Autism – patient information
In this article, we will describe information for patients and families about autism.
1. What is autism?
Autism spectrum disorder (ASD), or autism, is a broad term used to describe a group of neurodevelopmental conditions.
These conditions are characterised by problems with communication and social interaction. People with ASD often show restricted and repetitive interests or patterns of behaviour.
ASD is found in people around the world, regardless of race and ethnicity, culture, or economic background.
There are indications that instances of autism are on the rise. Some attribute this increase to environmental factors.
2. What are the symptoms of autism?
Symptoms of ASD typically start during early childhood, between ages 12 and 24 months. However symptoms may also appear earlier or later.
Early symptoms may include a marked delay in language or social development.
The DSM-5 (doctors standard classification of mental disorders) divides symptoms of ASD into two categories:
- Problems with communication and social interaction
- Restricted or repetitive patterns of behaviour or activities.
To be diagnosed with autism, a person must experience symptoms in both of these categories.
3. Problems with communication and social interaction
ASD can involve a range of issues with communication, many of which appear before age 5.
Here’s a timeline of what this might look like:
- From birth: trouble maintaining eye contact
- By 9 months: not responding to their name
- By 9 months: not displaying facial expressions reflective of their emotions (like surprise or anger)
- By 12 months: not engaging in basic interactive games, like peek-a-boo or pat-a-cake
- By 12 months: not using (or only using a few) hand gestures, like hand-waving
- By 15 months: not sharing their interests with others (by showing someone a favourite toy, for example)
- By 18 months: not pointing or looking where others point
- By 24 months: not noticing when others appear sad or hurt
- By 30 months: not engaging in ‘pretend play’ like caring for a baby doll
By 60 months of age: not playing turn-taking games.
Additionally, autistic children might have trouble expressing their feelings or understanding those of others starting at 36 months.
As they age, they might have difficulty talking or very limited speaking skills. Other autistic children might develop language skills at an uneven pace.
If there is a particular topic that’s very interesting to them, for example, they might develop a very strong vocabulary for talking about that one topic. But they might have difficulty communicating about other things.
As autistic children begin talking, they might also talk in an unusual tone that can range from high-pitched and ‘sing-songy’ to robotic or flat.
They might also show signs of hyperlexia, which involves reading beyond what’s expected of their age. Children on the autism spectrum might learn to read earlier than their neurotypical peers, sometimes as early as age 2. But they tend to not comprehend what they’re reading.
As they interact with others, autistic children might have difficulty sharing their emotions and interests with others or find it hard to maintain back-and-forth conversation. Nonverbal communication, like maintaining eye contact or body language, might also remain difficult.
These challenges with communication can persist throughout adulthood.
4. Restricted or repetitive patterns of behaviour or activities
In addition to the communication and social issues mentioned above, autism also includes symptoms related to body movements and behaviours.
These can include:
- Repetitive movements – like rocking, flapping their arms, spinning, or running back and forthlining objects, like toys, up in strict order and getting upset when that order is disturbed
- Attachment to strict routines – like those around bedtime or getting to school
- Repeating words or phrases – they hear someone say over and over again
- Getting upset over minor changes
- Focusing intently on parts of objects – like the wheel of a toy truck or the hair of a doll
- Unusual reactions to sensory input – like sounds, smells, and tastes
- Obsessive interests
- Exceptional abilities – like musical talent or memory capabilities.
5. Other characteristics
Some autistic people might experience additional symptoms, including:
- Delayed movement, language, or cognitive skills
- Seizures
- Gastrointestinal symptoms – like constipation or diarrhoea
- Excessive worry or stress
- Unusual levels of fear – either higher or lower than expected
- Hyperactive, inattentive, or impulsive behaviours
- Unexpected emotional reactions
- Unusual eating habits or preferences
- Unusual sleep patterns.
6. What is stimming?
‘Stimming’ is a term used to describe self-stimulating behaviours, e.g. involving repetitive motions or speech.
For example, someone might clap their hands, rub an object, or repeat a phrase. It is typically associated with autistic people. But nearly everyone does some form of stimming, whether that’s rubbing their hands together or biting their nails.
For autistic people, stimming can sometimes get in the way of daily life or cause physical harm. But it can also serve as a helpful coping mechanism for dealing with sensory overload or navigating uncomfortable situations, among other things.
7. What causes autism?
The exact cause of ASD is unknown. The most current research demonstrates there’s no single cause.
Suspected risk factors for ASD include:
- Having an immediate family member who is autistic
- Certain genetic mutations
- Fragile X syndrome and other genetic disorders
- Being born to older parents
- Low birth weight
- Exposure to heavy metals and environmental toxins
- A maternal history of viral infection
- Foetal exposure to the medications valproic acid or thalidomide.
However, multiple sources, old and new have concluded that vaccines do not cause ASD.
A controversial 1998 study proposed a link between autism and the measles, mumps, and rubella (MMR) vaccine. However, that study has been debunked by other research and was eventually retracted in 2010. Read more about autism and its risk factors.
8. What tests are used to diagnose autism?
Your child’s doctor may recommend a combination of tests for autism, including
- DNA testing for genetic diseases
- Behavioural evaluation
- Visual and audio tests – to rule out any issues with vision and hearing that are not related to ASD
- Occupational therapy screening
- Developmental questionnaires – such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).
9. Diagnosis
A team of specialists typically makes the diagnosis. This team may include:
- Child psychiatrist
- Child psychologist
- Occupational therapist (OT)
- Speech and language therapist (SALT).
10. Support for autistic people?
There is no ‘cure’ for ASD. Rather, for some autistic people, supportive therapies can help them feel better or alleviate certain symptoms.
Many approaches involve therapies such as:
- Behavioural therapy
- Play therapy
- Occupational therapy
- Physiotherapy
- Speech and language therapy.
Massages, weighted clothing and blankets, and meditation techniques may also help some autistic people manage symptoms. However, results will vary. Some people may respond well to certain approaches, while others may not.
Medication
There is no cure for autism spectrum disorder, and there is currently no medication to treat it. But some medicines can help with related symptoms like depression, seizures, insomnia, and trouble focussing.
Studies have shown that medication is most effective when it is combined with behavioural therapies.
Risperidone is the only drug approved for children with autism spectrum disorder. It can be prescribed for children between 5 and 16 years old to help with irritability.
Some doctors will prescribe other drugs in certain cases, including selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medication, or stimulants.
Summary
We have described information for patients and families about autism. There is alot that can be done to help your child.
Other resource
This is a good video.
