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Autism Overview

Autism is a spectrum of disorders rather than one distinctive disorder. Therefore, we refer to it as autism spectrum disorder (ASD). ASD affects about 1 in 59 children and is more common among boys when compared to girls. Boys have four times more chances to develop ASD than girls. Autism is a developmental disorder that can become apparent early in life. Some cases are identifiable as early age as 2. The socioeconomic background of a child does not play a role in the prevalence of the disorder. However, children coming from minorities are less likely to receive a diagnosis in time, if not at all. The earliest diagnosis, the better the outcome. Children who received a diagnosis early enough had better support regarding healthy development. ASD does not have a cure nor a specific diagnostic test, like a blood exam or an imaging test. Physicians base their diagnosis on developmental observations and behavioural patterns.


What is autism?

Autism is a spectrum of developmental disorders that affect a child's social skills and integration. It has many sub-types that form distinct behavioural patterns, all with its challenges and unique strengths. Children with ASD present with impaired social skills, repetitive behaviours, difficulties with speech, and nonverbal communication. An estimated 31% of children with a form of autism present with intellectual disability. Another 25% of children with ASD have a borderline intelligence index. These numbers suggest that individuals with autism face daily and significant difficulties with their social and private lives. Although some can live a regular life, others need assistance throughout their lifespan. 


What are the indicators of autism?

The typical developmental milestones differ in children with autism. Parents of children with autism need to keep themselves updated regarding the changes and hints that proceed from ASD. However, not all children will experience all the signs. Sometimes, even children without autism will appear to have some symptoms. Autism spectrum disorders appear with some of the following signs:

  • Six months: diminished facial expressions of joy, such as smiles, and decreased eye contact.
  • Nine months: lack of back-and-forth communication
  • Twelve months: diminished babbling and back-and-forth gestures, and little or no response to name.
  • Sixteen months: limited vocabulary
  • Twenty four months: meaningless or few two-word phrases


General signs at any age

Children, teenagers, or adults with autism spectrum disorders have some general signs that you could meet at any age. Individuals with autism usually don't practice eye contact. They prefer being alone and have difficulties understanding the feelings of others. Therefore, they would find it hard to recognise whether you're happy, sad, or even stressed. Also, they usually have delayed language development and loss of previously acquired skills. Echolalia is another characteristic of people with autism, meaning that they repeat words and phrases persistently. They also seem not to tolerate any minor changes in their environment. Another sign is repetitive behaviours that resemble ticks, and a minimum amount of interests, such as music or sports. Finally, individuals with ASD react profoundly to stimuli, such as sounds or smells.


What disorders does the spectrum of autism include?

The American Psychiatric Association included four distinct diagnoses into one big category, known as autism spectrum disorders. The disorders that belong to this umbrella term are the following:

  • Autistic disorder
  • Childhood disintegrative disorder
  • Asperger syndrome
  • Pervasive developmental disorder-not otherwise specified

ASD's symptoms may range from person to person. What all these conditions have in common is impaired social and communication skills. People with ASD seem to be in their world, isolated from their environments. Therefore, they might seem hard to approach or introverts. They also have a diminished capacity to communicate with body language.


What other symptoms do people with ASD have?

Some people with ASD may have additional symptoms of autism, like hyperactivity, meaning being very active. Others may be impulsive, meaning acting without thinking first. Attention-deficit is another characteristic of autistic people. Therefore, they might find it difficult to concentrate on one task. The following are some of the most common additional signs and symptoms of people with ASD:

  • Being aggressive
  • Causing self-harm
  • Emotional lability
  • Unusual eating or sleeping patterns
  • Being reckless or extremely fearful


An interesting thing about people with autism spectrum disorder is their unusual response to stimuli, like pain, sound, or smell. For example, some individuals may have an extraordinary tolerance to hurt, but over-react to smell or sound. Also, they might eat non-edible material, like dirt, or eat exclusively specific foods.


Autism and sleeping disorders

It is common for people with ASD to suffer from sleeping difficulties. Falling-asleep and staying-asleep insomnia is a challenge for most individuals with ASD. Their struggles with receiving a sufficient amount of rest interfere with their quality of life. Therefore, the lack of sleep will eventually result in more profound repetitive behaviours, which will finally hold them back from sleeping. This vicious cycle of disruptive sleeping is a usual burden in those who share a house with a person with autism. An estimated 44-86% of children with ASD report to having sleeping difficulties. However, despite the numbers, insomnia is the least studied aspect of ASD.


Quick facts on sleep problems in children with autism

  • Children with ASD experience regular insomnia
  • Insomnia worsens the general symptomatology of children with autism
  • On average, children with autism need eleven minutes more to fall asleep, when compared with the general population
  • In addition to insomnia, children may have a disruptive sleep cycle
  • A child with ASD may suffer from sleep apnea
  • Children with insomnia spend less time in their rapid eye movement (REM) phase when compared with the general population
  • Children with ASD that lack sleep present with more severe repetitive behaviours, hyperactivity, or attention-deficit
  • Sleeping problems in some people with ASD are due to gene mutations or medication used to treat the other symptoms
  • Sleeping problems may be secondary to other symptoms of ASD, such as anxiety or gastrointestinal disturbances


How to assess and treat sleep problems in children with ASD?

To assess sleep problems in children with autism, physicians use polysomnography. It is a sleep test that evaluates the brain waves of a person while sleeping. It also assesses their eyes, hands, and feet movements, as well as their breathing patterns. However, this test is not so practical, especially in children with autism that do not tolerate changes or interventions in their daily routine. Treating sleep problems in children with autism is quite challenging. It would be helpful, though, if children developed their private bed ritual. Besides, modifications in the lighting or temperature could also be accommodating. Pharmacological treatments include drugs against insomnia and melatonin supplements. In general, children should respect regular bedtime rules, for the body to adapt to custom hours of falling asleep and waking. Finally, weighted blankets could be helpful as well, by providing pressure stimulation that relieves anxiety and creates a safe sleeping environment.


Asperger's syndrome as part of the autism spectrum

In contrast with autism disorder that presents with intellectual disability, people with Asperger's syndrome seem to have the same mental capacity as an average person without the syndrome. However, these individuals struggle with social skills. Also, they practice repetitive behaviours that have as trigger an obsession. Today, Asperger's syndrome is not a separate diagnosis. It is part of the autism spectrum disorder. Asperger's syndrome presents with similar symptoms described above, such as avoidance of eye contact, social isolation, or obsession over a specific subject. They generally express little emotion through body language, such as smiles or gestures.



Pervasive developmental disorder not otherwise specified (PDD-NOS)

This condition describes individuals that do not meet the criteria for a specific autism diagnosis. However, they present with symptoms that suggest ASD. Usually, people with the disorder don't follow the same pattern of symptomatology but have similar developmental disturbances as children with autism. The signs and symptoms begin after three years of age. It is a form of atypical autism that affects people with profound retardation or with difficulties regarding receptive language.



Childhood disintegrative disorder

Childhood disintegrative disorder (CDD) or Heller's syndrome and disintegrative psychosis, begins after three years of age. Typical for this condition are developmental disorders regarding language, communication, and motor skills. It is one of the most well-understood subtypes of autism. Researchers do not know the cause of the condition. Children with this disorder experience at least two years of healthy development in all its aspects. Occasionally, seizures appear, as well. Therapeutic interventions are mainly educational. There is no pharmacological treatment that specifically targets the symptomatology of the condition.



What are the risk factors for autism?

Children can develop an autism spectrum disorder, regardless of their nationality or race. However, some specific factors increase a child's chance to develop autism. The following are some of the most well-established risk factors that make an individual more likely to grow up with autism:

  • Being a boy. Autism spectrum disorder is more common in boys than in girls. Females have four times fewer chances to develop an autism spectrum disorder.
  • Family history. A positive family history increases the risk of having a child with autism. Also, parents or relatives of children with autism might show some disintegrative social signs.
  • Existence of other disorders. Having fragile X syndrome and Rett syndrome raises a child's chances to present with symptoms of autism.
  • Preterm delivery. Extremely preterm babies are at high risk for autism spectrum disorder.
  • Age of mother or father. Researchers suggest that the age of parents may play a significant role. Older parents have more chances to have a child with autism.


How to diagnose ASD?

The diagnosis of ASD might be challenging. There is no specific medical test that can indicate or diagnose autism, like high blood glucose in diabetes, for example. Behavioural and developmental hints are the cornerstone of diagnosing autism in a child. Screening might start at 18 months old. However, most people get a diagnosis later in life, even though it might be a reliable one at only two years old. There are two steps to diagnose autism spectrum disorder. Firstly, physicians have to do a developmental screening. Secondly, a child should undergo a comprehensive diagnostic evaluation.


Developmental screening

Developmental screening is a set of questions that a doctor asks the parents about their child's milestones. These questions include a child's behaviour, speech or learning skills, motion, behaviour. The physician may also conduct tests on the kid directly. Parents and doctors should screen all children for developmental abnormalities. These tests should take place at nine months, eighteen months, and twenty-four or thirty months. Children with risk factors should receive additional screening. Children with any signs of autism should undergo a comprehensive diagnostic evaluation, which is the second step of diagnosing an autism spectrum disorder. Generally, all doctors should screen all children for any symptoms or signs of ASD.


Comprehensive diagnostic evaluation

If children show any signs of autism, they should undergo a comprehensive diagnostic evaluation. During this procedure, the doctor interviews the parents and assesses the child's behavior and social skills. Additionally, some neurological tests might also take place to evaluate other functions, such as vision or hearing. Some physicians prefer to refer the child to another specialist, such as a developmental specialist. Child neurologists, psychologists, psychiatrists are also experts in these disorders. These specialists know about the human brain, nerves, and mind of children and how to make a differential and definitive diagnosis of autism spectrum disorders.


Can you treat autism?

There is no definitive treatment for autism. Besides, there are individualised therapeutic interventions for each child, considering the heterogeneity of symptoms and family backgrounds. However, there are many ways to control the symptoms and improve the social skills and intellectual capacity of a child with autism. The outcome is better when there are early diagnosis and interventions. Children who receive treatment at preschool or before present with fewer symptoms and better social skills. Most therapeutic interventions target the symptomatology and not the disorder and its characteristics.


Pharmacological treatment

The available pharmaceutical approaches do not cure the disorder but target and improve their symptoms. Behavioural traits are the ones most commonly affected. The perspective behind the pharmacological treatment is to treat specific self-injurious or self-destructive behaviours. Therefore, children with autism can focus on other things, rather than focusing on repetitive and potentially dangerous behaviours. Some of the most well-established medication for autism and irritability is antipsychotics. FDA approves these classes of drugs for children with autism. However, there are other treatments that the FDA doesn't recommend. The following are some of the most well-known and widely-used drugs for autism spectrum disorder:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclics
  • Psychoactive or antipsychotic medications
  • Stimulants
  • Anti-anxiety medications
  • Anticonvulsants


Non-pharmacological interventions

Most children need non-pharmacological treatments to improve their symptoms and behavioural patterns. These interventions take place regularly and sometimes include the whole family. Keep in mind that families need to learn as well, how to live and grow with an autistic child. Therefore, there are educational programs for parents or siblings too. The following are some of the most widely-used interventions:

  • Joint attention therapy
  • Physical therapy
  • Social skills training
  • Speech-language therapy
  • Nutritional therapy
  • Occupational therapy
  • Parent-mediated therapy
  • Behavioural management therapy
  • Cognitive behaviour therapy
  • Early intervention
  • Educational and school-based therapies


Home remedies for autism

Children with autism might benefit from certain adjuvant home remedies. There are indications that a gluten-free diet might improve the symptoms of autism, especially if the child suffers from gastrointestinal problems, as well. Probiotics also help to improve the gut's health. Also, omega-3 fatty acids improve a child's development. Therefore, the diet of a child with autism is of extreme importance. Some children may benefit from melatonin supplements too to improve their sleep. As previously mentioned, individuals with autism have trouble sleeping. Most of them experience insomnia and have difficulties staying calm. Another method to improve sleeping is weighted blankets.


Weighted blankets for autism

Kids with an autism spectrum disorder find it difficult to sleep and relax. What could help them get some rest and be calmer during the night are weighted blankets. Weighted blankets weigh more pounds than an average blanket The purpose of this intervention is to apply deep pressure stimulation (DPS) during the night. DPS relaxes the nervous system and makes it easier for an individual to fall and stay asleep. This interventional technique helps children with insomnia fall asleep easier and fight the anxiety they usually experience. Although you can apply DPS manually too, weighted blankets offer the benefits of DPS during the night and without any effort from a third party.


Discussion and conclusions

Autism spectrum disorders are not common, neither rare. Scientists do not know its exact cause but suggest that some risk factors may raise a child's chances to develop an autism spectrum disorder. ASD is early identifiable and improves with early diagnosis and interventions. Although there is no therapeutic treatment for any of the autism subtypes, certain medication, and non-pharmacological interventions may improve the symptoms and the outcome of a child with the condition. The purpose of every therapeutic approach is to increase the quality of life of both the family and child.


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