Autism: An Overview

AUTISM is everywhere today. From international events (World Autism Awareness Week 2017 goes from March 27th to April 2nd), special schools and parental support groups to an increasing representation in media (“Sesame Street” just introduced Julia, an autistic muppet with an inclination toward music, “Rain Man” won four Oscars), autism cannot be overlooked.

As the availability of data varies wildly across countries, a reliable global estimate is hard to compile: but between 0.5 and 2 % of the world’s population seem to be affected, and the numbers are rising. This might be more due to broader and better diagnostic instruments together with increased awareness than due to a rise in actual case numbers: but at any rate, autism is changing the lives of millions of people worldwide, as well as those of their families, friends, teachers and caretakers.

So, what is autism? The word is derived from the ancient Greek “autós”, “self”, and roughly translates to “being oriented toward oneself”. As a diagnosis, it describes a neurodevelopmental disorder, an impairment of the brain with an onset in the early developmental period, usually diagnosed between the age of 1.5 and 3 years. The line between merely peculiar “normal” social behaviour and mild autism can be very thin, while more severe autism is immediately recognizable. It can manifest very differently in different people and frequently coincides with the symptoms of or full-fledged separate disorders, such as anxiety, ADHD, gastrointestinal disorders, sleep disturbances or language impairments–the DSM-5 diagnosis of Autism Spectrum Disorder (ASD) even groups together the previously separate diagnoses of autism, Asperger syndrome, childhood disintegrative disorder and PDD-NOS. All variations aside, there are some core symptoms consistent across all cases.

Probably the most striking behavioural manifestation is the arrest of or problems in social communication development (DSM-5 criteria A), resulting in severe deficits in social interaction, the picking-up of social clues, recognizing of contexts, maintaining interpersonal relationships or communicative behaviours (such as body language, facial expressions and eye contact). Another big component revolves around language skills: words or phrases are constantly repeated, and many autistic children have delayed or limited language development, with some even remaining completely nonverbal; at times, previously acquired speech abilities are lost again with the onset of autism. Frequently, autistic children ignore other children or unfamiliar adults, stick to themselves or refuse to engage in (pretend) play; they may not be able to express themselves or to empathize with others, to integrate with groups of peers or to read their social behaviour.

This is complemented by restricted and repetitive behavioural patterns (DSM-5 criteria B), which can manifest in a wide range of ways. Common repetitive behaviours are flapping, rocking or spinning, the sticking to certain routines and getting upset at changes in said routines, turning light switches on and off, opening and closing doors, spinning toys or lining them up. People with autism can be over- or under-sensitive to their environment, getting upset at loud noises or bright lights, not register pain or seek out specific smells or tastes (due to dysfunctional sensory processing, which can result in them chewing inedible items or pushing their bodies against walls or people).

As mentioned at the start, the prevalence of ASD is high, with around 0.5 to 2 % of people affected worldwide. Boys are at a much higher risks than girls: for example in the US, the CDC’s Autism and Developmental Disabilities Monitoring Network estimated in 2014 that about 1 in 68 children is affected, with a prevalence of 1 in 42 for boys compared to only 1 in 189 for girls; a 2015 survey among American parents suggests that the total number might be even higher.

While the spectrum of symptoms and behaviours is well documented, there is considerable uncertainty as to autism’s causes: a complex interaction of genetic and environmental factors is thought to be responsible, but the exact nature of this is still being explored. One popular example is the suggested link between autism and certain vaccinations or diets, which has often been claimed, but on the other hand also been refuted by various extensive studies. There is certainly evidence to suggest a genetic component, with siblings of children with ASD developing autism as well (and identical twins both being autistic) and cases running in families, but no specific genes have been identified so far.

There is no “cure” to autism in the same sense as there is a cure to an illness–but there is a variety of ways in which affected children and adults can be treated and supported to lessen or reverse symptoms, allowing them to lead independent and fully functioning “normal” lives. Naturally, it depends a lot on the individual person, where to place them on the autism spectrum and if they have concurrent other disorders; sometimes, there are aspects than can be treated medically, but most often it will come down to educational, therapeutic or analytic interventions.

The earlier an intervention is started, the higher the statistical chances of success: parents and families need to be guided and assisted by professionals as well as an educational system prepared to take on the specific needs of children with ASD–but there is a lot that can be done at home, from finding nonverbal ways to communicate and trying to promote certain behaviours within the child’s narrow interests up to providing structure and consistency.

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