What is Autism Spectrum Disorder?

Autism Spectrum Disorder Photo credit: Jerry Wang on Unsplash

Perhaps you’re a parent hoping to gain some insight into your child’s development and are concerned that your child might possibly have Autism Spectrum Disorder (ASD). Please note, a proper diagnosis will require having your child properly evaluated by a professional.

Reading through this post is merely the first step in a journey towards your child’s health, well–being and ultimate adult well adjustment that will involve their pediatricians, educators, therapists, coaches and family members.

Whatever your reasons for wanting to educate yourself on this subject, this post will provide you with the information you need to seek additional resources and be a more informed parent and member of your community.

The Definition of Autism Spectrum Disorder

ASD is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Parents often notice signs during the first three years of their child’s life. These signs often develop gradually, though some autistic children experience regression in their communication and social skills after reaching developmental milestones at a normal pace.

While ASD begins early in life it has no cure, only various treatments. The wide range of ASDs affects each person differently. There are certain individuals who do improve their symptoms enough to eventually test off of the spectrum. The earlier a child gets treatment, the better their outcome.

Formerly referred to simply as “Autism”, this diagnosis is currently known as Autism Spectrum Disorder. This is because there are five different disorders that fall under the term of “autism”, which have different symptoms and severities, but are related enough to be categorized together.

To keep our timeline straight, these five individual disorders, including Asperger Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD–NOS), were all combined under the umbrella of ASD in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). See our related post on The History of Autism Spectrum Disorder for a more detailed background on the timeline development of this condition.

The Prevalence of Autism Spectrum Disorder

In 2014, the U.S. Centers for Disease Control (CDC) reported that 1 in 68 school–aged children were diagnosed with ASD. More recent statistics place that number much higher, reporting 1 in 40 children aged 3 and older have been diagnosed with ASD.

Globally, as of 2015, ASD was estimated to affect 24.8 million people. In the 2000s, the number of ASD people worldwide was estimated at 0.001%–0.002% of the population. In the U.S., about 1.5% of children were diagnosed with ASD as of 2017 up from 0.7% in 2000.

There are 3 million people in the United States with ASD and tens of millions worldwide. This is a 1,000% increase in the last 40 years, and research shows that this change can only partially be explained by better awareness and diagnosis markers.

In 2013, an estimated $305.6 million went towards researching ASD. These funds paid for research on the causes, treatments, diagnoses and services of ASD. ASD diagnoses transcend racial, socioeconomic, and ethnic groups. The CDC’s latest research puts the incidence of ASD at 4.5 times more likely among boys than girls.

The Causes of Autism Spectrum Disorder

The short answer is: there is no single, simple answer. Some research points to a combination of genetic and environmental factors that may or may not play a role in the diagnosis.

Autism Speaks outlines three categories of risk factors that can contribute to ASD:

Genetic
Environmental
Brain biology differences

Some research supports that any one, or combination of these risk factors may result in an ASD diagnosis but, just as every child is different, every potential “cause” or “combination” of risk factors manifests differently for every child.

Here are some of the risk factors for ASD supported by research:

Family history of ASD (sibling, ancestor)
Parents’ advanced age
Genetic mutation
Gender—boys are 4–5 times more likely than girls
Premature birth (any prior to 26 weeks)
Individuals with certain genetic or chromosomal conditions such as Fragile X or Tuberous Sclerosis

Researchers are also investigating the potential factors of exposure during pregnancy and early childhood to certain infections, such as rubella, toxins including valproic acid, alcohol, cocaine, pesticides, lead, air and water pollution, fetal growth restriction, and autoimmune diseases, as well as the use of in vitro fertilization (IVF) for multiple births.

Controversies surround other proposed environmental causes; for example, the childhood immunizations vaccine hypothesis, which has since been disproven.

The Centers for Disease Control and Prevention is currently conducting a Study to Explore Early Development (SEED) across communities nationwide, to better understand potential risk factors for autism.

Autism Spectrum Disorder Photo credit: Vanessa Bucceri on Unsplash

Early Signs of Autism Spectrum Disorder

Your child’s pediatrician will screen your child for ASD at well–check visits at 18 months and 24 months. However, parents should always communicate concerns regarding their child’s development at any time. This article from American Academy of Pediatrics outlines what a well–check screening for ASD might look like.

The possible signs of ASD fall into three categories:

Social differences
Communication differences
Behavioral differences (repetitive and obsessive behaviors)

A skilled clinician who is trained in screening for ASD will be able to explain how these differences surpass other general developmental delays. Check our list of resources at the bottom of this post for further reading on the early signs and symptoms associated with ASD.

Should you have concerns about your child and would like to pursue screening for ASD beyond your pediatrician’s capabilities, contact your state’s Early Intervention or “Birth to Three” program. This directory of Early Intervention programs available at Autism Speaks will provide you with websites, phone numbers, and relevant information based on your state of residency.

A screening does not necessarily result in a diagnosis of ASD. If additional testing based on the findings of the screening is required, you’ll need a referral to a specialist trained in the diagnosis of ASD.

Evaluating For Autism Spectrum Disorder

In order to properly diagnose ASD, a specially–trained clinician such as a child neurologist, neuropsychologist, psychologist or developmental pediatrician will administer a lengthy and comprehensive evaluation that directly assesses your child’s skills in terms of social interaction, language and communication, and behaviors.

Pediatric Developmental Screening Flowchart Photo courtesy of the CDC

An evaluation for ASD is typically comprised of observational data by a clinician and parent input. Tests commonly used in an ASD evaluation are:

Autism Diagnosis Interview–Revised (ADI–R)
Autism Diagnosis Observation Schedule (ADOS)
Childhood Autism Rating Scale (CARS)
Gilliam Autism Rating Scale (GARS–2)
Communication and Symbolic Behavior Scales (CSBS)

The Autism Diagnosis Observation Schedule (ADOS) is the diagnostic tool that is most commonly used to evaluate a child for ASD. The Child Mind Institute does a great job explaining each of these tools and what parents should expect from an ASD evaluation—including good questions to ask of your clinician.

Overview of An Autism Spectrum Disorder Diagnosis

Autism Speaks provides parents with the most recently revised diagnostic criteria for ASD as published by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) outlined below:

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:
- Deficits in social–emotional reciprocity,
- Deficits in nonverbal communicative behaviors used for social interaction,
- Deficits in developing, maintaining, and understanding relationships
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal–nonverbal behavior
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper– or hypo–reactivity to sensory input or unusual interests in sensory aspects of the environment
Symptoms must be present in the early developmental period
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Regardless of your child’s status–whether they have an ASD diagnosis, are awaiting an evaluation, or show signs of other developmental delays–they can still receive skilled intervention and therapies.

Therapies for Autism Spectrum Disorder

No treatment has been proven to cure ASD, but several interventions (therapies) have been shown to reduce symptoms and improve the ability of autistic people to function and participate independently in a community. Behavioral, psychological, education, and skill–building interventions may be used to assist autistic people to learn life skills necessary for living independently, as well as other social, communication, and language skills.

Clinicians set measurable goals and align therapeutic activities with those goals in order to help your child make progress. Children with ASD benefit from therapies to improve developmental skills including language, communication, social skills, motor skills, academic skills, and life skills. Some examples of beneficial therapies for children with ASD are:

Occupational Therapy—sensory integration therapy
Physical Therapy
Speech & Language Therapy
Applied Behavior Analysis (ABA)
Hippotherapy—equine–assisted occupational therapy
Social Skills Classes
Floortime
Relationship Development Intervention (RDI)
Pivotal Response Treatment (PRT)
Verbal Behavior Therapy
SOMA–RPM: Rapid Prompt Method

In addition to these therapeutic interventions, more alternative therapy approaches have gained popularity for treating symptoms associated with ASD. While many of the above–mentioned therapies are rooted in evidence–based outcomes and research, these alternative therapies are backed by varying degrees of scientific proof. As with any intervention, parents should consult their physicians before embarking on any form of therapy.

Dietary supplements (omega–3, melatonin, probiotics)
Gluten– or casein–free diets
Qi Gong Sensory Massage
Hyperbaric Oxygen Chamber

Autism Spectrum Disorder and Sensory Processing

Sensory processing is the way that our central nervous system takes in information through our senses, internally processes that information, and then signals us to respond appropriately. ASD affects information processing in the brain and how nerve cells and their synapses connect and organize; making our body’s responses atypical. How this occurs is not yet well understood. This effect can be observed as motor, language, or behavioral skill difficulties.

Occupational therapists diagnose this inability as Sensory Processing Disorder (SPD). While Sensory Processing Disorder is not recognized as an independent diagnosis in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Based on their research, the STAR institute estimates that 75% of children with ASD display significant symptoms of SPD.

For people with ASD, the sensory processing dysfunction can manifest in language delays, fine and gross motor delays, strong sensory interests, sensory aversions, an inability to interact with people and objects, an inability to stay within an interaction and repetitive sensory stereotypies (stimming).

Therapy also aims to reduce challenging behaviors and build upon strengths. ASD manifests in varying degrees of severity, such that some autistic adults may not ever be able to live independently. As awareness to ASD has increased in our culture, individuals have fallen into two factions: those seeking a cure, and those believing ASD is simply just a difference to be accepted instead of cured.

Sensory Processing Disorder Resources

Autism Spectrum Disorder in the Movies

This list of the 10 Best Documentaries about ASD

Web Resources

There are many professional organizations that aim to educate parents on ASD.

Additional Resources

Here are some resources on the early signs and symptoms associated with ASD.

Sources:
WHAT IS AUTISM SPECTRUM DISORDER?
https://harkla.co/blogs/special-needs/autism-spectrum-disorder
by Alescia Ford-Lanza MS OTR/L, ATP April 04, 2018
WHAT IS THE HISTORY OF AUTISM SPECTRUM DISORDER?
https://harkla.co/blogs/special-needs/history-of-autism
by Casey Ames March 30, 2018
The history of autism
https://www.autism.org.uk/advice-and-guidance/what-is-autism/the-history-of-autism
Historical Perspective
https://www.nationalautismcenter.org/autism/historical-perspective/
Wikipedia – Autism
https://en.wikipedia.org/wiki/Autism
How autism became autism
The radical transformation of a central concept of child development in Britain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757918/
by Bonnie Evans

The Repurposing Life