Autism spectrum disorder (ASD)
Autism spectrum disorder (ASD) is a developmental disorder that is generally noticed in early childhood. Affected people have problems with social understanding, social behaviour and communication.
The term ‘autism spectrum disorder’ has replaced ‘autism’, as it has been increasingly recognised that this is a complex condition with a wide range of symptoms and varying degrees of severity.
Asperger syndrome (or Asperger’s disorder) was previously considered a distinct condition from autism with milder symptoms. Now, symptoms previously diagnosed as Asperger syndrome are included in autism spectrum disorder.
People with ASD don’t look any different from anyone else. They are not physically disabled, although they may have learning disabilities. The common factor that those with ASD share is difficulty in making sense of their world, and in particular a difficulty in understanding the mental states of other people.
What are the symptoms of ASD?
Children and adults with ASD have problems in the areas of:
- social interaction;
- social communication; and
- restricted and repetitive behaviours.
In children, symptoms can include:
- delayed development, particularly of language skills;
- speech may be unusual in terms of tone or rhythm (may speak in a monotone voice or sing-song voice);
- repetition of certain phrases;
- an inability to understand metaphor, sarcasm or irony;
- solitary play and withdrawal from others;
- lack of imaginative play;
- apathy toward other people’s attempts at communication;
- a dislike of physical affection;
- displays of temper towards the self or others;
- difficulty with changes in routine;
- lack or absence of eye contact;
- inappropriate body language;
- repetitive and compulsive behaviour (such as lining things up) which, if interrupted, may provoke temper tantrums;
- repetitive movements, such as hand flapping;
- unusual behaviours;
- overly focussed interests, or a lasting, intense interest in certain topics;
- preoccupation with parts of objects;
- difficulty in learning; and
- inflexible adherence to particular routines or rituals.
Sometimes children who have previously been meeting their developmental milestones regress and lose some of their language or social skills.
In addition to these problems, many children with autism spectrum disorder have strengths, such as:
- above average intelligence;
- being able to learn and remember things in detail; and
- in some, extraordinary talent or brilliance in specific skills (such as music, mathematics or art).
It’s important to note that many children display some of the symptoms of autism spectrum disorder some of the time without having ASD. It is when these symptoms occur often or most of the time that they may be a sign of ASD.
What problems do people with ASD experience?
People with ASD may appear aloof and indifferent to other people and often cannot understand the meaning of gestures, facial expressions or tone of voice. They may also have difficulty initiating and maintaining back-and-forth conversations.
Because of their limited capacity to understand other people’s feelings, people with ASD do not develop friendships easily. Children with ASD often don’t enjoy experiences that other children their age enjoy, such as birthday parties, and are not interested in other children their own age.
Children with ASD may have problems with imaginative or pretend play and often have extreme difficulty coping with changes to routine.
Many people with ASD have strong reactions to sensory experiences — they may be either fascinated or afraid of particular sounds, textures or visual experiences, such as loud noises, bright lights or busy environments. Some people with ASD have a very high tolerance to pain.
Children with ASD may appear to live in a world of their own, in some cases using a language or vocabulary only they understand.
Although ASD is often associated with learning problems, not all people with these disorders are affected in this way. Indeed some people with ASD have superior cognitive functioning and excellent memories. Every person with ASD is affected differently and some live and work successfully in the community, having adjusted to the effects of their condition on their lives.
How common is ASD?
ASD is among the most common developmental disabilities, affecting about one in 100 children in Australia. The characteristics usually show themselves in the first 2-3 years of life.
Boys are affected more than girls – in fact boys are 4 times more likely to be diagnosed with ASD than girls. However, girls who have the condition are more likely to show more severe symptoms.
What causes autism spectrum disorder?
The exact cause of ASD has not yet been pinpointed, but doctors believe that some people are more likely to develop ASD because of the genes they have inherited.
Families with an affected child have a higher risk of a subsequent child having autism spectrum disorder than that of the general population. However, researchers think that several genes influence the development of ASD, and that the cause is complex — possibly a combination of genetic and environmental factors.
There are a number of neurological disorders that have symptoms similar to those of ASD. ASD can also be associated with certain other medical conditions including:
- tuberous sclerosis (a rare genetic disorder causing tumours to develop in the brain and other organs);
- Tourette’s syndrome;
- Rett syndrome (a genetic developmental disorder that affects girls);
- Fragile X syndrome (a chromosomal abnormality, more common in boys, which causes intellectual disability and heart problems); and
- some biochemical and metabolic disorders.
There is also an association between autism spectrum disorder and epilepsy. Seizures (fits) often start either in early childhood or in adolescence.
Many children with ASD experience associated mood or anxiety disorders. Attention deficit hyperactivity disorder (ADHD) is also associated with ASD.
How is autism spectrum disorder diagnosed?
Your doctor will ask about behaviours that you are concerned about and examine your child’s behaviour and development.
If your doctor thinks that your child may be likely to have ASD, they will refer him or her for further tests, diagnosis, advice, treatment and education.
A team of health professionals may be consulted to evaluate your child. Health professionals that can help with the diagnosis of ASD include:
- developmental paediatricians;
- child psychologists or psychiatrists;
- occupational therapists; and
- speech pathologists.
To help with diagnosis, you may also be asked to complete a questionnaire asking about certain behaviours and symptoms that you have noticed in your child.
Treatment of autism spectrum disorder
While there is no cure for autism spectrum disorder, there are treatments available.
There is a wide range of features associated with ASD, so treatment for your child will depend on their specific symptoms and needs. A treatment programme developed specifically for your child can help them develop skills, improve behaviour and development and make the most of their strengths. This will help them to adapt to their environment. Early intervention treatment programs have been shown to improve outcomes for children with autism spectrum disorder.
Treatment programmes may consist of behavioural therapy, occupational therapy, speech therapy, and sometimes medicines. Education of parents is also usually an important part of the treatment programme.
There are treatment programs that can help your child with social interactions, communicating with others and addressing behavioural problems. Some children with ASD benefit from intensive behavioural therapy.
If your child has learning difficulties, there are also structured educational programs that may help.
Speech therapists (also called speech pathologists) can help with language and speech problems to help your child communicate with others.
There are medicines available to treat some of the symptoms associated with autism spectrum disorder (ASD).
Medicines can be used to help treat:
- aggressive behaviour;
- hyperactivity; or
- sleep problems.
Your doctor will want to regularly review your child’s medications to assess whether they are helping and to check for any side effects.
There is currently limited evidence for the effectiveness of complementary therapies for children with ASD. You should discuss any complementary therapy with your doctor and treatment team.
Helping children with autism program
Since mid-2008, increased funding has been available in Australia through Medicare under the 'Helping Children with Autism' program. This improves access to speech pathologists, occupational therapists and psychologists, as well as paediatricians or psychiatrists for both assessment and treatment.
To obtain this package, your child needs to be younger than 13 years at the time of initial assessment and referred to a psychiatrist or paediatrician for this service by your general practitioner (GP).
Support groups for ASD
There is support available for families affected by autism spectrum disorder. Meeting with other people who are dealing with similar issues can be very helpful.
It’s important that parents and carers of children with ASD look after themselves as well. Talk to other parents as well as healthcare providers about ways to manage and getting advice on coping strategies.
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4. American Academy of Pediatrics (AAP). New DSM-5 includes changes to autism criteria (Jun 2013). http://www.aappublications.org/content/early/2013/06/04/aapnews.20130604-1 (accessed Apr 2016).
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