center for Behavioral Studies website at behavior.org/vb.
Occupational Therapy addresses a combination of cognitive, physical and motor skills. Its goals including helping a child or adult gain age-appropriate independence and participate more fully in life. For a person with autism, occupational therapy often focuses on skills for appropriate play or leisure skills, learning and self-care skills.
Speech Language Therapy is usually included as a part of autism behavioral intensive therapy programs. With a variety of techniques, speech-language therapy addresses a range of challenges often faced by persons with autism. For instance, some individuals on the autism spectrum do not speak, while others love to talk but have difficulty using conversational speech and/or understanding the nuances of language and nonverbal cues when talking with others.
Sensory Integration Therapy helps children and adults with autism that have challenges in processing sensory information such as movement, touch, smell, sight and sound. Sensory integration ( SI) therapy identifies such disruptions and uses a variety of techniq ues that improve how the brain interprets and integrates this information. Occupational therapy often includes sensory integration. Other times it is delivered as a stand-alone therapy. Certified occupational and physical therapists provide sensory integration therapy.
Social Skills Training, in both one-on-one and peer group settings, has become a very common treatment for individuals with autism that have a great deal of difficulty with social interactions. Social skills taught during training sessions range from simple skills like eye contact to more difficult skills like inviting a peer for a playdate. Studies have shown that this type of intervention program can significantly improve social competence and social skill development. Though social skills training is not an official or certified form of therapy, professionals like social workers, speech therapists and psychologists often focus largely on improving social skills when treating both children and adults with autism.
Medications At this time, the only medications approved by the FDA to treat aspects of ASD are the antipsychotics risperidone (Risperdal) and aripripazole (Abilify). These medications can help reduce irritability—specifically aggression, self-harming acts, or temper tantrums—in children ages 5 to 16 who have ASD. Additional drugs are often used to help improve symptoms of autism, although not specifically approved by the FDA for this purpose. These can include other antispychotics, as well as antidepressant and stimulant medications.
Children with ASD can also develop mental disorders such as anxiety disorders, attention deficit hyperactivity disorder (ADHD) or depression. Research shows that people with ASD are at higher risk for some mental disorders than people without ASD. Managing these co-occurring conditions with medications or behavioral therapy can reduce symptoms that appear to worsen a child's ASD symptoms. Controlling these conditions allows children with ASD to focus more on managing the ASD.
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institute of Mental Health
The information on this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified mental health provider with any questions you may have regarding a medical condition. We do not recommend or endorse any specific tests, mental health providers, products, procedures, opinions, or other information that may be mentioned on this site. Reliance on any information provided herein is solely at your own risk.