Autistic spectrum disorders affect the way a person communicates with, and relates to, other people. Many (but not all) people with an autistic spectrum disorder also have a learning disability. People with autistic spectrum disorders usually need specialist care and education.
Many people feel that autism should not be called a disorder. The term autistic spectrum condition is often used instead of autistic spectrum disorder.
Autism and autistic spectrum disorders
Autism is a group of similar disorders with varying degrees of severity. The term autistic spectrum disorders (ASDs) is often used rather than autism.
All people with ASD share certain difficulties but there is a spectrum of severity from mild to severe. Asperger's syndrome is now included within ASD.
People with Asperger's syndrome don't have the general learning disabilities (reduced intellectual ability) that many autistic people have, but they may have specific learning difficulties (eg, dyslexia). They may have fewer problems with speech but may still have difficulties with understanding and processing language.
What are the symptoms of autistic spectrum disorders?
Symptoms usually become apparent in the first three years of life. Half of parents become concerned in the first 12 months. Some children with Asperger's syndrome are only diagnosed after they have started school.
The symptoms of ASD vary between people. Some have minimal symptoms whereas others may have severe difficulties. People with ASD have varying levels of intelligence. A few have very high IQs; however, a low IQ is found in about 5 out of 10 people with ASD.
There are four different groups of symptoms, all of which usually occur in children with ASD.
There are different types of problems and not all will occur in each case. These can generally be described as 'not being able to get on with people'. So the child may:
- Seem to be aloof.
- Have little or no interest in other people, which can result in having no real friends.
- Not understand other people's emotions - for example, not understanding why anyone has been cross with them.
- Prefer being alone.
Sometimes a child may seem to lose social skills that they once had. This may be skills such as waving goodbye. This is found in about 1 out of 4 cases.
Problems with language and communication
Speech usually develops later than usual. When it does, the language (the use and choice of words) may not develop well. The sort of problems that children with ASD may have include one or more of the following:
- Not being able to express themselves well.
- Not being able to understand gestures, facial expressions, or tone of voice.
- Saying odd things - for example, repeating your words back to you, time and time again.
- Using odd phrases and odd choices of words.
- Sometimes using many words when one would do.
- Making up their own words.
- Not using their hands to make gestures as they speak.
- Not being able to understand difficult orders.
- Tending to take words and phrases literally, so that they have difficulty understanding idioms.
Again, sometimes a child may seem to lose skills that they once had. This is found in about 1 out of 4 cases.
Pretend play is usually limited in children with ASD. Games and activities that they learn tend to be repeated over and over again. Games may remain exactly the same every day. Games are usually those that a younger child would play. Imagination is also required to understand what other people are thinking or why they have done something. People with ASD may therefore find it very difficult 'to walk in someone else's shoes'.
These are typical and include one or more of the following:
- Odd mannerisms such as hand-flapping or other unusual movements.
- Anger or aggression if routines are changed. Children with ASD may hurt themselves when they are angry by banging their head or hitting their face. Sometimes this is done as a means of communication.
- Actions may be repeated over and over again (like rocking backwards and forwards).
- Obsessions may develop in older children and adolescents. For example, they may have interests in unusual things like train timetables and lists.
- Excessive reaction to taste, smell, texture or appearance of food. They may have extreme food fads.
Parents often find these problems very confusing and may become frustrated.
Seizures (epilepsy) occur in around 3 in 10 cases. This usually happens for the first time around puberty. Seizures usually happen in children who are severely affected by ASD.
How common are autistic spectrum disorders?
Around one in 100 children has an ASD. Boys are four times more likely than girls to be affected.
What is the cause of autistic spectrum disorders?
The cause is not really known. There is some evidence that it may be passed down in families. Twins and brothers have a higher chance of also being autistic.
There are also some conditions in which ASD is more common. These include Down's syndrome, Tourette's syndrome and tuberous sclerosis.
In recent years, there has been speculation that the measles, mumps and rubella (MMR) vaccine may somehow cause autism. However, there is no evidence to support this.
How are autistic spectrum disorders diagnosed?
Your child has a series of health checks to ensure they are developing normally. At these checks you will be asked if you have any concerns. If you have noticed, for instance, that your child doesn't always look at you, or doesn't point to show you things, or doesn't wave or clap - you should mention it. Your health visitor or doctor may then ask you a few questions and watch your child. They may want your child to have a hearing test. Sometimes hearing problems can make it difficult for a child to be sociable.
If they are concerned about an ASD they may ask a special team to observe your child. This team will normally be made up of several different types of health professional. They will observe your child over a period of time before making a decision about the diagnosis. Their observations decide whether your child has an ASD.
Blood tests may be taken. These do not test for an ASD but help to look for and rule out other conditions that may seem similar.
What is the treatment for autistic spectrum disorders?
There is no cure for ASD. The specialist education and support aim to maximise the potential of each child as they grow into adults. It is thought that the earlier the specialist input is started, the better the outcome.
Most children with ASD are under the care of a child specialist. Other people will also offer support. They might be speech and language therapists, occupational therapists and educational psychologists. The types of treatments that may be provided include the following:
- The mainstay of treatment is special education support. This is to help with language, social skills and communication skills. There are three or four main types. The people who have assessed your child will decide what is best to support them.
- Behavioural therapy which aims to reduce 'bad' behaviours and promote 'good' behaviours.
- Medication does not have a role in treating the core symptoms of autism but may be considered to help with specific ASD-related problems if other ways of coping aren't working. Therefore medication may be considered to help treat associated problems such as anxiety, depression, obsessive-compulsive disorder, challenging behaviour or sleep problems. Medications are only used alongside non-medication treatments - eg, behavioural therapy - and never as the only treatment.
What is the outlook?
An ASD is a lifelong condition. As the severity can vary, it is difficult to predict the outcome (prognosis) for each child.
Some adults with ASD manage to work and get by with just a little support. In particular, many people with Asperger's syndrome are able to manage well, and live independently or need little support when adult. However, many people with autism need more substantial support and many as adults live at home with parents or family or in a residential home.
Further reading and references
Autism in under 19s: recognition, referral and diagnosis; NICE Clinical Guideline (September 2011 - last updated December 2017)
Autism in under 19s: support and management; NICE Clinical Guideline (August 2013 - last updated June 2021)
SIGN 145 Assessment diagnosis and interventions for autism spectrum disorders; Scottish Intercollegiate Guidelines Network - SIGN (2016, revalidated August 2019)
Autism; a booklet for adults, partners, friends, family members and carers, Scottish Intercollegiate Guidelines Network (SIGN)