Autism

From Simple English Wikipedia, the free encyclopedia
A young boy with autism has arranged his toys in a row before falling asleep. Always arranging things in a certain way is a sign of autism.

Autism is a developmental disability. Autism changes how someone thinks, understands the world, moves, communicates, and socialize. Autism is also called the autism spectrum. That means that every autistic person is different. Some autistic people may need a lot of help with one thing. Other autistic people may not need help with the same thing. It may be easy to tell when someone is autistic, or it may not be.[1]

The main areas of difference from non-autistic people is thinking differences (how people think and understand the world), sensory processing differences (how people feel), motor differences, communication differences, and socializing differences.[2]

Autism is present from birth. About 1 in 44 or 2% of children are autistic.[3] Signs of autism are usually present when a child is around two or three, but some people are not diagnosed until later. Some people are not diagnosed until they are adults. There is no cure for autism and many autistic people do not want a cure.[4][5] They want to be accepted as different. This is called neurodiversity.[6][7] Autistic people that want their differences to be accepted may be part of the autism rights movement.

History[change | change source]

Early history[change | change source]

The word “autism” comes from the Greek word “autos”, meaning “self.” The term describes conditions in which a person is removed from social interaction: an “isolated self”.[8] The term "autism" was first used by a psychiatrist named Eugen Bleuler in 1911 to describe one group of symptoms of schizophrenia.[9] Sigmund Freud considered this idea and thought it was related to narcissism.[10]

Discovery[change | change source]

In the 1940s, two researchers were studying autism in different countries; Hans Asperger in Austria and Leo Kanner in the United States.

In 1943 Leo Kanner (a doctor from Johns Hopkins University) did a study of 11 children. He found out that they had difficulties such as changing environments, being sensitive to certain stimuli, having speech problems, and allergies to food. Later he named the children’s condition “early infantile autism”,[11] now called autism.

Hans Asperger was doing a similar study in Austria He found they also had “[...] a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest and clumsy movements”.[12] It used to be thought that Hans Asperger and Leo Kanner were looking at different children, that Hans Asperger found a "mild form" of autism. This was the initial justification for Asperger syndrome. However, later research found that they were doing research on similar populations.[13] Hans Asperger was also doing research in Nazi-controlled Austria, which believed in eugenics. Eugenics is the idea that some people are better than others. In Nazi-controlled Europe, people who were considered "lesser" were murdered, imprisoned, and discriminated against. Recent research has discovered that Hans Asperger sent children with disabilities to be murdered.[14]

The refrigerator mother theory[change | change source]

In 1943 and 1949, Kanner described the children he studied in scientific papers. In these papers, he wrote that he thought the children's parents were not loving them enough. He wrote that this might be part of the reason why the children had autism.[15][16] For example, in 1949 he wrote that the children's parents showed no warmth, or love, to their children.[16] He thought the parents were so "cold" that he compared them to refrigerators:

“[The children] were left neatly in refrigerators which did not defrost. Their withdrawal seems to be an act of turning away from such a situation to seek comfort in solitude”.[16]

This idea became known as the refrigerator mother theory. For decades parents were blamed for causing their children's autism by not loving their children enough.[17] By now, we know this is not true.[18]

Later history[change | change source]

Schizophrenia and autism were linked in many researchers’ studies. It was in the 1960s when medical professionals started to see these two disorders as separate conditions. Since 1980, Kanner’s so-called "early infantile autism" is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the DSM came out with a more accurate definition of autism in 1987. Since then, early infantile autism is called autism disorder. For the first time the DSM also introduced standardized criteria to diagnose autism. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) expanded the definition of autism and included milder cases of autism. Asperger’s syndrome was added as a type of autism in 1994.

Recent history[change | change source]

Autism used to be considered different conditions. Some diagnoses in the past include: Classical autism, Asperger's syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). However, none of these seperate diagnoses exist anymore. Both the US DSM-V (2013) and the ICD-11 (2022) have combined the existing diagnoses into one diagnosis: Autism spectrum disorder.[1]

This happened because doctors found that these diagnoses were frequently used in different ways. For example, one person could get a diagnosis of classical autism from one doctor, Asperger's from a second doctor, and PDD-NOS from a third doctor. This was hurting people's ability to access services and supports.[19]

Additionally, recent research shows that Hans Asperger sent autistic children to be murdered by Nazis. Because of this, the diagnosis is less frequently used[20]

Symptoms[change | change source]

Interaction[change | change source]

  • may like objects more than faces as a baby
  • may not look at faces for more than a second
  • may prefer being alone, or not interested in making friends
  • may not react to signs of love (for example, hugging)
  • difficulty in knowing how other people feel
  • laughing or crying at the wrong times[21]

Communication[change | change source]

  • may not talk or communicate much
  • may speak with little change in tone or pitch (sometimes called speaking "robotically")
  • difficulty with words that are spelled or sound the same but have different meanings (homophones and homonyms)
  • trouble with understanding gestures or facial expressions[22]
  • may produce different facial expressions to non-autistic individuals[23]

Restricted behavior[change | change source]

  • may do the same action repeatedly (stimming)
  • may have limited interests (called a special interest)
  • difficulty in coping with changes in routine

Sensitivity[change | change source]

  • Greater sensitivity
  • Avoiding certain foods because they dislike the textures, or eating things that aren't food [24]
  • attraction to specific noises
  • good attention to detail
  • good balance skills (sometimes)

In 2021, an online survey of 16-90 year-olds showed that autistic men are more likely to be bisexual, while autistic women are more likely to be homosexual.[25]

Frequency[change | change source]

There are many studies on how many autistic people are out there. In the United States, the CDC does studies. In 2018, they found that 1 in 44 children are autistic. That is about 2%. This number keeps going up.[26] Many people wonder why there are more and more autistic children. Some people think that something is causing it. But really, most scientists think that we are getting better at diagnosing autism. More doctors know about autism and can diagnosis children that they see. More people have access to medical care and can get a diagnosis.[27]

Underdiagnosis[change | change source]

In the past, autism was considered a disorder for white boys. Still, more white boys are diagnosed. Girls and children of color are underdiagnosed. Underdiagnosed means that girls and people of color are not diagnosed as often as they should be.[28] This means that many girls and children of color do not get a diagnosis. They may receive a different diagnosis, or they may not receive any diagnosis at all. Now, more girls and children of color are getting diagnosed. Many women and people of color also get a diagnosis or realize they are autistic as adults.[29]

Causes[change | change source]

Scientists do not know exactly what causes autism. There may be many different causes for the different types of Autism Spectrum Disorder.[30] Scientists do know about some things that make a person more likely to have an Autism Spectrum Disorder.

Genetics and heritability[change | change source]

The autism spectrum disorders are highly heritable disorders.[31] This means that it is very likely (over 90%) that the child of an autistic person will also be on the autism spectrum. The reason for this are certain genes. These genes are linked to autism and are passed on from a parent to the child. Already Leo Kanner and Hans Asperger noticed that fathers of autistic children often preferred being on their own over being with people. Because of this, Kanner and Asperger suspected a genetic cause. Studies with families with a child on the autism spectrum were done to investigate this theory. They found that sometimes the children’s parents (fathers as well as mothers) also show social difficulties, shyness and problems with understanding contextual information when talking to someone. Some studies have found this in only 10 out of 100 families, some in as much as 45 out of every 100 families.[32]

Other than the studies done on children who had autistic parents, recently a couple of studies were done on children who either had a sibling or a twin showing autistic signs. Similar to the results in the autistic parents studies, most children having autistic siblings/twins were found out to be showing autistic traits. According to a recent study, around fifty percent of babies with autistic siblings showed some kind of behaviour different from what's expected, around one fourth of them took longer to do certain things most babies can do as they grow up (for example, looking at the faces of others and sitting up without help), and around 17% of all were later diagnosed with ASD (Autism Spectrum Disorder).[33]

Twin studies also showed that it is much more likely that identical twins are both on the autism spectrum than that non-identical twins are both on the autism spectrum. Identical twins have nearly the same DNA. Because they share genes, it is very likely that they are either both autistic or both not autistic. Non-identical twins share only half of their genes which makes it less likely that they both have the disorder. Scientists have shown that a child is 20 to 80 times more likely to be autistic if they have a sister or brother who is autistic.[34]

However, it is not a single gene that increases the risk for autism spectrum disorders. Several genes have been linked to the disorder. All of the found related genes can in sum only explain one or two out of every ten autism cases. None of the genes that have been found to play a role in autism can explain more than one out of every 100 cases.

The genetic influences include:[35][36]

  • mutations,
  • genetic syndromes (for example, Fragile X syndrome),
  • de novo (newly occurring in a family) as well as inherited copy number variations (CNV) — a CNV is the duplication or deletion of a gene — and
  • single nucleotide variants (SNV) - an SNV is a change in one nucleotide that occurs with very low frequency.

The affected genes influence:[37]

  • the interaction between brain cells and synaptic functioning,
  • neuronal growth and neuronal migration (the wandering of a neuron from its birthplace to its final location in the brain) and
  • inhibitory and excitatory neurotransmission.

Neural correlates[change | change source]

Researchers have not found a single neuronal correlate for autism spectrum disorders. In other words, no abnormal functioning of the brain is the only cause of autism. Still, scientists found some differences between the brains of autistic people and the brains of people who are not autistic. These differences are found in the anatomy of the brain, the activity in certain brain regions, and the connections between brain regions. It is a general tendency that autistic people use the same brain regions as other people but show different activity. In some areas the activity is less, in others it is stronger. However, this may only be true for male autistic people. Throughout the last years, studies have shown that brains of autistic women might be like normal men's brains.[38]

Some researchers grouped autistic people's difficulties into three main areas in order to investigate their neuronal basis.

Theory of mind[change | change source]

Researchers say that building a theory of mind is one of the main problems for autistic people. This makes it difficult for them to interact with others. Problems in social interaction are probably worsened by low preference for social stimuli, such as faces. This tendency has been found in studies tracking the person’s eye movements[39] and in EEG studies. EEG studies showed lower than normal activity in the fusiform face area (FFA), a brain region that is usually active when seeing faces.[40] However, the results of other studies could not show this.

Also, scientists measured brain activity of people on the autism spectrum with fMRI while they were thinking about their own emotions. They found activity in the same brain regions as in non-autistic people. The difference was that some regions which are important for thinking about oneself and emotions (especially the anterior insula) were less active in autistic people.[41] Other brain regions were much more active. These findings may explain the difficulties people with autism experience when trying to understand complex facial expressions and emotions (such as shame and jealousy).

Executive function[change | change source]

People on the autism spectrum show a lower ability for executive function. Executive function means physical, emotional and cognitive self-control. This includes planning actions, focusing, shifting attention, and flexibility of behaviour and thinking. Autistic people's ability can improve but it will remain below non-autistic people's ability in executive function.

Problems with executive function are probably caused by large networks in the brain.[42] Grey matter and white matter irregularities have a negative influence on the way different brain regions work together (functional integration).[43] A smaller corpus callosum leads to abnormalities in working memory (an active process of keeping a memory until it is needed) and planning actions.[44]

Central coherence[change | change source]

Central coherence is the ability to build wholes out of parts. It is weak in people with autism. This means that autistic people focus more on details. They cannot build wholes out of them. Not being able to pay attention to wholes results in difficulties with perception and language. People with autism usually need more time for dealing with information coming from their surroundings. They typically also need more time for responding. However, performance varies between people on the autism spectrum. The term central coherence may also include many interacting aspects. This makes it difficult to find the cause for it in the brain. Neural correlates for central coherence are not yet known.[42]

Familial risk factors[change | change source]

The risk for autism spectrum disorders can be increased if the mother uses thalidomide, valproic acid or drinks too much alcohol during pregnancy.[32] The risk for autism also increases with the age of father and mother at the time of pregnancy.[35]

Scientists know that parents do not cause their children's autism by not being loving enough.[17]

Vaccines[change | change source]

Scientists do know for sure that vaccines do not cause autism.[45][46][47] Vaccines do not even make a person more likely to have autism, even if they are already at a high risk for autism before they get their vaccines.[48]

In 1997 A. Wakefield and others found autism signs one month after the measles-mumps-rubella (MMR) vaccine was applied. They released a paper[49] in which they claimed that autism is caused by the MMR vaccine. However, the study had several flaws:

  1. they did not leave out children that they knew had genes linked to autism,
  2. they did not test the children's abilities before the vaccine was given,
  3. neuropsychological and endoscopic tests were not blind (meaning the scientists already knew things that might make them biased before they did their tests),
  4. they did not have control subjects.

Also, no believeable biological mechanism could explain how the MMR vaccine leads to autism.[50] Since then many case-control studies have been done to investigate the relationship between vaccines and autism. This means they compared a group which was vaccinated with a group that was not vaccinated but apart from that identical. They did not find MMR vaccines to be the cause of autism. Neither did they find an increased risk for autism by the vaccination.[32]

Parents also worried that thiomersal (US: thimerosal; a substance that makes vaccines and other medicines usable for a longer time) might cause autism because it contains mercury. No harm from the amount of ethylmercury in vaccines was known. Yet, vaccines for infants containing mercury were taken from the market. Mercury poisoning triggers clearly different symptoms than autism. Still, researchers did studies about this topic. They did not find a connection between thiomersal and autism.

Finally, a third theory was suggested. It was stated that many vaccines at the same time would weaken the immune system of infants. However, autism is not a disorder that is related to the immune system. Also, single and also many vaccines do not weaken the immune system.[50]

Diagnosis[change | change source]

Diagnosing autism can be hard because there is no medical test like a blood test. Instead, an evaluation is made by a team of doctors and other health professionals who are experienced in autism and know the person trying to get diagnosed.[51]

Diagnosis in children[change | change source]

A reliable diagnosis can first be given at the age of two. At the age of 18 and 24 months, children should get a check-up. If anything wrong is noticed, a further evaluation is done. In this, a team of professionals will talk to the child’s guardians about the child’s behaviour and see what they are like in different settings. This may also include behavioural or physical assessments as well as intelligence tests or developmental tests. A good, detailed history of the child is often very useful in getting a diagnosis.[52]

Diagnosis in adults[change | change source]

Autism can be diagnosed in adults as well as children. This can be difficult because autism has symptoms that can also be a part of other disorders, such as OCD, that may have appeared by adulthood. An expert will usually ask the adult about concerns, challenges in life (such as socially or behaviourally) as well as standardised testing in these areas. They also often ask for a developmental history.[53]

Diagnostic and Statistical Manual (DSM-5)[change | change source]

In 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In order to be diagnosed with autism, a person must fulfill two standardized criteria. It is important that individuals must show symptoms from early childhood, even if those symptoms are recognized later. These symptoms have to limit everyday functioning. These symptoms also cannot be explained by an intellectual disability or a developmental delay.[54]

Autism Spectrum Disorder is characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours.[54]

Co-occurring conditions[change | change source]

Autism spectrum disorder includes a wide range of symptoms, skills and levels of disability. Some autistic people also have learning disabilities, mental health issues or other conditions. This means that autism can also co-occur with other conditions and symptoms of the following disorders:[55]

In the DSM-V, making a diagnosis of autism means a formal diagnosis of other psychiatric disorders cannot be made. Therefore, other mental health conditions may be undiagnosed in an autistic person, because it is impossible to make a comorbid clinical diagnosis.[55]

Treatment[change | change source]

Since autism is a spectrum, every person with autism is different. Different treatments help different people. There are a few different categories of treatment. The main ones are medication, different therapies and diets. The treatment is fitted depending on what a person with autism needs.

Medication[change | change source]

It is still unclear what causes autism. There may be a few causes. At the moment, it is only possible to lower the symptoms of autism. A full recovery from autism is not possible.[56] If therapies cannot reduce the symptoms of autism, medications are used additionally.[57] Often, several medications are used at the same time to treat different symptoms of autism.[56]

Selective Serotonin Reuptake Inhibitors (SSRI)[change | change source]

Serotonin is a chemical messenger that transports signals between cells and is very important for normal function, such as with sensory perception, memory, learning, and sleep, all of which are impaired in autistic people.

Researchers have not yet found a link between autism and serotonin, although they have been successful in treating autism with SSRIs, which stop cells from absorbing serotonin, meaning more is used for signals.[56]

They can be used to treat repetitive behaviour, aggression, hyperactive behaviour and outbursts of anger.[58] The SSRIs can have many side-effects. Usually the medication is better tolerated by adults than by children. Examples of SSRIs are Clomipramine, Fluvoxamine, Sertraline, Venlafaxine, Trazodone and Mirtazapine.[59]

Antipsychotic medication[change | change source]

Dopamine is a chemical messenger in the brain. It helps to do movements, release hormones and strengthen cognitive abilities. Researchers found that increasing the amount of dopamine in the brain will worsen the symptoms of autism. Substances that help to reduce symptoms of autism are the antipsychotic drugs. There are two types of antipsychotic medications. One of the types are typical antipsychotics. They block the sites where dopamine would bind to a cell. Atypical antipsychotic drugs on the other hand block the sites where dopamine or serotonin would bind to a cell.[57] Antipsychotic medicine is the most successful treatment for excitability in autism.[59] It can also help to reduce aggression, self-injury, hyperactivity and repetitive behaviours, although it may have many side-effects.[57] Originally, antipsychotic medications were used to treat mental disorders like depression, bipolar disorder or schizophrenia.[60] Examples of antipsychotic drugs are Haloperidol, Clozapine, Risperidone and Paliperidone.[59]

Psychostimulants[change | change source]

In the beginning, psychostimulants were only used for patients with attention deficit hyperactivity disorder. Researchers found out that they can also help patients with autism. The medication can reduce hyperactivity and inattention in people with autism. The medication can have many side-effects. Examples are Methylphenidate, Clonidine and Guanfacine.[59]

Diet[change | change source]

People with autism often have problems with their digestive organs like the stomach or gut. These problems could be inflammations, abdominal pain, gas, diarrhea or bacterial overgrowth. The reasons may be malnutrition, food intolerances or allergies. Specific food products causing these problems are left out from the diet. In many cases, products containing gluten or casein, the main protein occurring in dairy products, are excluded. In many cases vitamins, minerals as well as essential fatty acids are additionally provided. A big problem is that many autistic people cannot tell that they have pain. Because of this, many problems concerning the digestive organs are not noticed.[61]

Therapies[change | change source]

Occupational therapy[change | change source]

Therapy can be used to minimize distress caused by sensory overload. Special therapy plans are created for each autistic person. What is part of these plans depends on what the autistic person needs help with. The therapist tries to help the autistic person in many different aspects.

One part of this is sensory integration. The therapist will help the patient to make sense of different sensory inputs. For example, they may ask a child patient to play with finger paints or collect objects from a bag of dried beans.

Another part is the training of daily life activities. The therapist may help the patient to get used to things like getting dressed, eating, hygiene, shopping and financial management. These may be done one step at a time if the activity involves multiple steps, such as cooking.

Play therapy is also helpful, especially for children. It can be useful to learn about certain emotions, which can be hard for autistic people. This can also be used to help learn social conventions, such as shaking hands instead of hugging when meeting a stranger.[62]

Therapy with animals[change | change source]

Often animals are used to help autistic people. Most often dogs or horses are used. The people diagnosed with autism can care for these animals, pet them, and, in the case of the horse, even ride on them. Studies showed that the interaction between an autistic person and animals can increase communication, reduce stress, fear, and aggression, and reduce the severity of the symptoms of autism.[63]

Music therapy[change | change source]

Music therapy consists of two parts. One is an active listening part. Here, the therapist is making music himself or playing music from a record. In the other part, the autistic person can make music himself like playing an instrument or singing. Music therapy will improve different aspects of communication.[64]

Art therapy[change | change source]

Here, different materials and techniques are used to draw pictures. The aim of art therapy is to make the autistic person more flexible and relaxed and to improve communication skills, self-image and learning skills. The effects of the therapy can be long lasting and transferred to the school, work or home setting.[65]

Related pages[change | change source]

Other websites[change | change source]

Scientific studies

References[change | change source]

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