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102-398: The pervasive developmental disorders included autism , Asperger syndrome , pervasive developmental disorder not otherwise specified (PDD-NOS), childhood disintegrative disorder (CDD), overactive disorder associated with mental retardation and stereotyped movements, and Rett syndrome . The first four of these disorders are commonly called the autism spectrum disorders ; the last disorder

204-452: A neurodevelopmental disorder , but the autism rights movement (and some researchers) see autistic people as part of humanity's natural neurodiversity . From this point of view, autistic people may also be diagnosed with a disability of some sort, but that disability may be rooted in the systemic structures of a society rather than in the person; thus, proponents argue that autistic people should be accommodated rather than cured. On

306-602: A "level" system, which ranks how in need of support the patient is, level 1 being the mildest and level 3 the severest, while the ICD-11 system has two axes, intellectual impairment and language impairment, as these are seen as the most crucial factors. Autism is currently defined as a highly variable neurodevelopmental disorder that is generally thought to cover a broad and deep spectrum , manifesting very differently from one person to another. Some have high support needs, may be nonspeaking , and experience developmental delays; this

408-438: A broader medical condition or syndrome , representing about 25% of ASD cases. The causes of syndromic autism are often known, and monogenic disorders account for approximately 5% of these cases. Non-syndromic autism, also known as classic or idiopathic autism, represents the majority of cases, and its cause is typically polygenic and unknown. Autism has a strong genetic basis, although the genetics of autism are complex and it

510-551: A few years later. Classic autism was said to be characterized by widespread abnormalities of social interactions and communication, severely restricted interests, and highly repetitive behavior. Of the PDDs, Asperger syndrome was closest to classic autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with it, but were understood to potentially have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism )

612-688: A five-year-old child with autism was killed by botched chelation therapy (which is not recommended for autism as risks outweigh any potential benefits). Globally, classic autism was understood to affect an estimated 24.8 million people as of 2015 . After it was recognised as a distinct disorder, reports of autism cases substantially increased, which was largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness (particularly among women). Several other conditions were commonly seen in children with autism. They include: The Neo-Latin word autismus (English translation autism )

714-477: A fraudulent study , parental concern about a potential vaccine link with autism (and subsequent concern about ASD) has led to lower rates of childhood immunizations , outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children. Diagnosis of classic autism was based on behavioral symptoms, not cause or mechanism. The ICD-10 criteria for childhood autism postulate that abnormal or impaired development

816-566: A lack of eye contact, inadequate body language and a lack of emotional or physical response to others' behaviors and emotions. These social impairments can cause difficulty in relationships. Communication impairments shown in people with LFA include lack of communication (both oral communication — i.e., nonverbal autism — and body language), repetitive use of words or phrases, and lack of imaginative play skills. They also may respond only to very direct external social interaction from others. Specific behavioral impairments that may be exhibited by

918-648: A low demand for coordination that ameliorated many challenges associated with disruptive turns." Autistic interests, and thus conversational topics, seem to be largely driven by an intense interest in specific topics ( monotropism ). Historically, autistic children were said to be delayed in developing a theory of mind , and the empathizing–systemizing theory has argued that while autistic people have compassion ( affective empathy ) for others with similar presentation of symptoms, they have limited, though not necessarily absent, cognitive empathy . This may present as social naïvety, lower than average intuitive perception of

1020-575: A model of social patterns, and develop coping mechanisms, referred to as " masking ", which have recently been found to come with psychological costs and a higher increased risk of suicidality. ASD includes a wide variety of characteristics. Some of these include behavioral characteristics which widely range from slow development of social and learning skills to difficulties creating connections with other people. Autistic people may experience these challenges with forming connections due to anxiety or depression, which they are more likely to experience, and as

1122-923: A neurotypical bias in autism research, which has come to be scrutinized for "dehumanization, objectification, and stigmatization". Recent research has proposed that autistics' lack of readability and a neurotypical lack of effort to interpret atypical signals may cause a negative interaction loop, increasingly driving both groups apart into two distinct groups with different social interaction styles. Differences in verbal communication begin to be noticeable in childhood, as many autistic children develop language skills at an uneven pace. Verbal communication may be delayed or never develop ( nonverbal autism ), while reading ability may be present before school age ( hyperlexia ). Reduced joint attention seem to distinguish autistic from non-autistic infants. Infants may show delayed onset of babbling , unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with

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1224-563: A person can depend on context, and may vary over time. While the DSM and ICD greatly influence each other, there are also differences. For example, Rett syndrome was included in ASD in the DSM-5, but in the ICD-11 it was excluded and placed in the chapter on Developmental Anomalies. The ICD and the DSM change over time, and there has been collaborative work toward a convergence of the two since 1980 (when DSM-III

1326-1216: A person with LFA include adherence to nonfunctional rituals or routines, repetitive motor functions such as hand flapping or complex whole body movements, and restrictive or obsessive patterns of interest that are abnormal. Other symptoms may include preoccupation with sensory elements of play materials such as their odor, feel, or noise they generate. There is no known cure for autism, and very little research addressed long-term prognosis for classic autism. Many autistic children lack social support , future employment opportunities or self-determination . The main goals when treating autistic children are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes. Services should be carried out by behavior analysts , special education teachers, speech pathologists , and licensed psychologists . Intensive, sustained special education programs and behavior therapy early in life often improves functioning and decreases symptom severity and maladaptive behaviors; claims that intervention by around age three years

1428-505: A person's ASD diagnosis did not influence their interest level. Thus, there has been a recent shift to acknowledge that autistic people may simply respond and behave differently than people without ASD. So far, research has identified two unconventional features by which autistic people create shared understanding ( intersubjectivity ): "a generous assumption of common ground that, when understood, led to rapid rapport, and, when not understood, resulted in potentially disruptive utterances; and

1530-547: A pervasive feature of the individual's functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities. ICD-11 was produced by professionals from 55 countries out of the 90 involved and is the most widely used reference worldwide. The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision ( DSM-5-TR ), released in 2022,

1632-403: A plan based on a person's needs and desires and work with them to achieve their set goals. Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them. Therapists will create

1734-473: A plan that focuses on the type of stimulation the person needs integration with. Applied behavioral analysis (ABA) is considered the most effective therapy for autism spectrum disorders by the American Academy of Pediatrics . ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills and diminishing problematic behaviors like eloping or self-injury by creating

1836-412: A plan that focuses on what the child needs. Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help people learn to adapt their environment to their skill level. An occupational therapist will create

1938-448: A pointing hand instead of the object to which the hand is pointing. Autistic children may have difficulty with imaginative play and with developing symbols into language. It is also thought that autistic and non-autistic adults produce different facial expressions, and that these differences could contribute to bidirectional communication difficulties. Autistic individuals can display many forms of repetitive or restricted behavior, which

2040-628: A result isolate themselves. Other behavioral characteristics include abnormal responses to sensations (such as sights, sounds, touch, taste and smell) and problems keeping a consistent speech rhythm. The latter problem influences social skills, leading to potential problems in understanding for interlocutors. Autistic people's behavioral characteristics typically influence development, language, and social competence. Their behavioral characteristics can be observed as perceptual disturbances, disturbances of development rate, relating, speech and language, and motility. The second core symptom of autism spectrum

2142-561: A role in its development. Multiple studies have shown structural and functional atypicalities in the brains of autistic people. Experiments have been conducted to determine if the degree of brain atypicality yields any correlation to the severity of autism. One study done by Elia et al. (2000) used magnetic resonance imaging (MRI) on the midsagittal area of the cerebrum, midbrain, cerebellar vermis , corpus callosum , and vermal lobules VI and VII to measure brain atypicalities in children with low-functioning autism. The results suggested that

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2244-423: A set of closely related and overlapping diagnoses such as Asperger syndrome and the syndrome formerly known as Kanner syndrome . This created unclear boundaries between the terms, so for the DSM-5 and ICD-11, a spectrum approach was taken. The new system is also more restrictive, meaning fewer people qualify for diagnosis. The DSM-5 and ICD-11 use different categorization tools to define this spectrum. DSM-5 uses

2346-491: A small effect, and some of which are rare and have a large effect. The most common gene disrupted with large effect rare variants appeared to be CHD8 , but less than 0.5% of autistic people have such a mutation. The gene CHD8 encodes the protein chromodomain helicase DNA binding protein 8, which is a chromatin regulator enzyme that is essential during fetal development. CHD8 is an adenosine triphosphate (ATP)–dependent enzyme. The protein contains an Snf2 helicase domain that

2448-567: A specialized plan that uses behavioral therapy techniques such as positive or negative reinforcement to encourage or discourage certain behaviors over-time. There are no medications specifically designed to treat autism. Medication is usually used for problems as a cause of autism, such as depression, anxiety, or behavioral problems. Medicines are usually used after other alternative forms of treatment have failed. Early, intensive ABA therapy has demonstrated effectiveness in enhancing communication and adaptive functioning in preschool children; it

2550-399: A steady course without remission (different developmental timelines are described in more detail below). Autistic people may be severely impaired in some respects but average, or even superior, in others. Clinicians consider assessment for ASD when a patient shows: These features are typically assessed with the following, when appropriate: There are many signs associated with autism;

2652-448: A substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome. As of 2018 , understanding of genetic risk factors had shifted from a focus on a few alleles to an understanding that genetic involvement in ASD is probably diffuse, depending on a large number of variants, some of which are common and have

2754-468: A tendency to be associated with sedation and weight gain . Melatonin supplementation has been shown to improve insomnia related to autism. Stimulant therapy may improve mental processing speed when there is comorbid ADHD. Before the DSM-5 (2013) and ICD-11 (2022) diagnostic manuals were adopted, ASD was found under the diagnostic category pervasive developmental disorder . The previous system relied on

2856-493: A trend of increasing prevalence over time. This increasing prevalence has reinforced the myth perpetuated by anti-vaccine activists that autism is caused by vaccines . Boys are also significantly far more frequently diagnosed than girls. There is no known cure for autism, and some advocates dispute the need to find one. Early intervention services based on applied behavior analysis (ABA) aim to teach children self-care, social and communicative skills. Guidelines from

2958-496: Is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life. It was last recognized as a diagnosis in the DSM-IV and ICD-10 , and has been superseded by autism spectrum disorder in

3060-402: Is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as deficits in social interaction and social communication. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across

3162-427: Is a commonly used form of augmentative and alternative communication with children and adults who cannot communicate well orally. People are taught how to link pictures and symbols to their feelings, desires and observation, and may be able to link sentences together with the vocabulary that they form. Speech-language therapy can help those with autism who need to develop or improve communication skills. According to

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3264-571: Is a division among doctors on the use of the term PDD. Many use the term PDD as a short way of saying PDD-NOS. Others use the general category because the term PDD actually refers to a category of disorders and is not a diagnostic label. PDD is not itself a diagnosis, while PDD-NOS is a diagnosis. To further complicate the issue, PDD-NOS can also be referred to as "atypical personality development", "atypical PDD", or "atypical autism". Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to

3366-708: Is a pattern of restricted and repetitive behaviors, activities, and interests. In order to be diagnosed with ASD under the DSM-5-TR, a person must have at least two of the following behaviors: Autistic people can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows. Self-injurious behaviors are relatively common in autistic people, and can include head-banging, self-cutting, self-biting, and hair-pulling. Some of these can result in serious injury or death. Following are theories about

3468-734: Is acquired during childhood. Autistic people display atypical nonverbal behaviors or show differences in nonverbal communication . They may make infrequent eye contact , even when called by name, or avoid it altogether. This may be due to the high amount of sensory input received when making eye contact. Autistic people often recognize fewer emotions and their meaning from others' facial expressions, and may not respond with facial expressions expected by their non-autistic peers. Temple Grandin , an autistic woman involved in autism activism, described her inability to understand neurotypicals ' social communication as leaving her feeling "like an anthropologist on Mars". Autistic people struggle to understand

3570-686: Is also well-established for improving the intellectual performance of that age group. It is not known whether treatment programs for children lead to significant improvements after the children grow up, and the limited research on the effectiveness of adult residential programs shows mixed results. Although many alternative therapies and interventions were used, few are supported by scientific studies. Treatment approaches have little empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance. Some alternative treatments placed autistic individuals at risk. For example, in 2005,

3672-661: Is bidirectional, research on communication difficulties has since also begun to study non-autistic behavior, with researcher Catherine Crompton writing in 2020 that non-autistic people "struggle to identify autistic mental states, identify autistic facial expressions, overestimate autistic egocentricity, and are less willing to socially interact with autistic people. Thus, although non-autistic people are generally characterised as socially skilled, these skills may not be functional, or effectively applied, when interacting with autistic people." Any previously observed communication deficits of autistic people may thus have been constructed through

3774-447: Is crucial are not substantiated. No known medication relieves autism's core symptoms of social and communication impairments. Augmentative and alternative communication (AAC) is used for autistic people who cannot communicate orally. People who have problems speaking may be taught to use other forms of communication, such as body language, computers, interactive devices, and pictures. The Picture Exchange Communication System (PECS)

3876-584: Is evident before the age of 3 in receptive or expressive language used in social communication, development of selective social attachments or reciprocal social interactions, or functional and symbolic play. The children would also be required to exhibit six other symptoms from three macro-categories pertaining to qualitative impairment in social interactions, quantitative abnormalities in communication, and restricted/repetitive/stereotyped patterns of behavior, interests, and activities. ICD-10 differentiates high functioning and low-functioning autistic people by diagnosing

3978-590: Is heritable. After an older child is diagnosed with ASD, 7% to 20% of subsequent children are likely to be as well. If parents have one autistic child, they have a 2% to 8% chance of having a second child who is autistic. If the autistic child is an identical twin, the other will be affected 36% to 95% of the time. A fraternal twin is affected up to 31% of the time. The large number of autistic people with unaffected family members may result from spontaneous structural variation , such as deletions , duplications or inversions in genetic material during meiosis . Hence,

4080-420: Is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects. It has been proposed to classify autism using genetics as well as behavior. Autism spectrum disorder (ASD) can be classified into two categories: "syndromic autism" and "non-syndromic autism". Syndromic autism refers to cases where ASD is one of the characteristics associated with

4182-522: Is more likely with other co-existing diagnoses. Others have relatively low support needs; they may have more typical speech-language and intellectual skills but atypical social/conversation skills, narrowly focused interests , and wordy, pedantic communication. They may still require significant support in some areas of their lives. The spectrum model should not be understood as a continuum running from mild to severe, but instead means that autism can present very differently in each person. How it presents in

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4284-399: Is much rarer, and is sometimes placed in the autism spectrum and sometimes not. There is a division among doctors on the use of the term PDD. Many use the term PDD as a short way of saying PDD-NOS. Others diagnose the general category label of PDD because they are hesitant to diagnose very young children with a specific type of PDD, such as autism. Both approaches contribute to confusion about

4386-693: Is not a recognized diagnosis in either the DSM or the ICD . The term overlaps with severe autism and profound autism , as opposed to mild or moderate , which do not necessarily correlate with severe and profound levels of intellectual disability , where profound is the most severe level. Those who display symptoms for LFA usually have "impairments in all the three areas of psychopathology : reciprocal social interaction, communication, and restricted, stereotyped , repetitive behaviour". Severe impairment of social skills can be seen in people with LFA. This could include

4488-711: Is possible to identify general factors, but much more difficult to pinpoint specific ones. Given the current state of knowledge, prediction can only be of a global nature and so requires the use of general markers. Research into causes has been hampered by the inability to identify biologically meaningful subgroups within the autistic population and by the traditional boundaries between the disciplines of psychiatry , psychology , neurology and pediatrics . Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans , to help further neurogenetic studies of autism; one example

4590-422: Is responsible for the hydrolysis of ATP to adenosine diphosphate (ADP). CHD8 encodes a DNA helicase that functions as a repressor of transcription, remodeling chromatin structure by altering the position of nucleosomes. CHD8 negatively regulates Wnt signaling . Wnt signaling is important in the vertebrate early development and morphogenesis. It is believed that CHD8 also recruits the linker histone H1 and causes

4692-445: Is that by the age of five, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, while the PDD label makes it more difficult to receive aid for early childhood intervention . The pervasive developmental disorders were: The first three of these disorders are commonly called

4794-710: Is the current version of the DSM. It is the predominant mental health diagnostic system used in the United States and Canada, and is often used in Anglophone countries. Its fifth edition, DSM-5 , released in May 2013, was the first to define ASD as a single diagnosis, which is still the case in the DSM-5-TR. ASD encompasses previous diagnoses, including the four traditional diagnoses of autism— classic autism , Asperger syndrome , childhood disintegrative disorder , and pervasive developmental disorder not otherwise specified (PDD-NOS)—and

4896-399: Is unclear whether ASD is explained more by rare mutations with major effects, or by rare multi-gene interactions of common genetic variants. Complexity arises due to interactions among multiple genes, the environment, and epigenetic factors which do not change DNA sequencing but are heritable and influence gene expression . Many genes have been associated with autism through sequencing

4998-568: Is usually made during early childhood. Individuals who received diagnoses based on the DSM-IV maintain their diagnosis under the autism spectrum disorders. However, an editorial published in the October 2012 issue of American Journal of Psychiatry notes that, while some doctors argue that there is insufficient evidence to support the diagnostic distinction between ASD and PDD, multiple literature reviews found that studies showing significant differences between

5100-772: The Centres for Disease Control (CDC), NICE, and European Society for Child & Adolescent Psychiatry endorse the use of ABA as it reduces symptoms that impair daily functioning and quality of life, although NICE acknowledges that ABA does not meet the highest level of evidence quality. Additionally, some in the autism rights movement oppose its application due to a perception that it emphasises normalisation. Speech and occupational therapy , as well as augmentative and alternative modes of communication , are effective adjunctive therapies . At present, no medication has been shown to reduce ASD's "core symptoms". Some atypical antipsychotics can alleviate comorbid irritability, though with

5202-456: The DSM-5 (2013) and ICD-11 (2022). Globally, classic autism was estimated to affect 24.8 million people as of 2015 . Autism is caused by a combination of genetic and environmental factors , with genetic factors thought to heavily predominate. Controversies surrounded other proposed environmental causes ; for example, the vaccine hypothesis , which although disproved, continues to hold sway in certain communities. After DSM-5/ICD-11

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5304-548: The DSM-III-R provided a checklist for diagnosing autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorder. [REDACTED] Media related to Autism at Wikimedia Commons Autism spectrum disorder Autism , or autism spectrum disorder ( ASD ),

5406-486: The Review Journal of Autism and Developmental Disorders published a systematic review of 21 studies investigating associations between ASD, problematic internet use, and gaming disorder where the majority of the studies found positive associations between the disorders. Exactly what causes autism remains unknown. It was long mostly presumed that there is a common cause at the genetic, cognitive, and neural levels for

5508-669: The Vienna University Hospital adopted Bleuler's terminology autistic psychopaths in a lecture in German about child psychology . Asperger was investigating Asperger syndrome which, for various reasons, was not widely considered a separate diagnosis until 1981, although both are now considered part of ASD. Leo Kanner of the Johns Hopkins Hospital first used autism in English to refer to classic autism when he introduced

5610-481: The autism spectrum disorders ; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not. In May 2013, the Diagnostic and Statistical Manual –5th Edition ( DSM-5 ) was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with

5712-879: The underlying spectrum . For example, some are nonverbal , while others have proficient spoken language. A formal diagnosis of ASD according to either the DSM-5 or the ICD-11 criteria requires not merely the presence of ASD symptoms, but symptoms that cause significant impairment in multiple domains of functioning, in addition to being atypical or excessive for the individual's age and sociocultural context. Common signs of ASD include difficulty with social interaction and verbal and nonverbal communication , along with perseverative interests , stereotypic body movements , rigid routines, and hyper- or hypo-reactivity to sensory input . The World Health Organization (WHO), UK National Institute for Health and Care Excellence (NICE), and American Psychological Association classify autism as

5814-452: The DSM-5, the DSM separated social deficits and communication deficits into two domains. Further, the DSM-5 changed to an onset age in the early developmental period, with a note that symptoms may manifest later when social demands exceed capabilities, rather than the previous, more restricted three years of age. These changes remain in the DSM-5-TR. For many autistic people, characteristics first appear during infancy or childhood and follow

5916-452: The Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows. No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors. Autistic individuals may have symptoms that are independent of the diagnosis. An estimated 0.5% to 10% of individuals with classic autism show unusual abilities, ranging from splinter skills such as

6018-698: The ability to use simple movements to express themselves, such as pointing at things. Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally , and take turns with others. However, they do form attachments to their primary caregivers. Most autistic children displayed moderately less attachment security than neurotypical children, although this difference disappears in children with higher mental development or less pronounced autistic traits. Children with high-functioning autism have more intense and frequent loneliness compared to non-autistic peers, despite

6120-592: The additional code of intellectual disability. Classic autism was listed as autistic disorder in the fourth edition of the American Psychiatric Association 's diagnostic manual, as one of the five pervasive developmental disorders (PDDs). However, the PDDs were collapsed into the single diagnosis of Autism Spectrum Disorder in 2013, and the WHO 's diagnostic manual ICD-11 (which had listed it as childhood autism in its previous edition ) followed suit

6222-517: The age of six months and become established by age two or three years. Some autistic children experience regression in their communication and social skills after reaching developmental milestones at a normal pace. It was said to be distinguished by a characteristic triad of symptoms: impairments in social interaction, impairments in communication, and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis. Individual symptoms of autism occur in

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6324-516: The caregiver. In the second and third years, autistic children may have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences and more likely to simply repeat others' words ( echolalia ). The CDC estimated in 2015 that around 40% of autistic children do not speak at all. Autistic adults' verbal communication skills largely depend on when and how well speech

6426-417: The cause of self-injurious behavior in children with developmental delay, including autistic children: The suicide rate for verbal autistics is nine times that of the general population. Studies have supported the common belief that autistic people become exhausted or burnt out in some situations. Autistic people may have symptoms that do not contribute to the official diagnosis, but that can affect

6528-653: The child's specific needs. Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services, play a critical role in improving the outcome of individuals with PDD. Classic autism Classic autism , also known as childhood autism , autistic disorder , (early) infantile autism , infantile psychosis , Kanner's autism , Kanner's syndrome , or (formerly) just autism ,

6630-412: The common belief that autistic children prefer to be alone. Making and maintaining friendships often proves to be difficult for autistic people. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply. Differences in communication may be present from

6732-461: The contrary, other scientists argue that ASD impairs functioning in many ways that are inherent to the disorder itself and unrelated to society. The neurodiversity perspective has led to significant controversy among those who are autistic and advocates, practitioners, and charities. The precise causes of autism are unknown in most individual cases. Research shows that the disorder is highly heritable and polygenic, and neurobiological risks from

6834-513: The current disorder-focused spectrum model deconstruct autism into at least two separate phenomena: (1) a non-pathological spectrum of behavioral traits in the population, and (2) the neuropathological burden of rare genetic mutations and environmental risk factors potentially leading to neurodevelopmental and psychological disorders, (3) governed by an individual's cognitive ability to compensate. The World Health Organization 's International Classification of Diseases (11th revision), ICD-11 ,

6936-400: The development of the autism spectrum, but it cannot be guaranteed that they are determinants for the development. ASD may be under-diagnosed in women and girls due to an assumption that it is primarily a male condition, but genetic phenomena such as imprinting and X linkage have the ability to raise the frequency and severity of conditions in males, and theories have been put forward for

7038-449: The environment are also relevant. Autism frequently co-occurs with attention deficit hyperactivity disorder (ADHD), epilepsy and intellectual disability , and research indicates that autistic people have significantly higher rates of LGBTQ+ identities and feelings than the general population. Disagreements persist about what should be included as part of the diagnosis, whether there are meaningful subtypes or stages of autism, and

7140-682: The exposure starts at a younger age. In April 2021, Research in Autism Spectrum Disorders published a systematic review of 12 studies of video game addiction in ASD subjects that found that children, adolescents, and adults with ASD are at greater risk of video game addiction than those without ASD, and that the data from the studies suggested that internal and external factors (sex, attention and oppositional behavior problems, social aspects, access and time spent playing video games, parental rules, and game genre) were significant predictors of video game addiction in ASD subjects. In March 2022,

7242-612: The first year of life, and may include delayed onset of babbling , unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words ( echolalia ) or reverse pronouns . Deficits in joint attention may be present — for example, they may look at

7344-586: The general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits. Autistic people have social impairments and often lack the intuition about others that many people take for granted. Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers differ more strikingly from social norms ; for example, they have less eye contact and turn-taking , and do not have

7446-576: The general term of autism spectrum disorders (ASDs). The American Psychiatric Association has concluded that using the general diagnosis of ASD supports more accurate diagnoses. The grouping of these disorders into ASD also reflects that autism is characterized by common symptoms and should therefore bear a single diagnostic term. In order to distinguish between the different disorders, the DSM-5 employs severity levels. The severity levels take into account required support, restricted interests and repetitive behaviors, and deficits in social communication. There

7548-562: The genomes of affected people and their parents. But most of the mutations that increase autism risk have not been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality , and none of the genetic syndromes associated with ASD have been shown to selectively cause ASD. Numerous genes have been found, with only small effects attributable to any particular gene. Most loci individually explain less than 1% of cases of autism. As of 2018 , it appeared that between 74% and 93% of ASD risk

7650-848: The health of their child when developmental milestones are not met, including age appropriate motor movement and speech production. The fifth edition of the DSM removed PDD as a category of diagnoses, and largely replaced it with ASD and a measure of the relative severity of the condition. The eleventh edition of the ICD also removed the category. Symptoms of PDD may include behavioral and communication problems such as: Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information—loud noises, lights—are common. Diagnosis

7752-410: The individual's age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually

7854-815: The interpersonal relationship difficulties between autistic people and their non-autistic counterparts and how to solve them through teaching neurotypical social skills, but newer research has also evaluated what autistic people want from friendships, such as a sense of belonging and good mental health. Children with ASD are more frequently involved in bullying situations than their non-autistic peers, and predominantly experience bullying as victims rather than perpetrators or victim-perpetrators, especially after controlling for comorbid psychopathology. Prioritizing dependability and intimacy in friendships during adolescence, coupled with lowered friendship quantity and quality, often lead to increased loneliness in autistic people. As they progress through life, autistic people observe and form

7956-547: The label early infantile autism in a 1943 report. Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders. Starting in the late 1960s, classic autism was established as a separate syndrome. It took until 1980 for the DSM-III to differentiate autism from childhood schizophrenia. In 1987,

8058-458: The memorization of trivia to the extraordinarily rare talents of prodigious autistic savants . Sensory abnormalities are found in over 90% of autistic people, and are considered core features by some, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders. An estimated 60–80% of autistic people have motor signs that include poor muscle tone , poor motor planning , and toe walking . It

8160-525: The midbrain structures correlate with certain developmental behavioral aspects such as motivation, mnemonic, and learning processes, though there is more research needed to confirm this. Furthermore, many developmental processes may contribute to several types of brain atypicalities in autism; therefore, determining the link between such atypicalities and severity of autism proves difficult. Although theories regarding vaccines lack convincing scientific evidence, are biologically implausible, and originated from

8262-408: The organization Autism Speaks, "speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech". People with low-functioning autism may not be able to communicate with spoken words. Speech-language pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns. The SLP will create

8364-443: The other hand, genes controlling expression of glial and immune cells in the brain, e.g. astrocytes and microglia , respectively, are over-expressed, which correlates with increased number of glial and immune cells found in postmortem ASD brains. Some genes under investigation in ASD pathophysiology are those that affect the mTOR signaling pathway, which supports cell growth and survival. All these genetic variants contribute to

8466-572: The person or the family. In September 2018, the Review Journal of Autism and Developmental Disorders published a systematic review of 47 studies published from 2005 to 2016 that concluded that associations between autism spectrum disorder (ASD) and screen time was inconclusive. In May 2019, the Journal of Developmental and Behavioral Pediatrics published a systematic review of 16 studies that found that children and adolescents with ASD are exposed to more screen time than typically developing peers and that

8568-544: The presence of any other medical conditions is important, it is not taken into account when making a diagnosis. Before the release of the DSM-5, some clinicians used PDD-NOS as a "temporary" diagnosis for children under the age of five when, for whatever reason, they are reluctant to diagnose autism. There are several justifications for this. Very young children have limited social interaction and communication skills to begin with, so it can be difficult to correctly diagnose milder cases of autism in toddlers. The unspoken assumption

8670-438: The presence of other disorders or factors that likely contribute to the symptoms, other neurodevelopmental or mental disorders, intellectual disability, or language impairment). The symptom domains are (a) social communication and (b) restricted, repetitive behaviors, and there is the option of specifying a separate severity—the negative effect of the symptoms on the person—for each domain, rather than just overall severity. Before

8772-1396: The presentation varies widely: The broader autism phenotype describes people who may not have ASD but do have autistic traits , such as abnormalities in eye contact and stimming . According to the medical model, autistic people experience social communications impairments . Until 2013, deficits in social function and communication were considered two separate symptom domains. The current social communication domain criteria for autism diagnosis require people to have deficits across three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships. A deficit-based view predicts that autistic–autistic interaction would be less effective than autistic–non-autistic interactions or even non-functional. But recent research has found that autistic–autistic interactions are as effective in information transfer as interactions between non-autistics are, and that communication breaks down only between autistics and non-autistics. Also contrary to social cognitive deficit interpretations, recent (2019) research recorded similar social cognitive performances in autistic and non-autistic adults, with both of them rating autistic individuals less favorably than non-autistic individuals; however, autistic individuals showed more interest in engaging with autistic people than non-autistic people did, and learning of

8874-419: The range of diagnoses that included the word "autism". Rather than distinguishing among these diagnoses, the DSM-5 and DSM-5-TR adopt a dimensional approach with one diagnostic category for disorders that fall under the autism spectrum umbrella. Within that category, the DSM-5 and the DSM include a framework that differentiates each person by dimensions of symptom severity, as well as by associated features (i.e.,

8976-917: The regulation of long non-coding RNAs (lncRNAs), and the regulation of X chromosome inactivation (XCI) initiation, via regulation of Xist long non-coding RNA, the master regulator of XCI, though competitive binding to Xist regulatory regions. Some ASD is associated with clearly genetic conditions, like fragile X syndrome , but only around 2% of autistic people have fragile X. Hypotheses from evolutionary psychiatry suggest that these genes persist because they are linked to human inventiveness, intelligence or systemising. Current research suggests that genes that increase susceptibility to ASD are ones that control protein synthesis in neuronal cells in response to cell needs, activity and adhesion of neuronal cells, synapse formation and remodeling, and excitatory to inhibitory neurotransmitter balance. Therefore, although up to 1,000 different genes are thought to increase

9078-772: The repression of β-catenin and p53 target genes. The importance of CHD8 can be observed in studies where CHD8-knockout mice died after 5.5 embryonic days because of widespread p53-induced apoptosis. Some studies have determined the role of CHD8 in autism spectrum disorder (ASD). CHD8 expression significantly increases during human mid-fetal development. The chromatin remodeling activity and its interaction with transcriptional regulators have shown to play an important role in ASD aetiology . The developing mammalian brain has conserved CHD8 target regions that are associated with ASD risk genes. The knockdown of CHD8 in human neural stem cells results in dysregulation of ASD risk genes that are targeted by CHD8. Recently CHD8 has been associated with

9180-448: The risk of ASD, all of them eventually affect normal neural development and connectivity between different functional areas of the brain in a similar manner that is characteristic of an ASD brain. Some of these genes are known to modulate production of the GABA neurotransmitter, the nervous system's main inhibitory neurotransmitter. These GABA-related genes are under-expressed in an ASD brain. On

9282-409: The significance of autism-associated traits in the wider population. The combination of broader criteria, increased awareness, and the potential increase of actual prevalence, has led to considerably increased estimates of autism prevalence since the 1990s. The WHO estimates about 1 in 100 children had autism between 2012 and 2021, as that was the average estimate in studies during that period, with

9384-546: The social and non-social components of ASD's symptoms, described as a triad in the classic autism criteria. But it is increasingly suspected that autism is instead a complex disorder whose core aspects have distinct causes that often cooccur. It is unlikely that ASD has a single cause; many risk factors identified in the research literature may contribute to ASD. These include genetics, prenatal and perinatal factors (meaning factors during pregnancy or very early infancy), neuroanatomical abnormalities, and environmental factors. It

9486-523: The social context and subtext of neurotypical conversational or printed situations, and form different conclusions about the content. Autistic people may not control the volume of their voice in different social settings. At least half of autistic children have atypical prosody . What may look like self-involvement or indifference to non-autistic people stems from autistic differences in recognizing how other people have their own personalities, perspectives, and interests. Most published research focuses on

9588-417: The term "autism" has become more commonly used in reference to the autism spectrum more broadly. Autism is a highly variable neurodevelopmental disorder whose symptoms first appear during infancy or childhood, and generally follows a steady course without remission . Autistic people may be severely impaired in some respects but average, or even superior, in others. Overt symptoms gradually begin after

9690-432: The term, because the term PDD is intended by its coiners and major bodies to refer to a category of disorders and not be used as a diagnostic label. The terminology PDD and ASD is often used interchangeably and varies depending on location. The onset of pervasive developmental disorders occurs during infancy, but the condition is usually not identified until the child is around three years old. Parents may begin to question

9792-558: The two disorders significantly outnumbered those that found no difference. The World Health Organization ’s International Classification of Diseases , 10th edition ( ICD-10 ) categorized PDD into five distinct subtypes, each with their own diagnostic criteria. The five subtypes, childhood autism , atypical autism , Rett syndrome , Asperger syndrome and childhood disintegrative disorder , are characterized by abnormalities in social interactions and communication. The disorders were primarily diagnosed based on behavioral features, although

9894-482: The utility or meaning of body language , social reciprocity, or social expectations, including the habitus , social cues , and some aspects of sarcasm, which to some degree may also be due to comorbid alexithymia . But recent research has increasingly questioned these findings, as the " double empathy problem " theory (2012) argues that there is a lack of mutual understanding and empathy between both non-autistic persons and autistic individuals. As communication

9996-540: Was coined by the Swiss psychiatrist Eugen Bleuler in 1910 as he was defining symptoms of schizophrenia . He derived it from the Greek word autós (αὐτός, meaning "self"), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance". The word autism first took its modern sense in 1938 when Hans Asperger of

10098-619: Was diagnosed when the criteria were not met for one of the other four PDDs. People would usually attract a diagnosis of Asperger syndrome rather than classic autism if they showed no substantial delay in language development , but early language ability was found to be a poor predictor of outcomes in adulthood. Low-functioning autism (LFA) is a degree of autism marked by difficulties with social communication and interaction, challenging behavior, and differences in social or emotional reciprocity . Sleep problems, aggression, stereotypical, and self-injurious behavior are also common symptoms. LFA

10200-444: Was presumed initially that there was a common cause at the genetic, cognitive, and neural levels for classic autism's characteristic triad of symptoms. However, over time, there was increasing evidence that autism was instead a complex and highly heritable disorder whose core aspects have distinct causes which often co-occur. The exact causes of autism are unknown, but it is believed that both genetic and environmental factors play

10302-574: Was published and ICD-9 was current), including more rigorous biological assessment—in place of historical experience—and a simplification of the classification system. As of 2023, empirical and theoretical research is leading to a growing consensus among researchers that the established ASD criteria are ineffective descriptors of autism as a whole, and that alternative research approaches must be encouraged, such as going back to autism prototypes, exploring new causal models of autism, or developing transdiagnostic endophenotypes . Proposed alternatives to

10404-462: Was released in June 2018 and came into full effect as of January 2022. It describes ASD as follows: Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for

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