Autism Spectrum Disorder

Autism spectrum disorder affects how people interact with the world around them, influencing communication, social relationships, and behavior in unique ways. While there is no cure, early intervention and support can make a meaningful difference in helping individuals with autism reach their full potential and live fulfilling lives.

Table of contents

• What is Autism Spectrum Disorder?
• Signs and Symptoms
• What Causes Autism?
• How Common is Autism?
• Diagnosis and Screening
• Treatment and Support
• Living with Autism Spectrum Disorder

What is Autism Spectrum Disorder?

Autism spectrum disorder is a developmental disability caused by differences in the brain. This means it affects how a child’s brain develops and works from an early age^[2]. The term “spectrum” is important because it reflects that autism affects people in many different ways and to varying degrees^[3].

People with autism may behave, communicate, interact, and learn in ways that are different from most other people^[2]. There is often nothing about how they look that sets them apart from others. The abilities of people with autism can vary significantly. Some people with autism may have advanced conversation skills, while others may be nonverbal. Some people need a lot of help in their daily lives, while others can work and live with little or no support^[2].

Autism begins before the age of 3 years and can last throughout a person’s life, although symptoms may change over time^[2]. Some children show autism symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months of age or later. Some children with autism gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had^[2].

Signs and Symptoms

People with autism often have problems with social communication and interaction, and restricted or repetitive behaviors or interests^[2]. They may also have different ways of learning, moving, or paying attention. It is important to note that some people without autism might also have some of these symptoms^[2].

Difficulties in Social Interaction

Individuals with autism often show significant difficulties in social interactions. These difficulties may include trouble understanding the feelings and intentions of others, maintaining eye contact and facial expressions, and adapting to social norms and expectations^[14]. People with autism may experience challenges in establishing and maintaining friendships. They may not understand the two-way nature of social interactions, or they may feel uncomfortable sharing interests and activities^[14].

Young children with autism may not follow your gaze or look at things you’re pointing to. They may not respond to their name, seem uninterested in taking-turn games like peek-a-boo, not seek you out to share something they’ve discovered, or prefer to play by themselves^[6].

Communication Challenges

Communication deficits are a core feature of autism. This may show up as delays in language development, including delays in saying first words or simple sentences. Some individuals with autism may not use language to communicate at all^[14]. Even among individuals with autism who have normal language skills, they may have difficulty using language in conversations to communicate thoughts, feelings, or needs. Understanding and using body language and facial expressions may also be affected^[14].

Older children with autism may talk about a narrow range of topics, have one-sided conversations without back-and-forth talk, seem uninterested in starting a conversation, or have difficulty expressing their feelings or understanding how others feel^[6].

Repetitive Behaviors and Interests

Individuals with autism often display restricted, repetitive patterns of behavior and interests. These may include a strong fixation on specific topics or activities, repetitive body movements such as rocking or clapping, and an overreliance on daily routines^[14]. These repetitive behaviors are sometimes seen as a way of self-soothing or as an attempt to control an environment that otherwise feels unpredictable and overwhelming^[14]. People with autism may use repeated movements or actions to calm themselves or express joy^[5].

Sensory Sensitivities

Many individuals with autism have unusual reactions to sensory experiences. They may have very strong or delayed responses to sound, light, touch, taste, or odor^[14]. For example, some individuals with autism may find background noises in their everyday environment unusually harsh, or they may not notice pain or other bodily sensations^[14]. They may become overwhelmed in loud or busy places^[5].

What Causes Autism?

Scientists believe there are multiple causes of autism that act together to change the most common ways people develop^[2]. We still have much to learn about these causes and how they impact people with autism. Available scientific evidence suggests that there are probably many factors that make a child more likely to have autism, including environmental, biological, and genetic factors^[7].

Some people with autism have a known difference, such as a genetic condition. Other causes are not yet known^[2]. Research suggests that both genetic and environmental factors play a key role in autism’s development^[14]. The highly heritable nature of autism, the role of environmental factors, and genetic-environmental interactions are emphasized in current research^[14].

Although we know little about specific causes, autism is not caused by poor parenting or vaccines. Studies have thoroughly examined whether there is a connection between vaccines and autism, and the evidence consistently shows no link^[8].

How Common is Autism?

According to the World Health Organization, about 1 in 127 persons worldwide had autism in 2021^[7]. More than one in 100 people are autistic, and there are at least 700,000 autistic adults and children in the UK^[5]. In the United States, about 1 in every 31 children has autism^[6].

These numbers are not the same as the number of people with an autism diagnosis. They are based on research about the true figure, which is likely to be higher. More research is needed to know for sure^[5]. The prevalence of this diagnosis has increased over the past few decades, and it is unclear whether this is solely due to increased awareness of milder forms of the disorder among medical providers^[12].

People of all ages, genders, and ethnicities can be autistic. But people from marginalized groups can face more barriers to getting a diagnosis. This can be because of a lack of awareness about the true diversity of autistic people^[5].

Diagnosis and Screening

There is no specific medical test to diagnose autism spectrum disorder^[9]. Healthcare professionals look for signs of developmental delays at regular well-child checkups. If a child shows any symptoms of autism, they will likely be referred to a specialist who treats children with autism for an evaluation^[9].

The specialist may observe the child and ask how they have developed or changed over time in terms of interacting socially, communicating, and behaving. They may give the child tests covering hearing, speech, language, level of development, and social and behavioral issues. They may present structured social and communication interactions to the child and score their performance^[9].

Early diagnosis of autism coupled with prompt, evidence-based intervention will result in the best possible outcome for the child^[13]. Parents should track their child’s developmental milestones and share any concerns with their child’s doctor at every check-up^[2]. If there is a long wait between a positive screen and a diagnostic evaluation, it’s best to initiate early intervention services even before a formal diagnosis is made^[13].

Treatment and Support

There is no cure for autism spectrum disorder^[3][17]. The concept of a cure is offensive for many autistic people and their families. An intervention should never aim to “treat autism”^[17]. However, getting treatment early, during the preschool years, can make a big difference in the lives of many children with the condition^[3].

Current treatments for autism seek to reduce symptoms that interfere with daily functioning and quality of life^[10]. Treatment works to minimize the impact of the core features and associated deficits of autism and to maximize functional independence and quality of life^[13]. All support should be person-centered and promote autistic people’s dignity, keep people safe, healthy, and happy, and enable autistic people to do the things they love^[17].

Early Intervention Services

Early intervention services can greatly improve the development of a child with autism^[2]. Research shows that in an appropriate educational setting, early intervention for at least 2 years prior to the start of school can result in significant improvements, and some children may gain enough skills to successfully enter a regular education elementary school setting^[13].

Individualized, intensive interventions with behavioral, educational, and psychological components are the most effective treatments for autism. Early initiation of treatment, ideally in infancy, improves long-term outcomes^[15]. Behaviorally oriented programs designed for individuals with autism should be implemented as soon as the diagnosis is suspected^[15].

Types of Treatment Approaches

There are many types of treatments available. These treatments generally can be broken down into the following categories: behavioral, developmental, educational, social-relational, pharmacological, psychological, and complementary and alternative^[10].

Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. A notable behavioral treatment is applied behavior analysis (ABA), which encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. ABA uses behavioral psychology principles to systematically teach new skills and reduce challenging behaviors^[13].

Developmental approaches focus on improving specific developmental skills, such as language skills or physical skills. The most common developmental therapy is speech and language therapy, which helps improve understanding and use of speech and language. Some people with autism communicate verbally, while others may communicate through the use of signs, gestures, pictures, or an electronic communication device^[10].

Occupational therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people. It can also include sensory integration therapy to help improve responses to sensory input^[10].

Physical therapy can help improve physical skills, such as fine movements of the fingers or larger movements of the trunk and body^[10].

Medication

The current treatment options for the core symptoms of autism are limited to psychosocial therapies. Medications have been most effective in treating the associated behavioral symptoms of autism^[12]. Pharmacotherapy may be considered for associated behavioral symptoms, but potential benefits must be weighed against adverse effects. Some psychotropic medications may paradoxically increase irritability or aggression in a subset of patients^[15].

Risperidone and aripiprazole are currently the only medications FDA approved for symptoms associated with autism spectrum disorders, targeting the irritability often seen with this diagnosis^[12]. Children and adolescents with autism appear to be more susceptible to adverse effects with medications; therefore, starting with low doses and increasing very slowly is recommended^[12].

Special Education

Special education is central to the treatment of autism. Individualized programs should be developed by educators experienced with autism and related conditions^[15]. Federal law mandates free and appropriate public education for children with disabilities, starting at age 3 years. Services for children younger than 3 years are determined at the state level^[15].

Living with Autism Spectrum Disorder

For many people with autism and their families, daily life is not easy. Finding resources and planning for the future can help families improve their quality of life^[16]. Living with a person with autism affects the entire family. Meeting the complex needs of a person with autism can put families under a great deal of stress—emotional, financial, and sometimes even physical^[16].

Physical Health and Safety

To stay healthy, people with autism need the same basic health care as everyone else. They need to eat well, exercise, get enough rest and plenty of water, and have complete access to care, including regular physical and dental check-ups^[16]. It is important to find healthcare providers who are comfortable caring for people with autism.

Sometimes when people with disabilities have a behavioral change or issue, it may be because they have a medical problem they cannot describe. For instance, head banging could be related to a disability, or it could be due to a headache or toothache. For this reason, it is important to find out if there is a physical problem before making changes in treatment or therapy^[16].

Safety is important for everyone. People with disabilities can be at higher risk for injuries and abuse. It is important for parents and other family members to teach their loved one how to stay safe and what to do if they feel threatened or have been hurt in any way^[16].

Transitions and Adulthood

The transition from high school to adulthood can be especially challenging for a person with autism. There are many important, life-changing decisions to make, such as whether to go to college or a vocational school or whether to enter the workforce, and if so, how and where^[16].

It is important to begin thinking about this transition in childhood, so that educational transition plans are put in place—preferably by age 14, but no later than age 16—to make sure the individual has the skills they need to begin the next phase of life^[16]. Vocational engagement is important for long-term independence and self-esteem. Both paid and unpaid work experiences can be difficult to obtain, and disability accommodations may be limited. Early transition planning and workplace supports can improve employment outcomes^[15].

As children with autism become adolescents and young adults, they may have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may come to the attention of healthcare providers because they also have conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder, which occur more often in people with autism than in people without autism^[2].