Autism Spectrum Disorder

What is autism spectrum disorder?
Autism spectrum disorder (or autism) refers to a range of lifelong developmental conditions that affect how people see the world and interact with others. [1] Because autism is a spectrum disorder, each person with autism has their own strengths and challenges. [2] These challenges include communication and social interaction, or restricted and repetitive patterns of behaviours, activities or interests. [3] Some people with autism may also have learning disabilities, mental health issues or other conditions, meaning each person needs a different level of support to learn and develop. [2] Autism affects around 1 in 100 people [4] and is estimated to affect three times as many men as women. [5] Autism is not a disease so it cannot be cured. [2] 

What causes autism?
The reason that some people have autism is not completely clear. However, scientists believe that it is most likely related to a person’s genes. There are several different genetic reasons for autism: [3]

• Inheritance – autism is a genetic trait that can be passed down through a family 
• Interactions between different genes
• ‘Spontaneous mutation’ – a change to a gene that happens for no reason that we know of.

A common myth is that vaccines cause autism, but many scientific studies involving hundreds of thousands of people show that this is not the case. [6]

What are the signs of autism?
Some children show signs of autism from a very young age, but others with milder versions of autism do not show signs until later in their lives, and can sometimes reach adulthood without being diagnosed. [7] The common signs of autism are listed below. Not everyone with autism will show all of these signs, and some children who don’t have autism may show some of them. [8] 

Early signs of autism in young children include:

By 6 months old

• Few or no big smiles 
•  Limited or no eye contact

By 9 months old

• Little or no back-and-forth sharing of sounds, smiles or other facial expressions

By 12 months old

• Little or no babbling
• Little or no back-and-forth gestures such as pointing, reaching or waving
• Little or no response to name

By 16 months old

• Very few or no words

By 2 years old

• Very few or no meaningful two-word phrases (not including repeating of phrases) 

Signs of autism in older children and adults include: [8,9]  

• Avoidance of eye contact
• Delayed or absent speech
• Problems listening, concentrating and understanding
• Frequent repetition of words and phrases
• Taking things literally
• Difficulty sensing and interpreting peoples’ feelings
• Difficulty expressing feelings
• Over or under sensitivity to sound, touch, taste, smell or light
• Rituals or repetitive behaviours (such as flicking fingers in front of one’s eyes, rocking back and forth)
• Disliking changes to routine
• Difficulty making friends and socialising
• Focussed interests

How is autism diagnosed?
If your doctor thinks you or your child might have autism, they will refer you to a specialist. 

For children
The specialist will carry out some assessments to find out if your child has autism. They might include: [10,11] 

• Detailed questions about your child’s development and family history
• Observations of your child doing tasks
• Assessments of your child’s language and communication skills, cognitive function, motor function and behaviour

For adults
For the specialist to diagnose you with autism, they need to see that you have struggled with communication, social interaction, and repetitive behaviours or interests since early childhood. They must also see that these difficulties have limited your everyday life. The specialist might ask you to bring along somebody who knew you as a child, such as a parent or older sibling. This is because they will need to ask detailed questions about how you behaved as a young child. [12] 

What treatment options are available for autism?
The most effective therapies for autism are behavioural therapy, occupational therapy, speech therapy, physical therapy, and some medications. [13]

Behavioural therapy
These therapies focus on understanding how learning occurs and teaching children as young as two years old the basics of communication and social interaction. [14]. A therapist supports a person to change their behaviour based on principles of learning derived from behavioural psychology. The therapy encourages positive behaviours and discourages negative behaviours. In addition, the therapist teaches new skills and helps the person to apply those skills to new situations [13] 

Occupational therapy
Occupational therapy teaches people with autism the skills to do daily activities that involve movement and coordination. [13] The therapy focuses particularly on developing skills for movements of the wrists, hands, fingers, feet and toes. These movements are used in daily tasks such as dressing, using utensils, cutting with scissors and writing. For young children with autism, the therapy often focuses on improving co-ordination and ability to do simple tasks. In older children, occupational therapy often looks to improve social behaviour and increase independence.

Physical therapy
Similar to Occupational Therapy, physical therapy is used to improve the individual’s ability to participate in everyday activities. Physical therapy teaches and improves skills such as walking, sitting, coordination and balance. 

Speech therapy
Speech therapy is an important treatment for people with autism, as they have problems with speaking and communicating in social situations. [13] Speech therapy helps to improve a person’s communication skills, so they can better express their needs or wants.

Some people with autism do not speak at all, and the use of gestures, sign language, and picture communication are often useful tools to improve their abilities to communicate.

Medication
There is no cure for autism, and currently there are no medications that treat it directly. However, some medications can help modify some behaviours associated with autism, including irritability, insomnia, aggression and lack of focus. [13] By reducing these disruptive behaviours, other therapies, such as behavioural therapy, may be more effective. Medication should be prescribed and monitored by a qualified doctor. 

What is the outlook for a person with autism?
People living with autism have complex healthcare needs throughout their life. [13]  Early diagnosis, along with tailored support from a range of healthcare workers, is essential to help people with autism reach their potential and live as normal a life as possible. At the moment, there are no treatments that address the underlying cause(s) of autism, although some medications are effective in treating some of the associated characteristics. However, scientists are learning more about the underlying causes of autism spectrum disorders. This new knowledge is also helping scientists to develop new medications that may be able to modify the changes in the brain that play a role in autism spectrum disorders. Some of these new medications are being tested in clinical trials.