Autism spectrum disorder (ASD), or autism, encompasses a diverse range of brain developmental conditions. The disorder manifests in early childhood but is often not recognized and diagnosed until later. In the United States, roughly one in every 36 children has been diagnosed with autism, with prevalence increasing by 178% since 2000.
Those with the condition range from high functioning to severely debilitated, with autism impacting all areas of life, including learning and employment opportunities. Social and communication problems can lead to victimization and bullying, social isolation, learning delays, stressful family dynamics, and, later, an inability to function, work, and live independently.
According to Discovery ABA, around three-quarters of autistic adults are unemployed, and 40% of children with ASD are nonverbal. With some with autism requiring full-time help and care, the disorder can also take its toll on families and caregivers.
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What Is Autism?
The main characteristic of ASD is some level of difficulty in communication and social interactions, often accompanied by atypical behavioral patterns. It includes ailments previously perceived as separate, such as childhood disintegrative disorder, unspecified pervasive developmental disorder, and Asperger’s syndrome.
These traits include hyperfocus on details, challenges in switching between activities, and unexpected reactions to stimuli and sensations. Intellectually, the disorder presents differently across individuals, from superior intelligence to disabling impairment. Those with ASD frequently also experience comorbidities such as anxiety, depression, attention deficit hyperactivity disorder (ADHD), and disruptive behaviors such as self-harm and sleeping challenges.
What Causes Autism?
There is no one leading known cause or cure. Several factors contribute to developing the disorder, including genes and the environment.
Various genes may be responsible, including mutations and genetic conditions such as Fragile X and Rett syndrome. For some individuals, genes may impact how their brains develop and function, for example, how their brain cells communicate. At the same time, environmental contributors, such as air pollutants, medications, pregnancy complications, and viruses, may trigger symptoms. Risk factors include:
- Family history: Families with one child with ASD are more likely to have another.
- The child’s sex: Boys are four times more likely to develop autism than girls.
- Preterm birth: Babies born before 26 weeks are at increased risk.
- Other genetic disorders.
- The age of the parents: Older adults are more likely to have children with ASD.
There is no way to prevent autism, and no cure is available. However, early and intensive treatment can significantly relieve symptoms and improve functioning and quality of life for those with autism and their families and caregivers.
What Are the Signs and Symptoms of Autism?
Symptoms can occur in early infancy, while others may manifest later. Most are present by age two. Initial signs may include a lack of responsiveness, indifference to caregivers, and reduced eye contact. Later indications include a loss of language skills or withdrawal.
Typically, those with ASD show signs of delayed development, have learning difficulties or struggle to apply what they learn to everyday tasks and social interactions. Crucially, each case is unique, with every child presenting differently in behavior and intensity.
A list of common symptoms includes an individual:
- Resisting holding or cuddling.
- Not responding to their name.
- Appearing not to understand simple requests or questions.
- Not speaking or battling to speak.
- Repeating words or sentences verbatim.
- Low levels of showing curiosity, pointing out, or sharing items of interest
- No conversing except to make requests.
- Speaking in a singsong or robotic voice, abnormal rhythm, or tone.
- Retreating into their own world.
- Lack of facial expression and eye contact.
- Non-recognition of nonverbal clues in facial expressions, voice tone, or body postures.
- Not expressing feelings and lack of awareness of others’ emotions.
- Showing inappropriate social interaction, including unusually disruptive, aggressive, or passive behavior.
In addition, there may be repetitive, limited behaviors, activities, or interests. These patterns can include:
- Atypical light or touch sensitivity while also oblivious to temperature or pain.
- Hand flapping, spinning, rocking.
- Focusing on specific foods and refusing others.
- Not engaging in make-believe behavior.
- Harmful behaviors such as head banging or biting.
- Peculiar rituals and routines with distress if not followed.
- Clumsiness, walking on toes, or unusual movements such as exaggerated or stiff body language.
- Fascination with details while not understanding function.
The amount and variability of symptoms can make identification, treatment, and management challenging. However, the occurrence or severity of the patterns often reduces with age. If you notice symptoms and are concerned, it’s best to see a medical professional, as ASD is one of several disorders that may be responsible.
How Is Autism Diagnosed and Assessed?
Doctors recommend conducting developmental tests when children display language, cognitive, and social skill delays. If your child doesn’t do any of the following by the expected age, it may be time to see your doctor:
- Smile or respond with a cheerful expression by six months.
- Mimic facial expressions or sounds by nine months.
- Vocalize with coos or babbles by 12 months.
- Gesture with waves or points by 14 months.
- Vocalize with single words by 16 months.
- Play “pretend” by 18 months.
- Vocalize with two-word phrases by 24 months.
Also, consider booking an appointment if your child loses language skills at any age. Identifying severity is usually based on the intensity of impact on functioning and well-being.
Unlike many physical conditions, there is no blood or other tangible test that can determine the presence of ASD. Instead, the medical professional assesses your child’s behavior and developmental history. Diagnoses can be possible from 18 months of age or even earlier. Still, many aren’t diagnosed and helped until they are adolescents or adults.
Monitoring abilities and skills versus expected milestones can help professionals understand and assess progress and behavior. Your doctor, too, will conduct developmental monitoring through questions and play. They may also administer developmental screening – a regular element of well-child visits with or without known disorders. In this more formal assessment, your doctor or nurse may ask about your child’s thinking, language, movement, behavior, and emotions, including completing a questionnaire.
According to the American Academy of Pediatrics (AAP), behavioral and developmental screening should be conducted routinely. It should happen at nine, 18, and 30 months, with ASD-specific screening done at 18 and 24 months. However, if you, another caregiver or a medical professional have any concerns, screening should occur as soon as possible.
If screening tests indicate a concern, a formal evaluation by a specialist is needed. These professionals could be child psychologists, developmental pediatricians, occupational therapists, and speech-language pathologists. This specialist assessment may include additional tests, questions, surveys, genetic testing and counseling.
If this evaluation results in an ASD diagnosis, your specialist will discuss intervention options and recommend a personalized treatment protocol. Evidence-based psychosocial interventions are ideal for enhancing social and communication skills and improving the well-being of people with ASD and their caregivers.
How Is Autism Treated?
The experience of ASD and its challenges can vary widely across diagnosed children and adults. As a result, personalized therapy routines can also differ significantly. In addition, one or more primary care professionals and specialists may be required. Treatment focuses on reducing symptoms to improve functioning and daily quality of life. It can be provided at home, health, community, or educational institutions.
Recommended modalities could include:
- Developmental – such as speech and occupational therapy for improving skills.
- Psychological – cognitive behavioral therapy to help manage mental health symptoms that occur in almost eight in every ten children with autism.
- Educational – focusing on visual learning and consistency.
- Social-relational – improving social and emotional skills.
- Behavioral – to help adjust responses and reactions.
Pharmaceutical or complementary medicines are also used not to address any core ASD symptoms but to help relieve co-occurring problems such as depression, self-harm, high energy levels, and sleep issues.
Research has confirmed that behavioral approaches have the best results. Applied Behavior Analysis (ABA) is the leading modality with the most supporting evidence. It is broadly accepted by healthcare professionals, educators, and clinics. Support and therapy will likely be lifelong and adapted to each life stage to help people with autism thrive, potentially including transportation and housing.
What Is Applied Behavior Analysis?
This therapy aims to discourage undesirable behaviors and replace them with healthier habits to improve various skills. Two teaching methods are used – Discrete Trial Training (DTT) and Pivotal Response Training (PRT).
The first (DTT) employs detailed, step-by-step instructions to teach a preferred behavior. These guidelines are broken down into bite-sized portions, rewarding healthier responses and ignoring poor behaviors.
The second (PRT) focuses on a few “pivotal” skills deemed most likely to help someone with ASD learn other skills. For example, teaching a child with autism how to initiate communication differently may help them build their conversational abilities and social skills and develop and strengthen emotional bonds.
Both approaches are practical and effective. However, some children and adults with autism are unable, for reasons such as mental health, behavioral, or functional challenges, to attend therapy locations physically. In this case, technological advances can bring a range of therapies into the home through telehealth and online therapy for autism.
What Are the Benefits of Online Therapy for Autism?
Essential modalities such as occupation, speech, and ABA therapy are available online. This “virtual” approach can keep therapy on track and consistent during downtimes or be used as a primary therapy vehicle. In addition, conducting treatment via electronic audio, video, and app messaging provides the following advantages:
- Easier access to therapy – no need for transport.
- Increased parent training and involvement.
- Training in a natural rather than clinical environment.
- Increased child and parent comfort and sense of safety.
- Flexible session times – therapy is available in the evenings and on weekends.
- Help when you or your child need it – asynchronous feedback and messaging available beyond real-time therapy session times.
- The ability to emulate complex social situations virtually.
- Almost unlimited access to stimulating digital props aligning with the patient’s interests.
- It has proven as effective as on-premise therapy.
Vitally, as highlighted by Stanford psychologist Grace Gengoux, online intervention often provides enticing motivation to begin and maintain therapy among those with ASD. She reports, “These are the core skills that children with autism need to practice – but using their interests, which are at our fingertips when we’re online.”
Moreover, convenient online therapy platforms offer aligned therapist matches for tailored treatment, affordable rates, efficient systems and technical support, and needs-driven subscription durations. BetterHelp is one such provider, offering a network of over 30,000 credentialed and experienced professionals.