Autism

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The **autism spectrum**, commonly called **autism**, or also known as **autism spectrum disorder** is a developmental condition.

## Overview
Autism changes how one thinks, understands the world, moves, communicates, and socializes. Autism may make it hard for someone to make friends, read facial expressions, or effectively socialize and communicate. People with autism might need routines more, such as having the same food for breakfast everyday and getting upset if their routine is changed. 

They might also repeatedly move their body, be super interested in a specific subject and sensitive to loud sounds. Autism is a spectrum disorder, which means that every person with autism will have different symptoms and varying severity of symptoms. Some autistic people may need a lot of help with a particular task. Others may not need the same extent of help.

## History
### Early history
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." The term "autism" was first used by a psychiatrist named Eugen Bleuler in 1911 to describe one group of symptoms of schizophrenia. Sigmund Freud considered this idea and thought it was related to narcissism.

### Discovery
In the 1940s, two researchers were studying autism in different countries; Hans Asperger in Austria and Leo Kanner in the United States. Particularly, Kanner (a doctor from Johns Hopkins University) did a study of 11 children in 1943. 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," now called *autism* spectrum disorder.

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”. It used to be thought that Hans Asperger and Leo Kanner were looking at different children and that Hans Asperger found a "mild form" of autism. This is the reason the label of Asperger syndrome was created. 

However, later research found that they were doing research on similar populations. 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 because of their genetics. In Nazi-occupied Europe, people who were considered inferior, including those with disabilities, were subject to genocide. Hans Asperger sent children with disabilities to be murdered.

### Early misconceptions
#### The *refrigerator mother* theory
In 1943 and 1949, Kanner described the children he studied in scientific papers. 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. In 1949 he wrote that the children's parents showed no warmth or love to their children. Now we know this is not true.

### Research
The main areas of difference from non-autistic people are how they understand their surroundings, sensory processing differences, motor differences, communication differences, developmental differences, and socializing differences. 

This happened because doctors found that these diagnoses were frequently used in different ways. For instance, 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 support.

## Symptoms
Signs of autism are usually present when a child is around two or three, but some are not diagnosed until later years in their lives, especially adulthood. There is no cure for autism. Many autistic people do not want a cure. They want to be accepted as different. This is called neurodiversity. Autistic people who want their differences to be accepted may be part of the autism rights movement.

### Persistent deficits
Both the ICD-11 and the DSM-5 define autism by deficits. Deficits are areas where autistic people are not as good at something as non-autistic people. Autistic people have disagreed with how autism is defined by deficits and not by differences. In Welcome to the Autistic Community, a Simple English book, about being autistic, they refer to differences, rather than symptoms or deficits. Researchers and autistic advocates are working together on creating a way to diagnose that is based on autistic people's experiences of autism and is not deficit based.

The symptoms or characteristics of autism can look different depending on how old you are. Doctors are supposed to keep that in mind while diagnosing autism. For example, a toddler and an adult, while they both are autistic, may show it very differently.

These symptoms must be persistent. Persistent means that these symptoms must keep happening over a long span of time. If a symptom only happened once, it wouldn't be persistent. Autism is life-long.

### Onset
These are the two areas where symptoms must be present to diagnose autism spectrum disorders. Both the ICD-11 and DSM-5 say that there have to be some symptoms in childhood, but that sometimes symptoms won't fully manifest until later.

NHS England calculated in 2022 that autistic people without a learning disability were more likely to die. On average, they live about 5 years less than other people.

## Frequency
There are many studies on how many autistic people there are. In the United States, the CDC has done studies. In 2018, they found that 1 in 44 children are autistic. That is about 2%. According to the World Health Organization (WHO), 1 in 100 children worldwide are diagnosed with autism. This number keeps going up. Many people wonder why there are more and more autistic children. Some people think that something is causing it. But most scientists think that we are getting better at diagnosing autism. More doctors know about autism and can diagnose children that they see. More people have access to medical care and can get a diagnosis.

### Lack of diagnosis
In the past, autism was considered a disorder for white boys. Still, more white boys are diagnosed, and it is 4 times more diagnosed in boys than in girls. Girls and children of color are under-diagnosed. Under-diagnosed means that girls and people of color are not diagnosed as often as they should be. They may be given a different diagnosis, or they may not get 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. Another reason might be that girls are more likely to mask or camouflage their autism to fit in.

## Causes
Scientists do not know exactly what causes autism. There may be many different causes for autism. Scientists do know about some things that make a person more likely to have an Autism Spectrum Disorder.

### Genetics
Autism may be caused by genes. Genes are passed on from parents to children. If you have an autistic family member, you are more likely to be autistic. Some doctors look for the genes that cause autism. This is criticized by some autistic people.

### Differences in the brain
Some researchers think that differences in the brain may cause autism. However, no type of abnormal functioning of the brain is the cause of autism. Still, scientists found some differences between the brains of autistic people and the brains of people who are not autistic. Autistic people might use certain parts of the brain more than non-autistic people. 

A study by a group at Stanford Medicine found that there are structural and functional differences in the mesolimbic reward pathway of children with autism, particularly in the connections between the nucleus accumbens and the ventral tegmental area. The mesolimbic reward pathway is the pathway that allows people to find social interactions and other stimuli rewarding. The risk for autism also increases with the age of father and mother at the time of pregnancy.

Maternal folate deficiency is also a prenatal and perinatal factor that is a risk factor for autism. Folate (Folic Acid) is a micronutrient that is a type of B vitamin. This nutrient can play a vital role in a uterus’s development and the production of healthy red blood cells. It was hypothesized that maternal supplementation of folate can help reduce a baby’s risk of developing ASD. 

Research on the relationship between folate and Autism Spectrum Disorder has had mixed results. Studies conducted by Raghavan et al. (2017) and Levine et al. (2018) found that when a mother was exposed to folate through supplements before and/or during pregnancy, there was a reduced risk of the child having Autism.

## Debunked theories
Some things don't cause autism. People used to think they did.

### *Refrigerator Mother* theory
Scientists used to think that the parents caused autism by not loving their child enough. This is **not true.** Scientists know that parents do not cause their children's autism. Vaccines don't make a person more likely to have autism, even if they are already likely to have autism before they get their vaccines.

A paper seen as wrong by some said in 1997 that vaccines caused autism. According to some, this study did not do research the right way. Many studies have shown that this is not true. Vaccines do not cause autism. This paper was retracted because it was seen wrong by the scientists.

## Diagnosis
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.

### Children
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.

### Adults 
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.

### DSM-5
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 have 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. Autism Spectrum Disorder is characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours.
* Attention deficit hyperactivity disorder (ADHD)
* Obsessive-compulsive disorder (OCD)
* Learning disability
* Intellectual disability
* Anxiety disorder
* Hypermobility
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. If therapies cannot reduce the symptoms of autism, medications are used additionally. Often, several medications are used at the same time to treat different symptoms of autism. 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.

#### Antipsychotics
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 is typical antipsychotics. They block the sites where dopamine would bind to a cell. Atypical antipsychotic drugs block the sites where dopamine or serotonin would bind to a cell. Examples of antipsychotic drugs are Haloperidol, Clozapine, Risperidone and Paliperidone.

### Therapies
#### Applied Behavioral Analysis
Applied Behavior Analysis uses research-supported data to design treatment protocols that aim to reduce problematic behavior among individuals with autism and build habits and skills to help them live more independently. It often includes different types of therapies including occupational therapy, speech therapy, etc.

#### Occupational therapy
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.

#### Animal therapy
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.

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

#### Art therapy
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.

## Related pages
* Monotropism
* Asperger syndrome
* Nonverbal learning disorder

## Other websites
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## References