Imagine yourself when you are in a class that composes of children who need special education. There is a child in front of an aquarium in that class. You realize his smooth movements, perfect smile, and how calm he is the opposite of the rest of the class. You go next to him and start to talk about fish in the tank but he doesn’t listen to you, even he doesn’t realize you are there. He smiles like thinking about some jokes, swings on his feet, and does not have any communication with others. After some point, you realize other signs and ask questions to the teacher about his situation. Then the teacher says he has ASD which is Autism Spectrum Disorder.
Here is some information about what is ASD (Autism Spectrum Disorder). I will start with the definition, brief history, and then move on to characteristics of the disease according to DSM – 5. DSM – 5 is a standard classification system that is used for the diagnosis of psychological and mental disorders used by professionalists. After that, I will give more information about the developmental course such as can autism be diagnosed at birth or later. It will be interesting because there are lots of variables. Later that, you will find a piece of information about how it affects life quality and how the child’s life quality can be enhanced.
First of all, here is an important point. If the person has this disease we shouldn’t call him or her autistic. We should call them the person who has Autism Spectrum Disorder (the person with autism). It sounds that they are the same but there is a huge difference between those expressions.
Autism Spectrum Disorder (ASD)
Autism is one of the neurodevelopmental disorders in DSM – 5. At the basic level, it is characterized by impairments in social interaction, communication and language, and stereotyped behaviors and interests. In the beginning, it was called Asperger Syndrome.
Asperger Syndrome is a more severe form of autism. Besides the same symptoms with autism they have good language ability but an unusual volume and high tone. They have pedantic speech and mostly do not care about others’ opinions. They keep on monologues even there is another individual near to them.
After some point psychologists realized that criteria couldn’t fit enough other symptoms of autism and they developed new criteria. Then, they collected Asperger Syndrome and autism under the same title which is Autism Spectrum Disorder.
Before diagnosis, parents usually notice some symptoms of the disorder in their children. Children can have big problems in social relations, for example, they can ignore other people, forget about others’ existence, or rarely close to others. Children with ASD occasionally start a game with other children. They are nonreactive. For having healthy communication, two people have to focus on each other or at least have to realize each other but with the children who have ASD have unhealthy interaction, verbal communication, or emotional communication.
Moreover, they can have unique behaviors. For example, obsessive behaviors, being overly sensitive to some noises or odors, clapping hands, walking on the balls of the feet or turning around themselves are the most displayed behaviors by them. Parents generally realize those behaviors and take their children to the psychologist or psychiatrist.
Diagnostic Criteria ( DSM – 5)
• Deficiency in social communications and social interactions currently or by history
o Having problems in the eye to eye conversations
o Lack of understanding and using nonverbal behaviors such as social expressions, gestures and body language
o Deficits or absence in developing peer relations
o Having problems in social-emotional relationships such as not closing to others, not having back and forth conversations and lack of sharing of interests and emotions
• Restrictive and repetitive behaviors, activities or interests
o Stereotyped motor movements (e.g. turning around themselves)
o Specified using of objects ( e.g. lining up toys, flipping objects)
o Repetitive speech such as echolalia (mechanical and meaningless repetition of the words of another person or themselves)
• Extreme distress or overreaction even in tiny changes in verbal or nonverbal behaviors
o Inflexible routines or ritualized patterns (e.g. need to take the same route every day, eat the same food every day, wear the same clothes every day)
o Having highly fixated or restricted intensity and focus on activities and behaviors
o Unusual interest in the social environment (e.g. overly focused in shining and/or turning objects)
o Excessive or unusual reactivity to sensory stimuli which are mostly smelling and touching
• Symptoms of the disorder should appear in the early developmental period
• Symptoms should disrupt or limit functionality ( especially should be clinically significant impairment)
Problems in Daily life
Impairments in the language (e.g. language comprehension behind production which means that in a normal child understanding comes first and then they produce words and sentences, but in children with autism producing comes first and it means they say something meaningless at the beginning)
Motor deficits (e.g. walking on the balls of the feet, clumsiness)
Self-injury ( e.g. banging their heads to the wall, biting the wrist, slapping themselves)
Disruptive behaviors ( e.g. severe temper tantrums, aggressive behaviors, over-challenging behaviors)
Depression; especially in adolescence it is common because they have some problems which they cannot handle and it triggers mostly depression.
Developmental Course of Autism Spectrum Disorder
Can autism spectrum disorder be diagnosed at birth?
Before birth, it is impossible to identify ASD. Some factors can cause having that disorder such as prenatal and perinatal factors. For example; gestation more than 42 weeks and first of after 4th born are risk markers. Also, exposure to toxins and infections in the womb, especially when in the 2nd trimester, can cause ASD.
On the other hand, obviously, there is a relationship between neurological functions, social and emotional impairments. It causes brain enlargement but it starts after 1 year. It means that there is no way to detect a disorder before 12 months.
At Which Stage of Life Can Autism Spectrum Disorder Be Diagnosed?
Psychologists can recognize and diagnose autism during the second year of life. Before 12 months, it is hard to notice because developmental delays are not severe.
Professionalists firstly think about mental retardation when the child comes with suspicion of ASD. Because even they do not have the same severity, they have similar symptoms such as epilepsy, sleeping problems, mental, and aggressiveness. However, the child may not display all the autistic behaviors, despite having mental retardation.
For diagnosis, at least the child should be 12 months old because before that time symptoms are not shown appropriately and can be mixed with other neurodevelopmental disorders.
After 1 year, if the child starts impairment in social behaviors, emotional expressions, and language skills, then you should take the child to the professionalists.
Language development is the first delayed symptoms. Parents usually differentiate that impairment. Children may have no eye contact. For example, they can have a problem with joint attention. It means that parent call 4 or 5 times and there is no answer, then parents joint something like a toy at the same time say ‘look’ and still there is no answer. On the other hand, they can have a problem with initiating joint attention. It means that while normally developed children are playing, they suddenly stop and want to look or call their parents, however, there is no expectancy with the children with ASD because they mostly ignore everyone around them.
During the second year of life, symptoms start to be more apparent. Because children have more people around themselves and social interactions start. If the children have ASD, they mostly have weird and repetitive behaviors. They don’t want to interact with other children.
Even it is a neurodevelopmental disorder, it is not a degenerative disorder. It is not a condition leading to progressive loss of functioning.
Professionalists often mark symptoms in early childhood, especially in the early school years. Because the lack of social interactions is the most important marker of autism and it mostly starts with school. Before school, if it is not severe enough, most parents cannot recognize the symptoms. For example, maybe parents work and grandparents take care of children and cannot realize the problem or maybe parents do not have enough knowledge about what is autism and cannot realize the symptoms of the disorder. However, in school, firstly the teacher can notice problems an let the parents informed.
Can Autism Be Diagnosed in Adulthood?
Autism is mostly diagnosed in childhood but if the symptoms are not severe enough to meet criteria, people may have not a diagnosis at childhood. In adulthood, it is a confusing process to identify whether there is a problem or not. Because adaptability is high in adults. If the person has problems in that adaptability in daily routine, it causes lack of empathy, lack of social interactions, needs to be taken care of by another person, then it could be considered as Autism Spectrum Disorder.
Prevalence Rate of Autism Spectrum Disorder
Symptoms appear out of 110 children.
Boys have 4 times more predisposition than girls. Besides that, especially boys with ASD in adolescence period can develop epilepsy which is a medical condition in which suffer experiences seizures and blackouts.
Last 25 years, the prevalence rates increase up to %300.
Autism Spectrum Disorder can be diagnosed in every socioeconomic status, race, and ethnicity. It is unrelated to social class.
ASD is a lifelong condition. If the professionalists diagnose the children with autism, it does not change ever. It means if the child is diagnosed at age 2, the child will be diagnosed at any point of a lifetime.
The prevalence rates are increasing because of increasing awareness and changing of diagnostic criteria. On the other hand, thanks to awareness about ASD is much more increasing, it leads to more intervention to work.
Heritability of Autism Spectrum Disorder
There is a 90% heritability in autism. It is a mostly genetic disorder, more than affected by environmental factors. According to some studies, children with ASD may inherit DNA mutation from fathers.
People who have siblings with autism are in the risk group. They are more vulnerable than others. Atypical eye contact, visual tracking, lack of social smiling, frequent sensory oriented behaviors, and lack of social interests are risk markers. If the child who has siblings with autism displayed these kinds of behaviors, the child should see a professionalist.
Treatment of Autism Spectrum Disorder
Can Autism Spectrum Disorder Be Cured/Treated?
Autism is not a curable disorder. Although there is no cure for ASD, certain actions and behaviors can help pregnant women in order to reduce the risk of autism. For example, a pregnant woman should not take medication during pregnancy, should avoid drinking alcohol, seek treatment for health conditions if she has other than pregnancy, and vaccination is could be important for increasing risk.
While parents cannot prevent the child is born with autism, they can increase their children’s life qualities. With special education and special treatment, children can have high-quality lives. They can live independently. They can work in their adulthood and even they can marry and have children. Obviously, it needs early intervention.
Types of treatments change according to the child’s individual needs. Because ASD is a spectrum disorder which means some individuals have mild symptoms, unlikely some individuals have severe symptoms. Everyone is special and everyone needs special treatments.
Even the treatments are different, the goal is the same which is reducing the symptoms and improving learning and understanding.
Psychological treatments are more useful than genetic and neurological treatments, even more, white hope than medication. Behavioral therapy is the most preferred psychological treatment. Also, therapies which are composed of parent-child interaction are commonly used.
Medication or drug therapy is more beneficial for reducing negative symptoms of autism spectrum disorder. As a medication, people with ASD use anti-psychotic drugs that are used for schizophrenia and it helps them in order to reduce social withdrawal, stereotyped motor behaviors, self-injured behaviors, and over-exaggerated aggression. However, as is the case with every medication, it has positive effects as well as side effects on people such as addiction to those drugs or impairments in muscle activities.
If the person is high functioning in autism, the person needs higher education or already has a higher IQ than normally developed individuals. The rate of unemployment is high among them. They rarely married. They remain socially naive, vulnerable, and withdrawn.