Autism Spectrum Disorder

AUTISM SPECTRUM DISORDER
2025 UPDATE
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Autism spectrum disorders are neurodevelopmental disorders characterized by developmental delays in language and communication, difficulties with reciprocal social behavior, restricted areas of interests, ritualized, repetitive and stereotyped behavior (Mulick and Rice, 2015). Autism is now called “Autism Spectrum Disorder” (ASD). Starting in 2013 Autism Spectrum Disorder is a term that has been used by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The term “spectrum” is used to describe different variations and levels of severity of autism. ASD encompasses autism and a milder condition, once called Asperger’s Disorder. 

According to the Center for Disease Control and Prevention (CDC) ASD is a lifelong condition first evident in childhood. Based on data collected it is now reported that 1 in 44 children appear to have ASD. Studying antigens in 2013 (substances in vaccines that cause the immune system to produce disease-fighting antibodies) the CDC found no relationship between vaccinations and the development of ASD. Since 2006 over billions of dollars have been granted to the CDC, the National Institute of Health (NIH) and other federal agencies to perform research on ASD.

Common problems found with children with ASD include academic/learning problems, social skills deficits, difficulties in communication and poor mood regulation. About 60 percent of children with ASD wander. To “wander” means leaving a supervised area. This is common in toddlers who are exploring their environment and learning independence. After age four wandering is less common for most children. For some children this presents safety concerns. Specific symptoms of ASD include: 

•  Poor eye contact 
• Difficulty making friends
• Being uncomfortable in social settings
• Not sharing enjoyment of objects or activities
• Talking at length about specific subjects without realizing that others are not interested in discussing this subject
•  Unusual tone of voice (such as robot voice) 
• Difficulty understanding another person’s point of view (such as figures of speech)
• Difficulties with back-and-forth conversations
• Not responding to having his or her name called
• Repeating certain behaviors or words
• Long term and intense interest in certain specific subjects
• Interest in moving objects or parts of objects
• Becoming upset with changes in routine
• Difficulties with sensory experiences, such as sound, light, clothing or food textures
• Difficulty sleeping

PREVELANCE

In 2017 the CDC estimated that 2.1 percent of adults have ASD in the U.S.

In children it is estimated that 4.4 percent of boys have ASD and 1.3 percent of girls have ASD.

RISK FACTORS (from NIMH)

• Having a sibling with ASD
• Having older parents
• Genetic conditions such as Down Syndrome, Fragile X Syndrome or Rett Syndrome
• Very low birthweight.

GENETICS

An estimated 200 to 1,000 genes impact autism susceptibility. 

The majority of autism cases appear hereditary. It tends to run in families. No evidence suggest you can develop autism as an adult.

In 2024 UCLA Health Sciences published research showing a link between genetic risk of ASD and observed cellular activity across different layers of the brain related to ASD

ASSESSMENT AND DIAGNOSIS

Symptoms of ASD generally appear in the first two years of life. The American Academy of Pediatrics recommends that children be screened for ASD. An accurate diagnosis involves more than just an interview or a quick “screening test.” A more comprehensive psychological evaluation should involve:

•  Reviewing the developmental history of the child or adult;
• Direct observation of their behavior by the clinician;
• Direct testing involves such tests a measures of intelligence, autistic behavior, achievement, adaptive behavior and personality;
• Behavioral observations should be made by parents and teachers using rating scales. These observations are made with various psychological tests designed to measure and categorize various behavior;
• An assessment of their language skills;
• A written report should be offered with diagnoses and recommendations for treatment.

In addition to a psychological evaluation other professionals may also provide help in assessing this issue, such as a pediatrician or a speech-language pathologist.

TREATMENT

Educational goals involve the type of educational setting that is appropriate as well as instructional techniques and goals. Such goals should be guided by the assessment recommendations given about the child (such as intelligence and achievement tests findings). 

Early intensive behavioral interventions (EIBI) can be very helpful by determining basic behavior problems and determining appropriate strategies to deal with theses behaviors. When delivered early in a child’s life (from ages three to eight) EIBI can help recover delays in learning and language acquisition. Such treatment typically occurs for at least two years.

Treatment of high functioning autism (formerly called Asperger’s disorder) requires less intensive treatment. However, a comprehensive psychological evaluation often discovers learning disabilities, social impairment and other behavior problems in these children that need to be addressed. Typical interventions for these children involve anxiety management, anger management and social skill development. Not to be overlooked is the role of parents in treating ASD. Parents often need education and support in how to manage and teach their children.

Medication treatment of ASD is rather complicated. There is no known medication treatment specifically for ASD. Instead, some psychiatric medications may be helpful in managing certain behaviors or other disorders that also occur with ASD, such as attention problems, difficulties regulating mood or social anxiety. 

ADULTS WITH ASD

 It is not uncommon that young adults in their twenties or thirties come to our office for a psychological evaluation for ASD. These are usually high functioning cases that were not recognized while in school. As ASD can have major effects on adult functioning and job performance an assessment can be quite helpful in determining appropriate job placement, possible disability and problems in social functioning. 

REFERENCES AND SOURCES OF INFORMATION

AutismSociety.org

AutismSpeaks.org

Mulick, J. and Rice, C. Assessing and treating autism spectrum disorders. In Psychologist Desk Reference, Oxford Press, 2015.

National Institute of Mental Health

Center for Disease Control

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association. 

Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies external iconexternal icon. Vaccine. 2014 June;32(29):3623–3629.

 Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism pdf icon [PDF – 5 pages] external icon. JAMA. 2003;290:1763–6.

Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, et al. A population-based study of measles, mumps, and rubella vaccination and autism external icon. N Engl J Med. 2002;347 (19):1477–1482.