Autism isn't new. Researchers started discussing the condition in the 1940s. But even in 2020, questions remain. What does the diagnosis mean? How does autism develop? Can it be prevented?
Each year, researchers pore over the data and look for answers to these questions. And each year, we understand a little more about what autism means and how we can support people living with the condition.
Here's a summation of what researchers and experts know right now, along with tools you can use to support someone you love.
What Is Autism?
Describing autism isn't easy. As Autism Speaks explains, this isn't one simple condition. Instead, the term refers to a broad range of conditions that sit along a spectrum.
Everyone with autism has challenges involving:
- Social skills. Eye contact and reciprocal conversation are often difficult.
- Repetitive or restrictive behaviors. Repeating words, focusing on one topic to the exclusion of others, or struggling with routine changes are common.
- Speech and nonverbal communication. Sing-song or loud speech is often present, and that might be paired with an inability to read body language.
Some people with autism have only mild impairment, and others need help with everyday activities.
The symptoms may seem worse as people grow and society places higher expectations on them, the Autism Society explains. But to meet diagnostic rules, people must develop the issue in childhood, even if it goes undiagnosed until later in life. Symptoms often appear by age 2.
What Causes Autism?
No one is entirely certain what causes autism, but research is ongoing. We're closer now than ever before to understanding why problems develop and what prevention steps families should take.
Autism Speaks reports that autism risks rise due to:
- Genetics. Autism tends to run in families. If a parent has the issue, their children are more likely to face the same challenges.
- Parental ages. If moms and dads wait until late in life to start a family, their children have a higher risk of autism.
- Birth or pregnancy complications. Babies born premature or at a low birth weight have a higher risk of autism. So do twins and triplets.
- Closely spaced pregnancies. If there is less than a year between a new pregnancy and a prior birth, the child faces a higher risk of autism.
Enhanced risks don't equate to causality. A mom who is older and has two children close together won't automatically have two children with autism. But these factors are linked to a higher risk of developing the disorder.
The National Institutes of Health explains that risks and causes likely combine and intertwine. Perhaps people need multiple risk factors, all at once, to develop the disorder.
That complexity is part of what makes researching autism so difficult. To control for all the factors and how they intertwine, researchers need to develop very long-lasting studies with neurotypical children and autistic children. They then need to tease out each factor individually. That work hasn’t yet been done.
Researchers do know that some medical conditions can enhance autism risk. Those conditions include:
- Congenital rubella syndrome.
- Fragile X syndrome.
- Phenylketonuria (PKU), if left untreated.
- Tuberous sclerosis.
They also know that prenatal vitamins are crucial. Research suggests that prenatal vitamins taken regularly during the first month of pregnancy can lower autism risk. Some women may not know that they're pregnant at this early stage. But those who do know have the opportunity to provide crucial nutrition to aid in fetal brain development.
Moms can also look for opportunities to reduce exposure to toxins. Lead paint, air pollution, and cigarette smoke aren't healthy for any baby. They may also increase a child's risk of developing autism.
Moms should talk with their doctors about what to avoid and what might be safe, as research in this area is ongoing, with new studies published regularly. Doctors are the best source of up-to-date information.
How Is Autism Diagnosed?
About 1 child in 54 has an autism diagnosis, says the Centers for Disease Control and Prevention. That number seems to go up every year, and often, people wonder why that's the case.
Laboratory tests aren't used to diagnose autism or place people along the spectrum. Instead, doctors use interviews and observations to come to a diagnosis. People must display the attributes assigned to autism and must show them first in childhood.
It's possible that more risk factors for autism exist in 2020 than in the past. For example, if polluted air really can spark autism, and air quality gets worse each year, that could explain the increasing numbers of children diagnosed.
But it's also possible that professionals have grown more adept at spotting autism signs, and they're willing to give that label to people with only mild impairment. That could also make diagnosis numbers rise.
To make a diagnosis, professionals analyze:
- Physical attributes. No brain scan or blood test can help doctors make a diagnosis. But people with autism may have physical signs, including flapping hands, monotone speech, or a lack of eye contact.
- Patient interviews. Doctors talk to their charges and ask them how they feel about daily interactions and discussions.
- Other interviews. Parents, teachers, and peers often have important insights to share with professionals.
Doctors may also look for comorbidities. Researchers say it's common for people with autism to also have these conditions:
- Bipolar disorder
- Gastrointestinal disorders
- Sleep disorders
Sometimes, blood tests or lab tests can help to diagnose these issues. For example, a contrast test could help doctors spot disorders of the gastrointestinal tract in which food isn't moving as quickly as it should.
But some issues are diagnosed through even more interviews. That's sometimes difficult for people with autism.
Researchers point out that tests made to uncover psychiatric disorders such as depression are written with the neurotypical in mind. Someone with autism may not understand the questions or respond to them in the way the authors intended. That could lead to overdiagnosis or underdiagnosis.
Skilled mental health practitioners with plenty of experience know how to administer and interpret these tests to give people with autism the help they need.
Care at Home
Parents want the best for their children, and they want to support them as they grow. After a child receives an autism diagnosis, parents have additional work to tackle.
Parents looking for a home autism treatment may hop online and read about special autism diets that eliminate casein (found in dairy products) and gluten (found in wheat, rye, and barley). The American Academy of Dietetics explains that this is an unproven theory. No reputable research proves that eliminating these two food elements will make a person with autism any better or worse.
But people with autism do face real food challenges, including:
- Smell sensitivities. Strong scents can be disorienting or overwhelming for some people with autism. Foods with a very strong scent profile, such as blue cheese or marinara sauce, can be distressing.
- Texture aversions. Crunchy or crackling foods can be upsetting for some people with autism. They may prefer soft, pliant foods instead.
- Consistency concerns. Routine and predictability are important to some people with autism. They may prefer to eat the same things every day, with no experimentation at all.
Due to concerns like this, poor nutrition is common among people with autism. Autism Speaks explains that unusual eating habits increase a child's risk for social difficulties and poor performance at school.
Experts recommend ruling out underlying health conditions before trying to alter a child's diet. GI issues that spark stomach upset could make anyone feel picky.
After those possibilities are addressed, encourage your child to experiment. Offer many different types of food, and ask the child to touch, sniff, or nibble those foods. If a child actively dislikes a food, ask why. You could entice your child to try new things and build verbal skills at the same time.
Parents play a key role in helping children with autism understand how to thrive in the world. You may also have conversations about clothing, potty training, and communication every single day. Sometimes, your words will penetrate. Sometimes they won't.
Experts recommend connecting with support groups whenever possible. Talk with other parents who are raising a child with autism, and borrow best practices and tips liberally. Reach out on the tough days and ask for help. Offer encouragement in return. You need your own network of support to effectively support your child.
Therapy Choices for ASD
Parents can do a lot at home to help their autistic children in 2020. But often, children need more than their parents can supply. Therapists fill the gap and help children build up crucial skills.
Applied behavior analysis (ABA) therapy is the primary form of treatment for autism. ABA involves:
- Observation. Professionals identify a child's triggers and what reinforces or eliminates them.
- Segmentation. Large sequences, such as brushing teeth, are broken up into small steps.
- Positive reinforcement. Completion of a step merits a small reward.
- Repetition. The child repeats the task, with smaller rewards over time, until it becomes habitual.
Experts explain that ABA is similar to what parents do at home every day. You probably used these techniques to help your child talk or crawl, for example. But ABA gives structure and support to these theories, so professionals can apply them consistently.
ABA has critics. Some people with autism suggest that the therapy works to extinguish their natural coping tendencies. For example, some people with autism flap hands or twirl when they're overwhelmed by emotion. They find the technique helpful, and they may not feel they need therapy to resist the urge to move that way.
But the therapy can help people with autism to tackle critical tasks they'll need to live independently. A child emerging from treatment with the ability to go to the bathroom alone could head to school rather than learning at home.
Modern therapists listen to their clients. It's not about building a robotic child who only responds to certain stimuli in a set way. It's about helping a child to communicate and thrive. This takes an distinct approach that is tailored to the needs of each child.
ABA can be quite enjoyable for children and parents. Researchers say therapists and technicians use playful techniques, including happy voices and claps of praise, with young children. They share emotions and make the treatment fun.
It can take time to find the right ABA provider. It's critical to find a practitioner that listens to a child and makes the treatment fun. It's also important to find a practitioner who is trained and credentialed. But with the right professional and the right help, this therapy can be critical for children.
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