Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a developmental disorder that involves impairments in social interaction and communication, challenges with sensory processing, and repetitive behaviors. The term "spectrum" reflects the fact that symptoms vary across different individuals, ranging in type and severity.
ASD is an umbrella diagnosis in the DSM-5, replacing the four pervasive developmental disorders described in the previous edition—autistic disorder, Asperger's syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. Individuals display ASD symptoms on a continuum, or spectrum, showing ranges of mild to severe symptomatology. Those on the mild-to-moderate end of the spectrum are sometimes colloquially referred to as having Asperger's syndrome, though this is no longer a formal diagnostic category. They may also be referred to as "high functioning."
People with autism may appear indifferent and remote and can have difficulty forming emotional bonds with others. They may have unusual responses to sensory experiences—the noise of a leaky faucet, for example, might become extremely disruptive.
Autism is found in many different countries and across racial, ethnic, religious, and economic backgrounds. Its prevalence has been estimated at roughly 1 percent of the world population. In data released by the Centers for Disease Control and Prevention (CDC) in 2021, about 1 in 44 U.S. children were identified as having ASD. The earlier the disorder is diagnosed, the sooner a child can be helped through treatment interventions.
The DSM-5 diagnostic criteria for autism spectrum disorder include:
- Persistent deficits in communication and social interaction, such as:
- a lack of responsiveness during social interactions
- abnormalities in the use of gestures, eye contact, or facial expressions
- no interest in peers or difficulty understanding relationships
- Restricted and repetitive behaviors and interests, such as:
- specific movements or spoken phrases
- insistence on "sameness" and routines
- intense, limited interests in particular objects
- low or high levels of sensitivity to the sensory environment, including sights, sounds, or smells
In order to qualify for a diagnosis, symptoms should be present early in a child's development, must cause "clinically significant impairment in social, occupational, or other important areas of current functioning," and must not be better explained by another condition such as intellectual disability or global developmental delay. Many children who have ASD exhibit average to above average intellectual ability; however, autism and intellectual disability frequently co-occur. Individuals who have challenges with social communication but do not exhibit other symptoms of Autism Spectrum Disorder may better match the criteria for Social (Pragmatic) Communication Disorder.
The DSM-5 further describes three levels of severity for symptoms related to social communication and restricted, repetitive behaviors.
- Social communication
- Requiring very substantial support (Level 3): Severe impairments and limitations in social functioning, with minimal initiation of social interactions or response to social approaches by others.
- Requiring substantial support (Level 2): Deficits in communication and social interaction, with little initiation of social interactions and relatively little or abnormal response to social approaches by others.
- Requiring support (Level 1): Deficits in social communication, with difficulty initiating social interactions and responding to social approaches by others; may seem to have relatively little interest in social interaction.
- Restricted, repetitive behaviors
- Requiring very substantial support (Level 3): Inflexible behavior and extreme difficulty dealing with change; behaviors interfere with functioning in all contexts.
- Requiring substantial support (Level 2): Inflexible behavior and difficulty dealing with change; behaviors interfere with functioning in a range of contexts.
- Requiring support (Level 1): Inflexibility significantly interferes with functioning in one or more contexts; challenges with organizing and planning limit the ability to be independent.
To learn more about symptoms and diagnosis, visit our Autism Center.
When do symptoms of autism first appear?
Symptoms of ASD tend to become apparent during the second year of a child's life, and doctors can often make a diagnosis by age 2. In more severe cases, symptoms may be recognizable earlier in life, while people with relatively subtle symptoms may not be diagnosed until adolescence or adulthood. In practice, according to the CDC, most children are not diagnosed until after age 4.
Do autism symptoms improve with time?
While behavioral challenges worsen during adolescence in some children who have ASD, according to the DSM-5, most show some improvements in later childhood and adolescence. However, some individuals, especially those with severe autism, may continue to struggle with significant symptoms and may not be able to live independently.
Are autism symptoms different in males vs. females?
Boys and men are significantly more likely to be diagnosed with autism than are girls and women, and some experts suggest that differences in symptom presentation may contribute in part to this gender disparity. Some research suggests that males with autism spectrum disorder may demonstrate more externalizing symptoms such as aggression, show less interest in socializing, and become fixated on “unusual” interests that are noticeable to observers and in sync with many autism stereotypes.
Females, by contrast, tend to display internalizing symptoms, such as depression or anxiety, that may not immediately suggest an autism diagnosis; they may also become fixated on “normal” things like books or celebrities, which parents or clinicians may not immediately recognize as a repetitive behavior. Girls with autism may also become overly concerned with peer relationships, while boys with autism may be more likely to behave like “loners.”
What is “profound autism”?
In December of 2021, a team of researchers argued in The Lancet that a new category of autism, known as “profound autism,” should be created. The proposed category would encompass individuals with intellectual disabilities and minimal language skills, many of whom require substantial or even round-the-clock care. While some autism experts and advocates applauded the move, arguing that it will help severely autistic individuals and their caregivers get the supports they need, others argued that dividing autistic people by function does little to overcome significant barriers to care that many face and may be used to justify harmful practices such as coercive control. Currently, profound autism is not considered an official diagnostic category.
The specific causes of autism are not fully understood, but research indicates that genes interact with aspects of the environment to determine whether an individual has autism. Recent evidence suggests that the disorder may be caused by random genetic mutations, as it is associated with advanced maternal and/or paternal age at conception; such mutations would likely account for the great variability of impairment and neural systems involved.
There is also evidence that the disorder may be caused by failure of embryonic brain cells to undergo normal patterns of migration during early development, affecting later brain structure and wiring of nerve-cell circuits that control social skills, language, movement, and other abilities.
A sex imbalance in the number of affected children (four times more males than females) has led some researchers to argue that the disorder may also be related to fetal exposure to abnormally high levels of testosterone in utero. Many of the traits of autism are said to reflect male cognitive and behavioral preferences, such as orientation to detail rather than the big picture, affinity for things rather than social experience, facility for math and numbers, and even linguistic impairment; children with autism can accumulate a large vocabulary without being able to sustain a conversation. This theory, called the “extreme male brain,” was developed by psychologist Simon Baron-Cohen in the 1990s but has been critiqued and questioned by some researchers in recent years.
A false belief that autism is caused by standard childhood immunization with mercury-containing vaccines persists—despite many studies discrediting the link and retraction of the original research paper linking autism to immunization.
To learn more about the causes of autism, visit our Autism Center.
Which groups are at the highest risk for autism?
Common risk factors for autism include sex (males are more likely to be diagnosed than females), a family history of autism, and certain medical conditions such as fragile X syndrome. Preterm babies and babies born to older parents may also be at increased risk.
Is there a connection between vaccines and autism?
No. Rigorous, peer-reviewed research consistently finds no link between childhood vaccinations and the development of autism. This false claim first originated in a 1998 study that was later retracted and discredited but has continued to gain traction in the years since.
There is no cure for ASD, but early treatment can help mitigate the challenges associated with it. The National Institute of Mental Health advises that there is not one best treatment for all cases of ASD, but medical professionals can confer with diagnosed individuals and their families to determine an approach that works.
Therapeutic and educational interventions can help people with ASD learn important social and practical skills and reduce harmful behaviors.
Applied Behavioral Analysis (ABA) focuses on improving specific behaviors—such as communication, hygiene, and competence in domestic or job-related tasks—and minimizing negative behaviors, such as self-harm. ABA may be practiced with both children and adults and with individuals whose symptoms range from mild to severe. Therapists can work within schools, homes, and/or community centers to evaluate and modify treatment as it progresses.
Among other forms of therapy that can contribute to treatment are occupational therapy (OT), which aims to improve a variety of skills needed for daily life, such as dressing, eating, and fine motor movements (e.g., writing or coloring); sensory integration therapy, which can help someone with ASD deal with aversive sensory input (i.e. sights, sounds, touch); and therapy types that focus on verbal and nonverbal communication skills.
While existing drug-based treatments do not address the primary symptoms of ASD, a doctor may prescribe medication to help alleviate challenges such as aggression, hyperactivity, anxiety, or depression.
To learn more about autism treatments, visit our Autism Center.
What is the best treatment for autism?
Behavioral and skill-based approaches are usually considered the front-line treatment for autism. These approaches may include Applied Behavioral Analysis (ABA), occupational therapy (OT), play therapy, social skills training, and others, which generally focus on promoting desired behaviors, minimizing problematic or dangerous behaviors, and teaching the skills the individual needs to manage in daily life. Autistic individuals who struggle with communication may benefit from speech therapy. Psychotherapeutic approaches such as CBT can help individuals with autism, especially older adolescents and adults, deal with feelings of low self-esteem, anxiety, or depression that occur alongside or in response to their autism symptoms.
Can medication help with autism?
Currently, no medications are approved to treat autism symptoms specifically. However, co-occurring symptoms such as anxiety or depression, or behavioral problems such as aggression or hyperactivity, may be treated with medication in some cases. Because some medications come with the risk of significant side effects, individuals and families should work closely with a doctor to determine the correct dosage and to ensure the medication is having the desired effect.