28 min · Autism
April 29, 2020

Autism (Autism Spectrum Disorder - ASD): The Definitive Guide

Otsimo is a mobile game platform dedicated to democratize special education for special needs children and their caregivers. Democratization of special education also means easy access to information for all. We are aware that knowledge is power, and it goes without saying that before venturing into any sorts of efforts, we need to know what we are going into. By compiling this definitive guide, we attempted to provide anything and everything on autism spectrum disorder for everyone to benefit from in their research about ASD. Various sources were utilized to compile this guide, all of which can be referred to within the article.

Autism Spectrum Disorder (ASD) is a complex neuro-developmental condition. It typically involves difficulties in social interaction, speech and nonverbal communication. Individuals on the Autism Spectrum Disorder also exhibit restricted and repetitive behaviors.

ASD presents itself differently for each individual. The symptoms and severity thereof vary from person to person. American Psychiatric Association states that ASD is typically diagnosed with obvious signs presented at the age of two or three.

However, some children may not be seen as developing the disorder until they are toddlers, a couple of years may pass before being diagnosed with autism.

This lifelong condition does not yet have a known treatment or cure. Early intervention and education help individuals live independently and productively.

According to 2014 data by the Centers for Disease Control and Prevention (CDC) , one in every 59 children is diagnosed with autism.

Autism spectrum disorder is four times more common in boys than in girls, except for Rett Syndrome. Compared to boys, many girls diagnosed with ASD exhibit less obvious signs.

What is autism?

Autism Spectrum Disorder or Autism is an umbrella term indicating a range of neurodevelopmental disorders. These are typically associated with social and communication impairments as well as repetitive movements.

Harvard Medical School defines ASD as a term used for a group of disorders caused by brain development at early ages.

In the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013, all autism disorders were gathered under the umbrella diagnosis of autism spectrum disorder.

Autism spectrum disorders cause communication troubles. People with autism struggle with understanding what other people think and feel. They have a hard time expressing themselves via words and gestures. Autism may also cause problems in learning.

Skills of people with autism may develop differently. They may have trouble in communication, but be exceptionally good at math and things related to memory. This may even help them do well in problem solving.

The definitive reason for autism has not been discovered. The Rett Syndrome, which causes autistic behaviors, is known to have a genetic cause. However, the cause of other types of autism are still not known.

Studies suggest that autism may be inherited. It may also result from an abnormality that occurs in early infancy, or from abnormal levels of chemicals in the brain. Contrary to popular belief, studies have not found any link between vaccines and autism spectrum disorder.

The severity and combination of symptoms of autism are different for each person. These depend on various risk factors as well as the progress of the disorder.

DSM-5 Definition for ASD

American Psychiatric Association’s DSM-5 is the standard reference in diagnosing autism spectrum disorders. In 2013, it updated the criteria of autism spectrum disorders diagnosis.

By updating the criteria for diagnosis, the manual aimed to achieve more accurate diagnosis, identify symptoms to guarantee treatment, as well as to assess the severity level.

What are the DSM-5 criteria?

One of the changes made to the diagnosis of autism in the fifth edition of the manual is that it gathered four different categories of autism disorders under the umbrella term “autism spectrum disorders”.

The previous categories were:

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

Prior to DSM-5, symptoms of autism were listed under three categories:

  • Social impairment,
  • Language and communication impairment, and
  • Repetitive/restricted behaviors.

In the updated manual, such symptoms were reclassified into two categories of symptoms as persistent deficits in social communication/interaction, and restricted, repetitive patterns of behavior.

The manual also removed the specific symptom category of language/communication impairment and created a new and separate diagnosis of social communication disorder for disabilities in social communication without repetitive behaviors.

Sensory issues were added under the restricted/repetitive behavior category as a symptom. This category also includes hyper- or hypo-reactivity to stimuli (lights, sounds, tastes, touch) or unusual interests in stimuli (staring at lights, spinning objects).

The manual also includes a severity assessment scale ranging from Level 1 to Level 3 based on the support needed for daily function.

Additional diagnostic criteria were added for the assessment of intellectual disability, language level, any known genetic causes of autism such as fragile X syndrome and Rett syndrome, as well as the presence of autism-associated medical conditions like seizures, anxiety, and gastrointestinal disorders.

Additionally, a severity rating scale is included. Additional diagnostic criteria were added to include assessments for language level, intellectual disability, known genetic causes of autism, as well as the presence of autism-associated medical conditions such as seizures, disruptive sleep, anxiety, and gastrointestinal disorders.

What are the Autism Spectrum Disorder diagnostic criteria ?

The following full text of the new diagnostic criteria for autism spectrum disorder and the related diagnosis of social communication is provided by the American Psychiatric Association to Autism Speaks by special permission.

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
  3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. (See table below.)

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat food every day).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
  4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:

  • With or without accompanying intellectual impairment
  • With or without accompanying language impairment
  • Associated with a known medical or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition.)
  • Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
  • With catatonia

Severity levels of autism spectrum disorders

According to the manual, there are three severity levels for autism spectrum disorders, as specified in the following table :

Severity LevelSocial CommunicationRestricted, Repetitive Behaviors (RRB)
Level 3 “Requiring very substantial support”Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2 “Requiring substantial support”Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1 “Requiring support”Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

Types of Autism Spectrum Disorders

Autism is a spectrum disorder. Until recently, autism disorders were identified to have several different types as autism and Asperger’s syndrome. However, the American Psychiatric Association published a different classification in its fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. This edition gathered all autism disorders under the umbrella diagnosis of autism spectrum disorder.

In the fourth edition of the Diagnostic Manual, autism spectrum included five autism spectrum diagnoses. They were Asperger’s syndrome, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Autistic Disorder, Childhood Disintegrative Syndrome, and Rett Syndrome.

Such classification created confusion among practitioners. They were difficult to define clearly. This caused different practitioners selecting different diagnoses for the same patient.

In order to overcome the confusion the practitioners, teachers and therapists used clarifying terms like “mild autism”, “severe autism” and “high-functioning autism”. However, these terms are not diagnoses. They are descriptions. The definition of “mild” or “severe” varied from practitioner to practitioner.

American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013 has only one “autism spectrum disorder” in it. However, the old terms are still in use.

Some of the old terms are a little more clear than Autism Spectrum Disorder Level II. Understandably, this creates confusion among people as to what types of autism spectrum disorders there are.

The broad diagnosis of autism spectrum disorders contains a set of developmental delays and disorders. These affect social and communication skills.

They also impact motor and language skills. Since it is a broad diagnosis, it can contain people with high IQs as well as mental retardation.

Prior to DSM-5, autism spectrum diagnosis included autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), Asperger’s syndrome, Childhood Disintegrative Disorder and Rett Syndrome.

Autistic Disorder is the typical case when people think of an individual with autism. It is also known as the classic case of Autism. Individuals with autistic disorder may have issues with communication, both verbal and non-verbal.

They have differences in the development of their language, behavior and social skills. These development issues can cause delays in speech or lack of expressions.

They cause the individual to struggle in social interaction, communication, and these individuals have restricted and repetitive behaviors, activities and interests.

Such individuals may have a difficult time maintaining eye contact while speaking, for instance. Or they may clap their hands repeatedly.

Asperger Syndrome , also called Asperger’s Syndrome, is a form that was discovered by Hans Asperger and presents challenges socially. Such challenges may have milder symptoms compared to those in classic Autistic Disorder.

However, they create their own unique difficulties in the individuals’ lives. People with Asperger’s syndrome may come across as awkward and rude as they may act inappropriately in social situations.

They may seem unempathetic and selfish. They also struggle with expressing themselves nonverbally.

Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) was one of the subtypes prior to the publication of DSM-5. It is also known as the “ atypical autism ” as individuals with this disorder exhibit some of the symptoms associated with autism (“classic autism).

It can be best described as individuals that do not fall under either category, but are nonetheless autistic. “Not otherwise specified” means that the individual’s symptoms differ from symptoms characteristic of other pervasive developmental disorders, such as Rett syndrome.

Boys are affected by PDD-NOS four times more than girls. Many children with only several symptoms of an autism condition are often diagnosed with PDD-NOS.

Individuals with PDD-NOS can be placed in one of the following three categories :

  • High-functioning group - symptoms largely overlap with Asperger’s syndrome, except for having a speech delay or cognitive impairment
  • Second group - symptoms more similar to those of autistic disorder, but does not meet all symptoms
  • Third group - meets all diagnostic criteria of autistic disorder but stereotypical and repetitive behaviors are mild.

What is Autism Awareness?

April is autism awareness month. The United Nations adopted April 2 as World Autism Awareness Day in 2007. Every year this month, governmental institutions and associations organize autism-related fundraisers and awareness increasing campaigns. Autism-friendly presentations are made to acknowledge people on the autism spectrum.

Blue is the color for autism awareness. People wear blue shirts to participate in the events. And many people who celebrate the month do not have autism spectrum disorders. Parents, practitioners, teachers and various other people also celebrate the month.

Autism awareness month creates mixed feelings. The history of the events generate different responses on people, especially on those who are autistic self-advocates.

History of Autism Awareness

Back when it was first discovered, not much was known about autism. Its diagnosis has changed over the years. In the 1990s, professionals even believed that autism was caused by bad parenting. Refrigerator mothering was the term used to indicate lack of attention to children by their mothers.

Representation in the movie “Rain Man” gives a great idea how autism was treated in those days.

Then, a psychologist with an autistic son, Dr. Bernard Rimland punctured the refrigerator mother theory. He established the organization The Autism Society. The Society states on its website that it was the first nation-wide awareness program back in the 1970s.

The Society designed and adopted the iconic Autism Awareness Ribbon in 1999. It granted the use of the ribbon to other non-profit organizations so as to establish a unity.

In 2005, an organization called Autism Speaks was founded by Bob and Suzanne Wright, grandparents of an autistic child. This organization has a great influence over the autism community.

During Autism Awareness Month, the organization holds autism-related events. It initiated an international effort called Light It Up Blue, where iconic buildings are lit in blue to raise awareness. It became the most popular autism non-profit across the world.

Autism Awareness Events

Autism Awareness Month starts on April 2, which is Autism Awareness Day. During this day, everything turns blue. People pose for pictures in their blue shirts, and blue lights surround houses.

The puzzle piece, which is a symbol for autism, can be found everywhere. News stories and articles cover autism-related topics. Significant buildings like Sydney Opera House in Australia are lit up in blue.

Schools organize autism awareness events. Communities across the world organize fundraisers and marches for the event during the month of April.

Responses

Not everyone likes autism awareness month. Some of the autistic self-advocates and many other groups have had issues with the perspective reflected during this month. The color blue is dominantly used in autism awareness month communications.

This also may make people feel like the awareness campaigns disregard women and girls on the spectrum, since the color blue is generally related to boys and men.

In addition, since Autism Speaks is such a large organization, it generally dominates autism awareness month. The organization shows television commercials and publishes various forms of communications, dominating the attempts.

Its approach to the disorder is different than that of those who think autism is a set of personal qualities rather than a “disease”. Also, the organization’s past investments in researching the connection between autism and vaccines, in spite of many research that proved no connection between the two, caused the community to think that they use their resources unnecessarily.

Concerned that your child may have autism spectrum disorder?

If at any point in time, you feel like your child is presenting certain signs of autism, you should consider speaking to your child’s pediatrician.

Early Signs of Autism

Learning and catching the signs are important for early intervention. Parents and caregivers should be able to identify the developmental milestones their child should be reaching.

The timing and severity of the symptoms vary for each child. Some babies exhibit symptoms within the first few months. Others do not show any symptoms until they are two or three years old.

Many children do not exhibit all of the symptoms. Some children who do not have autism may show some of the symptoms. Thus, professional evaluation is crucial in diagnosis of autism spectrum disorders.

In 2013, the criteria for diagnosing Autism Spectrum Disorders were gathered under two categories:

  • Persistent deficits in social communication and interaction, and
  • Restricted, repetitive behavior patterns

These are some of the most basic symptoms that children with autism have in common. Autism spectrum disorder symptoms are typically first seen before the child turns three. However , only half of children with autism are diagnosed before kindergarten. There are some other symptoms indicating that your child may be on the autism spectrum disorder.

At birth, a child with autism may not seem to have an autism spectrum disorder.

By 6 months, the infant may show few or no big smiles and warm, joyful expressions. The child may respond abnormally to being touched. They may stiffen or go limp when they are picked up, instead of hugging. They make no eye contact.

Within the first year of their lives, infants with autism may not show normal developmental behaviors. They may not smile at the sound of their mother’s voice, point out objects to catch someone’s attention, reach out to others with their hands, attempt one-syllable conversations or may not maintain eye contact, and they show little interest in other people.

By 16 months, children with autism use few or no words. They may use few or no meaningful, two-word phrases. At any age, they may lose previously acquired speech, babbling, or social skills.

They usually avoid eye contact. Children on the spectrum may have difficulty in understanding other people’s feelings.

Here are some of the behaviors that can be seen in children with autism of any age:

  • Delayed language development
  • Resistance to changes in routine or surroundings
  • Restricted interests
  • Intense reactions to sounds, smells, lights, tastes, and/or colors
  • Persistent preference for solitude

Indications and symptoms vary from mild to severe. Some children on autism spectrum disorder may ignore other children and play alone, while others may not engage in make-believe play.

They may spend hours repeatedly laying out objects in lines, sitting silently in a trance-like state or concentrating on only one object or topic.

Children with autism may have disordered speech indications. They may not speak much. Their speech patterns may be different.

For instance, instead of saying what they want, they may ask “Do you want water?”. The words they use may be an imitation of what the other person said.

Repetitive behaviors are common in children with autism spectrum disorders. They may repeat the same phrase or a particular action like clapping or rocking back and forth.

Children on the spectrum may also exhibit abnormal behaviors. They may develop obsessive behaviors like wanting to take the same route to school every day.

Children with autism spectrum disorder may become intensely preoccupied with certain things and become hyperactive, aggressive, destructive, or impulsive. They may even intentionally hurt themselves.

Interfering with such behaviors may generally result in emotional outburst of the child. Symptoms and indications vary from mild to severe. A child with autism spectrum disorder may show all or only some of the above symptoms.

Such signs of autism spectrum disorder are generally seen before the child turns three. However, only half of children with autism are diagnosed before going to kindergarten.

Symptoms of Autism Spectrum Disorder

Autism is a developmental spectrum disorder that impacts the individual in terms of many aspects of their lives. There are multiple causes of the disorder. However, most of such causes are still unknown.

Often , there is nothing to differentiate an individual with autism from other normally-developed people.

But an individual with autism may communicate, interact, behave, and learn in different ways from most other people. Learning and many other abilities of individuals with autism range from severely challenged to being gifted. Some may require a lot of help while others may need less.

Social communication challenges, and restricted and repetitive behaviors are the core symptoms of autism spectrum disorders.

In autism spectrum disorder, these symptoms begin in early childhood, but they may go unrecognized. Such symptoms also persist and interfere with daily life.

Social communication challenges

Though no two ASD cases are the same, there are certain common characteristics and challenges that impact development of social communication skills. Social communication challenges may include verbal, non-verbal, and written difficulties.

Social communication impairments in ASD include deficits in the aspects of joint attention, behavior and emotional regulation, social reciprocity, and language as well as related cognitive skills.

Individuals with deficits in social communication skills may face challenges in terms of social orienting, monitoring emotional states, initiating interaction, understanding and using verbal and non-verbal communication, effectively regulating their emotional state, etc.

How to identify social communication challenges

Lack of non-verbal gestures, such as pointing, showing, and giving, is one of the most seen social deficits in children with ASD.

These actions start to be visible around the age of 8 months. The majority of the child’s gestures by 12 months of age should onsist of pointing, showing, and giving.

Such a gesture that indicates a child wants something is developmentally absent in children with ASD. Children diagnosed with autism spectrum disorder generally find using socially appropriate language and understand the meaning of social interactions.

A child with autism spectrum disorder may use limited gestures, limited to no eye contact, limited facial expressions and other non-verbal language cues.

Each individual is impacted by social communication challenges to a different degree. However, there are certain common symptoms.

Individuals with autism generally have trouble paying attention to people. They may not be able to follow what is pointed at. It is difficult for an individual with autism to gauge and adapt the language for different listeners and situations.

They may not provide background information when necessary, and may use inappropriate language. It takes a long time for these individuals to reach developmental milestones in terms of language.

It is rare for an individual with autism spectrum disorder to involve or encourage others in play or interaction. Individuals diagnosed with ASD may talk, but generally face challenges while using words to make a back-and-forth conversation.

They may not be able to interpret the tone of the conversation. It is challenging for them to make inferences and understand implied meaning. They may take things too literally in a conversation.

Restricted and repetitive behaviors

American Psychiatric Association stated in its DSM-5 criteria that individuals with autism spectrum disorder must exhibit at least one restricted, repetitive and stereotyped behaviors or interests, in addition to social communication challenges.

These are called restricted and repetitive behaviors; RRBs in short. They are one of the core characteristics of autism spectrum disorders.

An individual with autism spectrum disorder has limited and repetitive patterns of behavior. Their interests or activities may also be restricted and repetitive.

Individuals with autism exhibit repetitive movements like rocking or hand flapping .

These actions may be caused by changes in their environment. They are quite sensitive to changes in their routines .

Individuals diagnosed with autism spectrum disorder generally develop specific routines and become disturbed if this routine is disrupted even in a minor way. Restricted and repetitive behaviors also include self-harm, such as banging head on objects.

People diagnosed with autism spectrum disorder generally have problems with coordination. They may even have odd moving patterns like walking on their toes, stiff or exaggerated body language.

Details of an object may fascinate individuals with autism spectrum disorder. Spinning of the washing machine fascinates them, for instance. They may be unusually sensitive to stimuli such as light, sound or touch. But they may be indifferent to pain or temperature.

During play , individuals with autism generally don’t engage in imitation or make-believe play. They take things literally.

Individuals with autism may fixate on certain objects or activities with excessive intensity or focus. They may also have lasting, intense interests in certain topics, such as numbers and details.

Severity of the behaviors vary from individual to individual.

However, repetitive actions and routines make up the key behavioral signs of the disorder. Fixation on objects is also another sign to show restricted and repetitive behaviors.

In children, repetitive behavior can manifest as highly restricted, fixated interests that are actually abnormal in terms of intensity or focus.

For instance , children with autism spectrum disorder may excessively preoccupy themselves with unusual objects or perseverative interests.

In the new DSM-5 criteria, behavioral markers include sensory processing issues. Many individuals with autism spectrum disorder, especially children, are over- or under- sensitive to stimuli such as sounds, lights, textures or smells.

They may become hyper- or hypoactive to sensory inputs. Certain sensory aspects of the environment may unusually interest individuals with autism spectrum disorder.

Too much sensory input may overwhelm them. In addition, children with autism spectrum disorder may be disturbed or uncomfortable due to a lack of sensory input.

These individuals may try to get such sensory input by excessively smelling or touching objects. They may be fascinated visually with lights or movement.

They may also show an apparent indifference to other sensory inputs, such as pain or temperature.

Read more: Restricted and Repetitive Behaviours in Autism

Concerned that your child may have autism spectrum disorder?

With one in 59 children being diagnosed with autism spectrum disorder in the United States, parents seem to have started to notice the early signs.

It is important for parents to ask “Is my child developing at the rate they should be developing?” in order to find out if their children are on the spectrum.

American Academy of Pediatrics recommends autism spectrum disorder screening tests for children at their 18 month and 24 month checkups.

However, currently, there is no biological screening test to detect autism spectrum disorder. In addition, there are a lot of grey areas when it comes to diagnosing ADS since it is a wide spectrum.

Despite the fact that we have learned a lot more about the disorder in the last decade, the average age of autism spectrum disorder diagnosis has not changed in the last fifteen years .

Autism spectrum disorder can be accurately diagnosed as early as the age of two . Research shows that parents are able to detect early signs of autism before the child turns one.

However, the average age in the United States for diagnosis of ASD is still around 4.5, which is around 53 months.

In general, children are being diagnosed two years later on average than the recommended age. Parents can notice the early signs in order to prevent late diagnosis.

Learning the early signs of autism spectrum disorder will help parents act on the diagnosis more quickly.

Read: Signs of Autsim in Different Age Groups

Each baby develops at their own pace. So, there is no definitive timeline to follow. However, children with autism spectrum disorder generally show certain signs before they reach the age of two.

Autism spectrum disorder signs appear in early stages of development. There are clear deficits in language skills and social interactions to indicate developmental deficit.

If your child does not smile or show happy expressions by 6 months, or mimic sounds or facial expressions by 9 months, your child may have delays in cognitive, language and social skills.

By 12 months, the child should be able to babble or coo, and point or wave by 14 months. A child with a typical cognitive development would say single words by 16 months and plays make-believe games by 18 months.

By the age of 2, your child should be able to form two-word sentences. If you notice any deficits in language or social skills at any age, or think that your child might have autism spectrum disorders, consult your doctor about it.

Read: Screening for Autism - Does Your Child Have the Symptoms for ASD?

Autism Spectrum Disorder Checklist

Children with autism spectrum disorder may need different levels of help in various aspects of their life. The amount of help depends on the level of support, which is determined based on the level of deficit in terms of social communication, and restricted and repetitive behaviors.

There are certain items and checklists that the parents, teachers and physicians can use to see whether a child is on the spectrum.

  • Autism Spectrum Disorder Screening Test

Unfortunately, there is no medical test, like a blood test, to detect autism spectrum disorder. Diagnosis is made by looking at the child’s development and behaviors by a doctor.

It is possible to reliably detect ASD before the child reaches the age of two. However, many children do not receive this diagnosis until they are much older. There are various reasons for such a delayed diagnosis.

Due to unavailability of autism specialists, evaluations that take a lot of time, cost of the process and primary care providers not being able to diagnose the disorder, the diagnosis of ASD may be delayed.

In addition, most of the families rely on the resources they have within their own community. However, resources vary vastly based on the location. A National Institutes of Health study revealed that only 7% of the developmental pediatricians practice in rural areas. According to the study, some states do not even have a developmental pediatrician.

It also claims that there is a nation-wide issue of shortages in subspecialist providers. The study suggests that overall, children with autism spectrum disorder are diagnosed two years later on average.

CDC states that autism spectrum disorder is diagnosed at two steps. The first step is the developmental screening.

Developmental Screening

During this short test, the doctor asks the parent some questions. They talk to the parent, play with the child during examination while making the developmental screening test. This reveals how the child speaks, behaves, and learns. The doctor then detects if there are any areas of problem in the development of the child.

The screening for developmental delays and disabilities should be done when the child is 9 months, 18 months, and 24 or 30 months old. In other words, the screening should be done during the well-child doctor appointments.

If the child is at high risk for ASD or they have behaviors associated with ASD, additional screenings should be carried out. Having a sibling or other member of the family with an ASD would be a high risk factor .

Doctors should screen especially those who are at higher risk for developmental problems. Babies who had developmental issues due to pre-term birth or have a sibling with an ASD are at higher risk for ASD. Request that your doctor routinely checks your child through this type of developmental test.

The second step, which is the comprehensive diagnostic evaluation, comes after once the doctor sees any signs associated with ASD.

Comprehensive Diagnostic Evaluation

The second step is a comprehensive diagnostic evaluation . During this evaluation, the child’s behavior and development are reviewed and the parents are interviewed.

The child’s hearing and vision is tested. Genetic and neurological testings may also be done in addition to other medical testing.

Children and their parents may be referred by their primary care doctors to a specialist. Comprehensive diagnostic evaluation can be done by developmental pediatricians, child neurologists, and child psychologists or psychiatrists.

Developmental pediatricians are the doctors who are specially trained in child development and children with learning and behavioral issues and special needs.

Child neurologists are doctors who mainly work on the brain, spine, and nerves. Child psychologists or psychiatrists are doctors who know about the human mind.

Levels of Support for Autism Spectrum Disorder

Everyone with autism receives the same diagnosis of autism spectrum disorder. However, as autism is a spectrum disorder, the severity of the disorder may differ from mild to moderate and to severe.

In addition to the core symptoms of autism spectrum disorder, many people have additional associated symptoms as intellectual or language impairments.

So as to better describe individual autism cases, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) featured three levels of support ratings across two areas as social communication (SC) and restricted and repetitive behaviors (RRB).

Clinicians are expected to diagnose with severity classifications. These classifications were determined by the American Psychiatric Association as Level 1 (“Requiring Support”), Level 2 (“Requiring Substantial Support”), and Level 3 (“Requiring Very Substantial Support”).

Splitting such classifications across two areas, namely social communication and restricted and repetitive behaviors, mirrors the core symptoms of autism spectrum disorder.

These levels indicate the ability of those with autism spectrum disorder to communicate, adapt, and overcome the restricted interests, and manage their daily life. While individuals at Level 1 need relatively little support, those at Level 3 need a lot of support.

Although ASD levels of support make sense, it is not easy for clinicians to assign a level to a diagnosis. The process of assigning levels may be subjective depending on the clinicians’ assessment.

In addition, individuals’ level of support may change over time as they improve their skills and make progress in general.

What do the levels of support mean and how to assign them?

Level 1 - Requiring Support

Level 1 is the least severe classification. Individuals in this classification have social communication issues. Without support in place, deficits in social communication may cause noticeable impairments.

People at this level struggle to initiate social interactions. They may respond inappropriately in communications. Individuals in this classification may quickly lose interest in social interactions.

In terms of restricted and repetitive behavior domain, people at Level 1 of ASD may exhibit inflexible behavior. Thus, they may have a hard time adapting to new contexts and changes.

They also struggle with organization and planning. They need relatively little support compared to other levels.

Level 2 - Requiring Substantial Support

Individuals at this level struggle with social communication more compared to those at Level 1. It is quite difficult for them to hold a conversation due to their severe social deficits. They have deficits in both verbal and nonverbal social communication skills.

Having support does not prevent social impairments. People classified to be in Level 2 rarely initiate social interactions.

They show abnormal responses to social attempts of others. Their interaction is limited to narrow social interests. They attempt odd, nonverbal communication.

Behavior of people at Level 2 is inflexible. They struggle to cope with change. When they are faced with a change of focus or action, they become distressed.

Casual observers easily notice other restricted and repetitive behaviors as they occur frequently.

Level 3 - Requiring Very Substantial Support

This level is the most severe ASD diagnosis. Individuals classified to be within this level have severe deficits in verbal and nonverbal social communication skills.

Such deficits cause severe impairments in their functionings. They cannot initiate social interactions and give minimal response to social attempts by others.

Behaviors of individuals at Level 3 are highly inflexible . They have extreme difficulty in coping with change.

Their behaviors are highly restricted and repetitive. They get distressed and have difficulty in adapting the change.

Diagnosis of Autism Spectrum Disorder

Autism spectrum diagnosis includes significant deficits in social and behavioral as well as developmental deficits and delays. Within the last few decades, the prevalence of diagnosis for the disorder has increased.

This may be due to the increased awareness regarding the milder forms of the disorder.

Diagnosis in young children

The symptoms and severity of autism spectrum disorder vary. Therefore, diagnosis of such a disorder is not always easy. There is no specific medical test to confirm the disorder. It is detected by observing the behaviors of the individual.

In diagnosis of young children, the parent and the child’s physician play a great role. During regular checkups, the physician will look for developmental delays. Parents may also prompt the physicians to look further if they see certain symptoms in their child’s behaviors.

If the child’s doctor detects any symptoms indicating autism spectrum disorder, they will refer the child to a specialist. This specialist may be a child psychiatrist or psychologist, pediatric neurologist or developmental pediatriciation, if available.

This specialist will make an evaluation. In order to determine the disorder, the specialist will observe the child and ask questions about the child’s social interactions, communication skills, and behaviors.

The specialist may also do some tests on speech, developmental level, hearing, and social behavioral issues.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association will be used as a guide.

Diagnosis in adolescents

In recent years, the awareness regarding autism spectrum disorder increased. This caused milder forms of the disorder to be diagnosed early on. However, there are certain cases where early diagnosis was not made for children with ASD due to various reasons.

For instance, children and adolescents who had received an attention-deficit/hyperactivity disorder (ADHD) diagnosis were diagnosed with autism, on average 1.8 years later than children without a pre-existing ADHD diagnosis.

Parents of children who have both ASD and ADHD diagnosis were found to express their concern regarding autism spectrum disorder at a significantly later time. This leads to a substantial 2-year delay in the diagnosis of autism.

However, there are many available screening tools and methods available today. Older children and adolescents are generally aware that they are different from other children their age.

Diagnosis in adults

Unfortunately, most available clinical services related to autism spectrum disorder focus generally on children since it is a disorder that presents its symptoms during early childhood.

Despite early attempts at figuring out ASD focused mainly on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. It may damage adult functioning.

Symptoms of autism spectrum disorder in adults are parallel to those of children. Adults with ASD may have difficulty in interpreting others’ feelings. They may also struggle with handling their emotions, or have trouble keeping up a conversation.

Adults diagnosed with ASD are strict with their daily routines and may overreact to changes. They may also be extremely interested in a particular topic, which may border on obsession .

Diagnosing autism spectrum disorder in adults is generally challenging. Since people who were not diagnosed when they were younger exhibit milder symptoms, they can be more difficult to diagnose.

Also, adults with ASD may be good at managing or disguising their symptoms as they have been living with the disorder for some time.

Asperger’s Syndrome

Learn everything there is to know about Asperger’s Syndrome from its symptoms to its diagnosis.

What is Asperger’s Syndrome?

Asperger’s Syndrome , Asperger Syndrome, or Asperger’s Disorder is a type of autism spectrum disorder. It is named after Hans Asperger , a Viennese pediatrician.

Hans Asperger first discovered the syndrome in 1944, when he described a set of behavior patterns exhibited by some of his patients. Most of these patients were males.

Hans Asperger noticed that despite having normally developed in terms of intelligence and language, these males had impaired social skills and could not communicate properly.

Social communication challenges as well as restricted and repetitive behaviors, the core symptoms of autism spectrum disorder, also occurred in these patients. However , it was found that such symptoms present differently than those of infants with autism spectrum disorder.

They require different treatments and social attitudes. The American Psychiatric Association added Asperger’s syndrome to its official diagnostic manual in 1994. The disorder is believed to affect one in 300 people, 90% of whom are males .

Asperger’s syndrome used to be a stand-alone condition with a specific diagnosis. However, the fifth edition for the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), the guide used by doctors to make diagnosis, removed the specific classification of Asperger’s syndrome.

Children showing signs of Asperger’s syndrome are now diagnosed with autism. They are considered to be on the autism spectrum. This wide spectrum contains various combinations of different degrees of severity for these disabilities.

Children with behaviors indicating autism spectrum disorder are described with terms such as “low-functioning”, “high-functioning”, “autistic tendencies”, “pervasive developmental disorder” and many more.

Children with Asperger’s syndrome are generally deemed to be on the high-functioning end of the autism spectrum.

Boys are three times more likely than girls to be diagnosed with Asperger’s syndrome. Although it is no longer a stand-alone diagnosis, the term Asperger’s syndrome is still used by many parents and medical communities.

Read: Diagnosis and Symptoms of Asperger’s Syndrome

Symptoms of Asperger’s Syndrome

People with Asperger’s syndrome struggle with understanding social conventions. They may not be able to read social cues despite having normal, and sometimes superior intelligence.

This causes people to perceive individuals with Asperger’s syndrome often as rude or tactless. It can be hard for them to make friends.

Irony, humor, and metaphors confuse such individuals. As they struggle with making the meaning of the tone of voice and facial expressions, it is hard for them to interpret the meaning of a social interaction. They may use inappropriate body language.

There are certain signs and symptoms indicating Asperger’s syndrome:

  • Repetitive speech
  • Inappropriate or awkward movements
  • Obsession with certain topics
  • Failure to reciprocate both socially and emotionally
  • Narrow interest
  • Lack of common sense
  • Poor coordination

Children with Asperger’s syndrome may not show any delays in language development. However, they struggle with using language in social settings. They generally have good grammar skills and advanced vocabulary at an early age. But they may be very literal for a social context.

In general, children diagnosed with Asperger’s syndrome can function in everyday life. They may have problems with organization skills, but usually have average and even above-average intelligence.

Causes of Asperger’s Syndrome

In the past, people believed that developmental disorders emerged due to parents being distant and unemotional towards their children. However, this has been proven not to be true. It was found out that these disorders are caused by the functioning of the brain.

The causes of autism spectrum disorders, and Asperger’s Syndrome, are still being investigated by researchers. With the advancement of technology, we took one step further to figuring out the causes of autism spectrum disorders.

Advanced brain imaging and MRIs indicated structural and functional differences in the brain. Therefore, abnormalities in the functioning of the brain are thought to be one of the causes of Asperger’s Syndrome.

Also, genetics play a significant role in Asperger’s Syndrome and autism spectrum disorders. Although the cause of Asperger’s syndrome is not understood entirely, a strong genetic basis is known to affect the development of the disorder.

This means that the syndrome, like most autism spectrum disorders, tend to have genetic roots and run in families. In addition, more than one environmental factor, such as maternal diabetes, are thought to play a role in the development of all autism spectrum disorders.

Research found that Asperger’s syndrome may be associated with other mental health problems. Such mental issues include depression and bipolar disorder. It is proven that the syndrome is not caused by emotional deprivation.

It is also not caused by bad parenting. This is also wrong. People assume individuals with Asperger’s syndrome must have been raised by bad parents as they seem intentionally rude or inappropriate.

However, unlike this idea, Asperger’s syndrome is a neurobiological disorder, the causes of which are not really understood.

Diagnosis and Treatment of Asperger’s Syndrome

Just like other autism spectrum disorders, there is no test to detect Asperger’s syndrome. It is difficult to diagnose the disorder.

Also, since most individuals with Asperger’s syndrome have become accustomed to handling themselves in social situations, diagnosis may be delayed. Children with Asperger’s syndrome function well in many aspects of their life, so the symptoms they show might be overlooked.

In order to diagnose Asperger’s syndrome, the behaviors of the child should be observed while they are in a social situation, like how they play with their friends or how they react to a new video game.

Early intervention in terms of education and social training is quite important for children with Asperger’s syndrome, while the brain is still developing.

The child should be diagnosed by a mental health professional or other specialists. The specialist will conduct an evaluation of your child. This evaluation includes taking the history of when symptoms were noticed first.

The specialist also assesses the motor and language skills development as well as the behavior of the child. The key here is to detect if there are any social development deficits in the child.

There is no typical treatment of Asperger’s syndrome. There are certain therapies and training that can help depending on the development level of the child. These include specialized educational interventions, social skills training, and language therapies. Early intervention is key.

After receiving behavioral and educational help, people with Asperger’s syndrome can lead a normal life . Although many people still struggle with social concepts in their upcoming ages, some adults do so well that they no longer fall under the category of Asperger’s syndrome’s symptomatic diagnosis.

This means that some individuals with Asperger’s syndrome may continue to need support for everyday living, while others are able to find jobs and develop relationships.

Difference between Autism and Asperger’s Syndrome

Distinguishing the difference between autism and Asperger’s syndrome can be challenging. Continuous research causes the definition of autism spectrum disorders to change constantly.

Over the years, Asperger’s syndrome has been classified and reclassified as being on the autism spectrum or a separate disorder on its own.

Although individuals with autism spectrum disorder and Asperger’s syndrome may exhibit similar symptoms, there are some key differences.

In general, people with autism do not struggle with speech impairments. Such impairment or inability often characterize individuals with autism spectrum disorder.

Although those with Asperger’s syndrome may have difficulty in understanding idioms, jokes, or sarcasm, they are able to speak and enunciate clearly.

Moreover, autism spectrum disorders are generally detected in children before they reach school age. This means that the symptoms and severity of autism spectrum disorder present earlier than those of Asperger’s syndrome.

Since Asperger’s have social and communication effects, the syndrome may go undetected until the child faces difficulties in school.

Individuals with Asperger’s syndrome generally score as high as or higher than their peers and often have superior IQ scores.

Causes of Autism

The causes of Autism can be explained by a plethora of findings.

What causes autism?

There is no definitive cause of autism spectrum disorder. The scientific evidence obtained in the last decade indicates that there is a strong genetic component to ASD. However, certain genetic causes can only be identified in around 20% of the cases at the most.

In recent years, certain genetic and environmental factors were identified to contribute to autism.

For instance, advanced paternal age increases the chance of autism spectrum disorder, or boys are four times more likely to be diagnosed with the disorder than girls. Low birth weight and prematurity are also among the well-established risk factors.

Scientists are starting to find out more about biological pathways involved in autism spectrum disorder based on certain clues from genetic anomalies found in some individuals on the autism spectrum disorder. So we know that genes play a role as well.

It is also found out that environmental factors also have a role in autism risk. For instance, the drug taken by pregnant mothers for nausea years ago, called thalidomide, was reported to have caused autism symptoms in the child. However, such drugs are no longer in use for pregnancy.

But such findings suggest that autism may begin as early as in the womb. Scientists around the world are now looking into other environmental factors. Everyday new findings emerge regarding environmental risk factors, especially those that occur during fetal growth.

For example, exposure to air pollution or pesticides during pregnancy has been found to have implications. Other chemicals are also being researched to see if they affect the development of autism spectrum disorder.

Contrary to popular belief, vaccines do not cause autism. Many studies have been conducted to find a link between autism and vaccines such as the measles-mumps-rubella (MMR) vaccine, vaccines with a mercury-based preservative (thimerosal) or simultaneous receipt of multiple vaccines.

None have found any link between autism and vaccination. Numerous evidence has been examined by professional boards and organizations. For instance, Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have published articles indicating that vaccines do not cause autism.

The reason this belief emerged is that in 1998 a paper was published indicating such link. In 2010, this paper was retracted. It was found that the author manipulated the data to show a link between MMR vaccines and autism.

His medical license was revoked due to falsifying of data intentionally. We need to spend the resources and energy on what is really important, which is finding out what does cause autism spectrum disorder, as well as how to prevent or treat it.

Autism Risk Factors

The causes of autism have not been determined in full clarity. Years of research lead to show that ASD is a multifactoral disorder caused by genetic, epigenetic and environmental factors.

Genetic Risk Factors

Genetics are proved to affect the risk of developing certain types of autism spectrum disorder. Several different genes seem to be involved in ASD. Studies show that around 10% of children with ASD can be associated with other genetic or neurological disorders, such as fragile X syndrome.

In addition, if there is already a child with autism in a family, the possibility of having another child with autism spectrum disorder increases by 25 times compared to the general population. Moreover, the studies done on twins revealed that identical twins have 60% to 90% chance of concordance rate for having autism.

This risk rate decreases to 0 to 24% in nonidentical twins. Also, structural mutations may increase the risk of ASD. Some of these genetic mutations were found to be inherited.

Environmental Risk Factors

Studies on environmental risk factors of autism spectrum disorder are still in their infancy as the focus has generally been on genetic studies. Recent studies showed that in addition to genetic factors, certain environmental factors also contribute to the development of autism spectrum disorder.

For instance, parental age is determined to have an impact. A study indicates that an increase in maternal or paternal age increases the risk of having a child with autism spectrum disorder by 18% to 21%, respectively.

Moreover, a strong relationship has been established between the use of certain medications during pregnancy and autism spectrum disorder. Valproate, a drug used for epilepsy and bipolar disorder, is one of such medications.

In addition, some studies examined the link between development of autism spectrum disorder and the use of selective serotonin reuptake inhibitors (SSRIs) by pregnant women. SSRIs are a drug class that are generally used to treat major depressive and anxiety disorders.

The results of the studies showed that the risk of autism spectrum disorder in children increases by 50% for women who received SSRIs during pregnancy.

However, when exposed and non-exposed groups are compared, there was no significant increase in the risk of autism spectrum disorder in their children.

Other confounding factors may affect such association. Previous studies suggest that one of the possible perplexing factors may be underlying maternal psychiatric disorder.

Autism Facts

  • CDC determined in 2018 that 1 in 59 children is diagnosed with autism spectrum disorder.
  • Boys are four times more likely to be diagnosed with ASD compared to girls.
  • There is no medical method of detection for autism spectrum disorder.
  • Autism affects all ethnic and socioeconomic groups.
  • Minority groups tend to be diagnosed later and less often.
  • Genetics are proven to be involved in the development of autism spectrum disorders.
  • Older parental age impacts development of autism.
  • A child with autism in the family may create a 2 to 18% chance of having another child with autism.
  • Among identical twins, if one child has autism the other will be affected 36 to 95% of the time. Among non-identical twins, there is a 31% chance of the other twin having autism.
  • Vaccines do not cause autism.
  • Applied Behavior Analysis (ABA) and related therapies are most often used for intervention for ASD.
  • Speech and occupational therapies are also effective on many children with autism spectrum disorder.
  • Around one thirds of individuals with autism are non-verbal.
  • Drowning is the leading cause of death for individuals with autism.
  • Autism spectrum disorder may affect the entire body.
  • Children with ASD are eight times more likely to suffer from a type of chronic gastrointestinal disorders.
  • Autism is a lifelong disorder. Its impacts span across the life of the individual.
  • Individuals with autism may suffer from obesity.
  • In 2011, the total costs for ASD in the United States were estimated to be $11.5 billion to $60.9 billion, consisting of medical costs to loss of work.
  • Medical expenditures for children and teens with ASD were estimated to be 4.1 to 6.2 times greater than that of those without ASD.
  • Intensive behavioral interventions for children with autism cost around $40,000 to $60,000 per child per year.

Medication and autism

There are currently no medications that specifically treat autism or its core characteristics. Rather, pharmaceutical intervention has focused on treating possible coexisting disorders that individuals with autism often face.

Currently, the U.S. Food and Drug Administration (FDA) has approved two medications for the treatment of irritability in children with autism. Risperidone, an antipsychotic, is appropriate for children aged 5 to 16. Aripiprazole, another antipsychotic, is approved for children aged 6 to 17.

ADHD, depression, anxiety, irritability, and aggressiveness are relatively common symptoms of autism, and there are well-established medications that treat these symptoms.

SSRIs (selective serotonin reuptake inhibitors), for example, are a class of drugs often used for the treatment of major depression. SSRIs also show success in alleviating anxiety.

Even if an individual with autism does not meet the criteria for a diagnosis of depression or anxiety, health professionals have had success in minimizing these symptoms by using SSRIs “off-label” (Off-label means that the drug is being used in an un-approved manner.). Examples of medications that may be used “off-label” use are:

- SSRIs: A group of antidepressants that treat feelings of sadness, anxiety, and irritability. - Tricyclics: Another group of antidepressants for the treatment of depression and compulsive disorders. - Antipsychotic medications: Risperidone and Aripiprazole are FDA-approved for the treatment of irritability in children of certain age groups. - Stimulants: A group of medications that treat inattentiveness and hyperactivity. - Anti-anxiety medications: For relieving symptoms of anxiety and panic. - Anticonvulsants: These medications treat seizure disorders.

One caveat is that these medications have side effects. Another caveat is that these medications vary widely depending on their formulations.

Balancing the right formulation, dosage, and tolerable side effects is a timely process that can be frustrating and require routine doctor visits. Individuals may spend months working with their doctors to find the “right fit.”

Individuals with autism and parents of children with autism should be wary of companies that tout claims or “cure-alls” for the treatment of autism.

These so-called therapies not only mislead consumers about their effectiveness, but they also come with health risks. Examples include:

  • Detox diets or cleanses
  • Detox mineral baths
  • Oxygen Therapy
  • Oral supplements

Any medication used for the treatment of the symptoms of autism must be confirmed by a health professional. Medication plans, which include introducing drugs on a trial basis, test the effectiveness of pharmaceutical intervention.

Medication plans require frequent monitoring by individuals with autism, parents, and health professionals.

Therapies for autism

Learn about the different therapies that are used and recommended by doctors.

Behavioral therapy

The behavioral challenges facing children and adults with autism include poor social skills, poor communication, and difficulties adapting to change.

Applied Behavior Analysis (ABA) is a therapy of positive reinforcement and negative consequences. Goal behaviors, as defined by the therapist and parents, are “rewarded” whenever the individual with autism uses that behavior.

Over time, the reward system encourages the individual to adopt the goal behavior in a meaningful, natural way.

Conversely, negative consequences discourage harmful behavior. When the therapist or parent takes away a reward or has no reaction to the negative behavior, the individual with autism learns to stop using the behavior and to replace it with a positive one.

Understanding how behavior works is a crucial part of successful ABA. Individuals with autism learn to break down behavior into components: the antecedent (what precedes or elicits the behavior); the resulting behavior itself; and the aftermath (reward or negative consequence).

With practice, they develop an awareness of their environment and how it affects them. They learn to anticipate different situations and plan their reactions. Eventually, the individual habituates goal behaviors.

ABA has been a hallmark therapy for autism because it is flexible. Every individual with autism has unique symptoms and challenges, and ABA is easily tailored to meet each person’s needs.

ABA can also be used at home, at school, or in the community. Using ABA in a variety of places means that therapy is consistent and adaptable to work on different behaviors in different environments.

Read: Autism and Behavioural Therapy

Psychological therapy

Psychological therapy addresses the mental challenges that individuals with autism may encounter, including coexisting mental disorders, working through emotions, and navigating transitions.

Individuals with autism often report experiencing irritability, aggressiveness, or extreme emotional responses. Small disruptions (like a routine change) can result in a rollercoaster of emotions, while larger disruptions can elicit feelings of helplessness, frustration, and confusion.

Additionally, individuals with autism often describe more serious feelings of depression or anxiety. These symptoms can be debilitating and drastically impact a person’s quality of life.

A coexisting mental condition, like major depression or anxiety disorder, is serious and needs to be addressed by a health professional.

Psychological therapy, also known as talk therapy, addresses these emotions, transitions, and possible mental disorders.

Talk therapy is performed on a regular basis with a professional, usually a psychiatrist, psychologist, licensed therapist, or social worker.

These professionals may use one or several types of therapy, including one-on-one sessions and family sessions.

The goal is to help the individual break down the mechanics of how they are feeling and why they are feeling that way. Over time, the individual learns how to handle negative feelings and navigate difficult transitions.

Educational therapy

Children with autism benefit from a structured learning environment that is tailored to address their specific needs. Going to school involves a number of skills like effective communication, interacting with peers, and following directions.

Educational therapists help children with autism to be productive learners and to build positive relationships with their peers and teachers.

Educational therapists are trained in a range of skills. They assess a student’s learning needs and create an individualized plan specific to the student’s learning goals.

The plan may address learning disorders (like dyslexia), attention problems, or procrastination. Tackling a student’s challenges and teaching new skills often means using a “cocktail” of resources like ABA, CBT (cognitive behavioral therapy), speech therapy, or music therapy.

Educational therapists work with children one-on-one and within the learning environment itself, often in conjunction with the school’s special education resources.

Difficulties for adults with autism

The right diagnosis

In many adults with autism, the disorder routinely elicits feelings of anxiety, situational stress, and depression. Adults seeking treatment for one or more of these symptoms may be unaware of underlying autism.

Mis-diagnosis, unfortunately, is not uncommon, leading to frustration for both the patient and clinician. Getting an accurate diagnosis is crucial for proper management of the disorder and empowering patients to a greater understanding of autism and for contextualizing some of the difficulties they have faced.

Studies have shown that taking a slow, conservative approach to diagnosing autism and related issues yields a better outcome. Herein lies another difficulty facing adults with autism.

Finding a doctor who is trained in recognizing and understanding autism can be arduous, thereby inducing further stress and exacerbating mental health issues.

Getting a correct diagnosis takes time. There will be regular doctor visits and tests, which can take time away from a person’s work, school, or social life. Added to this, patients run into medical-related financial obligations and the task of navigating insurance policies or government-sponsored support.

Equal and fair employment

Over the past few decades, research on autism has countenanced a greater awareness of the disorder and put in motion job-related protections for individuals with autism.

Still, adults with autism continue to face training and employment challenges. Common symptoms of autism in adults, like atypical communication, sensory processing issues, poor social skills, and coordination, create barriers during the hiring process.

The National Autistic Society reported that in 2016, only 16% of adults with autism in the UK had full-time work. In 2015, the National Autism Indicators Report (US) reported that only 58% of young adults with autism had ever worked after high school. Most of these jobs were low-wage or part-time.

Family

Adults with autism are at increased risk for stress-related and psychological difficulties. The heritability of autism also places burdens on families with two or more individuals with autism, particularly when a parent with autism is caring for a child with autism.

Emotional distress and atypical behaviors on the part of an individual with autism are two of the many issues that overburden families and strain relationships.

The large body of research related to autism and families focus mainly on children, therefore leaving research on adults nearly nonexistent.

Autism awareness societies and internet-based sources indicate that adults with autism continue to face challenges with social interactions and may continue to live at home longer than their peers.

Older adults

Older adults with autism spectrum disorder face unique challenges as they age. Age-related diseases like dementia and Alzheimer’s require not only age-appropriate but also autism-appropriate interventions.

There is little research on age-appropriate health services and strategies for older adults with autism.

Consequently, medical professionals, caregivers, and family members commonly suffer from this training and support void. Also, older adults often face more considerable financial burdens that preclude or limit treatment options.

Parenting a Child with Autism

Having a child be diagnosed with autism opens up a multitude of hurdles for parents. There is no universal flow chart for parenting a child with autism. Once a child is diagnosed, parents will need to tailor a treatment plan that tackles their child’s specific needs.

This treatment plan may require numerous doctor visits, therapeutic interventions, and educational changes, all of which take up time and heighten stress levels.

Learning to care for a child with autism also means developing toolsets to combat new mental and physical health worries. Stay-at-home mothers or fathers may be more susceptible to stress-related difficulties because of their primary caretaker role.

Parents of a child with autism suffer from elevated stress, which puts them at risk for anxiety, depression, high blood pressure, elevated heart rate, and other related problems.

Siblings also face hardships. They may become jealous or resentful, thinking that their parents prioritize the other child or give him or her “special treatment.”

In addition, siblings may find some of the behaviors related to autism embarrassing, which in turn can lead to self-alienation from family and peers. Developing autism-appropriate parenting strategies are crucial for maintaining a healthy home.

Strategies for parenting a child with autism

Attend to your health needs

Parents of a child with autism may benefit from receiving health-related interventions. Talk therapy fosters mental and emotional well-being. Parents who put their own physical health on the back burner, citing time constraints, are at elevated risk for developing complications later on. It is vital for parents to allocate time for routine medical check-ups.

Get organized

Organization is a common strategy for healthy families, and it reaps extra benefits for children with autism. Many children with autism are routine-oriented and easily become frustrated when their routines change.

Using an organizational tool like a daily planner or a task app eases the burden of having to “keep everything straight.” These tools also give the child a physical guideline, so they know what to expect.

Get out

Going outside of the home exposes children with autism to new environments, offering parents the opportunity to teach social and behavioral techniques. It is also a great way to incorporate some “care-free” time into busy schedules.

For routine-oriented children with autism, it is helpful to set aside a day and time explicitly dedicated to an “outside” activity.

Going for a walk or playing at the park are both easy ways to get out of the home and foster community interactions.

Breathe

Relaxation techniques like breathing exercises are simple tools that can help parents cope with the ups and downs of parenthood. Breathing exercises can be done anywhere and at any time, making them an ideal intervention for acute stress.

Online literature and video resources are widely available and will go through the rubric of the breathing exercises. There are also mobile apps, which may offer convenient daily reminders, tips, and ambient music.

Practice mindfulness

Mindfulness meditation is an increasingly popular technique that promotes awareness, calm, and acceptance of how one feels. While labeled as a type of meditation, mindfulness does not require any special accommodations like silence or a solitary space. With practice, one can practice mindfulness nearly anywhere and for any amount of time, from seconds to minutes.

Reach out

Community support for parents of children with autism is largely available and takes only a little digging to find. Online support is abundant, and parents can network and share stories via numerous platforms on social media.

Community autism groups and meetings are another way to find support. These groups offer parents the opportunity to connect with their communities, share tips, and talk with individuals facing similar challenges.

Be school savvy

As a child with autism reaches school age, parents inevitably have to learn the ins and outs of special education, learning accommodations, and working closely with teachers. By US law, school districts must provide special education accommodations to children with disabilities.

Parents are encouraged to get involved with their child’s school, either by connecting with other parents of children with autism or by attending PTA meetings. Attending school functions, getting to know your child’s teachers, and networking with other parents are prime opportunities for finding new resources and support.

Educate

An autism diagnosis extends beyond the child and into families and social circles. Parents of a child with autism are tasked with educating not only themselves but others around them.

Family members and close friends may not understand the diagnosis, deny the diagnosis, or inadvertently disrespect boundaries. By taking the time to discuss your child’s diagnosis and any behavioral or social parameters in place, parents can ensure that interactions with family and friends are healthy and productive.

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