Autism

When people refer to “Autism” today, they are usually talking about Autism Spectrum Disorders (ASD), which are five complex, brain-based disorders that affect a person’s behavior as well as social and communication skills. The Centers for Disease Control describes ASDs as:  "developmental disabilities that cause substantial impairments in social interaction and communication and the presence of unusual behaviors and interests. Many people with ASDs also have unusual ways of learning, paying attention, and reacting to different sensations. The thinking and learning abilities of people with ASDs can vary—from gifted to severely challenged. An ASD begins before the age of 3 and lasts throughout a person's life." 

Autism is four times more likely to affect boys than girls, and is found in all racial, ethnic, and social groups. There is no known single cause for autism, although the best available science points to important genetic components. Through twin studies, scientists have determined that autism is a genetically based condition. If one identical (monozygotic) twin has autism then there is an 80-90% chance that the other twin will also be diagnosed with an autism spectrum disorder. For non-identical (dizygotic) twins the chance is about 3-10% that both twins will develop autism spectrum disorder. The chance that siblings will both be affected by ASD is also about 3-10%. 

Scientists are unsure what, if any, environmental triggers may be involved in autism.  One theory, popular in the late 1990’s and early 2000’s, that vaccines cause autism, has since been disproven by numerous studies conducted around the world. 

Autism Spectrum Disorders are characterized by significant impairments in social interaction and communication skills, as well as by the presence of extremely challenging behaviors.  Such behaviors include repetitive motor behaviors (hand flapping, body rocking), insistence on sameness, resistance to change and, in some cases, aggression or self-injury. Many individuals with an autism spectrum disorder have significant cognitive impairments, although some have typical or even above average IQs.  30-50% of people with autism also have seizures.

Dr. Leo Kanner first described autism in 1943.  He reported on eleven children who showed a marked lack of interest in other people, but a highly unusual interest in the inanimate environment. Initially, autism was thought to be an early form of schizophrenia, which led to the belief that its onset could be caused by negative experience or bad parenting. We now know that this is not the case.

There are five Autism Spectrum Disorders, sometimes called Pervasive Developmental Disorders (PDD):

  • PDD-NOS (Pervasive Developmental Delay - Not Otherwise Specified).
  • Autism (sometimes referred to as Classic Autism, Early Infantile Autism, Childhood Autism, or Autistic Disorder)
  • Asperger Syndrome
  • Rett Syndrome
  • Childhood Disintegrative Disorder

Signs for Infants and Children

Early signs of autism can often be detected in infants as young as 6-18 months. For example, if a baby fixates on objects or does not respond to people, he or she may be exhibiting early signs of an autism spectrum disorder.

Older babies and toddlers may fail to respond to their names, avoid eye contact, lack joint attention (sharing an experience of observing an object or event by gazing or pointing), or engage in repetitive movements such as rocking or arm flapping. They may play with toys in unusual ways, like lining them up or focusing on parts of toys rather than the whole. Parents who notice these signs, or are concerned their children are not meeting developmental milestones, should contact their pediatricians and request a developmental screening. The American Academy of Pediatrics recommends routine screening of all infants for autism as part of 18-month and 24-month well-baby examinations. 

Learn more about the early warning signs of autism including milestones for development up to age 5and what to do if you are concerned.

Early diagnosis and early intervention are critical. Studies show that about half of children with autism who are in an evidence-based early intervention program from age 3-5 can gain enough skills to be mainstreamed for kindergarten. There are now evidence based interventions for babies as young as 12 months old, and studies are underway to design treatments for 9 month old babies at risk for autism.

Signs for Adolescents and Adults

Although autism is commonly diagnosed in children, it is possible that an ASD does not go diagnosed until adolescence or adulthood. In this population, autism manifests itself as difficulties in socialization, atypical communication, and restricted mental flexibility. Just like for children, certain red flags can suggest that an adult may have autism. These signs can appear at any stage of adulthood, be it age 19 or age 60.  Just as getting a diagnosis at a young age opens the door to therapies and medications that can prove effective, an adult diagnosis can help improve the quality of life of higher-functioning autistic adults.

It can be difficult to propose that someone has autism, especially when they have lived most of their lives without a diagnosis. In most cases, diagnoses are meant to serve as explanations for particular behaviors that may have been overlooked or attributed to other difficulties earlier in life. The Asperger’s Association of New England suggests that, when telling a person that he or she may have autism, it is best to lead with positive behavioral traits then follow with traits that could be attributed to autism. They explain that a person may respond with denial, relief, or anger, but, in most cases, recognizing the characteristics of autism can provide affected individuals with a new level of self-awareness. If you suspect that you or someone you know has autism, look out for these traits and contact your doctor for more information:

  • Anxiety in social situations
  • Trouble empathizing
  • Difficulty understanding body language, gestures, facial expressions, social innuendos
  • Trouble forming and maintaining relationships
  • Difficulty making conversation (particularly chatting, making small talk)
  • Trouble understanding or practicing socially appropriate behaviors
  • Trouble understanding double meanings
  • Anxiety in group settings
  • Tendency to interpret information too literally
  • Difficulty making eye contact
  • Restricted or unique interests (such as obsessions with dictionaries or encyclopedia facts)
  • Obsession with rigid routines and sameness
  • Trouble making plans for the future

Sometimes, a person will establish a self-diagnosis of autism based on independent research and self-observations. However, a medical diagnosis is required to be eligible for government support resources for adults with disabilities. Additionally, an official diagnosis can lead to insights about behavioral strengths and weaknesses, which can help individuals plan for the future. To acquire an official diagnosis, ask your primary care doctor for a referral to a clinical psychologist or a psychiatrist.

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