Autism is a pervasive, persistent developmental disorder. Symptoms can be detected at approximately eighteen months and may persist for a person's entire life. The cause of this disorder is unknown. There is no cure, but there are several effective treatments.
Diagnosis
Autism has three primary diagnostic criteria; difficulty in communicating, difficulty in socializing, and restricted interests.
An autistic person may have difficulty in communication; both the physical act and the meta-knowledge of the purpose of communication. People with more severe autism often have highly restricted vocabularies and subjects they are able to communicate about. They will typically not ask questions or initiate communication with others. Many autistic children have delayed or absent development of vocal communication, relying instead on physically prompting others. Intervention frequently focuses on developing vocal communication skills, the use of questions and requests, or development of alternate methods of communication.
For a long time, autistic people were believed to have an underdeveloped or absent "theory of mind"; that is, recognizing the desires and intentions of others. However, new research in the 2010's and onward has led to an alternate theory known as double empathy
which proposes that autistic individuals have the same capacity for empathy, but that the two groups approach communication differently. This leads to a perceived lack of sympathy and empathy due to their difficulty in parsing the feelings of non-autistic people. Many also have difficulty in recognizing voice tone, facial expressions, or other social signals from non-autistic individuals. Some people with autism also have difficulty with the abstract or imaginary, leading to difficulty in social interaction and play. Intervention focuses on recognizing social cues, emotions, and proper polite behavior.
Restricted interests is the symptom most frequently recognized in media, but the least significant medically. A person with autism may develop an interest in a narrow range of subjects, and limit their communication almost exclusively to these things. This extends to their living habits; frequently people with autism have a very restricted diet due to their unwillingness to try new foods. On average, people with autism engage in less outdoor and community activities. This limited diet and lack of activity lead to health concerns in many people with autism. Intervention focuses on flexibility, rewarding new behavior, and using preferred behavior as a reward for accomplishing other goals.
Autism is also sometimes accompanied by sensory processing difficulties, which can lead to sensory overload if the source of over-stimulation isn't either switched off or removed from the environment (or the person if it's a tactile issue with clothing). Examples of sensory processing difficulties can include, but are not limited to:
- Certain colors, patterns, or speeds of flashing lights or colors can cause distress, similar to how some speeds of strobe-light can trigger seizures in epileptic people.
- Extremely severe panic attacks triggered by sudden, loud noises. This one is very commonplace among autistic individuals.
- Aversion to certain tactile stimuli, or textures. This can make certain clothing unbearably uncomfortable for an autistic person to wear, or make certain food unpalatable due to its texture, even if its flavor is agreeable.
Autism is a medical condition and as such a formal diagnosis must be conducted by an appropriate medical doctor. Many experts believe that autism has been over-diagnosed due to loose criteria; the definition is expected to tighten in the DSM-V. Symptoms can be recognized by adults for further study. A California ad campaign recommended seeking a diagnosis if your child did not know 200 words by the age of 2. A parent can also look for their child being unwilling to engage in cooperative or imaginative play with others.
Causes
The underlying mechanism of the observed symptoms of autism is currently thought to be significant differences in the structure and function of the brain. These differences vary significantly among persons with autism, meaning each individual can present in very different ways. Brain development is possibly the most complicated part of human development, so a multi-hit hypothesis is most likely. That is, autism is due to the cumulative effect of several factors on an individual rather then a single controlling cause.
Several factors are known to increase risk of autism. Older age and obesity in either parent increases risk. A family history of autism increases risk. Being male increases risk. Exposure to substances and situations that are known to cause other developmental differences also increase the risk of autism. Auto-immune responses in mother and child increase risk.
Other factors have been decisively ruled out as increasing risk. These include vaccination, parenting style, and parent personality. Exposure to heavy metals may increase risk, but this is considered a minor factor by scientists.
Treatment
There is no medicinal intervention for autism, although drugs may be used to regulate symptoms in some cases. Treatment focuses on intense behavioral interventions to enhance life skills and reduce harmful behaviors. These generally focus on improving communication skills, improving social skills, and increasing range of interests.
Example: SJ selects only green pieces when playing board games and slams the ground when not allowed to use them. SJ is given a check sheet with five boxes; each time he uses a piece that is not green, he receives a check. When the five boxes are filled, SJ is allowed a preferred activity (time on an iPad).
Example: TK brushes against people when walking in public. TK is given training by holding her elbows out and walking through a room past her aide. If she is able to do so five times, she can move on to the next activity. The phrase "personal space" is used as a reminder when she goes into public.
Example: UL uses only single words when requesting items, such as "ball". UL is taught the word "want" and is gradually only given a ball when he uses the phrase "want ball".
Each autistic person expresses the condition differently, so interventions must be designed in consultation with a trained professional. However, once designed interventions can be given by anyone, such as parents, with only minimal training.
Care must be taken that treatments are intended to enhance the independent functioning, autonomy, and dignity of the autistic individuals. Common negative side effects of behavioral therapy include inappropriate repetition of therapeutic language and techniques, over-dependence on prompts, and suppression of emotion.
One discredited form of treatment is aversion therapy, most commonly associated with electroshock or spanking. This kind of therapy has been repeatedly proven to be ineffective at controlling behavior and is rightly condemned as unethical. Aversion therapy should never be used for any condition; sadly, the practice does continue in some places.
Many autistic adults and self-advocacy groups have challenged the current status-quo of treatment for individuals with autism, on the grounds that treatment is too often based on making things easier for those who are not autistic, rather than helping autistic individuals maximize their potential. Examples include trying to eliminate "stimming" behavior and pushing verbal speech as a measure of success.
This is closely tied to the neurodiversity movement, which takes the stance that rather than being a solely medical disease that needs to be "cured," autism is best understood as a combination of some differences in understanding and perception, some impairments, and some social barriers to achievement and acceptance. Neurodiversity started in the autistic community, but has since broadened to include a variety of neurological conditions. The movement itself is rooted in the social model of disability, which distinguishes between the actual impairments and limitations of a person's condition (e.g. a paraplegic who is unable to walk) and the social barriers that those people face (e.g. buildings with only stairs).
Often, the behaviours seen as problematic are attempts to cope with the aforementioned sensory processing issues. As a result, the following measures can often prevent many of the behavioral problems from even showing up in the first place:
- Sunglasses to ease the effects of lighting that's too bright.
- Noise-cancelling headphones, or failing that, earplugs, to block out the worst of loud ambient noise.
Life
Autism has a spectrum and encompasses a wide number of people with varying severity. This can range from a person who is completely non-vocal and self-harming, to a person who merely feels awkward in social situations due to not following subtle shifts in mood.
Autistic people have a normal distribution of intelligence. However, autistic people as a group have a lower measured average IQ than the whole population. This is probably due to reduced question asking, reduced social interaction, limited interests, and difficulty in taking tests.
Ninety-five percent of autistic improve with intervention. Early intervention is preferred with the greatest improvement shown when intervention is done at an early age. Focused behavioral interventions can improve the life quality and development of nearly all people, so it is better to intervene than to wait to see if development starts on its own.
An approach gaining traction is providing nonverbal autistic people with AAC (Augmentative and Assisted Communication) in the form of electronic speech synthesizers that use pictorial buttons to allow the patient to communicate in a way they find most usable.
