Meetaut! https://meetaut.com The #1 App for Autism Mon, 13 Jan 2020 13:56:15 +0000 en-US hourly 1 https://wordpress.org/?v=5.3.4 https://meetaut.com/wp-content/uploads/2020/02/cropped-Ribbon-favicon-32x32.png Meetaut! https://meetaut.com 32 32 What is Asperger’s Syndrome? https://meetaut.com/what-is-asperger-syndrom/ https://meetaut.com/what-is-asperger-syndrom/#respond Mon, 02 Dec 2019 09:57:09 +0000 https://meetaut.com/?p=2767 Asperger’s syndrome referred to individuals that showed an average, or above average, level of intelligence and learning abilities, but faced noticeable social communication issues....

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Disclaimer: Any information provided in this article is not meant to diagnose or treat. It should not replace the consultation with a professional qualified to deal with the autistic spectrum disorder (ASD).

Asperger’s Autism

Definition of Asperger’s Syndrome (“AS”)

Asperger’s syndrome refers to individuals that show an average, or above average, level of intelligence and learning abilities, but face social communication issues that affect their lives in a non-neglectable way.

The Asperger’s syndrome was diagnosed, until 2013 (DSM 4), in people that struggled with:

  • socialization, communication, friendships and, more in general, interaction with the external world;
  • non-verbal communication (challenges to recognize and classify signals like gestures, facial expressions, tone of the voice, eyes expressions and the emotional patterns of others)
  • emotional intelligence (failure to understand if other persons were happy or angry, or if someone was talking normally, sadly, or in an engaging way)
  • management of sensory inputs (like loud sounds)
  • narrow span of interests, and an obsessive focus on very few topics
Greta Thunberg officially diagnosed with Aspergers
Greta Thunberg has been officially diagnosed with Asperger’s syndrome

Asperger’s vs. Level 1 Autism (Difference DSM 4 and DSM 5)

Until 2013 and according to DSM IV, Asperger’s syndrome was classified as one of the five types of autism (a mild type, otherwise called, “high-functioning autism”).

In 2013, the American Psychiatric Association released the DSM-5 directive that, among other innovations, unified the symptoms of autism under the umbrella of a single pathology, called “Autism Spectrum Disorder” (ASD) with three levels of severity.

Therefore, Asperger’s disorder is no longer mentioned as a type of autism under DSM V, even if the symptomatology of “Level 1 ASD” matches “Asperger’s” quite closely.

With the introduction of DSM 5 the term “Asperger’s syndrome”, even if popular, is bound to become outdated. The new taxonomy shall be used for new diagnosis.

Asperger’s in girls and women

The diagnosis of Asperger’s disorder for girls and women is more challenging than men, due to women’s superior ability to camouflage social and communication deficiencies in the quest to be perceived as “normal”.

This may explain why Asperger’s disorder shows a remarkably higher incidence in men than women (figures may hide undiagnosed women).

Daryl Hannah Asperger
The talented and beautiful Daryl Hannah has been officially diagnosed with Asperger’s

The Asperger’s symptoms

a) Asperger’s symptoms in toddlers and children

The typical symptoms of Asperger’s syndrome in toddlers and children are:

  • lack of eye contact
  • lack of response to stimuli (child does not smile, doesn’t look at people talking or smiling, and shows signs of anxiety when touched, hugged or cuddled)
  • inability to read other people’s emotions (child doesn’t seem to understand the difference between an angry and a happy expression for instance)
  • flat tone of voice, lack of laughter, display of a cold (even robotic) personality
  • over interest in few topics and stereotyped behavior
  • distress in case of changes in routine (meals at the same time every day, things ordered in the same way, same way back and forth from school)
  • lack of mental retard (Asperger’s score average or above-average IQ)
Signs of Asperger's syndrome
The signs of the Asperger’s Syndrome (Source: Verywell)

b) Asperger’s symptoms in adults

A frequent question is “What are the signs of Asperger’s in adults”? The answer is: basically, the same listed for children. Of course, adults may have learned to cope with Asperger’s during the course of life, and the symptoms may show up in a mild, sometimes difficult to diagnose, way.

Asperger's in adults
Isolation and lack of social/empathy skills characterize Asperger’s adults and children

Asperger’s diagnosis

Asperger’s diagnoses have been made by psychologists, pediatric neurologists, psychiatrists, development pediatricians. Diagnoses involved multidisciplinary teams and were executed partly at the doctor’s facility, partly at school or outdoor, where the symptoms could be better observed.

Asperger’s syndrome, like other types of autism, seems caused by genetic mutations affecting the brain (specifically, its neural connections), that have quite interesting impacts also on the sensorial abilities of the affected individuals (as shown in the image below).

Asperger's brain vs normal brain
Asperger’s brains have a greater vision than hearing capacity (Source: BetterHelp)

Asperger’s therapies

With the correct intervention strategy, several children with Asperger’s managed to cope with their social and communication disabilities and become very successful later in life.

There are few examples of highly successful Asperger’s, like Bill Gates, Steve Jobs, and many others (success rate is high in professions where attention to detail and introversion are assets, like programming or engineering, and architecture).

The most frequently used therapies for Asperger’s are/were:

  • Speech therapy: the goal of this therapy is to give the child a more intense way of communicating, fighting the tendency to talk in a flat, boring and unemotional way, or to entertain two-ways conversations with other people (talk, listen, respond)
  • Social skills therapy: these therapies, executed 1:1 or in a group, aimed at improving the child’s ability to deal with other people, keep eye contact, use and understand the non-verbal communication and express her/his emotional intelligence.
  • ABA therapy (applied behavior analysis): the ABA therapy is based on a “positive reinforcement” playful approach, i.e. the child is rewarded in case of a positive development of her/his social and communication skills (and discouraged in case of dysfunctional behavior);
  • Family therapies: these are all the therapies that parents learn with specialized professionals and have to apply at home
  • CBT therapy (cognitive behavioral therapy): the goal of these therapies is to increase the child’s ability to control her/his emotional outbursts, changing the mood, and control repetitive behaviors. The child is stimulated with subjects beyond her/his monomaniac field of interest and helped to minimize obsessive behaviors.
  • Medicaments: as for any other disorder on the spectrum of autism, there is no specific medicine to treat the Asperger’s syndrome yet; some conventional medicines are used to relieve some symptoms associated with the core pathology, such as anti-depressants, stimulants, serotonin reuptake inhibitors (SSRIs), psychoactive drugs, sleeping pills to fight possible chronic sleep disorders.

What is the difference between Asperger’s and autism?

Simply said, the Asperger’s syndrome was/is as a mild type of autism. Asperger’s and autism share the same symptoms, with different intensity and impairment. After the publication of DSM V in 2013, children that would have been diagnosed as Asperger’s according to DSM IV are now diagnosed as level 1 ASD.

Asperger checklist

Some checklists have been developed in the past to diagnose Asperger’s syndrome.

Asperger checklist

Even if a number of checklists to diagnose Asperger’s are available, they all seem to revolve around similar questions:

  1. Does your child seem inflexible, i.e. does she/he show distress and anxiety anytime a routine is changed?
  2. Does your child struggle to develop close friendships and tends to isolate himself, not looking for companionship with peers and family members?
  3. Does your child avoid eye contact when talking with others, or when you talk to her/him?
  4. Does your child struggle to communicate with others, i.e. her/his conversations seem dry and not a real exchange of opinions?
  5. Does your child seem to lack emotional intelligence, i.e. understand own’s and other people’s emotions?
  6. Does your child explode at times, with uncontrolled anger and fear, over-reacting to stimuli that could be managed differently?
  7. Does your child talk obsessively about a few topics, repeating her/his arguments indefinitely and not accepting different viewpoints?
  8. Does your child focus on himself exclusively, not caring for the needs and the emotions of others?
  9. Can you observe stereotyped body movements and behaviors like hand flapping, strange ways to play with games, twirling?
  10. Does your child struggle to do things that are normal for her/his peers and are connected to motor skills (for example riding a bike or playing at soccer)?

What is the Autism Quotient test?

The Autism Quotient Test (or AQ Test), developed by Simon Baron-Cohen of the Cambridge Autism Research Center, is one of the most known Asperger’s checklists. The test is articulated in a number of questions and a final score in points (Asperger’s get scores above 32 points).

Simon Baron-Cohen (Cambridge Autism Research Center)
Simon Baron-Cohen (Cambridge Autism Research Center)

Even if the Autism Quotient test cannot replace an in-depth expert examination, it can be used to have a first rough indication of the likelihood of being Asperger’s. 

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The 6 Key Therapies to Treat Autism https://meetaut.com/how-to-treat-autism/ https://meetaut.com/how-to-treat-autism/#comments Mon, 02 Dec 2019 09:54:51 +0000 https://meetaut.com/?p=2764 An overview of the ASD treatment options: medical, nutrition, behavioral (ABA), and some innovative options. ...

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Disclaimer: Any information provided in this article is not meant to diagnose or treat. It should not replace the consultation with a professional qualified to deal with the autistic spectrum disorder (ASD).

There is no medical treatment for autism spectrum disorder (ASD). There are only a number of behavioral therapies whose scope is to reduce the symptoms of autism, improving the child’s ability to function in a better way and develop her/his social, communication, and learning skills.

Given the complexity of the disorder and the kaleidoscopic ways it surfaces, there is no one-size-fits-all treatment. Therapies shall be tailor-made to fit the specific challenges of each child or adult.

Autism treatment: behavioral therapies ABA

What is evident, is that early diagnosis and treatment of the disorder (even before the 24th month after birth) may produce long-lasting positive results.

2 years old children show better responses than older children, to therapies as they can impact the brain in a more incisive way, helping the child enhance her/his critical social, communication, functional and behavioral skills.

This is why it is vital to track child development as early as possible and detect any possible autistic trait as early as possible in life. Some doctors managed to diagnose autism in 8-12 months old children and implement effective therapies that resulted in improved long-term life conditions.

If the signs and symptoms of autism are evident, parents are recommended to start therapy even before an official diagnosis is issued.

Autism treatment options

Throughout the years, a high number of alternative home or school bases therapies have been conceived and tested.

Parents should talk to experts to define the best treatment strategy for the child, and keep it updated based on the child’s changing needs. Therapies are generally multidisciplinary and involve a team of experts with different competencies and backgrounds (medical doctors, psychologists, caregivers, and others).

The key therapies for the autistic spectrum disorder can be classified as follows.

1) Medical/Biomedical treatment for autism

There is no medical treatment that can fix the autism spectrum disorder at its core however some specific medications are effective for reducing its symptoms.

Medical treatment for autism
Isolated pills

There are, for instance, medications to reduce the child’s hyperactivity (attention-deficit), to relief the child from depression and anxiety (anti-depressants), to control her/his severe behavioral problems (antipsychotic), to fight sleep disorders (benzodiazepine), selective serotonin reuptake inhibitors (SSRIs), or to treat the typical neurological or physical problems experienced by autistic children (gastrointestinal and metabolic issues, seizures, obsessive-compulsive disorder, and epilepsy).

Unfortunately, antidepressants and antipsychotics are largely used for older children and adults as the only available remedy at that stage in life.

2) Nutrition-based ASD therapies (“Autism Diet”)

No special diet is prescribed to autistic children generally, however, the intake of proper nutrition is important given the known relations between the digestion system and the brain.

Gluten and caseine free diet for autism

Sometimes, parents eliminate gluten and casein from the food of their autistic kids based on the general belief that they may make the condition worse. Unfortunately, there is no research that proves that the removal of proteins in wheat and milk products (gluten and casein) may have a positive impact on ASD. On the contrary, bone-building foods are important for autistic kids which tend to have thinner bones than the average population.

3) ASD Behavioral and communication therapies

Behavioral therapies, which can be very intensive and challenging both for the child and the family, are the most used to treat the autistic spectrum disorder today. Their goal is to address the symptoms of ASD (social, language, behavioral skills), and help children learn new competencies (especially in the social and communication areas). Of course, the type of autism (severity level) has a direct impact on the selection of the right treatment strategy.

“A.B.A.” Therapy (Applied Behavioral Analysis)

ABA therapy for autism

The “ABA Therapy” is the most known and practiced anti-ASD behavioral treatment: it helps children learn new skills and then generalize their application to multiple situations based on a reward & positive compensation motivational system of incentives.

The main types of ABA therapy are listed below:

  • EIBI (Early Intensive Behavioral Intervention): This type of ABA targets children under 5 years old
  • DTT (Discrete Trial Training): the therapy aims at breaking down the desired behavior into simple steps that the child can master progressively
  • Pivotal Response Treatment (PRT): This play-based therapy is based on compensating the child with something that the child has requested, (even with a badly formulated demand that can be interpreted). Therefore, the therapy leaves the child the possibility to formulate requests and rewards her/him for being able to communicate a demand. PRT uses a similar approach of ABA and is called pivotal as the child triggers the response of the therapist (and not vice versa).
  • VBI (Verbal Behavior Intervention): a therapy that improves the verbal skills of the child

Floor-time Therapy

Fllortime autism therapy

The name of the therapy comes from the fact that parents get down to the floor with the child to play at her/his level and foster interaction based on what the child is doing in a specific moment. Being close to the child, and letting the child feel close to the parents, expands the openness of the child to communicate and interact. Parents play the child’s favorite games and let her/him lead the experience.

Floor-time (a therapy invented by Dr. Greenspan and Dr. Weider) is a therapy for children on the autistic spectrum, sometimes used alternatively or in conjunction with the ABA therapy.

Occupational Therapy for Autism (OT)

The scope of Occupational therapy for autism (OT) is to help autistic people develop their cognitive, physical, social, and sensorial skills to become more independent and participate in activities in multiple contexts.

The areas of focus are self-care (using the toilette, bathing, eating, drinking from glasses, using the cutlery, dressing, grooming, teeth brushing), playing abilities, learning abilities (writing, reading, painting, shaping objects), and sensory awareness.

Occupational therapy for autism

The occupational therapy for autism (OT) is articulated in 30- or 60-minutes sessions, whose number depends on the starting level of the child (that is assessed at the beginning of the therapy by the specialist). It can be practiced at home, at school or in dedicated locations (clinic).

Social Skills Class

Social skill class therapy aims at improving how a child interacts socially and forms bonds with other children and adults. It can be executed at home, at school, or in a spontaneous community (1:1 or in groups). The technique is based on learning via role-playing or practice. Likewise ABA, parents shall be trained upfront to continue the therapy at home, and help the autistic child improve her/his social skills.

“ESDM” Therapy (Early Start Denver Model)

The ESDM therapy is used for autistic children from 12 up to 48 months and is based on a methodology similar to the ABA (therapists and family members use fun, compensation and playing attitudes to build rapport with the kid and foster learning). The scope of the therapy is to enhance the child’s social, communication and cognitive skills.

The ESDM therapy can be practiced at home, at school or at the autism clinic (multiple contexts are always beneficial). It is open both to kids with and without learning disabilities, 1 by 1 or in groups. It requires the direct involvement of the parents, to continue the therapy once they are at home with the kid.

Horseback Riding or “Hippotherapy”

Hippotherapy for autism

The therapy is based on creating a bond between the child and a trained horse. The child rides the horse with the support of a therapist and learns to understand the movements of the animal and react to them.

The Hippotherapy has shown positive results (enhanced social and language skills) in autistic persons up to 16 years of age. It also seems to calm down the children, making her/him quieter and less hyperactive

Relationship Development Intervention (RDI)

Relationship Development Interventions (RDI) are behavioral treatments focused on building social and emotional skills in autistic kids (the ability to build relationships and connect with other people emotionally). The primary therapists are the parents, who are trained beforehand by skilled instructors.

The therapy also teaches the child how to be more flexible, evaluate multiple perspectives (instead of being single-minded), manage change in routines with lower anxiety and distress, make use of all senses in a coordinated way.

The RDI therapy, like ABA, uses positive reinforcement to help the child crystallize her/his learnings.

Speech Therapy

Speech therapy for autistic spectrum disorder

As the name indicates, the speech therapy goal is to improve the communication and speaking abilities of the child. The therapy exercises the verbal, nonverbal (sign, gestures, facial expressions, body language), and social communication skills (communication in groups, taking turns in a conversation) of the child.

This therapy is generally guided by a speech-language pathologist (SLP). Some physical exercises may also be included (for example mouth and tongue control to generate clear sounds).

Some Android and iOS applications are available to help autistic children improve their speech abilities (how to pronounce a word exactly, for instance). These are sometimes called “iPad therapy”.

Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH)

“TEACHH” uses visual cues, such as picture cards, to help children learn everyday skills like getting dressed and basic self-care. The inputs of this therapy are broken down into progressive steps to foster engaging and dynamic learning.

The Picture Exchange Communication System (PECS)

PECS therapy for autism

This is a visual-based treatment similar to TEACCH that uses symbols instead of picture cards. In brief, the child is pushed to ask questions and communicate with the therapist through special symbols.

Sensory Integration Therapy (SIT)

Most children on the autism spectrum suffer from sensory issues. This therapy is designed for autistic children that feel distressed by things like bright lights, loud sounds, or the feeling of being touched. The therapist exposes the child to the badly tolerated stimuli little by little, and in a playful way, helping her/him get acquainted with it progressively (for instance, if the child is irritated by human touch, the therapist will slowly keep on touching her/him while playing together until she/he becomes less sensible and irritated). The SIT therapy may help the child deal with sensory inputs in a more relaxed and natural way (however, no statistical data are available to prove the effectiveness of the SIT therapy for autism).

4) Hyperbaric oxygen therapy

Hyperbaric chamber therapy for autism

Some studies have reported that the hyperbaric chamber therapy (letting the child breath pure oxygen in a high-pressure chamber) can improve the social and learning abilities of autistic people in a significant way (including less irritability and repetitive behaviors).

According to the promoters of the hyperbaric chamber treatment, such benefits come from the de-inflammatory action of pure oxygen on the brain and the gastrointestinal apparatus of the treated child.

Unfortunately, most autism researchers believe that these conclusions are either questionable or biased (as the study has been promoted by an organization that promotes the hyperbaric therapy (and the equipment behind it).

To draw a line on the actual effectiveness of this therapy, more rigorous and independent analysis is needed.

5) Educational therapies

Autistic children tend to respond well to structured educational programs delivered by multidisciplinary teams. This type of ASD therapy shows good success when started early in life and followed intensively. Educational programs address the typical shortcomings of the autistic spectrum, such as behavior in social contexts and communication with others.

6) Family therapies

Any home-based therapy falls under this general category: parents learn how to interact, play and communicate with their autistic children to stimulate their social, communication and behavioral skills. Essentially, parents attend courses to understand autism better, its challenges, and how to behave at home with their child.

Which are the most effective therapies for autism?

There is no objective answer to this question. Each child on the autistic spectrum has a unique set of challenges that shall be addressed with a customized intervention strategy. Hence, the right question to ask is “what is the most effective therapy for my child?”.

What is highly effective for a child may be totally ineffective for another; this is where the experience of trained specialists comes into play. Parents shall refrain from “do-it-by-yourself” approaches when treating autism but find out with the support of a recognized professional the most indicated mix of therapies starting from the assessment of the child’s unique challenges. 

According to Autismspeaks.org, the 8 most effective therapies for autism according to 8.000 interviewed parents are:

  1. Occupational Therapy for autism – 39%
  2. Speech Therapy – 27%
  3. ABA Therapy – 15%
  4. Social Skills Classes – 8%
  5. Hippotherapy (OT through horseback riding) – 2%
  6. GFCF Diet – 2%
  7. Psychiatrist/Psychologist sessions – 2%
  8. (5-way tie, each with 1%): Floor Time, RDI, PECs, Swimming, PRT

Any other existing therapy for autism had a less than 1% response rate (mainstream schooling, vision therapy, aqua therapy, iPad therapy, special nutrition therapy, etc.).

These data have empiric rather than scientific nature; therefore, it is recommended to try different approaches with a specialized therapist and find out the best approach with a trial-and-error approach.

What seems undoubted, is that the earlier the treatment begins, the better the outcomes for the child (probably because the brain of younger children is more plastic and adaptable than older ones). Late diagnosis is the most common reason why therapies are ineffective.

Who can deliver the ASD therapies?

Autism therapies shall be conceived and delivered by specialized professionals only. Parents should check that the therapist in charge of their child possesses the necessary requisites. Despite these can vary country by country, authorized professionals are people that:

  • Have a master’s degree or Ph.D. in psychology or behavior analysis (therapists with bachelor’s degrees shall be assisted by higher-education therapists)
  • Have passed a national certification exam for the elected therapy (example ABA)
  • Have a license to operate as ASD therapist (this requirement may not apply in some countries)

The typical professional qualifications involved with autism treatment are:

  • (Child) Psychologists
  • Behavior specialists (BCBA)
  • Occupational therapists
  • Speech and language pathologists (SLP) or speech therapists
  • Early intervention specialists
  • Developmental pediatricians
  • Neurologists
  • Special education teachers with specialization on autism spectrum disorders
  • Autism specialists

Parents shall contact the autism associations in their countries to get the local lists of the authorized autism clinics or centers, and therapists.

Who Pays the Treatment for Autism?

There is no easy answer to this question, as it would involve an analysis country by country (which is a massive research task beyond the scope of this article).

In general, it is safe to state that in most countries with a public health system autism therapies are (at least partly) supported by state programs and backed by autism Laws; in countries with a private health system, insurances cover, at least, some of the most accredited therapies (example ABA or OT, occupational therapy for autism).

The main point to highlight, though, is that autistic people are no longer supported by state or insurance programs as they reach the age of 18 (or 21 in some countries) and the burden comes back on the shoulder of their parents (or family members) entirely.

Most autistic adults end up in mental disease centers when their parents die or can’t support them any longer. By hitting such centers, autistic adults lose any special support, are treated like the other people that have mental issues that have nothing to do with autism and are kept under control (when hyperactive) with psychoactive medicaments.

Psychiatric hospital for autism

This is one of the most tragic and dark truths of autism, a situation not acceptable for a modern society.

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The 3 Types of Autism (DSM 5) https://meetaut.com/different-types-autism/ https://meetaut.com/different-types-autism/#respond Mon, 02 Dec 2019 09:43:57 +0000 https://meetaut.com/?p=2761 The types of autism spectrum disorders according to the DSM 4 (up to 2013) and DSM 5 classifications (after 2013)...

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Disclaimer: Any information provided in this article is not meant to diagnose or treat. It should not replace the consultation with a professional qualified to deal with the autistic spectrum disorder (ASD).

The Autistic Spectrum Disorder (ASD) is a genetic condition that afflicts 1 in 59 newborns (US statistics). The disorder is characterized by some typical symptoms with changing intensity and combinations.

The term “spectrum” is used to represent that the level of social, communication, behavioral skills impairment differs individual by individual.

Until 2013, DSM-4 identified 5 types of autism; however, in 2013 the American Psychiatric Association revised such nomenclature, introducing the term “autism spectrum disorder” to give physicians, caregivers, and families a clearer taxonomy.

It is appropriate to review both the older and the newer classifications, as many individuals are still diagnosed according to DSM-4. The DSM-5, in place since 2013, is now the new standard that is applied to all new diagnoses.

DSM-4 classification (valid until 2013)

DSM American Psychiatric Association

Until 2013 people with autism were classified into five types (from moderate autism, or high functioning autism, to more severe forms, called low functioning autism).

As a matter of fact, the DSM-4 classification was somehow confusing, and therapists could understand the meaning of each type in a different way (leading to unstandardized diagnosis). For these reasons, the American Psychiatric Association updated DSM-4 in 2013.

1) Pervasive Developmental Disorder (PDD-NOS)

PDD autism was called “atypical autism” and was characterized by the presence of milder or fewer symptoms compared to those of Asperger’s and “Classic” autistic persons.

Somehow, atypical autistic people met the criteria of the other two types but did not fall in either one clearly. PDD autism is now close to what DSM-5 calls “social communication disorder”.

2) The Asperger’s Syndrome (high-functioning autism)

Briefly said, Asperger’s Syndrome was considered the second mildest type of autism. In this category were classified highly functional individuals with mild impairment of their social skills and a tendency to have a narrow range of interests.

People with Asperger’s syndrome by DSM-4 are now classified as Level 1 ASD, according to DSM-5.

3) Autistic Disorder (“Classic” Autism)

This was the classic type of autism, characterized by the simultaneous presence of remarkable language and intellectual delays, social and communication deficiencies, and unusual behaviors and interests.

This type, the most severe on the scale, was the most commonly diagnosed if compared to the other 2 different types of autism.

4) Childhood Disintegrative Syndrome (Heller’s Syndrome)

The Childhood disintegrative disorder also called disintegrative psychosis or “Heller’s syndrome”, is an uncommon condition characterized by normal development of the child until 2 to 10 years of age, followed by a severe, unexpected and rather quick deterioration of her/his social, communication and sensory skills.

The root cause of CDD has not been found yet (seems neurological); CDD is one of the most devastating experiences the affected families, and the children themselves (unfortunately, most of them are able to realize the progressive deterioration of their skills).

5) The Rett Syndrome

The Rett syndrome is a genetic disorder that can be medically diagnosed and that affects girls mostly (if not exclusively). Before DSM-5, the Rett Syndrome was considered a type of autism; since 2013, and the introduction of DSM-5, it is no longer considered on the autism spectrum.

Girls affected by the Rett syndrome are characterized by a mild level of social impairment, and by the inability to use their hands properly.

DSM-5 classification (valid starting from 2013)

In 2013, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make the classification of the different types of autism clearer for anyone involved, from parents to therapists, and decrease the level of uncertainty and the lack of standardization existing in the previous classification DSM-4.

The DSM-5 nomenclature is the standard reference that healthcare providers shall use to diagnose a number of mental and behavioral disorders, including autism. 

According to DSM-5, autism is now considered a specific pathology (called “autism spectrum disorder”) and is classified in three levels of growing severity depending on an increasing level of support required by the affected individual:

  1. Level 1 (“Support Required”)
  2. Level 2 (“Substantial Support Required”)
  3. Level 3 (“Very Substantial Support Required”)
Autism spectrum disorder levels of severity
Autism Spectrum Disorder Levels of Severity 1 to 3 (Source: Discover Magazine)

Level 1 Autism type (high functioning autism)

High functioning autism (Asperger's)
High functioning autism (Level 1)

This is the case of those people that have deficits in social communication that may cause significant and evident impairment in case of lack of support.

People with level 1 autism, experience challenges with social interactions, struggle to create new relationships and respond in unconventional manners to social challenges (that others may perceive as awkward). Cognitive and language abilities may not be impaired, but interactions with others are somehow odd and typically unsuccessful.

A higher level of inflexibility and strict behavior are also generally present, which interfere with the possibility to interact in a flexible way in multiple contexts. Isolation and solitude are the general outcomes of this condition, in case of lack of support.

This is the closest type to the Asperger’s Syndrome pre-2013.

Level 2 Autism type (classic autism)

Level 2 ASD autism (classic)
Classic Autism (Level 2)

This is the closest case to the older “classic autism”: the person shows evident challenges with verbal/non-verbal communication, social interaction (even when support is available), awkward response to social challenges, and a rather narrow span of interests.

Level 2 autistic persons are also characterized by inflexible behavior and rules, resistance to change, repetitive movements and patterns that limit the possibility of the individual to operate efficiently in most contexts (sometimes even at home). Any change in routine is perceived with great distress and anxiety.

People with level 2 autism require substantial aid from parents, tutors, caregivers and special education routes and they have a lower-than-average functionality.

Level 3 Autism type (low functioning autism)

Severe autism. Low functioning autism DSM 5
Low functioning autism (Level 3)

Level 3 autism is the most severe type: the individual has clear impairments at all levels (social interactions, communication, language, learning). Social activity is very limited, speech is basic and most times difficult to understand, and isolation is the most natural attitude.

Level 3 autistic persons require very substantial support on a daily basis to survive. Low functioning autism is a very pervasive condition both for the individual, the families, and the caregivers.

Why the different types of autism have been revised by DSM-5?

There are basically three reasons that explain why the American Psychiatric organization revised DSM to get a more accurate definition, classification and treatment options for mental health disorders:

  • To allow specialists to formulate a more accurate diagnosis
  • To identify the conditions that entitle the patient to special treatment and support
  • To help the assessor define the severity level of the disorder
  • To have a consistent diagnosis that enables relevant statistical analysis about autism

The differences between the older and the latest autism types classification (DSM 4 vs. DSM 5) can be summarized as follows:

  • Consolidates the three pre-existing ASD symptoms (impairment of social, communication and behavioral skills) into just two categories (restricted behavioral patterns, including sensory deficiencies, and persistent challenges in social communication skill)
  • Instead of having three different categories (PDD-NOS, Asperger and Autism Disorder), DSM-5 identifies autism as a unique disorder (called ASD, autism spectrum disorder) with three levels of intensity (from mild to severe) in terms of required support by parents and therapists (low, high, very high)
  • Introduction of three explicit severity levels (autism scale: 1,2, and 3)
  • Introduction of additional assessment areas in the diagnosis: genetic tests (Rett and fragile X syndrome), intellectual ability, speech impairment, and analysis of medical symptoms (gastrointestinal issues, anxiety, sleep disorders)
  • Introduction of the new category of social communication disorder (a type similar to the PDD type of DSM-4) which is now not considered an ASD type but a communication disorder only. As this new type of pathology doesn’t fall into the autism spectrum disorder, families may struggle to get access to specific support plans funded by the state.

Should older patients (assessed with DSM 4) be re-assessed with DSM-5?

The American Psychiatric organization suggests parents have their children re-assessed with the new nomenclature, therefore the answer is yes. This may be important also to get access to state-sponsored support and therapies.

Autism diagnosis DSM 4 vs DSM 5
DSM 4 autism diagnoses may be updated to reflect the newest DSM 5’s classification

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Symptoms of Autism https://meetaut.com/the-symptoms-of-autism/ https://meetaut.com/the-symptoms-of-autism/#comments Mon, 02 Dec 2019 09:31:25 +0000 https://meetaut.com/?p=2757 The symptoms of autism for toddlers, children in pre-schooling at school agen, and adults. How ASD is diagnosed and by whom. ...

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Disclaimer: Any information provided in this article is not meant to diagnose or treat. It should not replace the consultation with a professional qualified to deal with the autistic spectrum disorder (ASD).

Common Symptoms and Signs of Autism

The first symptoms (or hints) of autism in children can be traced in the very first months of life (at least in some cases). However, the large majority of children with DSM-2 autism can be diagnosed at around 18-24 months. Some diagnosis comes later in life, and the disorder is sometimes confused with other mental issues (especially DSM-1 autism).

Of course, DSM-3 autism (the most severe) is relatively easier to assess than DSM-1 (high functioning), therefore some individuals may reach adulthood undiagnosed (or discover later in life that autism is the root cause of the difficulties experienced throughout life).

Let’s now explain the symptoms of autism for toddlers, children in pre-schooling/schooling age, and adults.

Signs of autism for toddlers (1-36 months)

Signs of autism in toddlers

Parents, tutors, caregivers should pay great attention, in the first 36 months after birth, on the possible presence of any of the following common symptoms and signs of autism for young children and get expert advice in case of doubts:

  • The child escapes eye contact with parents and/or other people, and does not look at things when others point at them
  • The child prefers solitude to company and has little joyful expressions if any
  • The child seems uninterested in cuddles and interaction with others (lack of empathy and reading other people’s feelings via gestures, facial expressions, or tone of voice)
  • The child has an obsessive interest for a few topics and stimulus, accompanied by a total lack of interest for others
  • The child expresses repetitive behavior, and in some cases self-destructive attitudes (compulsive movement of the hands, phrases repeated over and over, rocking back, and forth, flapping, spinning, banging the head or the arms against walls and furniture, starring at the washing machine, flipping levers up and down without pause, etc.)
  • The child shows hyper attention to sounds, touches, smells, or sights
  • The child has clear communication issues, both verbal and non-verbal; talking is monotone, flat, without emotions, at times the same sentences are repeated over and over (echolalia)
  • The child feels uncomfortable with anything different from the few known routines (e.g. daily schedule, meal, clothes, the route to school or hospital)
  • The child experiences epilepsy or seizure episodes
  • The child has little or no back-and-forth gestures such as pointing, showing, reaching or waving
  • The child shows ritualistic behaviors (e.g. lines up objects, touches objects over and over in a specific order)
  • The range of interests of the child is very restricted and monothematic

The intensity of these signs depends on the type of autism of the child: from the Asperger’s syndrome (a condition close to autism, but characterized by higher functioning levels, proper verbal skills, average/above average IQ), up to the disintegrative disorders (or low functioning autism, where children lack social and communication skills completely after the age of 2 or 3).

It is important to note, though, that some of the signs listed above may be shown by children without autism. Only specialized doctors can assess if behavioral and social deficiencies are related to the autism spectrum disorder, or to other pathologies, and their level of severity.

Signs and symptoms of autism for children in pre-schooling age (3 to 5 years)

For some children, the signs of autism might not become completely clear until they reach the age of preschool (or even a bit later, i.e. when they go to school).

This is the case of children that show mild symptoms up to approximately three years, but start experiencing noticeable development gaps compared to the children of their age quickly right after (learning difficulties, communication issues, the tendency to isolation, and the other common traits of the autism spectrum).

Signs of autism in pre-school kids (up to 5 years)

In these cases, the development gap becomes more and more evident day after day: in these circumstances, parents are advised to seek professional consultation (is autism the cause?).

The behavioral red flags of the autistic syndrome in this stage are:

  • Repetitive and compulsive movements, like flapping, prolonged rocking or spinning of objects, starring at moving devices and objects
  • Obsessive interest for specific toys or objects (and total indifference to all others)
  • Strong resistance to change in routines and environment, with uncontrolled negative reactions for any little change
  • Severe distress in case of unknown sounds, and agoraphobia (strong anxiety in public places)
  • Resistance to eat specific foods, especially solid ones
  • Issues at the toilette
  • Chronic sleep disorders or difficulties

The social red flags of the autistic spectrum disorder in this stage are:

  • The child is extremely reserved and does not socialize with school mates and teachers
  • Eye contact with peers, parents, and teachers is missing
  • Verbal issues start to appear, like grammatical errors, poorly constructed sentences, or obsession with specific words repeated over and over
  • Lack of social skills, interaction with others (even rejecting cuddles)
  • Solitary behavior is preferred to be playing and sharing experiences with others
  • The child never cries or cries all the time

Signs and symptoms of autism for children in school-age (5 to 10 years)

In the past, a large proportion of children got an ASD diagnosis only when hitting the school age, and ASD was often confused with other psychiatric diseases. Thanks to the autism awareness campaigns, children have better chances today to get a clearer diagnosis earlier in life (and initiate beneficial therapies).

Autistic symptoms at school age

The typical symptoms of autism for children in schooling age are:

  • Conversational issues with peers (single topic obsession, or tendency to have flat monologues without attention to the comments of others)
  • Inability to understand non-verbal communication, and tendency to take things literally (not understanding jokes and metaphors)
  • Monotonous tone of voice or unusual way of talking
  • Preference for solitude, distress for social gatherings, lack of friends
  • Strictness in following the rules, either in school and in games or any sort (including sport)
  • Social awkwardness
  • Unusual interests and obsessions, with a total lack of interest for different subjects
  • Unusual physical movements, such as biting, touching, rocking or finger flicking
  • Compulsive use of the senses like smell, touch, taste, hearing, and vision
  • Anxiety in case of changes in routines and people
  • Passive-aggressive behavior
  • Anxiety when dealing with any new circumstance, especially entering the teenager age
  • Expressing behavior that does not comply with socially accepted standards

Signs and symptoms of autism for adults

Adults with autism show similar symptoms like the ones listed above for the other age groups. However, while some people with mild autism become able to cope with their difficulties while moving from childhood to adulthood, finding somehow an acceptable balance, others spend their lives in isolation and frustration (sometimes unable to give a precise name to their condition).

Autism signs and symptoms in adults

Adults that recognize autism symptoms shall seek medical advice: a diagnosis may be challenging to accept but can be also liberating from another perspective. Many adults affirmed that an autism diagnosis brought a sense of clarity and relief, and set them on a new personal development path (ad hoc therapies, connection with other adults suffering the same condition, etc). Of course, all this is true for mild autism levels only.

Autistic vs. Normal Child Development

A non-autistic child shall show the following typical development path in the first 36 months from birth (any significant deviation can be considered a red flag for autism and double-checked):

Within 12 months:

  • The child looks at faces intently, responding to other people’s emotion with appropriate reactions
  • Smiles imitates some facial expressions, follows moving objects with a movement of the eyes or the head
  • Begins to babble, imitates sounds and words, and brings the hands to the mouth
  • Has single words like “mama” or “papa”, repeats sound or gestures for attention
  • Turns head toward direction of the sound, responds when called by her/his name
  • Pushes down on legs when feet placed on a firm surface; raises head and chest when lying on stomach
  • Smiles at mother or primary care-givers voice prefers them over all others
  • Can sit up without assistance, can pull self up to stand, walks holding on to furniture
  • Waves ‘bye-bye’ and points to objects

Within 24 months:

  • Walks alone, with support can negotiate stairs and furniture, carries and pulls toys while walking
  • Imitates behavior of others, excited about the company of other children
  • Has several single words by 15 to 18 months; uses simple phrases by 24 months

Within 36 months:

  • Uses 4-5 word sentences, understands most sentences and instructions
  • Imitates adults and playmates, expresses affection openly, separates easily from parents
  • Sorts objects by shape and color
  • Climbs well, runs, kicks a ball, negotiates stairs unaided

Autism Diagnosis

Early detection of autism is fundamental, as research demonstrates that the earlier in life the disorder is observed, the better the chances to start appropriate therapies to address the deficiencies of the child. Generally, autism is diagnosed in the following way for children:

  1. Pediatricians and general doctors, aware of the growing incidence of autism in the new generations, undertake specific autism detection tests at the 18th and 24th month after birth (some doctors check children even earlier, example at 9 months, or later, example at 30-36 months): with these checks, doctors try to identify possible deficiencies in terms of movements, behavior, learning, communication and speaking skills.
  2. If any doubt or issue occurs during these general checks, doctors will recommend more in-depth tests, which may include sensorial checks, developmental reviews, vision, hearing and talking tests, up to medical check-ups (genetic). These tests are executed by doctors specialized in autism or child psychologist. Special tests and checklists are used to diagnose autism, such as the so-called ADOS (autism diagnostic observation schedule) or Revised ADI-R or the Diagnostic Interview for Social and Communications Disorders (DISCO)

To diagnose autism, the symptoms shall show up early in life, be clear, be persistent, and affect the life of the child in a remarkable way. If signs have a short duration and are inconsistent, they can be attributed to causes different from autism (that doctors will investigate with other methods). One of the aspects of the diagnosis is the assessment of the severity of each deficiency, mainly in the social and communication areas.

For adults, the diagnosis generally comes after a spontaneous request from the individual.

ASD Diagnosis Process

The diagnosis of ASD is articulated in a number of typical steps:

  1. Preparation: Parents should come to the assessment well prepared, which means that they are expected to collect details about the children, like any previous analysis, test, and to note down all the atypical behaviors (autism red flags) of the child in the different circumstances. Parents should provide a truthful and accurate picture of the situation, and avoid hiding unpleasant issues
  2. Family and behavioral assessment: the first step is generally an in-depth assessment of the history of the family and of the behavioral traits of the child. Specific protocols have been developed for this phase, to make it as structured as possible (examples are the DISCO and ADOS schemes)
  3. IQ test: To test the cognitive and learning skills of the child suspected of autism, an IQ test is generally executed. Most autistic child show average or below average IQ levels, with some exceptions (for mild ASD or Asperger)
  4. Communication tests: this step, sometimes executed in cooperation with a speech pathologies expert, aims at assessing the level of verbal and non-verbal communication of the child. The main goal is to assess whether the child shows atypical communication skills and the existing deficiencies if any
  5. Medical tests: a number of physical tests are included in the assessment to ensure that the autisms symptoms are not related to physical conditions (EEG, blood test, visual examination, sensory tests, and genetic checkups)

At the end of the examination, which can take several days, the assessor issues a written report to state their conclusions. The whole process may take up to 2/3 weeks.

Parents take a positive ASD diagnosis very differently: for some, it represents a total shock, for others a sort of relief. In any case, the lives of both the parents and the child are changed by an autism diagnosis, and in some cases for the better (access to funding, support, the start of therapies, a clear understanding of the issue and how to deal with it).

Who can diagnosticate autism?

The presence, or the absence, of an autism spectrum disorder in a toddlers and young children shall be diagnosed by an ASD specialist, a multidisciplinary team, a pediatrician, a psychiatrist or a clinical psychologist experienced in the assessment of development disorder, and the diagnosis shall happen using the latest “Diagnostic and Statistical Manual of Mental Disorders (called DSM-V).

The DSM-5 methodology has been developed to make sure that diagnosis is consistent, standardized, and does not represent a stressful experience both for the individual and the family. Diagnosis can be executed either in public or private structures. As a quick assessment may be highly beneficial for the long-term results of the existing therapies (as ABA), it is recommended to consider a private test in case the waiting times at public structures are too long.

For children in schooling age or adults, a meeting with a specialized psychologist and/or psychiatrist is the best choice. In these cases, the diagnosis is a mix of psycho attitudinal, cognitive, behavioral tests, coupled with interviews aiming at rebuilding the life of the person from childhood to adulthood.

Most local autism associations keep records of the specialized doctors in the country or the area, and they can be the first reference for parents.

Why diagnosis is important?

In the case of suspects, parents are recommended to look for a diagnosis for a number of reasons:

  • An official assessment explains what is really going on with the affected individual
  • Specific therapies may be put in place, that could help the child later in life
  • Teachers, tutors, caregivers, and family members will have clearer directives on how to interact with the child
  • A diagnosis gives access to financial support (from the state) or entitles the family to get paid support from specialized therapists (instead of being, and feeling, alone)
  • Parents get a more in-depth understanding of ASD and knowledge about how to deal with this condition, even with the support of other families that share the same problem

Co-Diagnosis

The diagnosis of autism often involves other types of tests, to assess other areas of the child/adult cognitive or emotional setup: IQ tests (to assess the level of intelligence), ADHD, language and anxiety disorders tests.  The combination of concomitant issues is unfortunately not uncommon.

Autism Checklist

The following checklists may help the parent spot the red flags of the autism spectrum disorder. Consult an expert in autism if you have 5 or more positive answers for each ASD checklist.

Autism checklist for toddlers

  1. Does your child avoid eye contact with you (she/he doesn’t look at you when you talk to him or call him)?
  2. Does your child look indifferent when you smile her/him, without returning the smile or feeling any emotion?
  3. Does your child ignore you when you call her/him, or when someone in the family speaks or come close?
  4. If you point an object with your hand, does your look indifferent and do not look in the same direction?
  5. Does your child avoid using any non-verbal communication such as facial expressions, waving of hands, physical gestures?
  6. Do you have the impression that your child lives in “another world” and that she/he is indifferent to your stimuli and doesn’t seem to call for your attention?
  7. Is your child indifferent to cuddling, and does not seem to search for it?
  8. Does your child seem unable to imitate your movements, facial expressions, and tone of voice?
  9. Does your child prefer isolation than playing with other kids?
  10. Does your child look indifferent if you cry, or if you simulate pain and other signs of distress or discomfort?

Autism checklist for older children

In older children (example pre-schooling, schooling age), autism shows up as impaired social skills, communication problems, lack of flexibility, and learning delays.

ASD social skills impairment checklists

  • Is your child totally uninterested or unaware of what is going on around them (for example, when other children or family members are around)?
  • Does your child have severe issues when it comes to making friends, play or connect with peers or family members (and this cannot be traced back to shyness)?
  • Does your child become anxious when touched, held, or cuddled?
  • Doesn’t your child refrain from playing with games, or arrange available objects in order to invent new games, even if stupid)?
  • Does your child have trouble understanding and talking about own and other people’s feelings?
  • Does your child seem to be not interested in getting other people’s recognition or attention (but rather prefer to hide)?

ASD communication/language skills impairment checklists

  • Does your child speak with a very flat and unemotional tone of voice?
  • Does your child seem to talk only asking questions, and never making firm statements?
  • Does your child answer to your question, by repeating the question itself instead of formulating a real answer (maybe repeating the question multiple times)?
  • Did you notice your child repeated the same words again and again, even alone, and without any intention to communicate?
  • Did you notice an excessive rate of grammatical errors and wrong words in your child talks, which are uncommon given the age?
  • Do you feel that your child is at discomfort with imaginative and metaphoric talking, and tends to take everything you say literally, struggling with more complex reasoning?
  • Does your child talk about himself as talking about another person?
  • Do you sense that your child has severe issues in communicating her/his feelings, desires, needs?
  • Did you ever think that your child is mentally retarded due to limited comprehension and talking abilities?
  • Does your child lack the ability to understand ironic, funny, sarcastic talking?
  • Does your child have often facial expressions totally out of tune with what he is trying to say?
  • Does your child use little, if any, non-verbal communication like changing facial expressions, change of tone of the voice, gestures, pointing at things, hands movements?
  • Does your child react abnormally to loud noises (anxiety, distress) and looks unable to distract from them?

ASD behavioral skills impairment checklists

  • Does your child follow a rigid routine and becomes very anxious when a change occurs?
  • Does your child react badly when something is changed at home, like furniture, the position of households, or when certain domestic habits are changed (new time for lunch or dinner, or bedtime)?
  • Does your child have an obsessive interest for few objects at home and ignores the others?
  • Does your child show obsession for keeping things in a certain order and rearrange their position over and over?
  • Have you caught your child starring at rotating objects for hours (example: a spinning washing machine, a fan, a wheel)?
  • Does your child repeat over and over some specific movements, or when she/he feels in distress or happy? Examples are flapping the hands, stimming, banging the arms against the furniture, etc.?

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What is Autism? Key Things to Know https://meetaut.com/what-is-autism/ https://meetaut.com/what-is-autism/#comments Mon, 02 Dec 2019 09:02:04 +0000 https://meetaut.com/?p=2753 What is the autistic spectrum disorder (ASD): key signs, prevalence, DSM levels, causes, misconceptions, awareness day, facts and figures....

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Disclaimer: Any information provided in this article is not meant to diagnose or treat. It should not replace the consultation with a professional qualified to deal with the autistic spectrum disorder (ASD).

Autism definition

Autism, or autism spectrum disorder (ASD), is a complex genetic and medical condition that affects above to 100 million people in the world (and impacts above half billion people considering parents, relatives, and therapists).

People with autism are characterized by social skill issues, uncontrolled and repetitive behavior, self-injuring attitudes (head banging, arm biting and skin scratching are among the most common), possible cognitive deficiencies (learning difficulties), and struggle with verbal and non-verbal communication. The typical deficiencies of autism are present with different intensity in each individual, hence the term “spectrum” introduced by DSM-5 in 2013.

Besides behavioral and communication issues, people on the autistic spectrum show also the following symptoms:

  • sensory issues
  • chronic gastrointestinal disorders (8 times higher likelihood than average population)
  • sleep challenges (more than 50% have chronic sleep problems)
  • overweight/obesity, epilepsy (approx. 30%)
  • cognitive/mental problems like lack of attention (or its opposite)
  • anxiety (11%-40% impact)
  • a tendency to depression (7% of children and 26% of adults)
  • schizophrenia (4 and 35 percent of adults with autism vs. 1.1 % of the general population). 
What is autism?
Understanding autism: the symptoms of ASD

The ASD prevalence is constantly growing: according to the 2018 statistical data, 1 in 59 newborns are autistic (1 in 37 boys, and 1 in 151 girls).

The growth of prevalence of autism in the world between 1970 and 2018
The autism prevalence growth (source: TACANOW.org)

It is not yet clear if the higher incidence of autism recorded in the past few years relates to an actual increase of the disorder in the population, or if the number reflects an improved ability to diagnose it compared to the past.

However, it is quite astonishing to see that the probability to be autistic reached percentages close to 2%.

Understanding autism is a complex issue, given the high variability of symptoms and issues related to this disorder: actually, each autistic person differs from any other and has a very peculiar set of issues and strengths, sometimes extraordinary (like unparalleled memory, great artistic skills, and capabilities).

Some individuals are slightly affected by autism, so their learning and problem-solving abilities are just slightly impacted, whereas others are severely limited and unable to live independently from their parents or the specialized structures in which they are hosted.

The term “spectrum disorder” reflects the high variability that characterizes this condition.

Understanding autism is a complex issue

Autism can be diagnosed quite early, sometimes even at 12 or 18 months (some doctors could diagnose ASD in 8-months kids).

More complete and evident symptomatology appears at the age of 2 or 3 years, where the cognitive, social and communication deficiencies connected to this condition become more clearly detectable. Statistically, though, most diagnoses come only after the age of 3 or 4 years.

Autism is not a physical disability, therefore people on the autism spectrum are not physically recognizable (i.e. they look exactly like their peers, the only differences are of behavioral type). 

This special characteristic of the disorder makes the diagnosis very challenging, especially for high-functioning autism levels (DSM-1, Asperger).

Boys’ vs. Girls’ Autism Prevalence

Official figures portray a higher rate of autism for boys vs. girls, 1:5 or even 1:7. However, not everybody agrees on this remarkable higher prevalence, and believe that a more realistic ratio is 1:2 (official statistics may hide the real incidence of autism in girls).

According to some researchers, females have higher defenses against genetic mutations than males and lower chances of developing autism.

On the contrary, others are convinced that the lower incidence just reflects a better ability of females to hide their autistic disorder, vs. males, especially if it is mild. Also, most autism checklists are conceived to diagnose autism in boys, and therefore girls’ autism has lower chances of being detected.

Autism incidence in boys vs girls: 1 girl in 5 boys have autism
Different incidence of autism in boys vs. girls (source: Avishi ABA training)

For sure, autism has a different “flavor” in girls than males and is generally milder. The typical traits of autism in girls are:

  • Autistic girls seem to have a keen interest in animals, music, art, and literature
  • Strong imaginative and creative intelligence, coupled with the desire to escape into fictitious worlds
  • Obsession with the organization of things at home
  • Rejection vs. other female peers (lack of cooperation in playing or desire to stay alone instead of participating in groups)
  • Struggle to fit in, sometimes mimicking others
  • High self-control and camouflage abilities in the social context, coupled with explosions of anger at home
  • High sensory abilities, like sounds and touch stimuli

ASD Treatment Options

Even if no cure exists for autism, which means that the afflicted person has no hope to recover from this condition, some types of interventions are possible. The key types of treatments fall into these categories:

  1. Behavioral and communication therapies: Applied Behavior Analysis (ABA) promotes positive behavior and discourages negative behavior. Speech therapies improve communication skills.
  2. Occupational therapies: this approach can help with life skills like dressing, eating, and relating to people
  3. Sensory therapy: an approach used to mitigate the issues related to autistic persons that have problems with being touched or with sights or sounds.
  4. Drugs and Medications to help with symptoms of ASD, like attention problems, hyperactivity, or anxiety
  5. Special diets to cope with the general physical disorders that afflict people with autism (gastrointestinal issues, mainly)
The ABA therapy for autism is the golden treatment standard
ABA is one of the most used therapies for ASD (Source)

Challenges for Families and Society

The biggest challenges for the families confronted with autism are:

  • The fundamental loneliness of the child(ren) and the parents in coping with the disorder;
  • The lack of opportunities for autistic people after the age of 18, when the state support ends (more than half of the young adults with autism remain unemployed and unenrolled in higher education in the two years after high school, when state-based support ends);
  • The high costs incurred by the families to cope with the disorder, either in terms of live expenses or lost/lower salaries (as high as 60.000 $ per year, in the US);
  • Most people with autism will depend on their parents for life (approximately half of 25-year-olds with autism have never held a paying job)

Another, probably less discussed, issue is the social cost of autism: in the US, the overall expenditure for autism care reached $268 billion in 2015 and is forecasted at $461 billion by 2025 (majority of this cost is related to adult services) and the impact of people with autism on the public health expenditure is from 4 to 6 times higher than the rest of population.

Considering the possible higher prevalence of the disorder in the years to come, the impact of autism on society is becoming alarming at all levels.

Autism cost for society and families
The cost impact of autism on families and states (Source: Spectrum.org)

Autism spectrum disorder (ASD)

As mentioned, autism cannot be defined uniquely, as each autistic person shows different traits, deficiencies, and abilities (i.e. different types of autism). The term ASD (which stands for autism spectrum disorder) is therefore used to indicate the idea that autism may range from low to high functional, and that each autistic person has a very specific condition within a wide spectrum of possibilities. Autism presents differently in every single person.

Early recognition of the distinctive traits of an autistic child is important to define the most appropriate treatment, as there is no single recipe to cope with this disorder. Indeed, research has shown that children may overcome, at least partly, their difficulties when addressed early in life.

This is because early intervention can enhance the learning, communication and social skills of an autistic person, and have a positive impact on brain development.

The major areas that are affected by ASD are:

  • Social: autistic people may have little sensitivity for what others feel, think and tell them
  • Communication: a common trait of autistic people is to struggle with verbal and non-verbal communication, so their opportunities to express themselves with others are generally quite limited or stereotyped
  • Learning: this is an area where most of the variability of the disorder occurs. Some autistic children may show extraordinary abilities in learning specific subjects, and limited skills with other subjects
  • Behavioral: it is not uncommon to see autistic children showing repetitive gestures, and to express their feelings by uncoordinated movements of their arms, legs, and other parts of the body instead of using the spoken word.

DSM-4 autism levels

According to the Diagnostic Statistical Manual (DSM-4), revised between 1994 and 2013, autism was classified in the following four types:

  1. Asperger’s syndrome: a mild type of autism, characterized by good communication levels, average or above-average IQ (intelligence) and learning abilities, but the presence of social issues and obsessive interest for a limited number of topics and stimuli.
  2. “Typical” autistic disorder: this is the most common type of autism, where the signs and symptoms are clear and present in a typical way
  3. Disintegrative disorder: this is the case of children that have a rather “normal” development up to the age of 2 and then loose completely and communication or social skills, developing a severe dependency from their parents
  4. “Atypical” and pervasive disorder (PDD-NOS): this is the category used to classify children that do not fall in any of the above categories and are severely impacted in all dimensions.

DSM-5 autism levels

According to the DSM-5 classification issued in 2013, that replaced the previous edition, there is a single ‘umbrella’ diagnosis of autism spectrum disorder (ASD), with three levels/types (level 1, level 2 and level 3, with increasing order of severity, from high to low functioning). Level 1 ASD overlaps, essentially, with the Asperger’s syndrome definition of DSM-4.

DSM 5 introduced a new classification of ASD in 2013 (in 3 levels)
DSM 5 has introduced a new classification of autism in 2013

The Causes of Autism

Science has not yet understood the very root cause of autism.

The current belief is that the autism has a genetic nature, and that is connected with brain issues such as deficiencies existing in the cognitive areas in charge of processing sensory inputs and language (but there is no genetic or biological test to check this, and autism can only be diagnosed based on behavioral analysis).

At present, science believes that autism is connected with deficiencies existing in the communication among brain nerve cells, i.e. neurons, or among different regions of the brain.

In addition to genetic factors, some environmental ones add (like pollution, various sicknesses of the pregnant mother, lack of folic acids, exposure to chemicals before birth).

The causes of autism: genetic and environmental factors illustration
Autism may be caused by a combination of genetic and environmental causes

Autism has a similar global distribution in terms of race, ethnicity, social background, lifestyle, educational levels: all these factors do not seem to impact the risk of having an autistic child significantly.

Some level of correlation has been observed with the age of parents, i.e. older parents (above 45 years) have a higher risk of autistic children.

Also, families that experienced autism incur a higher risk, as genetics seem to play a role (in fact, parents who have a child with ASD have a 2 to 18 percent chance of having a second child who is also affected).

Other correlations have been observed between the risk of autism and the assumption, by the pregnant mother, of specific drugs and chemical substances, including alcohol and anti-seizure medicaments.

Bacterial infections during pregnancy have also shown some level of correlation with autism. Diabetic and obese mothers or parents affected by metabolic disorders like PKU and Rubella also have a higher likelihood of giving birth to an autistic child.

What is interesting to note is that boys have four times more risk to be autistic than girls; a fact that is not yet clearly understood.

What does not cause autism

While the root causes of autism are not clearly understood, it is instead clear that the disorder is not correlated with:

a) Bad parenting habits: after the second world war, when autism started to be diagnosed, bad parenting habits (coldness of the mother, i.e. “refrigerator mothers”, litigation between parents and other family-related issues) were believed to be the root cause of autism. We know today that these factors have no actual influence and that the disorder has a genetic, and not an educational, origin

b) Environment: in the past, some psychologists believed that bad environments may have been the main determining factor for autism in kids; this theory, has been totally abandoned, as ASD appears in different environments with similar prevalence (environmental causes surely contribute, but they do not seem to be the major driving force);

c) Medications and vaccines (mercury and MMR): also, these factors have no relation with autism, as explained in more detail below.

Vaccines and Autism

In the past 15 years, a lot of research has been done to ascertain the existence of a correlation between childhood vaccinations and autism and the results are clear: no correlation has been found between vaccines and ASD, and therefore it is safe to affirm that vaccines are not responsible for autism.

Vaccines and autism showed no correlation
Vaccines do not seem to have an impact on autism (Picture)

Misconceptions about Autism

Lots of false myths and misconceptions have surrounded autism, due to a lack of awareness and studies about this modern disease. The most common misconceptions are:

a) Any autistic person is like “Rain Man”: in reality, not all people affected by autism have extraordinary memory; while some have special artistic or intellectual gifts, the large majority have average or low IQ scores;

b) Vaccinations cause autism: as largely proven by multiples studies, there is no evidence that vaccinations cause the disorder; avoid vaccinations to prevent autism is, therefore, an arbitrary, non-scientific, decision that may harm the health of the kids;

c) Autistic kids have learning challenges: even if learning is generally a challenge for people with autism, and the process of learning tends to be slower than peers, autistic kids can learn and develop their cognitive and language abilities in proper environments and with the right approaches (which should be tailor-made to suit the needs of each child);

d) Autistic kids don’t want/need friends: the opposite is actually true, as most autistic children and adults like the company of other people and peers (even if some of them prefer solitude and isolation, living any social contact as a distressing situation). The real issue about socialization is that autistic people struggle to find opportunities to connect with other people or act in a “non-standard” way in social gatherings, which may cause rejection. However, the desire to have friends, play together and socialize is mostly there.

World Autism Awareness Day

The World Autism Awareness Day is celebrated on April 2 every year since the year 2008.

This celebration was proposed by the Qatari Royal Family (namely, Her Highness Sheikha Mozah Bint Nasser Al-Missned and her Husband, His Highness Sheikh Hamad Bin Khalifa Al-Thani) at the United Nations, and warmly welcomed by all the other Member States.

The goal of the World Autism Awareness Day is to promote the awareness of this disorder globally, and create the conditions for improved acceptance, research, and care at all levels (cultural, political and administrative).

In just ten years, the Autism Awareness Day has contributed significantly to raising the global awareness of this alarming phenomenon to a new level, creating the condition for better acceptance and commitment at all levels to search for better treatment options and study the possible causes.

Various symbols have been used to promote autism awareness, from painted hands, to the heart or the autism ribbon with the typical blue, green, yellow and red colors (and puzzle) that symbolize the variety and of the mysteriousness of the spectrum autistic disorder.

Autism awareness day: every 2nd of April

Facts and Figures about Autism

According to CDC, 1 in 59 children had an autism spectrum disorder (ASD) diagnosis in 2018 (1 in 37 boys and 1 in 151 girls). The data show that:

  • On average, autism is diagnosed at around age 3 (despite the disorder could be detected way earlier, possibly impacting the chances to give a beneficial early treatment)
  • Boys have a four times higher likelihood than girls to experience autistic disorders
  • 31% of children with ASD have an intellectual disability (IQ <70), 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to an above-average range (i.e. IQ >85)
  • Approximately 30% of autistic people do not possess verbal abilities
  • Twins: among identical twins, if one child has autism, the other will be affected by about 36 to 95 percent of the time. In non-identical twins, if one child has autism, then the other is affected about 31 percent of the time.  
  • Attention Deficient Hyperactivity Disorder (ADHD) affects an estimated 30 to 61 percent of children with autism. 
  • On average, autism costs an estimated $60,000 a year through childhood, with the bulk of the costs in special services and lost wages related to increased demands on one or both parents. Costs increase with the occurrence of intellectual disability. 

10 Famous people with ASD or Asperger

Wolfgang Amadeus Mozart had autism?

Wolfgang Amadeus Mozart

Historians now believe that Wolfgang Amadeus Mozart, one of the most talented musicians in history, was on the autism spectrum since he displayed several typical traits of the disorder, like extreme sensitivity to loud noises and evident communication issues.

Charles Darwin autism

Charles Darwin

Charles Darwin combined obsessive care for details with limited social and communication skills (a trait common to people who have Asperger’s). Today, some autism experts believe that the famous naturalist and scientist was on the autism spectrum to some degree.

Albert Einstein autism

Albert Einstein

According to Simon Baron-Cohen, one of the most famous experts of autism, Albert Einstein exhibited traits consistent with the spectrum disorder (genius intellect, loner tendencies, and obsessive, repetitive behavior).

Bill Gates Asperger

Bill Gates

Tech tycoon Bill Gates is another person that has been unofficially diagnosed with autism spectrum disorder (Asperger’s, most likely). The genius founder of Microsoft has some well-known eccentricities – like “rocking” back and forth – which could be explained by ASD.

Steve Jobs Asperger

Steve Jobs

Apple creator Steve Jobs had a notorious obsession with perfection, great intellect and general lack of empathy, the typical traits of ASD (Asperger probably).

Robbie Williams ASD Asperger

Robbie Williams

According to Robbie William himself: “Maybe Asperger’s or autism. I don’t know what spectrum I’m on – I’m on something. It’s quite hard work being in my head – I have an interesting compulsion, addiction, mental illness, I’d say.” 

Anthony Hopkins Asperger

Anthony Hopkins

Anthony Hopkins was officially diagnosed with Asperger’s and he credits his condition with making him extremely restless – and, in turn, an unusually hard worker.

Greta Thunberg Asperger

Greta Thunberg

As Greta affirmed: “I have Asperger’s, I’m on the autism spectrum, so I don’t really care about social codes that way”. It seems that her condition has been officially diagnosed.

Stanley Kubrick Asperger

Stanley Kubrick

Kubrick is known as an “intense, cool, misanthropic cinematic genius who obsesses over every detail.” Kubrick’s single-minded obsession with movies and cinema was so strong that he could only enjoy life when he was standing behind a camera.

Andy Warhol Asperger

Andy Warhol

Andy Warhol was never diagnosed with autism while he was alive, but autism expert Dr. Judith Gould insists that he “almost certainly had Asperger syndrome.” Warhol’s monosyllabic conversational style, meticulously structured routines, and unique creative vision all show strong signs that the legendary artist was on the autism spectrum, Dr. Gould says.

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