What is autism?
Autism spectrum disorder (ASD) refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of ASD must be present in early childhood, typically before age 3, though they may not become fully apparent until social demands exceed limited capacities.
The term “spectrum” reflects the wide variation in challenges and strengths possessed by each person with autism. There’s no standard “type” or “severity” of autism. ASD occurs in all ethnic, racial and socioeconomic groups. Estimates from CDC’s Autism and Developmental Disabilities Monitoring Network found that about 1 in 44 children have ASD.
What are the symptoms of autism?
People with ASD often have communication deficits and difficulties processing sensory information. Symptoms may include:
– Delayed language development
– Difficulty relating to others
– Excessive talking about favored topics
– Little to no eye contact
– Lack of pretend play skills
– Repetitive body movements or behaviors
– Persistent preference for routines
– Hyper- or hypo-reactivity to sensory input
– Unusual or intense reactions to sounds, tastes, textures, smells or sights
The type and severity of symptoms can vary widely across the spectrum for each person. Some people with ASD are able to live independently, while others require life-long care and support. About 31% of children with ASD have an intellectual disability.
What causes autism?
The exact causes of ASD are not fully understood, but research suggests genes can act together with influences from the environment to affect development in ways that lead to ASD. Some other possible risk factors and causes include:
– Genetics – Multiple genes are involved, often inherited from parents. About 20% of cases may result from spontaneous mutations.
– Prenatal environment – Exposure to high levels of certain hormones during early pregnancy may increase risk.
– Complications at birth – Metabolic and neurological abnormalities affecting the brain have been linked to higher ASD rates.
– Vaccines – Multiple studies show no association between vaccines like the MMR shot and development of ASD.
There are likely many genes and combinations involved that make each person susceptible. In most cases, it’s unclear exactly what combination of factors prompts ASD.
Is there a cure for autism?
There is currently no medical “cure” for ASD itself. The diversity of the autism spectrum does not allow for a single, uniform treatment. However, various therapies and interventions can improve social communication, behavior, functional skills and quality of life. Evidence-based approaches involve medications, behavioral and communication strategies, dietary approaches and complementary health strategies.
Medications
There are no medications that can specifically treat the core symptoms of ASD. But medication might be used to manage related symptoms and conditions, such as:
– Irritability and aggression – Risperidone (Risperdal) and aripiprazole (Abilify) can help reduce tantrums, aggression and self-harming behaviors.
– Inattention and hyperactivity – Stimulants like methylphenidate (Ritalin) and amphetamines (Adderall) are sometimes used for ADHD symptoms.
– Anxiety and depression – Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants provide relief.
– Seizures – Anticonvulsant drugs help control seizures. About a third of children with ASD develop epilepsy.
Medications should be prescribed cautiously because people with ASD often have adverse reactions. Therapy is needed to teach functional skills missed during key developmental stages.
Behavioral Therapy and Interventions
– Applied Behavior Analysis (ABA) – This structured teaching method uses rewards to reinforce socially desirable behaviors. It can improve communication, social skills and functioning. Intensity is key – 15 to 40 hours per week for at least 2 years.
– Speech Therapy – Hands-on instruction in language production and comprehension. Focus is on communication skills and social appropriateness. Augmentative and alternative communication (AAC) devices can also help.
– Occupational Therapy – Exercises and equipment to enhance coordination, sensory processing, fine motor skills, habits and focus. Improves ability to perform activities of daily living.
– Physical Therapy – Gross motor skills training through structured play, posture and balance exercises. Helps improve gait and coordination.
– Social Skills Training – Group or individual coaching to learn social cues, communication techniques, coping strategies and culturally appropriate behaviors.
– Cognitive Behavioral Therapy – Changing dysfunctional emotions, assumptions and behaviors by increasing self-awareness. Teaches appropriate responses.
– Parent Education – Parents and family act as therapists implementing interventions at home. Training teaches prompting techniques, reinforcement, generalizing skills etc. Parent involvement is crucial.
Combining therapies based on the child’s deficits and strengths is most effective. Consistency, intensity and starting interventions at an early age lead to the greatest improvements.
Dietary Approaches
Some dietary approaches and supplements claim to improve autism symptoms, but solid scientific evidence is lacking. Two of the most well-studied are:
– Gluten-free, casein-free (GFCF) diet – These proteins are poorly digested and may increase opioid activity in the brain, worsening autism behaviors. About 70% of children with ASD have shown improvements on a GFCF diet.
– Vitamin and mineral supplements – Correcting deficiencies in vitamins B6 and B12, magnesium, zinc and omega-3 may boost brain function. Consult a doctor before giving supplements.
Other unproven diets like ketogenic and anti-yeast diets have potential risks. Any restrictive special diet should be discussed with nutritionists and thoroughly researched before starting.
Complementary Health Approaches
A variety of mind and body practices have been shown to help children with ASD by reducing problem behaviors and anxiety, and promoting focus, language and social engagement. Popular options include:
– Music therapy – Listening, singing, dancing and playing instruments stimulate the brain regions affected in autism. Musical cues can improve coordination.
– Animal-assisted therapy – Interacting with therapy dogs promotes motor skills, cognitive functioning, socialization and confidence.
– Art therapy – Drawing, coloring and sculpting refine fine motor skills while allowing self-expression in a structured setting.
– PEERS intervention – Manualized social skills training prepares teens for handling bullying, developing friendships, dating etiquette and handling disagreements.
– Mindfulness – Meditation and yoga help develop impulse control, empathy, flexibility in thinking and self-awareness.
– Sensory integration – Customized sensory-based therapies (e.g. swings, trampolines) meet sensory needs and teach coping strategies.
Biofeedback, acupuncture, massage and outdoor behavioral therapy are other complementary approaches that may be calming. However, their effectiveness is not confirmed and benefits tend to be small.
What is the prognosis for childhood autism?
ASD is a lifelong disorder, but early diagnosis and intervention offer the best outlook. Intellectual disability worsens prognosis, while higher IQ and language skills improve it. About 1 in 5 children outgrow the disorder to function independently. With appropriate treatment and support, many people with autism can lead fulfilling, productive lives.
Here are some prognoses based on the level of functioning:
Individuals requiring substantial support
About 40% of people with autism are nonverbal or have very limited language. They require extensive lifelong care and support. Only about 15% are able to work simple jobs independently or live semi-independently with significant support.
Individuals requiring moderate support
Around 35% are able to speak and communicate but have significant social and learning disabilities needing moderate support. About 40% achieve fair independence as adults but continue needing some support and supervision to live in community settings and perform vocational work.
Individuals requiring minimal support
Roughly 25% of people with ASD are on the high-functioning end but still face communication and social barriers. With speech therapy, social skills training and coping strategies, many are able to attend regular classrooms, graduate high school, hold jobs and live independently with minimal support. They have the best prognosis.
Here is a table summarizing the prognosis according to level of functioning:
| Level of Functioning | Proportion of People with ASD | Prognosis |
|---|---|---|
| Requiring substantial support | 40% | Dependent on others for care, unlikely to live or work independently |
| Requiring moderate support | 35% | May achieve some independence with ongoing community support |
| Requiring minimal support | 25% | Can attend regular school, hold jobs, and live independently with some support |
While autism itself cannot be cured, the outlook depends largely on the severity of symptoms and incorporating evidence-based therapies and interventions. Some children may lose their diagnosis over time, but autism is a lifelong condition for most. With adequate treatment and support matching the person’s needs, those with ASD can lead fulfilling lives.
Conclusion
Autism spectrum disorder is a complex developmental condition caused by genetic and environmental factors influencing early brain development. There is no medical cure for autism itself. However, combining medications, behavioral therapies, dietary approaches and complementary health strategies can significantly improve communication, social skills, behavior and functioning.
Outlook depends on the severity of deficits as well as early, intensive intervention. About 25% are able to function relatively independently in adulthood with minimal support. But others require life-long, full-time care. Continued research to uncover treatments tailored to the specific needs of individuals across the spectrum offers hope for the future.