Autism

As they approach adulthood, people with Asperger's syndrome are more likely to develop depression and anxiety.

Pervasive developmental disorder, not otherwise specified (PDD-NOS)

This is the more common type of autism spectrum disorder and is associated with more severe symptoms than Asperger's syndrome, but less severe symptoms than autistic disorder. Children with PDD-NOS have:

• Impaired social skills;
• Impaired language skills;
• Some degree of repetitive behaviour, and;
• A later age of onset.

This is a highly variable type of autism spectrum disorder. If a child appears autistic, but doesn't meet all the criteria for autistic disorder, they are classified as having PDD-NOS.

Autistic disorder

There is rigid criteria for classifying autistic disorder. Children with autistic disorder:

• Have severely impaired social skills;
• Have severely affected speech and language skills;
• Show marked repetitive behaviour, and;
• Often have mental retardation and seizures.

Signs and symptoms

In children

Parents usually first notice the signs of autism spectrum disorder in their child during the child's first year of life. Parents might sense something is unusual with their infant, such as a lack of:

• Smiling;
• Speech;
• Gesturing and pointing;
• Eye contact, and;
• Affection and a dislike of being cuddled.

Autism spectrum disorder is characterised by difficulties in:

• Behaviour;
• Social interaction;
• Communication, and;
• Sensory sensitivity.

Behavioural difficulties

People with autism spectrum disorder can struggle to deal with their environment and this may manifest as unusual behaviour. Because they can feel overwhelmed by situations, people with autism spectrum disorder try and find ways to maintain some predictability and certainty. They may:

• Show repetitive behaviour, such as turning a light switch on and off;
• Insist on sticking to a specific routine, or;
• Carry out a task in the exact same sequence every time it is performed.

Because they often have a particular obsession about an activity, object or hobby, they may not be able to show interest in others, which can make it harder for them to make and keep new friends.

Social interaction

People with autism spectrum disorder may find it difficult to:

• Understand non-verbal communication that most of us use to communicate our feelings and thoughts, such as reading facial expressions, and;
• Share their own needs and feelings with others.

People with autism spectrum disorder may come across as being disinterested, aloof or even rude and may find it difficult to make new friends and maintain long-term friendships and relationships.

Communication

People with autism spectrum disorder may experience a range of communication problems. Their speech may be:

• Absent;
• Partially affected, with some broken fluency, or;
• Totally unaffected, with full fluency.

The speech of someone with autism spectrum disorder may be made up of repeated words, meaningless phrases, or they may repeat your own words back at you.

Sensory sensitivity

People with autism spectrum disorder may overreact or underreact to certain sounds, tastes, textures and smells. For example, they may at times show no response to being spoken to, while at other times they may be upset by quiet sounds. Some children with autism spectrum disorder might cope by making repetitive noises to drown out the offending sound, or by blocking their ears. Some children might become distressed by the feeling of certain fabric rubbing against their skin, or labels on clothing.

In adults

Autism spectrum disorder is a condition with which a person is born. It is commonly diagnosed during childhood and continues for the remainder of their life. However, in some people, if symptoms are very mild, it may go undetected until adulthood. These individuals usually suspect that they are 'different' throughout their life, but may not have had a formal clinical assessment. It is never too late to seek medical assessment, if you suspect having relevant symptoms.

Causes

It is not yet known what causes autism spectrum disorder. It is currently understood that changes during brain development, in combination with environmental and genetic factors, may be the cause. Having one child with autism spectrum disorder means you are more likely to have another child with autism spectrum disorder, but no specific gene has been isolated yet to prove the genetic link.

What does NOT cause autism spectrum disorder

Autism spectrum disorder is:

• Not caused by bad parenting, and;
• Not caused by vaccination or other medical treatments.

Measles, mumps and rubella (MMR) vaccine

A study published in 1998 by Dr Wakefield concluded that there was a causal link between the administration of the MMR vaccine and the development of autism spectrum disorder. This led to parental concern about risks of childhood vaccinations. Since then, this study has since been discredited, withdrawn from the journal in which it was originally published and Dr Wakefield's registration as a doctor in the UK was cancelled. Numerous other studies have since shown no link between childhood vaccinations and autism.

Thiomersal

Thiomersal is a preservative that was formerly used in some childhood vaccines. There was some concern of a causal link between those childhood vaccines that contained thiomersal and the development of autism spectrum disorder. Extensive research failed to demonstrate any such link, but as a precaution thiomersal is no longer used in standard childhood vaccines in many countries.

Methods for diagnosis

In a child

Behavioural problems associated with autism spectrum disorder usually become apparent before a child is three years old.

The diagnosis of autism spectrum disorder can be challenging, as its symptoms and behavioural problems can overlap with those associated with other disorders such as attention deficit hyperactive disorder (ADHD) and learning difficulties. Diagnosis of autism spectrum disorder usually requires a multidisciplinary approach and may involve a psychiatrist, psychologist, speech pathologist and, if the diagnosis relates to a child, a paediatrician.

There is no laboratory test that can conclusively diagnose this condition. Usually a range of clinical tests are performed to help in the diagnosis. Some of these include:

• Conducting a thorough medical history - asking questions about the child's development and interactions;
• Carrying out clinical observation to watch the child's behaviour and interactions;
• Carrying out an intelligence test, and;
• Conducting a hearing test, in case a hearing problem is the cause of the speech delays and impaired social skills.

Key diagnostic factors

Some of the following factors may be associated with a diagnosis of autism spectrum disorder:

• Language delay or regression - children may not develop normal speech or they may start to speak, only to regress later;
• Lack of interactive game-playing;
• Lack of non-verbal communication such as facial gestures and posture;
• Preferring to frequently play alone and/or lack friends;
• Repetitive, rigid interests, behaviour or activities;
• Feeding and dietary difficulties (due to their oversensitivities to taste, texture and smell), and;
• Sensory symptoms such as stroking, smelling or licking objects or people.

Some parents may feel traumatised if their child is diagnosed with autism spectrum disorder and may feel a sense of loss and grief about the potential future problems they envisage. In such instances, seeking emotional support from a family counsellor may prove helpful.

In adults

Because of improved understanding and knowledge of autism spectrum disorder, it is increasingly common for adults to now be diagnosed with this condition. Some adults might have read or seen something about autism spectrum disorder and may have recognised their own behaviour and symptoms.

Some adults may choose to seek professional advice for clinical assessment. Even though someone may have reached adulthood without undergoing clinical assessment of their behaviour and symptoms, having a clinical assessment may enable them to enhance their function and quality of life. Clinical guidance and assessment may also help their family and friends better understand the nature of their condition.

Adults may be diagnosed by an experienced psychologist or psychiatrist, who may ask questions relating to their childhood, friends, work and study to complete their assessment.

Types of treatment

Early intervention can help improve outcomes. The management plan for autism spectrum disorder needs to be tailored to accommodate the diverse nature of the symptoms and behavioural problems. Treatment may include behavioural and communication therapies, education therapies and medications.

Behavioural and communication therapies

Social stories

People with autism spectrum disorder can struggle to interpret social situations. One strategy that has been devised is to create a short 'social story' using words and images that can help a person understand a certain social situation, such as going to a birthday party or to a shopping centre. Reading the story prior to going into the situation can help to ease anxieties associated with being in a foreign situation.

Applied behaviour analysis

People with autism spectrum disorder can experience behavioural problems. Applied behaviour analysis is a program used to treat young children by reinforcing positive behaviour and dissuading negative behaviour.

Picture exchange communication systems (PECS)

People with autism spectrum disorder can experience communication difficulties. PECS can be used for children who do not speak freely, allowing them to express their needs and feelings. PECS uses pictures, objects and symbols, according to the child's age.

Hanen program

People with autism spectrum disorder can experience impaired social and communication skills. With the Hanen program, parents of children under the age of six years are taught various strategies to help their child improve their social and communication skills.

Education therapies

General strategies

Choosing a school that will best meet the needs of a child will improve the long-term outcomes and help them reach their potential. There may be schools that cater for the needs of students with autism spectrum disorder.

Some strategies to help a child with autism spectrum disorder become comfortable with their new school may include:

• Visiting the school multiple times for increasingly longer periods so that they can adjust to their new surroundings;
• Making a scrapbook of the school's buildings, classrooms, toilets and playground to help the child become more comfortable, and;
• Following a daily routine.

Treatment and education of autistic and communication-related handicapped children (TEACCH)

People with autism spectrum disorder may struggle with a standard curriculum and education environment. TEACCH is a teaching program that provides a structured physical environment and uses visual supports to make the sequence of daily activities predictable and tasks more easily understood. It is customised for each child and doesn't involve a standard curriculum.

Medications

Risperidone

Risperidone may be used to treat challenging behaviours such as aggression and irritability in older children with autism spectrum disorder. However, risperidone doesn't treat the core features of autism spectrum disorder.

Antidepressants

Many individuals with autism have concurrent mood changes, such as depression. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be used to treat depression in adolescents and adults with autism spectrum disorder. However, antidepressants don't treat the core features of autism spectrum disorder.

Methylphenidate

Methylphenidate may be used to treat severe and debilitating hyperactivity in children with autism spectrum disorder.

When considering appropriate treatment, it is important to take into consideration that all medications can be associated with side effects of varying severity.

Social support

Community accommodation

Adults with autism are encouraged to live independently in the community. Individual and shared accommodation facilities may be available, depending on the level of support needed and availability of funding. A doctor or social worker can help identify the available services.

Community services

Numerous local communities and related organisations are equipped to provide individuals with autism a range of social supports. These include alternatives to employment such as pre-employment training/volunteer work, transport services, and access to recreational activities and facilities.

Family and carers

Caring for individuals with autism can be both rewarding, but also challenging at times. Having a good understanding of the condition can help to predict challenges and reduce stress. Other parents and carers of individuals with autism can be good resources for support and understanding. As a carer of a child with autism, you may be entitled to financial support from various government departments.

To be able to provide ongoing care and support, it is equally important to also look after yourself. Some local community networks have family and carer services available to provide assistance with daily tasks such as light household duties, meal preparation and/or child care. Some organisations have support workers who can provide respite, which is temporary care for individuals with autism, to allow family and carers an opportunity to rest and recover.

Your local doctor can help you find the most appropriate support services and funding for your circumstances.

Complications

Depending on the severity of symptoms and behaviour problems, the lives of people with autism spectrum disorder can be significantly affected by their condition.

People with autism spectrum disorder:

• Experience a higher rate of unemployment;
• Are overrepresented in the homeless population and in the justice system;
• Are more likely to experience depression, anxiety and sleep disturbance;
• Are more likely to have epilepsy (it occurs in about one in three people with autism spectrum disorder), and;
• May experience sensory symptoms, may ignore extremes of pain and temperature and may be more likely to injure themselves.

Prognosis

Although autism spectrum disorder is a lifelong condition that has no cure, there are many ways to help someone with this condition so that they can lead a fulfilling life. Increased awareness and education about this condition, both in the community and among medical professionals, is contributing to early intervention, which means better outcomes.

Prevention

The exact cause of autism spectrum disorder is still to be determined, and currently there is no method of preventing this condition.