Autism Spectrum Disorder
A challenging diagnosis to briefly and succinctly describe, Autism Spectrum Disorder is primarily defined by significant and long-standing difficulties with social skills and the presence of highly repetitive and a rigid set of behaviors or interests that develop originally during childhood.
A variety of similar diagnoses that previously existed have been replaced in the DSM-5 and combined into Autism Spectrum Disorder. Conditions previously known as Autistic Disorder, Early Infantile Autism, Childhood Autism, Kanner's Autism, High-Functioning Autism, Atypical Autism, Pervasive Developmental Disorder Not Otherwise Specified (NOS), Childhood Disintegrative Disorder, and Asperger's Disorder have all been eliminated and replaced with the single diagnosis of Autism Spectrum Disorder.
The emphasis is on the word spectrum which is designed to allow the diagnosis to encompass various levels of severity. What may have been called Asperger's or High-Functioning Autism in the past is now just one end of the continuum of a single condition and not an entirely separate condition in and of itself.
The main two features of Autism Spectrum Disorder (ASD) are difficulties with socialization skills and highly repetitive and rigid behaviors and interests.
Difficulties with Social Skills
Autism Spectrum Disorder is a Neurodevelopmental Disorder which means that its signs and symptoms impact one's development. In the case of ASD it originates and affects the skills and abilities that a person would normally develop during childhood.
The difficulties with socialization or social skills referred to here is a broad term and can exhibit itself in a wide variety of ways. Common themes however include difficulties in back-and-forth relationships (e.g. being able to take turns talking and listening) and limitations or even a complete absence in attempts to communicate with others.
Some individuals may appear to seek out friendships, but even in these cases not fully appreciate or understand the mutuality that friendship entails. For example, they may only want their friend around to engage in a single shared interest or the friendship may be highly one-sided with limited sharing of feelings, thoughts, objects, and time.
Other examples can include a lack of eye contact and unusual body language. Instead of facing a person that is speaking, a person with ASD may avoid eye contact and/or direct their body away from the speaker.
A poor understanding of physical and facial gestures may also be seen. This could mean for instance not understanding that when someone else silently motions their head to the left that they want to discreetly alert you of something.
People with Autism Spectrum Disorder also frequently use language in a very literal way. This could lead them to have trouble understanding puns, word play, and sarcasm, among other things.
In younger children there may appear to be little to no interest in initiating or engaging in social interactions with others or the desire to imitate and copy the actions of those around them. They may not follow your motions if you attempt to point something out to them or pick up and bring toys back to you.
Children may also appear to lack the ability to imagine and avoid playing pretend; or when they do play, insist on abiding by the rules in a very strict and literal way.
In adults social difficulties may be more obvious when a person with Autism Spectrum Disorder tries to join in a group conversation or struggles to find an appropriate response to what someone else is saying. Adults may also appear to have unusual or exaggerated body language or struggle to coordinate verbal language and non-verbal communication. For instance, putting your head down when talking or hearing about something sad.
Repetitive and Rigid Themes
Just as it affects the social skills and abilities that a person would normally develop during childhood, Autism Spectrum Disorder also has an impact on the development of appropriate and typical behaviors and interests. Again this is a broad term and may show up in a variety of different ways. Repetitive patterns can be patterns of behavior, thoughts, or interests.
Repetitive behaviors may be simple movements such as flapping of the hand, bobbing of the head, or tapping of fingers. They can also be verbal utterances such as repeating a sound or word over and over again. Sometimes these sounds or words come from something heard from another person. In this case it may be called parroting or echolalia.
Repetitive behaviors may also be applied to objects such as lining up items, turning things over on their side, or pushing something back and forth. Someone with Autism Spectrum Disorder may also be likely to engage their senses repeatedly with objects, such as smelling or touching seemingly everything.
Sometimes an unusually intense interest in something will emerge. This can include being highly focused on a seemingly random object like an empty water bottle.
People with ASD also often tend to experience hypersensitivity or indifference to sensory stimuli, meaning things that they're exposed to through their senses. As an example, someone may appear to be extremely sensitive to changes in temperature, endlessly fascinated by a strobe light, or obsessed with the feel of a certain fabric. Conversely, a seeming indifference may also occur where a person might seem oblivious to a fireworks show or unaffected by something that would otherwise be felt as painful by another person like an injection or a burn.
In addition to repetition, themes of rigidity are also common. Even the smallest of changes in a person's routine can be highly distressing. This could be as simple as trying to rush someone with ASD in the morning to avoid being late to an appointment, changing the order of how you get dressed, or if a favorite brand of snack food is discontinued.
It is common for adults with with the condition to have learned how to limit their repetitive tendencies and behaviors in public. Thus even in cases where repetitive and rigid themes are no longer seen but existed during childhood, a diagnosis of Autism Spectrum Disorder may still be appropriate.
Levels of Severity
In addition to an actual diagnosis of Autism Spectrum Disorder, a clinician will likely include a number of other Specifiers to a formal diagnosis. These include whether or not there is a medical or genetic condition associated with the ASD diagnosis (e.g. Epilepsy or Rett Syndrome), whether or not there is an "intellectual impairment" or "language impairment", and whether or not there is catatonia or catatonic like symptoms such as slowing or freezing mid-action.
A clinician should also provide a severity level which is given in the form of a scale from 1-3 based upon the degree of support required. Level one is the mildest form and describes a person who requires some degree of support. Level two describes someone needing "substantial support" and level three refers to someone needing "very substantial support".
Across the lifespan, rates of Autism Spectrum Disorder are close to 1%. Males are four times as likely as females to be diagnosed with ASD. For females who are diagnosed, they are more likely than their male counterparts to also be diagnosed with Intellectual Disability.
Symptoms typically first emerge in the second year of life, with milder cases sometimes taking more time to be recognized and more severe cases frequently being recognized earlier.
It's also important for loved ones and professionals alike to keep in mind that some repetitive themes are typical of normal childhood development. For instance, wanting to watch the same cartoon over and over or preferring macaroni and cheese to all other foods is not in and of itself sufficient to warrant a diagnosis of Autism Spectrum Disorder.
The two year mark is important for another reason in that, while rare, sometimes a loss of already developed skills can occur in cases of ASD. If this is going to happen it most likely will occur during the first two years of life. Should this occur after a child's second birthday and particularly if it includes the loss of self-care skills such as feeding and using the bathroom it may suggest the need for additional medical testing.
A child's fifth birthday is another significant milestone for those diagnosed with ASD. Specifically the presence or absence of Intellectual Disability and any language impairment is a good indication of what may be expected later in life.
Fortunately ASD is not a degenerative disorder, meaning that over the course of one's lifespan, symptoms tend not to get worse than what is seen during the early childhood years. Although most people with ASD are unable to live and work independently as adults, they are able to continue learning and developing social, intellectual, and other skills and abilities throughout their lives.
For those who have Autism Spectrum Disorder as many as 70% will also have one other mental health diagnosis. 40% will have two or more additional diagnoses. Parents and other caregivers should look out for changes in sleep patterns, eating patterns, and other behavioral changes that may be an indication of another condition such as a Depressive Disorder, a Feeding and Eating Disorder, or a Sleep-Wake Disorder.
Although there is limited information about the causes of Autism Spectrum Disorder, there are some known risk factors including older parents, premature birth, and fetal exposure to the drug Valproate (used primarily for treating seizures, Bipolar and Related Disorders, and migraines).
Heredity also appears to play a significant role in the development of ASD. Research studies suggest that inheritance rates may be anywhere between 37% and 90%. Also as much as 15% of cases seem to be associated with a genetic mutation. However it appears likely that multiple contributing genetic mutations are a more likely cause of ASD than any single mutation.
Autism Spectrum Disorder is a Neurodevelopmental Disorder whose main symptoms include difficulties with social skills and highly repetitive and rigid behaviors and interests.
Likely having a strong genetic cause, those with ASD often exhibit the majority of their symptoms within the first 2-5 years of life. Though symptoms will likely continue well into adulthood, many adults with ASD have been able to continue to learn, grow, and to develop ways to control the behaviors associated with the condition.
Socialization issues tend to relate to challenges interacting with others, not appreciating gestures and other forms of non-verbal communication, and not showing a significant or typical interest in cooperating with others. Relationships as a result may often feel very one-sided.
Repetitive and rigid themes can include an unusually strong interest in an object, parroting a particular word or sound, simple movements that are excessively repeated such as tapping of one's hands or fingers, a very strict insistence on taking things literally and showing limited flexibility with rules and routines.
Though many adults may carry a diagnosis of Autism Spectrum Disorder, the symptoms that make it up must have been present during childhood, even if some of those symptoms are no longer present.
Finally, the term Autism Spectrum Disorder has taken the place of several other diagnoses that were previously their own separate conditions, such as Asperger's Disorder, Autistic Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (NOS).