Autism Spectrum Disorder: Diagnosis, Symptoms, and Management

Social media has popularised the word autism. People online have made the condition a part of their everyday vocabulary without knowing what it entails. Autism is much more than poor social skills or special interests. The condition was initially popularised by autistic individuals who wanted a platform to speak up. However, due to misinformation and over-generalisation people have started using autism to describe unrelated or stereotyped symptoms which has led to the widespread circulation of misinformation across the world. Autism Spectrum disorder is one of the most widely misunderstood mental health conditions with only a handful of individuals truly understanding it. 

What is Autism?

Autism is a neurodevelopmental disorder that negatively impacts how an individual interacts, communicates and behaves (National Institute of Mental Health, 2024). Being a neurodevelopmental condition, it is marked by disabilities in neurological and brain functioning. Autism Spectrum Disorder, also commonly known as just Autism, is considered a childhood disorder as its symptoms usually start appearing during the first three years of life.

Despite being considered a childhood disorder, it is a lifelong condition and can be diagnosed at any age (Psychiatry.org, 2024). But why is it called a spectrum? Autism spectrum disorder is characterized by varying levels of severity and types, making it a spectrum filled with diverse people. Approximately 1 in every 100 children around the globe is estimated to have autism (Zeidan et al., 2022). Autism is a condition that does not discriminate, as it can be diagnosed in individuals from all walks of life.

Signs and Symptoms: 

Autism Spectrum Disorder is often marked by persistent deficits in Social Communication and Repetitive Behaviour. Symptoms include: 

Social Communication and Interaction Deficits: 

• Avoiding or maintaining little eye contact.
• Do not look at or appear to be not paying attention to the person talking.
• Failure to conduct a normal back-and-forth conversation. 
• Reduced sharing of interests, emotions, or affect. 
• Struggles to start or hold conversations. 
• Poorly integrated verbal and nonverbal communication. 
• A complete lack of facial expression and nonverbal gestures. 
• Difficulty adjusting behaviour to suit various social situations. 
• Struggles to make or share imaginative play. 
• A complete lack of interest in peers. 
• Often rambling about their interests without understanding that others are not interested.
• They struggle to control the tone of their voice and may have a flat tone or an unusual sing-song voice.

Restricted and Repetitive Behaviour: 

• Stereotyped or repetitive motor movement and behaviour, such as repeating phrases or lining up toys. 
• Prefers monotony and adheres to a rigid routine or ritualized pattern of verbal and nonverbal behaviour. E.g., the need to eat the same food every day or wanting to follow the same route. 
• Abnormal intensity of focus on a restricted, fixated interest such as a strong attachment to sea creatures. 
• Being extremely sensitive or less sensitive to sensory input indifference to pain or temperature or fascination with light. 

People with Autism Spectrum Disorder may also display other related symptoms, such as 

• Delayed motor and language skills. 
• Delayed cognitive development. 
• Epilepsy or seizures. 
• Bizarre sleeping and eating habits. 

Causes and Risk Factors: 

Unfortunately, researchers have not yet determined the exact factors that cause autism. However, current literature has determined some risk factors that could contribute to the development of autism, such as. 

• Having a close relative or immediate family member who is autistic. 
• Various genetic mutations. 
• Genetic disorders such as Fragile X syndrome. 
• Metabolic imbalances and low birth rate. 
• Exposure to environmental toxins or heavy metals. 
• Prenatal exposure to certain medications such as thalidomide or valproic acid.  

Levels of Autism: 

Just as its name suggests, Autism Spectrum disorder is called a spectrum because it encompasses people with ranging levels of symptoms lying at different points of a scale. The levels are based on levels of functionality to help clinicians develop treatment plans. The Diagnostic and Statistical Manual of Mental Disorders 5-TR has given three levels of autism to indicate the compatibility of autistic symptoms with neurotypical behaviour. 

Level 1:

Individuals with level 1 autism usually do not need a lot of support. However, they showcase marked verbal and non-verbal communication deficits without support. While they can communicate with support, they often find it hard to communicate with neurotypical individuals. They also struggle to transition from one activity to another and avoid new activities. Independence may look different for autistic children as compared to neurotypical children (Rudy, 2024). 

Level 2:

Autistic people with level 2 autism require more support than people with level 1 autism and struggle to mask their symptoms. Social deficits can make holding conversations extremely difficult. Even with support, they often struggle to hold conversations or socialize in neurotypical behaviour. They tend to engage in repetitive behaviour that is usually not accepted in a neurotypical society, such as arm flapping. 

Level 3:

People with level 3 autism require the most support and cannot survive without it. They are more vulnerable to discrimination, abuse, and neglect than levels 1 and 2. They have poor self-regulation and are completely unable to mask their symptoms. They find both verbal and nonverbal communication difficult and struggle to express themselves. Level 3 autistic individuals face extreme difficulty changing routines or activities. Their repetitive behaviour makes it hard to function properly. However, timely and early interventions help alleviate and manage the burden of these symptoms and should be a basic human right. 

How to Diagnose Autism Spectrum Disorder:

Diagnosing Autism, especially in children, is usually a two-stage process that employs both caregivers’ description and clinicians’ observation.

Step 1: General Developmental Screening: 

Research suggests that autism can sometimes be identified at 18 months or younger. Clinicians recommend regular pediatric checkups and screening for early detection of symptoms. It is recommended that all children are screened for developmental delays at 9, 18, 24, and 30 months with autism-specific focus at their 18 and 24th month check. 

Step 2: Further Diagnostic Assessment: 

Diagnostic evaluation is conducted by a team of healthcare providers who have been specially trained and have experience in diagnosing Autism Spectrum disorder. The diagnostic assessment often includes: 

• Neurological examinations 
• Cognitive capacity and abilities assessment 
• Assessment to check the child’s language skills and capabilities 
• Objective observation of child’s behaviour 
• Testing age-appropriate skills needed to complete day-to-day activities such as dressing and eating 

Treatment: 

Currently, there is no specific treatment for autism spectrum disorder. However, with a combination of medication and psychological intervention, the symptoms can be managed to facilitate the integration of autistic people into society. 

• Medication: Medication is often prescribed to manage symptoms such as anxiety, depression, hyperactivity, and aggression. 
• Applied Behaviour Analysis (ABA): It involves carefully analyzing a child’s functional difficulties and challenges. This analysis is then used for developing a structured behavioural strategy to enhance their adaptive skills and reduce undesirable behaviours. 
• Social Skills Training: It helps children with autism to learn important social skills and navigate through social situations. 
• Speech and Language Therapy: Speech therapy can help improve a child’s speaking abilities and language comprehension and cope with speech delays.
• Occupational Therapy: Occupational therapy addresses deficits in adaptive skills related to everyday activities, such as fine motor skills.
• Parent Management Training: It equips parents with strategies to respond effectively to challenging behaviours and promote good behaviour in their children. Parent support groups assist families in dealing with the stresses associated with raising a child with autism. 
• Special Education Services: Schools offer these services under an Individual Education Plan (IEP), which may include various services and accommodations to address social communication challenges, limited interests, and repetitive behaviours. This can encompass specialized classes for very young children to support their language, social skills, and other developmental needs. 

Myths and Misconceptions: 

Unfortunately with growing awareness misinformation also enters the field. While people are becoming more informed many harmful stereotypes and misinformation are being consumed. Misconceptions are often even more harmful than not knowing about a condition at all. Some common myths that have been debunked are: 

1. Individuals with autism are violent: At times some autistic people may act hostile or aggressive due to sensory overload or distress, but it is not common for them to behave aggressively out of malice or pose danger to the wellbeing of others. 
2. The appearance of autism is relatively new: The condition was first introduced in 1943 by scientist Leo Kranner, however, the earliest description of a child with autistic symptoms was recorded in 1799. Autism as a condition has been there for many centuries however it was recognized as a condition pretty recently. 
3. Autism is caused by vaccines: Many researchers have tried to find a link between vaccines and autism, however, fortunately, no evidence was found showing a connection. Childhood vaccines time and again have proved that they are not correlated to vaccines. 
4. All individuals with autism have mental disabilities: No two autistic individuals are the same, people with autism are unique with a wide range of abilities. Current IQ tests include language and interpersonal skills that can underestimate their intelligence levels. Many autistic people graduate from college or work in intellectual fields. It is a harmful stereotype to overgeneralize mental disabilities that can be comorbid with autism. 
5. Autism is caused by poor parenting: In the 1950s many were under the assumption that autism is caused due to apathetic and unloving parenting methods. However, autism is a neurological condition and there is no link between parenting style and autism. 
6. Individuals with autism are unable to feel love or form meaningful relationships: Individuals with autism can feel emotions and empathy as much as others if not more. However, they have different ways of showing it that are not always understood by neurotypical individuals.
7. Autism is a complex condition that equips an individual with both strengths and limitations. Even though autism can be detected as early as 18 months many children are not diagnosed until later. Early detection and intervention help autistic individuals manage their symptoms effectively and become an active part of society.

Having an autistic child can also be mentally draining for parents and caregivers. It is important to pay attention to the emotional needs of all family members to foster a loving and nurturing environment. It is important to remember that autistic individuals are not rude or apathetic people and can feel a variety of emotions even if they are not able to show them. It is always necessary for us as humans to show empathy and support to autistic people to help them reach their full potential. 

FAQs

1. Can a child with Autism have a normal life? 

Autistic people can live a full life. Being autistic does not have to stop you from having a good and fulfilling life. It does not mean that you can never make friends, or have a good job or relationships. 

2. Why is Autism so common now? 

Research indicates that it has not become common instead due to growing awareness more children are being diagnosed and getting appropriate treatment. Other factors include air pollution, low birth rate and genetic mutations. 

3. How to prevent Autism during pregnancy? 

While you cannot prevent autism you can increase your chances of having a healthy baby by eating well-balanced meals, having regular checkups, and avoiding teratogens and stress. 

4. Can Autism be detected at birth?

No autism can be detected at birth, however, it can be detected as early as 18 months as developmental delays become easier to identify. Autism can be reliably diagnosed by the age of two.