Autism Spectrum Disorder (ASD): Symptoms and Treatment

Autism spectrum disorder (ASD) is a neurological condition that combines limited social skills and repetitive behavioral patterns. The symptoms and causes vary from person to person. Such differences make it difficult to diagnose and find the best possible treatment. There is no cure for ASD; however, some therapies and medications can help with behavioral, cognitive, and social development.

Key takeaways:
  • arrow-right
    ASD affects behavior and social development.
  • arrow-right
    Symptoms are not the same for everyone with ASD.
  • arrow-right
    ASD can be difficult to diagnose.
  • arrow-right
    There are neuroanatomical, genetic, environmental, and gender factors linked to ASD.
  • arrow-right
    Various therapies and medications can help with ASD management.

Prevalence

In 2012 WHO published a review estimating that 1 out of 100 people have an ASD diagnosis. More recent sources estimate the prevalence to be 1 in 59. Researchers believe that 10-33% of adults with ASD have an intellectual disability. In research on autistic children, these statistics vary between 11% and 65%. Additionally, 28.2% of those children are also diagnosed with attention deficit hyperactivity disorder (ADHD).

Why is it called the autistic spectrum?

Autism spectrum disorder symptoms vary and manifest differently in each individual. For example, one might have better social skills yet poorer behavioral management, or vice versa. Some may display minor deviations from the neurotypical population, and others — have severe deficits that are difficult to manage.

Those with ASD might also have an intellectual or learning disability, but that is not always the case. Many individuals have average to high IQs yet have particular social comprehension and self-management issues.

Symptoms

In The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR), ASD is identified by symptoms in all three social-emotional communication domains and at least two behavioral domains. These must be consistent and cause disturbances in everyday life.

Social-emotional communication

Social behaviors that appear unusual to the average person

The way ASD patients communicate may appear odd in general society. However, these differences in socializing are diverse and can range from unusual approaches to a complete lack of communication.

For example, the person could use irrelevant information in conversations, lack common interests with peers, and appear emotionless, withdrawn, or overly engaging.

Difficulties understanding and expressing verbal and non-verbal cues

Communicating through body language is automatic for most people without even noticing it. However, those with ASD may have to put constant effort into reading or expressing non-verbal cues. In some cases, the individuals may misinterpret or fail to recognize the message body language is conveying.

Deficits in this domain can include avoiding eye contact, being unable to recognize internal states in others (for example, when someone is feeling annoyed), smiling or frowning without emotional context, or lacking emotional expression.

Difficulties adapting to social situations and forming relationships

People with ASD might have little interest in friendships or lack an understanding of common social rules, sarcasm, and metaphors. Children with this condition may struggle with pretend play and adjust their behavior to different contexts.

Behavioral

Repetitive movements and compulsive behaviors

The person may feel the need to control their environment or the state of their mind in a certain way. For example, they might feel the need to arrange items in a specific order or seemingly unnecessary movements.

Strong specific interests

Obsessively collecting information about a favorite fictional character or items of interest are common in ASD. Individuals may fixate on specific ideas, hobbies, people, animals, or things.

Lack of flexibility in routine

Individuals can become intensely upset by a change in schedule or unpredicted events. On the other hand, some may have organizational and time management difficulties, often get distracted and struggle to keep up with a routine.

Unusual interest in/disregard for sensations

Sensory processing is often affected in ASD. Touch, smell, colors, flavors, and sounds can be intense or bland. Signs of this phenomenon may include excessively touching a surface, being repulsed by certain sounds, or ignoring pain when hurt.

Diagnostic difficulties

There is no way to detect ASD through biological screening, so clinicians have to depend on behavioral symptoms. It may be difficult to diagnose children under five years old since the symptoms in the behavioral domain tend to develop with age.

Furthermore, some children may present with diminished social and language skills acquired during their first two years. In such cases, the parents may not notice the signs of disrupted development, which can then become an obstacle to early interventions.

Children are more likely to receive a diagnosis if they also have a learning disability. Some high-functioning individuals with ASD, especially women, might mask the symptoms through social learning, which means they will not get diagnosed.

The downside of ASD masking is that it can lead to social exhaustion, breakdowns, and a sense of not being true to oneself. As a result, women are often misdiagnosed with other psychological disorders, such as schizophrenia, attention deficit hyperactivity disorder (ADHD), bipolar disorder, or borderline personality disorder.

Causes and risk factors of ASD development

It is not entirely clear what causes ASD. However, there have been some elements associated with this condition.

Neuroanatomy

Research suggests that children with ASD may have experienced relatively rapid brain development through the early years, causing non-standard neural connectivity. When the brain connections are different, the way we behave and understand the world is also different.

Genetic

Researchers found alterations in at least 100 different genes associated with ASD, the most common being CHD8 (0.5% of the cases). Certain combinations and inhibition of these genes predetermine a high risk of developing the condition — inheritability rates being up to 80%. However, only about 10% - 20% of autism cases develop because of genetics.

Environmental

ASD is linked to interferences in brain development that cause non-typical thinking patterns and behaviors. The environment can affect the brain, especially while in critical stages of growth, such as before and during birth.

First of all, poor health, lifestyle, and the mother’s diet during pregnancy can lead to a lack of nutrition or intoxication of the baby’s brain.

Paternal age has also been considered to be a possible factor. There may be a higher risk for the infant to develop ASD if the mother is over 40 years old or if the father is over 50 years old.

Other possible causes may be untimely birth and birth weight. Babies that are born too early, too light, or too heavy are also at higher risk of ASD.

Gender

Females are more likely to display introverted autistic traits, such as avoidance and social withdrawal. In contrast, males tend to present more external characteristics linked to repetitive behaviors, such as agitation and the need for a particular routine.

Males are three times more likely to be diagnosed with ASD. The reasons behind such gender differences are not yet well researched, but they could be attributed to a generally more advanced understanding of social cues and masking in females.

Non-pharmaceutical interventions

Naturalistic Developmental Behavioral Interventions (NDBI) is a group of intense social and adaptive methods that has many different variations and new emerging interventions. It is focused on real-life motivations, such as improved life quality and relationships, rather than rewards provided by teachers or caretakers. Such therapies include:

  • Early Start Denver Model (ESDM)
  • Joint Attention Symbolic Play and Engagement Regulation (JASPER)
  • Early Social Interaction (ESI)
  • Applied Behavioral Analysis (ABA)

Social Skills Training

Aims to teach everyday communication skills, peer-to-peer interactions, appropriate responses, and tone of voice modification. However, some therapists have criticized this intervention because it promotes masking and can lead to mental health issues in some patients.

Speech and language therapy

Treats young children with difficulties communicating or producing language. This therapy focuses on developing interactions and self-expression between the child and responsible adults, according to individual needs and abilities.

Augmentative and Alternative Communication (ACC)

This tool allows autistic patients with language difficulties to communicate through pictures and symbols.

Occupational therapy

For autism targets a person’s overall development and needs of the person from their early years. This includes teaching everyday skills, assessing and adjusting the environment to promote well-being, and working with parents and teachers to meet the child’s needs.

Counseling

Services can be accessed through schools, public health, or private sectors. Depending on the patient’s age and needs, counselors can assess and recommend further therapy and provide person-centered therapy.

Sensory-oriented treatments

Include enrichment of the environment, have been found to improve cognition significantly and reduce autistic traits in children of all ages. These include:

  • Sensorimotor stimulation
  • Tacpac

Pharmaceutical treatments

Such treatments should not be used without a prescription or clinical recommendation.

MedicationTargeted treatmentPossible side effects
Selective Serotonin Reuptake Inhibitors (SSRIs)Social deficitsManic symptoms in patients with a family history of bipolar disorder.
Tetrahydrobiopterin (BH4)Speech, inappropriate behaviors, and social functioningSleep deprivation and aggression (rare).
RisperidoneAgitation and irritabilityIncrease in appetite, weight gain, loss of energy.
AripiprazoleAgitation and irritabilityNausea, weight gain.
AtomoxetineADHD symptomsLoss of appetite, low mood, nausea.
MethylphenidateADHD symptomsLoss of appetite, sleep deprivation.
GuanfacineADHD symptomsFatigue, loss of energy, lowered heart rate, and blood pressure.

Myths About ASD

Myth 1: Vaccines cause autism

An article published in the 1990s wrote that children acquired autism following the measles vaccine. However, research has failed to find evidence for the claim. Furthermore, autism studies have shown that ASD is not acquired but can only be diagnosed starting later in infancy.

Myth 2: All people with ASD are dangerous

This belief can occur because of behavioral regulation issues in some patients. However, they are not more dangerous than any other person. On the contrary, autistic individuals are often strongly empathetic and naïve, which puts them at risk of being abused or exploited.

Myth 3: All people with ASD have special talents

Having specific interests is common in this condition. Therefore, some autistic individuals may acquire strong skills in a particular field through practice. However, such skills are not innate and can not be attributed to ASD.

Myth 4: All people with ASD are uninterested in friendships

Autistic individuals can often have difficulties forming relationships; however, that does not mean that they do not require friendships. Many ASD patients may have fewer, strong bonds, often with other individuals on the spectrum.

Every individual with autistic spectrum disorder is unique and deals with a range of distinct social problems. This condition is manageable with environmental enrichment, therapy, and, if necessary, medication. Behavioral interventions are also available to practice at home or in educational settings. Autism research is still scarce compared to the need for ASD-related developments, but emerging research may pave the way to a better understanding of the condition, support, and acceptance of neurodiversity.

Resources:

Leave a comment

Your email address will not be published. Required fields are marked