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, 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).
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).
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%.
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.
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.
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:
- Behavioral and communication therapies: Applied Behavior Analysis (ABA) promotes positive behavior and discourages negative behavior. Speech therapies improve communication skills.
- Occupational therapies: this approach can help with life skills like dressing, eating, and relating to people
- Sensory therapy: an approach used to mitigate the issues related to autistic persons that have problems with being touched or with sights or sounds.
- Drugs and Medications to help with symptoms of ASD, like attention problems, hyperactivity, or anxiety
- Special diets to cope with the general physical disorders that afflict people with autism (gastrointestinal issues, mainly)
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 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:
- 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.
- “Typical” autistic disorder: this is the most common type of autism, where the signs and symptoms are clear and present in a typical way
- 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
- “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.
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).
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.
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.
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
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 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.
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).
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.
Apple creator Steve Jobs had a notorious obsession with perfection, great intellect and general lack of empathy, the typical traits of ASD (Asperger probably).
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 was officially diagnosed with Asperger’s and he credits his condition with making him extremely restless – and, in turn, an unusually hard worker.
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.
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 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.