Autism spectrum disorder is a neurodevelopmental
condition that affects a person's ability to communicate, interact and behave
appropriately with others in social situations. Approximately 1 in 68 children
in the United States has autism, and the condition is about five times more
common in boys than in girls, according to the Centers for Disease Control and
Prevention (CDC).
Autism is characterized by impairments in social
skills, communication, and restricted and repetitive behavior such as hand
flapping and an insistence on sameness. Many children also have unusual sensory
responses, and may shy away from bright lights or may not notice if their
clothes are rough and twisted.
Earlier versions of the Diagnostic and
Statistical Manual of Mental Disorders (DSM), the American Psychiatric
Association's guide for diagnosis, listed autistic disorder, Asperger syndrome
and pervasive developmental disorder-not otherwise specified (PDD-NOS) and
childhood disintegrative disorder as separate diagnoses. In the latest edition
of the DSM, however, experts combined these conditions into one group called
autism spectrum disorder because they all appear to be varying degrees of the
same disorder, the association reported.
Despite controversy around the subject, there is no
evidence that links vaccination of a child with the development of autism,
according to the National Institute of Child Health and Human Development.
Symptoms of autism
No two people with autism are alike, but many
parents notice signs of the disorder when their child does not meet certain
developmental milestones, typically between 18 months and 3 years of age. For
instance, the child may have problems with eye contact, responding to his or
her name or engaging in imaginative play.
Caregivers may also notice that their child does
not appear to enjoy engaging and interacting with others, said Mayada
Elsabbagh, an assistant professor in psychiatry at McGill University in Quebec,
Canada.
However, mild forms of the disorder may not
become apparent until the child is older, and some people are not diagnosed
until adulthood.
"They may not be detectible until the child
starts reaching school age and starts having specific types of challenges that
highlight some of the social and communication problems that they have,"
Elsabbagh told Live Science.
Diagnosis of autism
The diagnostic process is different for every
person with autism. In some cases, pediatricians may use an autism screen,
often a short yes-or-no survey that looks for signs of autism, to see whether a
child may be at risk for the disorder. If the child screens positive, the
family may receive a referral to a specialist for a diagnostic evaluation.
When diagnosing autism, specialists rely on both
direct observational information and parent report data about the child's
behavior, said Elsabbagh, who encouraged parents to keep a detailed
developmental records of their children's growth.
"For older children, some clinicians will
seek input from the child's school, peers — how they interact in the settings
outside their home," she said. "What they're trying to do is compile
and put together these different sources of information and integrate them to
figure out if this a child with autism or, alternatively, does this child have
a general developmental delay that is not specific to autism?"
A thorough team of clinicians may also diagnose
additional disorders that often accompany autism, including attention deficit
hyperactivity disorder (ADHD), intellectual disability, epilepsy and
depression, she added.
People with certain genetic disorders, such as
fragile X syndrome, tuberous sclerosis complex and Angelman syndrome, also tend
to have autism, experts say.
Treatment of autism
There is no cure for autism spectrum disorders.
However, there are behavioral and educational therapies that may help reduce
symptoms. And early diagnosis is key to connecting children with autism to
treatment, Elsabbagh said.
One of the most frequently used therapies,
Applied Behavioral Analysis (ABA), for instance, uses rewards to encourage
people with autism to increase useful behavior and decrease impairing actions.
Parent-mediated interventions are also an effective therapy that teaches the
caregivers how to help their children in a natural environment, such as the
home.
For instance, children with autism saw
improvements in language and behavior after enrolling in the Early Start Denver
Model, a two-year intervention that uses ABA and other therapies in a classroom
setting, reported a 2010 study in Pediatrics.
"In reality, behavioral approaches are best
because we know that changing the environment around the child and interacting
with the child in different ways does change biological processes [in the
brain]," Elsabbagh said. "It does have an impact on shaping brain
development in a way that would be supportive and helpful for their
independence."
Medications do not treat the core symptoms of
autism, such as problems with communication, but can reduce symptoms such as
irritability. The U.S. Food and Drug Administration has approved two drugs for
autism — risperidone and aripiprazole — which treat aggression, irritability
and mood swings.
However, the long-term effects of these
medications are unknown, and often children with autism take multiple drugs to
treat other problems such as hyperactivity or depression, experts find. About
65 percent of children with autism have a prescription for a psychotropic
medication, a drug that can cross the blood-brain barrier, a 2013 study in the
journal Pediatrics reported. Furthermore, 35 percent of the children in the
study received prescriptions for two types of these drugs, and 15 percent had
three or more prescriptions, the study found.
"Drug therapies are by no means a substitute
for the behavioral approaches," Elsabbagh said. "They tend to be
viewed as a complementary approach that overall fits within the child's
treatment plan, but are a not a child's substitute for what therapies can do."
What's more, the market is inundated with
alternative treatments and diets that are not clinically proven to help people
with autism. "Sometimes the parents think these are substitutes and they
choose not to put their children in behavioral treatments," Elsabbagh
said. "And that takes away every chance the child could have to have a
more validated option."
Adults with autism
Most autism research focuses on children, but
more researchers are beginning to examine how the disorder affects the lives of
adults. Relative to the general population, fewer adults with autism enroll in
higher education, find a job or transition to independent living, research
shows.
About one-third of young adults with autism
attend college within eight years of leaving high school, said Anne Roux,
senior research coordinator at the Life Course Outcomes research program at the
A.J. Drexel Autism Institute at Drexel University in Philadelphia. Her team
used data from the National Longitudinal Transition Study-2, a nationwide
database that surveys students in special education programs.
About half of those with autism found a paying
job within the first eight years outside of high school, she said. In
comparison, 98 percent of typical people and 91 percent of people with
disabilities in general find paying work in that time frame.
"The autism number is quite a bit lower than
that, and that's the concern," Roux said. "You can see that they
struggle a lot early on." About half are not connected either to school or
to work within two years of leaving high school.
Furthermore, about 80 percent of young adults
with autism continue to live with their parents after high school, which is
more than the general population and adults with disabilities in general, Roux
said.
Researchers plan to study how school and
community programs can prepare students and young adults with autism with life
skills that will help them gain independence as they age, she said
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