Autism spectrum

Autism spectrum disorder
Other names
Infant stacking cans
Repetitively stacking or lining up objects is a common trait associated with autism.
SpecialtyPsychiatry, clinical psychology, pediatrics, occupational medicine
SymptomsDifficulties in social interaction, verbal and nonverbal communication, and the presence of repetitive behavior or restricted interests
ComplicationsSocial isolation, educational and employment problems,[1] anxiety,[1] stress,[1] bullying, depression,[1][2] self-harm
OnsetEarly childhood
DurationLifelong
CausesMultifactorial, with many uncertain factors
Risk factorsFamily history, certain genetic conditions, having older parents, certain prescribed drugs, perinatal and neonatal health issues
Diagnostic methodBased on combination of clinical observation of behavior and development and comprehensive diagnostic testing completed by a team of qualified professionals (including psychiatrists, clinical psychologists, neuropsychologists, pediatricians, and speech-language pathologists). For adults, the use of a patient's written and oral history of autistic traits becomes more important
Differential diagnosisIntellectual disability, anxiety, bipolar disorder, depression, Rett syndrome, attention deficit hyperactivity disorder, schizoid personality disorder, selective mutism, schizophrenia, obsessive–compulsive disorder, social anxiety disorder, Einstein syndrome, PTSD,[3] learning disorders (mainly speech disorders)
ManagementApplied behavior analysis, cognitive behavioral therapy, occupational therapy, psychotropic medication,[4] speech–language pathology
Frequency
  • One in 100 people (1%) worldwide[5]

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC),[6] is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Psychiatry has traditionally classified autism as a mental disorder, but the autism rights movement (and an increasing number of researchers) see autistic people with low support needs as a part of humanity's natural neurodiversity.[7] From this point of view, autistic people may also be diagnosed with a disability of some sort, but that disability may be rooted in the systemic structures of a society rather than in the person;[8] thus, proponents argue that autistic people should be accommodated rather than cured.[9] The neurodiversity perspective has led to significant controversy among those who are autistic and advocates, practitioners, and charities.[10][11]

There are many theories about the causes of autism; it is highly heritable and mainly genetic, but many genes are involved, and environmental factors may also be relevant.[12] The syndrome frequently co-occurs with other conditions, including attention deficit hyperactivity disorder, epilepsy, and intellectual disability. Disagreements persist about what should be included as part of the diagnosis, whether there are meaningful subtypes or stages of autism,[13] and the significance of autism-associated traits in the wider population.[14][15] The combination of broader criteria, increased awareness, and the potential increase of actual prevalence, has led to a trend of steadily increasing estimates of autism prevalence,[16] unintentionally aiding the disproven myth perpetuated by anti-vaccine activists that it is caused by vaccines.[17]

There is no cure for autism. Although early intervention services based on applied behavior analysis (ABA) can help children gain self-care, social, and language skills,[18][19][20][21] independent living is unlikely in more severe cases. Speech and occupational therapy, as well as augmentative and alternative modes of communication, are effective adjunctive therapies, but some in the autism rights movement consider ABA therapy unethical and unhelpful.[22] Pharmacological treatments may also be useful; the atypical antipsychotics risperidone and aripiprazole are empirically validated for alleviating co-morbid irritability, though these drugs tend to be associated with sedation and weight gain.[23]

  1. ^ a b c d Bonati M, Cartabia M, Clavenna A (January 2022). "Still too much delay in recognition of autism spectrum disorder". Epidemiology and Psychiatric Sciences. 31 (e1). Cambridge University Press: e1. doi:10.1017/S2045796021000822. LCCN 2011243374. OCLC 727338545. PMC 8786613. PMID 35012703. S2CID 245851335.
  2. ^ Pezzimenti F, Han GT, Vasa RA, Gotham K (2019). "Depression in Youth with Autism Spectrum Disorder". Child and Adolescent Psychiatric Clinics of North America. 28 (3): 397–409. doi:10.1016/j.chc.2019.02.009. PMC 6512853. PMID 31076116.
  3. ^ "At the intersection of autism and trauma". Spectrum News. 26 September 2018. Archived from the original on 17 November 2022. Retrieved 17 November 2022.
  4. ^ "Autism's drug problem". Spectrum News. 19 April 2017. Archived from the original on 11 November 2022. Retrieved 11 November 2022.
  5. ^ Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, Yusuf A, Shih A, Elsabbagh M (15 May 2022). "Global prevalence of autism: A systematic review update". Autism Research. 15 (5): 778–790. doi:10.1002/aur.2696. ISSN 1939-3806. PMC 9310578. PMID 35238171.
  6. ^ "COVID-19 guide – Autism Spectrum Condition (ASC)". NHS England. National Health Service, United Kingdom. 7 June 2020. Archived from the original on 12 June 2023. Retrieved 12 June 2023. ASC is a 'spectrum condition' meaning that, while all people with autism share certain difficulties, their condition affects them in different ways.
  7. ^ Pellicano E, den Houting J (April 2022). "Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 63 (4): 381–396. doi:10.1111/jcpp.13534. eISSN 1469-7610. ISSN 0021-9630. OCLC 01307942. PMC 9298391. PMID 34730840. S2CID 241118562.
  8. ^ Walker N (2021). Neuroqueer Heresies. Autonomous Press. ISBN 978-1-945955-26-6.
  9. ^ Bailin A (6 June 2019). "Clearing Up Some Misconceptions about Neurodiversity". Scientific American Blog Network. Nature America, Inc. Archived from the original on 29 June 2019. Retrieved 17 March 2022.
  10. ^ Robison JE (2020). "My Time with Autism Speaks". In Kapp SK (ed.). Autistic Community and the Neurodiversity Movement: Stories from the Frontline. Singapore: Springer. pp. 221–232. doi:10.1007/978-981-13-8437-0_16. ISBN 978-981-13-8437-0. S2CID 210496353.
  11. ^ Opar A (24 April 2019). "In search of truce in the autism wars". Spectrum. Simons Foundation. doi:10.53053/VRKL4748. S2CID 249140855. Archived from the original on 8 July 2022. Retrieved 9 July 2022.
  12. ^ Mandy W, Lai MC (March 2016). "Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 57 (3): 271–292. doi:10.1111/jcpp.12501. eISSN 1469-7610. ISSN 0021-9630. OCLC 01307942. PMID 26782158.
  13. ^ Rosen NE, Lord C, Volkmar FR (December 2021). "The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond". Journal of Autism and Developmental Disorders. 51 (12): 4253–4270. doi:10.1007/s10803-021-04904-1. PMC 8531066. PMID 33624215.
  14. ^ Losh M, Adolphs R, Piven J (2011). "The Broad Autism Phenotype". Autism Spectrum Disorders. Oxford University Press. pp. 457–476. doi:10.1093/med/9780195371826.003.0031. ISBN 978-0-19-996521-2.
  15. ^ Chapman R, Veit W (November 2021). "Correction to: The essence of autism: fact or artefact?". Molecular Psychiatry. 26 (11): 7069. doi:10.1038/s41380-021-01057-6. PMID 34697454. S2CID 239771302.
  16. ^ Wazana A, Bresnahan M, Kline J (June 2007). "The autism epidemic: fact or artifact?". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (6): 721–730. doi:10.1097/chi.0b013e31804a7f3b. PMID 17513984.
  17. ^ DeStefano F, Shimabukuro TT (September 2019). "The MMR Vaccine and Autism". Annual Review of Virology. 6 (1): 585–600. doi:10.1146/annurev-virology-092818-015515. PMC 6768751. PMID 30986133.
  18. ^ Cite error: The named reference Smith was invoked but never defined (see the help page).
  19. ^ Cite error: The named reference Cochrane was invoked but never defined (see the help page).
  20. ^ Cite error: The named reference AutismResearch2023Study was invoked but never defined (see the help page).
  21. ^ Yu Q, Li E, Li L, Liang W (May 2020). "Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis". Psychiatry Investigation. 17 (5): 432–443. doi:10.30773/pi.2019.0229. PMC 7265021. PMID 32375461.
  22. ^ Kirkham P (1 April 2017). "'The line between intervention and abuse' – autism and applied behaviour analysis". History of the Human Sciences. 30 (2): 107–126. doi:10.1177/0952695117702571. ISSN 0952-6951. S2CID 152017417.
  23. ^ "Medication Treatment for Autism". www.nichd.nih.gov/. 19 April 2021. Archived from the original on 7 February 2023. Retrieved 21 February 2023.

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