Autism Spectrum disorder
Comedian Dan Aykroyd, children’s author Hans Christian Andersen, movie director Tim Burton, naturalist Charles Darwin, poet Emily Dickinson, scientist and mathematician Albert Einstein, chess grandmaster Bobby Fischer, Microsoft founder Bill Gates, actress Daryl Hannah, late Apple CEO Steve Jobs, painter Michelangelo, music composer/ pianist Amadeus Mozart, and artist and cultural influencer Andy Warhol, just to name a few…
What do all of the above people have in common? Given their fame and success, I bet you’ll never guess. They all have islands of extreme expertise, but all also have social limitations in terms of their abilites to interact with others and their ability to communicate. What does that sound like? What diagnosis do they share? Autism.
Autism spectrum disorder (ASD) is a condition related to brain development that affects how a person relates to and socializes with others, and which also causes problems in communication and social interactions. Replacing just the single word autism, the term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and potential severity of the disorder of autism.
Autism spectrum disorder is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. The disorder extends into adulthood, causing problems with functioning in society, in school, and at work. Children often show symptoms of autism within the first year of life, though signs may be subtle at first. Sometimes children appear to develop normally in their first year, but then exhibit regression between 18 and 24 months of age as they develop autistic symptoms.
Symptoms of ASD
Children can show signs of autism spectrum disorder in early infancy. These include reduced eye contact, lack of response to their name and/or indifference to caregivers. Some children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose the language skills they’ve already acquired. Fairly definitive signs of ASD are usually seen by age two.
Each child with ASD will have difficulty with social interactions and will exhibit unique patterns of behavior and levels of severity, from low functioning to high functioning.
Some children with autism spectrum disorder may have difficulty learning, and some have signs of lower than average intelligence. Other children may have normal to high intelligence and learn quickly, but have difficulty communicating and applying what they know. Because of the unique mixture of signs and symptoms exhibited in each child, the severity of ASD can sometimes be difficult to determine. It’s generally based on the level of impairment and how that impairment impacts the ability to function.
A child or adult with ASD may have problems with social interactions and communication skills, including any of these signs:
Failure to respond to his/her name or appearing to not hear you at times
Resists cuddling and holding as child
Lacks facial expression
Prefers playing alone, retreats into his/her own world
Exhibits poor eye contact
Doesn’t speak/ has delayed speech/ loses previous speech ability
Can’t initiate or further conversation
Speaks with abnormal tone or rhythm; may use a singsong voice or robot-like speech
Repeats words or phrases verbatim, but doesn’t understand meaning
Doesn’t appear to understand simple questions or directions
Doesn’t express own emotions/ feelings and is unaware of others’ feelings
Inappropriate aggression or disruption to social interactions of others
Difficulty recognizing nonverbal cues, interpreting other people’s facial expressions, body postures, or tones of voice
A child or adult with ASD may exhibit limited and repetitive patterns of behavior, including any of these signs:
Performs repetitive movements, such as rocking, spinning or hand flapping
Develops specific routines or rituals, becomes disturbed at the slightest change
Performs self-harming activities, including biting or head-banging
Is unusually sensitive to light, sound, and/or touch, yet can be indifferent to pain or temperature
Has problems with coordination or exhibits odd movement patterns, such as clumsiness, walking on toes, and odd, stiff, or exaggerated body language
Is fascinated by small details of an object without understanding the overall purpose or function of the object. Ex: spinning wheels of a toy car
Doesn’t engage in imaginative or make-believe play
Fixates on an object or activity with abnormal intensity or focus
Has very specific food preferences: eats very few foods/ refuses certain textures
A child or adult with ASD may exhibit other signs and symptoms, such as:
Unusual Touch and Sound Sensitivities: They may recoil when touched, and/or may be extremely hypersensitive to certain sounds
Seizures: Approximately four out of ten people with ASD suffer from seizures; most commonly occurs in childhood or entering teenage years and in those with more severe cognitive impairment.
Bowel Disorders: People with ASD tend to have more gastrointestinal symptoms such as abdominal pain, constipation, and diarrhea than peers
Placing Inedible Objects in the Mouth: While it is common for babies and toddlers to put toys or other inedible objects in their mouths, older kids with autism may continue to do this even as they age. Some children have been known to put items like soil, chalk, and paints into their mouths, which means supervision is a must to prevent them from eating something toxic or choking on an object.
Sleeping Issues: Getting a child to sleep at an assigned time can be hard, but children with ASD often have different sleep patterns. ASD interferes with the “working clock” that regulates sleep patterns. Many children with ASD with sleep problems will have the problem in adulthood as well.
As they mature, some children with autism spectrum disorder become more engaged with others and show fewer behavioral disturbances, but some, usually those with the least severe problems, may end up leading normal or near-normal lives. But others continue to have difficulty with language or social skills, and for them, the teen years can bring even worse behavioral and emotional problems.
When to see a doctor
Babies develop at their own pace…they don’t necessarily follow the developmental timelines that Dr. Spock or other parenting book authors lay out. But children with autism spectrum disorder usually show some signs of delayed development before they are two years old. If you’re concerned about your child’s development or suspect that your child may have ASD, discuss your concerns with your pediatrician, as some ASD symptoms can look like other developmental disorders.
Your pediatrician may recommend developmental tests to identify if your child has delays in cognitive, language and social skills, or if your child doesn’t meet certain timelines:
Doesn’t respond with a smile or happy expression by 6 months
Doesn’t mimic sounds or facial expressions by 9 months
Doesn’t babble or coo by 12 months
Doesn’t gesture, point or wave by 14 months
Doesn’t say single words by 16 months
Doesn’t play “make-believe” or pretend by 18 months
Doesn’t say two-word phrases by 24 months
Loses language skills or social skills at any age
Causes of ASD
Autism spectrum disorder has no single known cause. Given the disorder’s complexity and the fact that symptoms and severity vary, there are probably many causes, with genetics and environment likely playing larger roles.
Genetics: Several different genes appear to be involved in ASD. For some children, ASD can be associated with another genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic mutations may increase the risk of autism spectrum disorder. Other genes may affect brain development or the way that brain cells communicate. Some genetic mutations are inherited, but others occur spontaneously.
Environmental factors: Researchers are currently exploring whether factors like viral infections, medications, complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.
Not from childhood vaccines: One of the biggest controversies in autism spectrum disorder centers on whether childhood vaccines can cause ASD. Despite extensive research, no reliable study has shown a link between autism spectrum disorder and any vaccines. In fact, the original study that ignited the debate years ago has been retracted due to poor design and questionable research methods. Not only do vaccines not cause ASD, but
avoiding childhood vaccinations can place your child and others in danger of catching and spreading serious diseases, including whooping cough (pertussis), mumps, and/or measles. So don’t let the fear of ASD keep you from allowing your child to have their vaccines.
Risk factors for ASD
The number of children diagnosed with autism spectrum disorder is rising. It’s not clear whether this is due to better detection and reporting or a real increase in the number of cases, or a combination of the two.
Autism spectrum disorder affects children of all races and nationalities, but certain factors increase a child’s risk. These risk factors may include:
Your child’s sex: Boys are about four times more likely to develop autism spectrum disorder than girls are.
Family history: Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It’s also fairly common for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.
Other disorders: Children with certain medical conditions have a higher than normal risk of autism spectrum disorder or autism-like symptoms. Some examples include fragile X syndrome, tuberous sclerosis, and Rett synsyndrome.
Extremely preterm babies: Babies born before 26 weeks of gestation may have a greater risk of autism spectrum disorder.
Parental ages: Children born to older parents may be more likely to develop ASD, but more research is necessary to fully establish this link.
Complications of living with ASD
The problems that come with ASD in terms of social interactions, communication, and behavior can lead to issues in life, including:
Problems in school and successful learning
Inability to live independently
Stress within the family
Victimization and being bullied
Prevention of ASD
There is no way to prevent autism spectrum disorder, but there are some treatment options. Intervention is helpful at any age, but early diagnosis and intervention is the most helpful to improve behavior, skills and language development. While children don’t usually outgrow autism spectrum disorder symptoms, with work, they may learn to function well within their environment.
Diagnosis of ASD
Your child’s doctor will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you’ll likely be referred for an evaluation to a specialist who treats children with autism spectrum disorder, such as a child psychiatrist/ psychologist, pediatric neurologist or developmental pediatrician.
Because autism spectrum disorder varies widely in symptoms and severity, making a diagnosis may be difficult. There isn’t a specific medical test to definitively diagnose the disorder. Instead, a specialist will make observations. These may include:
Observing your child’s development, social interactions, communication skills and behavior; done over time to determine if there have been changes.
Give your child tests which will cover hearing, speech, language, developmental level, and social and behavioral issues.
Score your child’s social and communication interactions.
Include other specialists in order to definitively determine a diagnosis.
Recommend genetic testing to determine if your child also has a genetic disorder such as Rett syndrome or fragile X syndrome.
Treatment for ASD
While there is no cure for autism spectrum disorder, early and intensive treatment can make a big difference in the lives of most children with ASD. The goal of treatment is to maximize your child’s ability to function by reducing ASD symptoms while also supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional, and behavioral skills that will make a huge impact on their adult lives.
The range of ASD “therapies” you’ll find on an internet search can be very overwhelming. If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child’s needs.
Some ASD treatment options may include:
Behavioral and communication therapies: Many programs address the range of social, language, and behavioral difficulties associated with ASD. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and apply these skills through a reward-based motivation system.
Educational therapies: Children with ASD often respond well to very structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Earlier intervention is better, and preschool children who receive intensive one on one behavioral intervention show more progress.
Family therapies: Parents and other family members can learn how to play and interact with their children in ways that promote social skills, manage problem behaviors, and teach communication and other daily living skills.
Other therapies: Depending on your child’s needs, they can have speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance. Any and all of these may be beneficial. Adding a psychologist to address problem behavior is also beneficial.
Medications: There are no specific medications to improve the core signs of autism spectrum disorder, but some medications can help control specific symptoms, including hyperactivity, behavioral issues, and anxiety. Always keep all health care providers updated on all medications or supplements your child is taking, as some can interact and cause dangerous side effects.
Some ASD takeaways
Autism spectrum disorder is a developmental disorder that causes problems with communication and social interactions. There are no specific tests for autism spectrum disorder, the diagnosis is made by observation and process of elimination. There are no one-size-fits-all therapies for autism spectrum disorder. Early detection and intervention are of utmost importance and make a greal deal of difference in determining the person’s likely functional level in adulthood. If your child exhibits some of the characteristics defined above, it is best to see your pediatrician for an evaluation.
For information on other psychiatric diagnoses and patient stories and experiences, please check out my book, Tales from the Couch, available on Amazon.com.Learn More
Intermittent Explosive Disorder
Intermittent explosive disorder (abbreviated IED) is a behavioral disorder characterized by extreme expressions of anger, often to the point of uncontrollable rage, that are disproportionate to the situation at hand. It is currently categorized in the Diagnostic and Statistical Manual of Mental Disorders as an impulse control disorder. IED belongs to the larger family of Axis I impulse control disorders listed in the DSM-IV-TR, along with kleptomania, pyromania, pathological gambling, and others. Impulsive aggression is unpremeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst (e.g.,tension, mood changes, energy changes, etc.).Learn More
Problem gambling (ludomania) is an urge to gamble despite harmful negative consequences or a desire to stop. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler’s behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria. Although the term gambling addiction is common in the recovery movement pathological gambling is considered to be an impulse control disorder and is therefore not considered by the American Psychological Association to be an addiction.Learn More
Pyromania in more extreme circumstances can be an impulse control disorder to deliberately start fires to relieve tension or for gratification or relief. Pyromania and pyromaniacs are distinct from arson and arsonists, whose motivations stem from psychosis, the pursuit of personal, monetary or political gain, or the intent to inflict harm for advantage or revenue. Pyromaniacs start fires to induce euphoria, and often fixate on institutions of fire control like fire stations and firefighters. Pyromania is a type of impulse control disorder.Learn More
Trichotillomania is the compulsive urge to pull out one’s own hair leading to noticeable hair loss, distress, and social or functional impairment. It is often chronic and difficult to treat.
Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. It may be triggered by depression or stress. Due to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% (overall) and may be as high as 1.5% (in males) to 3.4% (in females).
The name, coined by French dermatologist François Henri Hallopeau, derives from the Greek: trich- (hair), till(en) (to pull), and mania (“an abnormal love for a specific object, place, or action”).Learn More
Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape. Some kleptomaniacs may not even be aware that they have committed the theft.
Kleptomania was first officially recognized in the US as a mental disorder in the 1960s in the case of State of California v. Douglas Jones.
Kleptomania is distinguished from shoplifting or ordinary theft, as shoplifters and thieves generally steal for monetary value, or associated gains and usually display intent or premeditation, while kleptomaniacs are not necessarily contemplating the value of the items they steal or even the theft until they are compelled without motive.
Increasing brain research and clinical work indicate that shoplifting and stealing can become addictive-compulsive disorders. Hence, the terms “shoplifting addiction” or “theft addiction” or “compulsive theft or stealing” have gained popularity and credence recently. There even are books and support groups devoted to recovery from addictive-compulsive shoplifting or stealing. Most “theft addicts” are neither kleptomaniacs nor typical criminals who steal for profit or due to sociopathic or characterological issues.
This disorder usually manifests during puberty and, in some cases, may last throughout the person’s life.
People with this disorder are likely to have a comorbid condition, specifically paranoid, schizoid or borderline personality disorder. Kleptomania can occur after traumatic brain injuryand/or carbon monoxide poisoning.
Kleptomania is usually thought of as part of the obsessive-compulsive disorder spectrum, although emerging evidence suggests that it may be more similar to addictive and mood disorders. In particular, this disorder is frequently co-morbid with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder.
Relationship to OCD
Kleptomania is frequently thought of as being a part of obsessive-compulsive disorder, since the irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.
Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examining the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%) while others demonstrate low rates (0%-6.5%). Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found (2.2%-5.9%).Learn More