What is Autism?
Kanner autism, often known as “classic autism,” is a neurodevelopmental disease marked by social communication difficulties as well as confined and repetitive behaviors. It is now considered a component of the autism spectrum as a whole. The term “autism” was once only used to refer to Kanner autism, as is the case on this page, but it is now more generally used to refer to the entire spectrum.
During the first three years of a child’s life, parents commonly see indicators of autism. Although some autistic children experience regression in their speech and social abilities after attaining developmental milestones at a normal rate, these indicators usually appear gradually.
A mix of genetic and environmental variables has been proposed as the cause of autism. Certain infections, such as rubella, poisons, such as valproic acid, alcohol, cocaine, pesticides, lead, and air pollution, fetal growth restriction, and autoimmune illnesses are all risk factors during pregnancy. Other supposed environmental factors have sparked debates; for example, the vaccine theory, while being disproven, continues to hold sway in some areas.
Autism impacts information processing in the brain, as well as how nerve cells and synapses connect and organize. However, the mechanism behind this is unknown. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies autism spectrum disorder as a group of disorders that includes high-functioning autism (HFA), formerly known as Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS) (ASD).
Several therapies have been found to increase autistic people’s capacity to operate and engage independently in the community while reducing symptoms. Autistic people can benefit from behavioral, psychological, educational, and/or skill-building interventions to help them gain life skills, as well as other social, communication, and language skills. Therapy also seeks to reduce problematic habits while enhancing strengths. Some autistic adults are incapable of living on their own. There has emerged an autistic culture, with some people seeking a cure and others arguing that autism should be embraced as a difference to be accommodated rather than cured.
As of 2015, autism is thought to affect 24.8 million people worldwide. In the 2000s, the number of autistic people globally was predicted to be 1–2 per 1,000 people. As of 2017, over 1.5 percent of children in developed countries have been diagnosed with ASD, up from 0.7 percent in 2000 in the United States. Males are four to five times more likely than females to be diagnosed with it. Since the 1990s, the number of patients diagnosed has risen dramatically, possibly due to increasing awareness of the disease.
Autism is a highly varied neuro-developmental illness with symptoms that first occur during childhood or early adolescence and that often progress without remission. In some ways, autistic people are severely handicapped, while in others, they are ordinary, if not superior. After the age of six months, overt symptoms appear, become entrenched by the age of two or three years, and tend to persist throughout adulthood, albeit in a more subdued form.
A characteristic trinity of symptoms distinguishes it: Repetitive behavior, problems in social interaction, and communication issues Other features, such as abnormal eating, are prevalent but not required for diagnosis. Individual symptoms of autism can be found in the general population and do not appear to be strongly linked, with no clear distinction between pathologically severe and common features.
Autism and the related autism spectrum disorders (ASD; see Classification) are distinguished from other developmental diseases by social deficiencies. Autistic people have social deficits and often lack the intuition that many people take for granted when it comes to others. Temple Grandin, a well-known autistic woman, said she felt “like an archeologist on Mars” because she couldn’t understand the social communication of neurotypicals, or those with typical neurological development.
Early in childhood, unusual social development becomes obvious. Autistic children pay less attention to social stimuli, smile and glance at others less frequently, and reply to their own names less frequently. For example, autistic children deviate more dramatically from social standards than typically developed ones. They make less eye contact, take fewer turns, and they lack the capacity to express themselves through basic actions like pointing at things. Autistic children aged three to five years old are less likely to demonstrate social comprehension, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, or take turns with others.
They do, however, build bonds with their primary carers. Most autistic children are less secure in their attachments than neurotypical children, yet this gap diminishes in children with higher mental development or fewer autism characteristics. Face and emotion recognition tests show that older children and adults with ASD perform poorly, but this may be partly due to a reduced capacity to characterize their own emotions.
Despite the popular perception that autistic children prefer to be alone, children with high-functioning autism experience more intense and frequent loneliness than their non-autistic peers. For people with autism, forming and keeping friendships can be difficult. They believe that the quality of their friendships, not the number of them, determines how lonely they are. Functional connections, such as those that result in party invites, may have a greater impact on one’s quality of life.
Aggression and violence in people with ASD have many anecdotal stories, but few systematic investigations. According to the minimal research available, autism appears to be linked to violence, property destruction, and meltdowns in children with intellectual disabilities.
A third to half of the autistic population do not develop adequate natural speech to suit their daily communication requirements. Delay in the onset of babbling, atypical gestures, reduced responsiveness, and speech patterns that are not coordinated with the caregiver are all examples of communication differences that can appear as early as the first year of life. Autistic children’s babble, consonants, words, and word combinations become less frequent and diverse in their second and third years, and their gestures are less often integrated with words.
Autistic children are less likely to make requests or express their experiences, preferring instead to repeat what others have said (echolalia) or use reverse pronouns. Joint attention appears to be required for functional speech, and joint attention abnormalities appear to differentiate infants with ASD. They may, for example, glance at a pointing hand instead of the object it is pointing at, and they frequently fail to point at objects when commenting on or sharing an experience. Imaginative play and the development of symbols into words may be difficult for autistic youngsters.
In two studies, high-functioning autistic children aged 8–15 outperformed individually matched controls at basic language tasks involving vocabulary and spelling. In complicated language tests, including figurative language, understanding, and inference, both autistic groups fared worse than controls. These studies imply that people speaking to autistic people are more prone to overestimating what their audience understands because people are generally judged based on their fundamental language skills.
A sleeping youngster lies next to a line of a dozen or more toys.
A little autistic youngster who has lined up his toys.
Autistic people can engage in a variety of repetitive or restricted behaviors, which are classified as follows by the Repetitive Behavior Scale-Revised (RBS-R):
Repetitive movements, such as hand flapping, head rolling, or body rocking, are stereotyped behaviors.
Compulsive behaviors are time-consuming behaviors that a person feels forced to execute repeatedly or according to rigorous rules in order to relieve anxiety, such as placing objects in a precise sequence, inspecting things, or handwashing.
Sameness: an unwillingness to change, such as resisting having the furniture moved or being interrupted.
Unchanging everyday routines: an unchanging cuisine or a dressing ritual, are examples of ritualistic behavior. This is linked to sameness, and an independent validation suggests that the two parameters be combined.
Restricted interests: Obsessions or fixations with a single television show, toy, or game that are abnormal in theme or intensity of attention.
Self-injury: eye-poking, skin-picking, hand-biting, and head-banging are examples of such behaviors.
There does not appear to be a single repetitive or self-injurious behavior that is unique to autism, although autism does appear to have a higher rate of incidence and intensity of these behaviors.
Autistic people may experience symptoms that are unrelated to their condition, but that might have a negative impact on the individual or their family. An estimated 0.5 percent to 10% of people with ASD have exceptional ability, ranging from minor skills like trivia memorizing to the extremely rare abilities of prodigious autistic savants. In comparison to the normal population, many people with ASD have greater perceptual and attention skills. Sensory abnormalities are present in approximately 90% of autistic people and are seen as essential traits by some, despite the lack of evidence that sensory symptoms distinguish autism from other developmental disorders.
Under-responsivity (for example, walking into things) has a larger difference than over-responsivity (for example, anxiety from loud noises) or sensation seeking (for example, rhythmic movements). Poor muscle tone, poor motor planning, and toe walking are found in 60–80 percent of autistic people; motor coordination deficiencies are common across ASD and are more prevalent in autism proper. Unusual eating behavior is seen in almost three-quarters of children with ASD, and it was once used as a diagnostic sign. Selective eating is the most common issue, but eating rituals and food refusal sometimes occur.
There is some evidence that autistic people are more likely to experience gender dysphoria (see Autism and LGBT identities). Furthermore, autistic males are more likely to be bisexual, whereas autistic females are more likely to be homosexual, according to an anonymous online poll of 16-90 year-olds conducted in 2021.
One of the most prevalent co-occurring medical disorders among autistic people is gastrointestinal problems. These have been associated with increased social impairment, irritability, behavior and sleep issues, linguistic impairments, and mood shifts.
Stress levels are higher in parents of children with ASD. In these characteristics of the sibling connection, siblings of children with ASD report more appreciation for and less conflict with the afflicted sibling than siblings of healthy children, and they are similar to siblings of children with Down syndrome. Siblings of children with Down syndrome, on the other hand, reported lower levels of closeness and intimacy than did siblings of people with ASD, who have a higher risk of negative well-being and weaker sibling relationships as adults.
What causes autism?
Autism’s unique trifecta of symptoms has long been assumed to have a single origin at the genetic, cognitive, and neurological levels. However, there is growing evidence that autism is a multifaceted illness with multiple origins that frequently co-occur.
Autism has a significant genetic basis, yet the genetics of autism are complex, and it’s uncertain whether uncommon mutations with major effects or rare multigene combinations of common genetic variants are more responsible for ASD. Complexity emerges as a result of interactions between several genes, the environment, and epigenetic factors, which are heritable and regulate gene expression but do not change DNA sequence. Through sequencing the genomes of autistic people and their parents, many genes have been linked to autism.
Autism has a heritability of 0.7 for autism and as high as 0.9 for ASD, according to twin studies, and siblings of autistic people are around 25 times more likely to be autistic than the general population. However, the majority of the autism-causing mutations have yet to be discovered. Autism is rarely linked to a single Mendelian (single-gene) mutation or chromosome aberration, and none of the genetic disorders linked to ASDs has been proven to produce ASD selectively. A large number of candidate genes have been identified, with only minor effects attributable to any one of them. Individually, most loci account for less than 1% of autism cases.
The huge proportion of autistic people who have unaffected family members could be due to spontaneous structural variation in genetic material during meiosis, such as deletions, duplications, or inversions. As a result, a significant proportion of autism cases may be linked to highly heritable but non-inherited genetic causes: that is, the autism-causing mutation is not present in the parental genome.
Because it is assumed that autism is primarily a male condition, women and girls may be underdiagnosed. However, genetic phenomena such as imprinting and X linkage have the potential to increase the frequency and severity of conditions in males, and theories have been proposed for a genetic reason why males are diagnosed more frequently, including the imprinted brain hypothesis and the extreme male brain theory.
Fetal neurodevelopment is influenced by maternal diet and inflammation during preconception and pregnancy. In both term and preterm newborns, intrauterine growth restriction is linked to ASD. Inflammatory and autoimmune illnesses in the mother can harm the fetus’ tissues, worsening a hereditary condition or harming the neurological system.
Air pollution, particularly heavy metals and particles, may raise the incidence of autism during pregnancy. Certain foods, infectious diseases, solvents, PCBs, phthalates, and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit substances, immunizations, and prenatal stress have all been claimed without proof to contribute to or exacerbate autism. Some, like the MMR vaccine, have been thoroughly debunked.
Around the time of a normal vaccine, parents may see autism symptoms in their child for the first time. This has led to unfounded claims linking autism to vaccine “overload,” a vaccine preservative, or the MMR vaccine. The latter notion was backed up by a lawsuit-funded study that was later revealed to be “an elaborate scam.” Despite the lack of convincing scientific evidence and biological plausibility, parental concern about a possible vaccine link with autism has resulted in lower rates of childhood immunizations, outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.
Mechanism of autism
The symptoms of autism are caused by changes in the brain’s many systems as a result of development. The exact cause of autism is unknown. The pathophysiology of brain structures and processes linked to autism, as well as the neuropsychological links between brain structures and behaviors, are two areas where it works. Multiple pathophysiologies appear to be involved in the behaviors. There is evidence that disorders in the gut–brain axis are implicated.
According to a 2015 analysis, immunological dysregulation, gastrointestinal inflammation, autonomic nervous system malfunction, gut flora changes, and dietary metabolites may all contribute to brain neuroinflammation and dysfunction. According to a 2016 analysis, anomalies in the enteric nervous system may have a role in neurological disorders, including autism. The immune system and neural connections may be a conduit for diseases that start in the intestine to travel to the brain.
Synaptic impairment has been linked to autism in several studies. Autism may be caused by uncommon mutations that impair synaptic pathways, such as those involved in cell adhesion. According to gene substitution studies in mice, autistic symptoms are linked to later developmental phases that rely on synaptic activity and activity-dependent alterations. All known teratogens (agents that cause birth defects) linked to the risk of autism appear to act during the first eight weeks after conception, and while this does not rule out the potential of autism developing later, there is substantial evidence that autism develops extremely early in development.
The diagnosis is made on the basis of behavior rather than cause or mechanism. According to the DSM-5, autism is defined by persistent social communication and interaction difficulties across different situations, as well as confined, repetitive patterns of behavior, interests, or hobbies. These deficiencies appear in early childhood, usually before the age of three, and result in clinically substantial functional disability. Lack of social or emotional reciprocity, stereotyped and repetitive language use, idiosyncratic vocabulary, and a prolonged interest in strange objects are examples of symptoms. Rett syndrome, intellectual disability, or global developmental delay can not account for the disturbance. ICD-10 employs a nearly identical definition.
A variety of diagnostic tools are available. The Autism Diagnostic Interview-Revised (ADI-R), a semistructured parent interview, and the Autism Diagnostic Observation Schedule (ADOS), which uses observation and interaction with the child, are two of the most often used in autism research. The Childhood Autism Rating Scale (CARS) is commonly used in clinical settings to determine autism severity based on child observation. It’s also possible to employ the DISCO (Diagnostic Interview for Social and Communication Disorders).
A pediatrician will usually conduct a preliminary investigation by taking the child’s developmental history and physically inspecting him or her. If necessary, ASD specialists assist with diagnosis and evaluations, which include watching and measuring cognitive, communication, family, and other aspects using standardized methods, as well as taking into account any associated medical disorders.
A juvenile neuropsychologist is frequently consulted to analyze behavior and cognitive abilities in order to aid diagnosis and provide educational recommendations. At this stage, a differential diagnosis for ASD can include intellectual disability, hearing loss, and a specific language impairment such as Landau–Kleffner syndrome. The presence of autism can make diagnosing concurrent psychiatric diseases like depression more difficult.
When ASD is identified, clinical genetics investigations are frequently performed, especially if the accompanying symptoms point to a hereditary basis. Despite the fact that genetic technology allows clinical geneticists to trace an estimated 40% of cases to genetic causes, US and UK consensus guidelines only allow for high-resolution chromosomal and fragile X testing. A genotype-first paradigm of diagnosis has been proposed, in which the genome’s copy number variations are routinely assessed.
Several ethical, legal, and social challenges will arise as new genetic testing is produced. Given the intricacy of autism’s genetics, commercial availability of testing may come before full understanding of how to interpret test results. Metabolic and neuroimaging tests can be useful, although they aren’t always necessary.
ASD can be diagnosed as early as 14 months of age, although diagnosis becomes more stable over the first three years of life. For example, a one-year-old who satisfies diagnostic criteria for ASD is less likely than a three-year-old to do so a few years later. The National Autism Plan for Children in the United Kingdom suggests that it takes no more than 30 weeks from the initial worry to a final diagnosis and assessment, albeit few cases are handled that fast in practice.
Adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some cases, to claim disability living allowances or other benefits. Although the symptoms of autism and ASD begin early in childhood, they are sometimes missed; years later, adults may seek diagnoses to help them or their friends and family understand themselves, to assist their employers in making adjustments, or to claim disability living allowances or other benefits in some locations.
In females, physicians may have a harder time detecting signs of autism than in males. Masking has been found to be more common in autistic females than in autistic males. Masking can involve forcing oneself to make normal facial expressions and maintain eye contact. A significant proportion of autistic girls may be misdiagnosed, diagnosed late, or not identified at all.
On the other hand, the cost of screening and diagnosis, as well as the difficulty in securing payment, can obstruct or postpone diagnosis. It’s very difficult to identify autism in visually impaired people, partly because some of the diagnostic criteria are vision-based and partly because autistic symptoms overlap with those of common blindness syndromes or blindness.
Autism is one of five pervasive developmental disorders (PDDs), which are marked by widespread impairments in social interactions and communication, severely limited interests, and extremely repetitive behavior. These signs do not indicate illness, frailty, or emotional distress.
Rett syndrome and childhood disintegrative disorder share numerous signs with autism but may have unrelated origins. Asperger’s syndrome is the closest to autism in terms of signs and potential causes of the five PDD types; When the criteria for a more specific disease are not satisfied, PDD not otherwise specified (PDD-NOS; sometimes known as atypical autism) is diagnosed. Unlike autism, Asperger syndrome does not cause a significant delay in language development.
Autism’s terminology can be confusing, with autism, Asperger syndrome, and PDD-NOS being referred to as autism spectrum disorders (ASD) or autistic disorders, respectively, whilst autism is referred to as autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the basic autistic disorder; nonetheless, autism, ASD, and PDD are frequently used interchangeably in clinical practice. ASD is a subset of the broader autism phenotype, which includes people who don’t have ASD but exhibit autistic-like behaviors like avoiding eye contact.
The inability to define biologically relevant subgroups within the autistic community, as well as traditional boundaries between the professions of psychiatry, psychology, neurology, and pediatrics, has impeded research into causes. One example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects. This can be identified using newer technologies such as fMRI and diffusion tensor imaging, which can be seen on brain scans to aid further neurogenetic studies of autism; one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects. It has been recommended that autism be classified based on both genetics and behavior.
Individuals with severe impairments—who may be silent, developmentally disabled, and prone to frequent repetitive behavior such as hand flapping and rocking—to high-functioning individuals with active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication—have long been thought to fall on the autism spectrum. Because the behavior spectrum is infinite, the distinctions between diagnostic categories must be arbitrary.
At the age of 18 months, half of the parents of children with ASD are aware of their child’s atypical behaviors, and four-fifths are aware by the age of 24 months. Failure to satisfy any of the following milestones, according to the article, “is a clear indication that more testing should be done. Delays in referral for such tests can cause delays in early diagnosis and treatment, as well as have an impact on the long-term prognosis.
By six months, there had been no response to the name (or an eye-to-eye look).
By the age of twelve months, there is no babble.
By the age of twelve months, no gesturing (pointing, waving, etc.) is allowed.
By the age of sixteen months, he had not said a single word.
By 24 months, there were no two-word (spontaneous, not just echolalic) sentences.
At any age, any linguistic or social abilities are lost.
In 2016, the US Preventive Services Task Force concluded that it was uncertain if screening was beneficial or detrimental for children who had no reason to be concerned. All children in Japan are screened for ASD between the ages of 18 and 24 months, utilizing autism-specific formal screening tests. In the United Kingdom, on the other hand, children whose families or doctors suspect they may have autism are screened. Which method is more effective is unknown.
The Modified Checklist for Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the First Year Inventory are among the screening tools available; preliminary data on M-CHAT and its predecessor, the Checklist for Autism in Toddlers (CHAT), on children aged 18–30 months suggests that it is best used in a clinical setting and that it has low sensitivity (many false-negatives) but good specificity (few false-positives). It may be more accurate to use a broadband screener that does not differentiate ASD from other developmental problems before these tests.
Screening measures for behaviors like eye contact that are appropriate for one culture may not be appropriate for another. Although genetic testing for autism is currently impracticable in most circumstances, it can be considered in select situations, such as children with neurological symptoms and dysmorphic characteristics.
According to some writers, automatic motor evaluation could be used to evaluate children with ASD for behavioral, motor, and emotional reactions while watching videos on their smartphones.
While rubella infection during pregnancy causes less than 1% of instances of autism, the rubella vaccine can avoid many of these cases.
When treating autistic children, the major goals are to reduce related deficits and family distress while also improving quality of life and functional independence. Higher IQs are associated with greater therapy responsiveness and better treatment outcomes in general. There is no one-size-fits-all treatment, and treatment is usually tailored to the needs of the child. Treatment is mostly provided by families and the educational system. Behavior analysts, special education instructors, speech pathologists, and professional psychologists should provide services. Methodological flaws in intervention studies limit conclusive findings about efficacy.
However, in recent years, the development of evidence-based therapies has progressed. Although many psychosocial interventions have some positive evidence, implying that some form of treatment is preferable to no treatment, systematic reviews of these studies have generally been of poor methodological quality, their clinical results are mostly speculative, and there is little evidence for the relative effectiveness of treatment options.
Early intervention with intensive, long-term special education and behavior therapy can help children develop self-care, communication, and job skills, as well as improve functioning and reduce symptom severity and maladaptive behaviors. However, claims that intervention by the age of three years is critical are unfounded. While drugs have yet to be proven to aid with core symptoms, they may be used to treat related symptoms, including irritation, inattention, or repetitive behavior patterns.
Applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy are all common educational interventions used to treat depression, anxiety, and obsessive-compulsive disorder in adults without intellectual disabilities. Interventions either treat autistic traits holistically or focus treatment on a single area of impairment, depending on which approach is used. The quality of research on early intensive behavioral intervention (EIBI), which is a therapy technique including over thirty hours per week of organized ABA for very young infants, is currently low, and more rigorous research designs with larger sample numbers are required.
Two theoretical frameworks have been proposed for structured and naturalistic ABA therapies, as well as developmental social pragmatic theories, which are used in early childhood intervention (DSP). A parent training model is one interventional strategy that teaches parents how to execute various ABA and DSP procedures, allowing them to spread therapies on their own. Various DSP methods have been developed to explicitly give intervention systems to parents in their homes. Despite the fact that parent training models are still in their early stages of development, they have been shown to be beneficial in multiple trials and are considered a likely effective method of treatment.
Early, rigorous ABA therapy has been shown to improve communication and adaptive functioning in preschool children; it is also well-known for increasing that age group’s intellectual performance. Similarly, a teacher-led intervention that combines a more naturalistic type of ABA with a developmental social pragmatic approach has been demonstrated to benefit young children’s social-communication abilities, while there is little evidence for its use in treating global symptoms.
Educators are frequently misinformed about neuropsychological reports, resulting in a disconnect between what the report suggests and the teaching offered. It’s unclear whether children’s treatment programs result in meaningful advances as they grow older, and the scant research on the effectiveness of adult residential programs has yielded conflicting findings. Educators and academics are now debating whether or not it is suitable to include children with varied degrees of autism spectrum disorders in the general schooling group.
When behavioral treatment fails, medications may be used to address ASD symptoms that interfere with a child’s integration into a family or school. They can also be used to treat related health issues like ADHD or anxiety. More than half of children diagnosed with ASD in the United States are given psychoactive medicines or anticonvulsants, with antidepressants, stimulants, and antipsychotics being the most common drug types. Risperidone and aripiprazole, two atypical antipsychotic medications, have been approved by the FDA to treat related aggressive and self-injurious behaviors.
However, the possible advantages must be evaluated against the potential negative effects, and autistic people may react differently. Weight gain, fatigue, drooling, and aggression are all possible side effects. Antidepressants such as fluoxetine and fluvoxamine, as well as the stimulant methylphenidate, have been proven to be effective in reducing repetitive and ritualistic behaviors in some children with co-morbid inattentiveness or hyperactivity.
There is a paucity of trustworthy evidence on the efficacy and safety of pharmacological therapies for ASD in adolescents and adults. Autism’s basic symptoms of social and communication problems have yet to be alleviated by any medicine. Experiments in mice have shown that replacing or regulating gene function might restore or minimize some symptoms associated with autism, implying that medicines could be targeted at specific uncommon mutations known to cause autism.
Although there are several alternative therapies and interventions available, only a few have been scientifically validated. Many programs focus on success indicators that lack predictive validity and real-world relevance, and treatment approaches have minimal scientific evidence in quality-of-life circumstances. Alternative treatments may put the youngster in danger.
Because of the low intake of calcium and vitamin D, autistic children’s preferences for unusual foods can lead to a reduction in bone cortical thickness, which is worse in those on casein-free diets. However, suboptimal bone development in ASD has also been linked to a lack of exercise and gastrointestinal disorders. In 2005, a five-year-old autistic child died as a result of failed chelation therapy. Chelation is not suggested for autistic people since the hazards are greater than the benefits. CEASE therapy, a combination of homeopathy, vitamins, and “vaccine detoxification,” is another alternative medical technique with no proof.
A gluten-and casein-free diet is popular as an alternative treatment for autistic people, although there is no clear evidence to support it as a regular treatment as of 2018. According to a 2018 review, it may be a therapeutic alternative for particular types of children with autism, such as those with known food intolerances or allergies, or those with food intolerance indicators. The researchers looked at all of the prospective trials that have been done to date on the efficacy of a gluten- and casein-free diet in children with ASD (4 in total).
They all compared gluten- and casein-free diets to regular diets, as well as a control group (2 double-blind randomized controlled trials, 1 double-blind crossover trial, 1 single-blind trial). There was a considerable improvement in ASD symptoms (efficacy rate of 50%) in two of the investigations, which lasted 12 and 24 months. There was no significant effect in the other two studies, which lasted three months.
The authors came to the conclusion that a longer diet period might be required to treat ASD symptoms. Diet infractions, small sample size, participant variability, and the likelihood of a placebo effect were all identified as issues in the trials conducted. According to limited research, a gluten-free diet may help some autistic symptoms in the subset of people who have gluten sensitivity.
An expanding body of evidence supports mindfulness-based therapies for improving mental health in autistic adults, according to the findings of a comprehensive review of interventions to address health outcomes among autistic adults. Stress, worry, ruminating thoughts, rage, and aggression are all reduced. According to preliminary research, music therapy may improve social relationships, verbal communication, and nonverbal communication skills. Hyperbaric therapy for children with autism has been studied in the past. Pet therapy has been demonstrated to have favorable results in studies.
Autism has yet to be identified as a disease with a known cure. The severity of symptoms can sometimes be reduced to the point that people lose their ASD diagnosis; this might happen after rigorous therapy or not. The frequency with which this result occurs is unknown; reported rates in unselected samples have ranged from 3% to 25%. The majority of autistic children learn to communicate by the age of five or younger. However, a minority have developed communication skills later in life. Many autistic children lack social support, job prospects, and self-determination. Symptoms often become less severe with age, despite the fact that basic issues often endure.
There are a few high-quality studies that look at long-term prognosis. Some adults improve their communication abilities slightly, while others worsen; little research on autism after middle age has been done. Independent living is improbable with severe autism; learning language before the age of six, having an IQ above 50, and having a marketable skill all predict better prospects.
Transitioning to adulthood can be difficult for many autistic people. Autistic people are more likely than the average population to be unemployed or never have worked. About half of autistic adults in their twenties are unemployed.
Autistic people are more likely to experience greater stress as a result of psychosocial variables like stigma, which may lead to an increase in mental health concerns in the autistic population.