Thread:ZaStando27/@comment-45095942-20200222152612

=Autism spectrum= From Wikipedia, the free encyclopedia

Jump to navigationJump to search Autism spectrum, also known as autism spectrum disorder (ASD), is a range of mental disorders of the neurodevelopmental type. It includes autism and Asperger syndrome. Individuals on the autistic spectrum often experience difficulties with social communication and interaction and may exhibit restricted, repetitive patterns of behavior, interests, or activities. Symptoms are typically recognized between one and two years of age.[2]  Long-term problems may include difficulties in performing daily tasks, creating and keeping relationships, and maintaining a job.[9]

The cause of autism spectrum is uncertain.[5]  Risk factors include having an older parent, a family history of autism, and certain genetic conditions.[5]  It is estimated that between 64% and 91% of risk is due to family history.[10]  Diagnosis is based on symptoms.[5]  The DSM-5 redefined the autism spectrum disorders to encompass the previous diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder.[11]

Treatment efforts are generally individualized, and can include behavioural therapy and the teaching of coping skills.[5]  Medications may be used to try to help improve symptoms.[5]  Evidence to support the use of medications, however, is not very strong.[7]

Autism spectrum is estimated to affect about 1% of people (62.2 million globally) as of 2015.[2] [8]  In the United States it is estimated to affect more than 2% of children (about 1.5 million) as of 2016.[12]  Males are diagnosed four times more often than females.[9] [13]  The term "spectrum" can refer to the range of symptoms or their severity, leading some to favor a distinction between low-functioning people with autism who cannot act appropriately in social situations, or look after themselves, and high-functioning people with autism.

Contents

 * 1Classification
 * 2Signs and symptoms
 * 2.1Behavioral characteristics
 * 2.2Developmental course
 * 2.3Social skills
 * 2.4Communication skills
 * 3Causes
 * 3.1Genetic risk factors
 * 3.2Prenatal and perinatal risk factors
 * 3.3Disproven vaccine hypothesis
 * 4Pathophysiology
 * 4.1Mirror neuron system
 * 4.2"Social brain" interconnectivity
 * 4.3Temporal lobe
 * 4.4Mitochondrial dysfunction
 * 4.5Serotonin
 * 5Diagnosis
 * 5.1Evidence-based assessment
 * 5.2Comorbidity
 * 6Treatment
 * 7Epidemiology
 * 8History
 * 9Society and culture
 * 9.1Caregivers
 * 9.2Autism rights movement
 * 9.3Academic performance
 * 9.4Employment
 * 10References
 * 11External links

Classification[edit]
Further information: Autism § Classification

In the United States, a revision to autism spectrum disorder (ASD) was presented in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 2013.[14]  The new diagnosis encompasses previous diagnoses of autistic disorder, Asperger syndrome, childhood disintegrative disorder, and PDD-NOS. Compared with the DSM-IV diagnosis of autistic disorder, the DSM-5 diagnosis of ASD no longer includes communication as a separate criterion, and has merged social interaction and communication into one category.<sup id="cite_ref-15">[15]  Slightly different diagnostic definitions are used in other countries. For example, the ICD-10 is the most commonly-used diagnostic manual in the UK and European Union.<sup id="cite_ref-16">[16]  Rather than categorizing these diagnoses, the DSM-5 has adopted a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella. Some have proposed that individuals on the autism spectrum may be better represented as a single diagnostic category. Within this category, the DSM-5 has proposed a framework of differentiating each individual by dimensions of severity, as well as associated features (i.e., known genetic disorders, and intellectual disability).

Another change to the DSM includes collapsing social and communication deficits into one domain. Thus, an individual with an ASD diagnosis will be described in terms of severity of social communication symptoms, severity of fixated or restricted behaviors or interests, hyper- or hyposensitivity to sensory stimuli, and associated features. The restricting of onset age has also been loosened from 3 years of age to "early developmental period", with a note that symptoms may manifest later when social demands exceed capabilities.<sup id="cite_ref-IACC_17-0">[17]

Autism forms the core of the autism spectrum disorders. Asperger syndrome is closest to autism in signs and likely causes;<sup id="cite_ref-Lord_2000_18-0">[18]  unlike autism, people with Asperger syndrome usually have no significant delay in language development, according to the older DSM-IV criteria.<sup id="cite_ref-19">[19]  PDD-NOS is diagnosed when the criteria are not met for a more specific disorder. Some sources also include Rett syndrome and childhood disintegrative disorder, which share several signs with autism but may have unrelated causes; other sources differentiate them from ASD, but group all of the above conditions into the pervasive developmental disorders.<sup id="cite_ref-Lord_2000_18-1">[18] <sup id="cite_ref-NIMH-ASD-PDD_20-0">[20]

Autism, Asperger syndrome, and PDD-NOS are sometimes called the autistic disorders instead of ASD,<sup id="cite_ref-21">[21]  whereas autism itself is often called autistic disorder, childhood autism, or infantile autism.<sup id="cite_ref-Piven_22-0">[22]  Although the older term pervasive developmental disorder and the newer term autism spectrum disorder largely or entirely overlap,<sup id="cite_ref-NIMH-ASD-PDD_20-1">[20]  the earlier was intended to describe a specific set of diagnostic labels, whereas the latter refers to a postulated spectrum disorder linking various conditions.<sup id="cite_ref-23">[23]  ASD is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.<sup id="cite_ref-Piven_22-1">[22]

Signs and symptoms[edit]
Autism is characterized by persistent challenges with social communication, interaction across multiple contexts, understanding sarcasm, as well as restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, and lead to clinically significant functional impairment.<sup id="cite_ref-DSM_5_24-0">[24]  There is also a unique form of autism called autistic savantism, where a child can display outstanding skills in music, art, and numbers with no practice.<sup id="cite_ref-25">[25]  Because of its relevance to different populations, self-injurious behaviors (SIB) are not considered a core characteristic of the ASD population; however, approximately 50% of those with ASD take part in some type of SIB (head-banging, self-biting) and are more at risk than other groups with developmental disabilities.<sup id="cite_ref-26">[26]

Other characteristics of ASD include restricted and repetitive behaviors (RRBs) which include a large range of specific gestures and acts, it can even include certain behavioral traits as defined in the Diagnostic and Statistic Manual for Mental Disorders.<sup id="cite_ref-RRB_27-0">[27]

Asperger syndrome was distinguished from autism in the DSM-IV by the lack of delay or deviance in early language development.<sup id="cite_ref-DSM-IV-TR_28-0">[28]  Additionally, individuals diagnosed with Asperger syndrome did not have significant cognitive delays.<sup id="cite_ref-29">[29]  PDD-NOS was considered "subthreshold autism" and "atypical autism" because it was often characterized by milder symptoms of autism or symptoms in only one domain (such as social difficulties).<sup id="cite_ref-30">[30]  The DSM-5 eliminated the four separate diagnoses: Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder, and Autistic Disorder and combined them under the diagnosis of Autism Spectrum Disorder.<sup id="cite_ref-DSM_5_24-1">[24]

Behavioral characteristics[edit]
Autism spectrum disorders include 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. They may develop these difficulties of creating connections due to anxiety or depression, which people with autism are more likely to experience, and as a result isolate themselves.<sup id="cite_ref-31">[31]  Other behavioral characteristics include abnormal responses to sensations including sights, sounds, touch, and smell, and problems keeping a consistent speech rhythm. The latter problem influences an individual's social skills, leading to potential problems in how they are understood by communication partners. Behavioral characteristics displayed by those with autism spectrum disorder typically influence development, language, and social competence. Behavioral characteristics of those with autism spectrum disorder can be observed as perceptual disturbances, disturbances of development rate, relating, speech and language, and motility.<sup id="cite_ref-32">[32]

Developmental course[edit]
Autism spectrum disorders are thought to follow two possible developmental courses, although most parents report that symptom onset occurred within the first year of life.<sup id="cite_ref-Zwaigenbaum_2009_33-0">[33] <sup id="cite_ref-Lord_1995_34-0">[34]  One course of development is more gradual in nature, in which parents report concerns in development over the first two years of life and diagnosis is made around 3–4 years of age. Some of the early signs of ASDs in this course include decreased looking at faces, failure to turn when name is called, failure to show interests by showing or pointing, and delayed imaginative play.<sup id="cite_ref-Zwaigenbaum_2001_35-0">[35]

A second course of development is characterized by normal or near-normal development in the first 15 months to 3 years before onset of regression or loss of skills. Regression may occur in a variety of domains, including communication, social, cognitive, and self-help skills; however, the most common regression is loss of language.<sup id="cite_ref-Martínez-Pedraza_2009_36-0">[36] <sup id="cite_ref-Werner_et_al._37-0">[37]

There continues to be a debate over the differential outcomes based on these two developmental courses. Some studies suggest that regression is associated with poorer outcomes and others report no differences between those with early gradual onset and those who experience a regression period.<sup id="cite_ref-Mash_&_Barkley_38-0">[38]  While there is conflicting evidence surrounding language outcomes in ASD, some studies have shown that cognitive and language abilities at age ​2 1⁄2 may help predict language proficiency and production after age 5.<sup id="cite_ref-39">[39]  Overall, the literature stresses the importance of early intervention in achieving positive longitudinal outcomes.<sup id="cite_ref-Dawson_&_Osterling_40-0">[40]

Social skills[edit]
Social skills present the most challenges for individuals with ASD. This leads to problems with friendships, romantic relationships, daily living, and vocational success.<sup id="cite_ref-Barnhill_G._P._2007_116–126_41-0">[41]  Marriages are less common for those with ASD. Many of these challenges are linked to their atypical patterns of behavior and communication. It is common for children and adults with autism to struggle with social interactions because they are unable to relate to their peers.<sup id="cite_ref-42">[42]  All of these issues stem from cognitive impairments. Difficulty in this thought process means the individual has difficulty being aware of what others are thinking and what is going on around them.<sup id="cite_ref-43">[43]  This is closely related to the pragmatic difficulties of children with autism experience.<sup id="cite_ref-44">[44]

Communication skills[edit]
Communication deficits are generally characterized by impairments regarding joint attention and social reciprocity, challenges with verbal language cues, and poor nonverbal communication skills <sup id="cite_ref-45">[45]  such as lack of eye contact and meaningful gestures and facial expressions.<sup id="cite_ref-NIH2017Com_46-0">[46]  Language behaviors typically seen in children with autism may include repetitive or rigid language, specific interests in conversation, and atypical language development.<sup id="cite_ref-NIH2017Com_46-1">[46]  ASD is a complex pragmatic language disorder which influences communication skills significantly.<sup id="cite_ref-47">[47]  Many children with ASD develop language skills at an uneven pace where they easily acquire some aspects of communication, while never fully developing other aspects.<sup id="cite_ref-NIH2017Com_46-2">[46]  In some cases, individuals remain completely nonverbal throughout their lives, although the accompanying levels of literacy and nonverbal communication skills vary.

They may not pick up on body language or social cues such as eye contact and facial expressions if they provide more information than the person can process at that time. Similarly, they have trouble recognizing subtle expressions of emotion and identifying what various emotions mean for the conversation. They struggle with understanding the context and subtext of conversational or printed situations, and have trouble forming resulting conclusions about the content. This also results in a lack of social awareness and atypical language expression.<sup id="cite_ref-iidc.indiana.edu_48-0">[48]

It is also common for individuals with ASD to communicate strong interest in a specific topic, speaking in lesson-like monologues about their passion instead of enabling reciprocal communication with whomever they are speaking to.<sup id="cite_ref-NIH2017Com_46-3">[46]  What looks like self-involvement or indifference toward others stems from a struggle to recognize or remember that other people have their own personalities, perspectives, and interests.<sup id="cite_ref-iidc.indiana.edu_48-1">[48]  The ability to be focused in on one topic in communication is known as monotropism, and can be compared to "tunnel vision" in the mind for those individuals with ASD.<sup id="cite_ref-:2_49-0">[49]  Language expression by those on the autism spectrum is often characterized by repetitive and rigid language. Often children with ASD repeat certain words, numbers, or phrases during an interaction, words unrelated to the topic of conversation. They can also exhibit a condition called echolalia in which they respond to a question by repeating the inquiry instead of answering.<sup id="cite_ref-NIH2017Com_46-4">[46]  However, this repetition can be a form of meaningful communication, a way that individuals with ASD try to express a lack of understanding or knowledge regarding the answer to the question.<sup id="cite_ref-50">[50]

Causes[edit]
Main article: Causes of autism

While specific causes of autism spectrum disorders have yet to be found, many risk factors identified in the research literature may contribute to their development. These risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify general risk factors, but much more difficult to pinpoint specific factors. Given the current state of knowledge, prediction can only be of a global nature and therefore requires the use of general markers.<sup id="cite_ref-Tager-Flusberg_2010_51-0">[51]

Genetic risk factors[edit]
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 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 people with ASD have such a mutation. Some ASD is associated with clearly genetic conditions, like fragile X syndrome; however only around 2% of people with ASD have fragile X.<sup id="cite_ref-Lancet2018_52-0">[52]

As of 2018, it appeared that somewhere between 74% and 93% of ASD risk is heritable and that after an older child is diagnosed with ASD, 7–20% of subsequent children are likely to be as well.<sup id="cite_ref-Lancet2018_52-1">[52]  If parents have a child with ASD they have a 2% to 8% chance of having a second child with ASD. If the child with ASD is an identical twin the other will be affected 36 to 95 percent of the time. If they are fraternal twins the other will only be affected up to 31 percent of the time.<sup id="cite_ref-53">[53]

Some of the alterations that contribute to the development of the autistic spectrum: SNVs (single-nucleotide variations), indels (insertions-deletions) and SVs (structural variants). These associations have been identified through whole-genome studies, such as WGS (whole-genome sequencing) and GWAS (genome-wide analysis association studies).

In early onset disorders, such as autism, de novo mutations have been identified as risk factors. One study has identified 64 SNVs and 5 indels de novo on average. By performing an analysis of these variants, comparing cases and controls, considering SNVs and indels in 179 genes associated with autism or close to them, studies observed that the relative risk of missense mutations or variants in promoter regions and UTR (untranslated region), increases versus controls.[citation needed]

The identification of SVs has been very useful too, since structural alterations in the chromosomes are able to rearrange the genome, altering its functionality, depending on the size and the region they affect.

After the analysis, 98,785 SVs were identified, with an average of 5,843 variants per individual: 171 SVs were de novo, more frequent in the germ line. Some of these variants affected genes associated with autism, such as the GRIN2B gene, balanced translocation, or the deletion of exons 8, 9, and 10 of the CHD2 gene.

No significant differences were observed regarding the size of certain rearrangements in cases and controls, though a slight increase in number was observed for cases relative to controls.

All these genetic variants contribute to the development of the autistic spectrum, however, it can not be guaranteed that they are determinants for the development.<sup id="cite_ref-54">[54]

Prenatal and perinatal risk factors[edit]
Several prenatal and perinatal complications have been reported as possible risk factors for autism. These risk factors include maternal gestational diabetes, maternal and paternal age over 30, bleeding after first trimester, use of prescription medication (e.g. valproate) during pregnancy, and meconium in the amniotic fluid. While research is not conclusive on the relation of these factors to autism, each of these factors has been identified more frequently in children with autism, compared to their siblings who do not have autism, and other typically developing youth.<sup id="cite_ref-Garder,_Spiegelman,_Buka_55-0">[55]  While it is unclear if any single factors during the prenatal phase affect the risk of autism,<sup id="cite_ref-:1_56-0">[56]  complications during pregnancy may be a risk.<sup id="cite_ref-:1_56-1">[56]

Low vitamin D levels in early development has been hypothesized as a risk factor for autism.<sup id="cite_ref-57">[57]

Disproven vaccine hypothesis[edit]
Main article: MMR vaccine and autism

In 1998 Andrew Wakefield led a fraudulent study that suggested that the MMR vaccine may cause autism.<sup id="cite_ref-58">[58] <sup id="cite_ref-59">[59] <sup id="cite_ref-60">[60] <sup id="cite_ref-61">[61] <sup id="cite_ref-Godlee2011_62-0">[62]  This conjecture suggested that autism results from brain damage caused either by the MMR vaccine itself, or by thimerosal, a vaccine preservative.<sup id="cite_ref-Tan_and_Parkin_2008_63-0">[63]  No convincing scientific evidence supports these claims, and further evidence continues to refute them, including the observation that the rate of autism continues to climb despite elimination of thimerosal from routine childhood vaccines.<sup id="cite_ref-Waterhouse_2008_64-0">[64]  A 2014 meta-analysis examined ten major studies on autism and vaccines involving 1.25 million children worldwide; it concluded that neither the MMR vaccine, which has never contained thimerosal,<sup id="cite_ref-65">[65]  nor the vaccine components thimerosal or mercury, lead to the development of ASDs.<sup id="cite_ref-66">[66]

Pathophysiology[edit]
Main article: Autism § Mechanism

In general, neuroanatomical studies support the concept that autism may involve a combination of brain enlargement in some areas and reduction in others.<sup id="cite_ref-Koenig_2001_67-0">[67]  These studies suggest that autism may be caused by abnormal neuronal growth and pruning during the early stages of prenatal and postnatal brain development, leaving some areas of the brain with too many neurons and other areas with too few neurons.<sup id="cite_ref-Minshew_1996_68-0">[68]  Some research has reported an overall brain enlargement in autism, while others suggest abnormalities in several areas of the brain, including the frontal lobe, the mirror neuron system, the limbic system, the temporal lobe, and the corpus callosum.<sup id="cite_ref-69">[69] <sup id="cite_ref-70">[70]

In functional neuroimaging studies, when performing theory of mind and facial emotion response tasks, the median person on the autism spectrum exhibits less activation in the primary and secondary somatosensory cortices of the brain than the median member of a properly sampled control population. This finding coincides with reports demonstrating abnormal patterns of cortical thickness and grey matter volume in those regions of autistic persons' brains.<sup id="cite_ref-Sugranyes_2011_71-0">[71]

Mirror neuron system[edit]
Further information: Mirror neuron § Autism

The mirror neuron system (MNS) consists of a network of brain areas that have been associated with empathy processes in humans.<sup id="cite_ref-Fadiga_et_al_72-0">[72]  In humans, the MNS has been identified in the inferior frontal gyrus (IFG) and the inferior parietal lobule (IPL) and is thought to be activated during imitation or observation of behaviors.<sup id="cite_ref-Shamy-Tsoory_73-0">[73]  The connection between mirror neuron dysfunction and autism is tentative, and it remains to be seen how mirror neurons may be related to many of the important characteristics of autism.<sup id="cite_ref-Dinstein_74-0">[74] <sup id="cite_ref-Biological_Psychology_75-0">[75]

"Social brain" interconnectivity[edit]
A number of discrete brain regions and networks among regions that are involved in dealing with other people have been discussed together under the rubric of the "social brain". As of 2012, there was a consensus that autism spectrum is likely related to problems with interconnectivity among these regions and networks, rather than problems with any specific region or network.<sup id="cite_ref-Kennedy_et_al_76-0">[76]

Temporal lobe[edit]
Functions of the temporal lobe are related to many of the deficits observed in individuals with ASDs, such as receptive language, social cognition, joint attention, action observation, and empathy. The temporal lobe also contains the superior temporal sulcus (STS) and the fusiform face area (FFA), which may mediate facial processing. It has been argued that dysfunction in the STS underlies the social deficits that characterize autism. Compared to typically developing individuals, one fMRI study found that individuals with high-functioning autism had reduced activity in the FFA when viewing pictures of faces.<sup id="cite_ref-77">[77]

Mitochondrial dysfunction[edit]
It has been suggested that ASD could be linked to mitochondrial disease (MD), a basic cellular abnormality with the potential to cause disturbances in a wide range of body systems.<sup id="cite_ref-Haas_78-0">[78]  A recent meta-analysis study, as well as other population studies have shown that approximately 5% of children with ASD meet the criteria for classical MD.<sup id="cite_ref-Rossignol_79-0">[79]  It is unclear why the MD occurs considering that only 23% of children with both ASD and MD present with mitochondrial DNA (mtDNA) abnormalities.<sup id="cite_ref-Rossignol_79-1">[79]

Serotonin[edit]
It has been hypothesized that increased activity of serotonin in the developing brain may facilitate the onset of autism spectrum disorder, with an association found in six out of eight studies between the use of selective serotonin reuptake inhibitors (SSRIs) by the pregnant mother and the development of ASD by the child exposed to SSRI in the antenatal environment. The study could not definitively conclude SSRIs caused the increased risk for ASDs due to the biases found in those studies, and the authors called for more definitive, better conducted studies.<sup id="cite_ref-80">[80]  Confounding by indication has since then been shown to be likely.<sup id="cite_ref-81">[81]

Evidence-based assessment[edit]
ASD can be detected as early as 18 months or even younger in some cases.<sup id="cite_ref-82">[82]  A reliable diagnosis can usually be made by the age of two years, however, because of delays in seeking and administering assessments, diagnoses often occur much later.<sup id="cite_ref-Lord_2006_83-0">[83]  The diverse expressions of ASD behavioral and observational symptoms pose diagnostic challenges to clinicians who use assessment methods based on those symptoms. Individuals with an ASD may present at various times of development (e.g., toddler, child, or adolescent), and symptom expression may vary over the course of development.<sup id="cite_ref-Volkmar_1999_84-0">[84]  Furthermore, clinicians who use those methods must differentiate among pervasive developmental disorders, and may also consider similar conditions, including intellectual disability not associated with a pervasive developmental disorder, specific language disorders, ADHD, anxiety, and psychotic disorders.<sup id="cite_ref-85">[85]

Considering the unique challenges in diagnosing ASD using behavioral and observational assessment, specific practice parameters for its assessment were published by the American Academy of Neurology in the year 2000,<sup id="cite_ref-Filipek_(2000)_86-0">[86]  the American Academy of Child and Adolescent Psychiatry in 1999,<sup id="cite_ref-Volkmar_1999_84-1">[84]  and a consensus panel with representation from various professional societies in 1999.<sup id="cite_ref-Filipek_1999_87-0">[87]  The practice parameters outlined by these societies include an initial screening of children by general practitioners (i.e., "Level 1 screening") and for children who fail the initial screening, a comprehensive diagnostic assessment by experienced clinicians (i.e. "Level 2 evaluation"). Furthermore, it has been suggested that assessments of children with suspected ASD be evaluated within a developmental framework, include multiple informants (e.g., parents and teachers) from diverse contexts (e.g., home and school), and employ a multidisciplinary team of professionals (e.g., clinical psychologists, neuropsychologists, and psychiatrists).<sup id="cite_ref-Ozonoff_2005_88-0">[88]

As of 2019, psychologists would wait until a child showed initial evidence of ASD tendencies, then administer various psychological assessment tools to assess for ASD.<sup id="cite_ref-Ozonoff_2005_88-1">[88]  Among these measurements, the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) are considered the "gold standards" for assessing autistic children.<sup id="cite_ref-Corsello_2007_89-0">[89] <sup id="cite_ref-Huerta_2010_90-0">[90]  The ADI-R is a semi-structured parent interview that probes for symptoms of autism by evaluating a child's current behavior and developmental history. The ADOS is a semistructured interactive evaluation of ASD symptoms that is used to measure social and communication abilities by eliciting several opportunities (or "presses") for spontaneous behaviors (e.g., eye contact) in standardized context. Various other questionnaires (e.g., The Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist) and tests of cognitive functioning (e.g., The Peabody Picture Vocabulary Test) are typically included in an ASD assessment battery.

Comorbidity[edit]
Main article: Conditions comorbid to autism spectrum disorders

Autism spectrum disorders tend to be highly comorbid with other disorders. Comorbidity may increase with age and may worsen the course of youth with ASDs and make intervention/treatment more difficult. Distinguishing between ASDs and other diagnoses can be challenging, because the traits of ASDs often overlap with symptoms of other disorders, and the characteristics of ASDs make traditional diagnostic procedures difficult.<sup id="cite_ref-Helverschou_2011_91-0">[91] <sup id="cite_ref-Underwood_2010_92-0">[92]
 * The most common medical condition occurring in individuals with autism spectrum disorders is seizure disorder or epilepsy, which occurs in 11–39% of individuals with ASD.<sup id="cite_ref-Ballaban-Gill_&_Tuchman_93-0">[93]
 * Tuberous sclerosis, an autosomal dominant genetic condition in which non-malignant tumors grow in the brain and on other vital organs, is present in 1–4% of individuals with ASDs.<sup id="cite_ref-Wiznitzer_94-0">[94]
 * Intellectual disabilities are some of the most common comorbid disorders with ASDs. Recent estimates suggest that 40–69% of individuals with ASD have some degree of an intellectual disability,<sup id="cite_ref-Mash_&_Barkley_38-1">[38]  more likely to be severe for females. A number of genetic syndromes causing intellectual disability may also be comorbid with ASD, including fragile X, Down, Prader-Willi, Angelman, and Williams syndrome.<sup id="cite_ref-95">[95]
 * Learning disabilities are also highly comorbid in individuals with an ASD. Approximately 25–75% of individuals with an ASD also have some degree of a learning disability.<sup id="cite_ref-Obrien_&_Pearson_96-0">[96]
 * Various anxiety disorders tend to co-occur with autism spectrum disorders, with overall comorbidity rates of 7–84%.<sup id="cite_ref-Mash_&_Barkley_38-2">[38]  Rates of comorbid depression in individuals with an ASD range from 4–58%.<sup id="cite_ref-Lainhart_97-0">[97]  The relationship between ASD and schizophrenia remains a controversial subject under continued investigation, and recent meta-analyses have examined genetic, environmental, infectious, and immune risk factors that may be shared between the two conditions.<sup id="cite_ref-98">[98] <sup id="cite_ref-99">[99] <sup id="cite_ref-100">[100]
 * Deficits in ASD are often linked to behavior problems, such as difficulties following directions, being cooperative, and doing things on other people's terms.<sup id="cite_ref-Tsakanikos_2007_101-0">[101]  Symptoms similar to those of attention deficit hyperactivity disorder (ADHD) can be part of an ASD diagnosis.<sup id="cite_ref-Rommelse_et_al._102-0">[102]
 * Sensory processing disorder is also comorbid with ASD, with comorbidity rates of 42–88%.<sup id="cite_ref-Baranek_2002_103-0">[103]
 * Starting in adolescence, some people with Asperger syndrome (26% in one sample)<sup id="cite_ref-:17_104-0">[104]  fall under the criteria for the similar condition schizoid personality disorder, which is characterised by a lack of interest in social relationships, a tendency towards a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and apathy.<sup id="cite_ref-:17_104-1">[104] <sup id="cite_ref-:16_105-0">[105] <sup id="cite_ref-:5_106-0">[106]  Asperger syndrome was traditionally called "schizoid disorder of childhood".

Treatment[edit]
Main article: Autism therapies

There is no known cure for autism, although those with Asperger syndrome and those who have autism and require little-to-no support are more likely to experience a lessening of symptoms over time.<sup id="cite_ref-McPartland_107-0">[107] <sup id="cite_ref-Woodbury-Smith_108-0">[108] <sup id="cite_ref-Coplan_109-0">[109]  Several interventions can help children with Autism.<sup id="cite_ref-HHS2017_13-1">[13]  The main goals of treatment 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.<sup id="cite_ref-110">[110] <sup id="cite_ref-Smith_111-0">[111]  Although evidence-based interventions for autistic children vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing problem behaviors. It has been argued that no single treatment is best and treatment is typically tailored to the child's needs.<sup id="cite_ref-Myers_112-0">[112]

Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills. Available approaches include applied behavior analysis, developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.<sup id="cite_ref-Myers_112-1">[112]  Among these approaches, interventions either treat autistic features comprehensively, or focus treatment on a specific area of deficit.<sup id="cite_ref-Smith_111-1">[111]  Generally, when educating those with autism, specific tactics may be used to effectively relay information to these individuals. Using as much social interaction as possible is key in targeting the inhibition autistic individuals experience concerning person-to-person contact. Additionally, research has shown that employing semantic groupings, which involves assigning words to typical conceptual categories, can be beneficial in fostering learning.<sup id="cite_ref-113">[113]

There has been increasing attention to the development of evidence-based interventions for young children with ASD. Two theoretical frameworks outlined for early childhood intervention include applied behavioral analysis (ABA) and the developmental social-pragmatic model (DSP).<sup id="cite_ref-Smith_111-2">[111]  Although ABA therapy has a strong evidence base, particularly in regard to early intensive home-based therapy, ABA's effectiveness may be limited by diagnostic severity and IQ of the person affected by ASD.<sup id="cite_ref-114">[114]  The Journal of Clinical Child and Adolescent Psychology has deemed two early childhood interventions as "well-established": individual comprehensive ABA, and focused teacher-implemented ABA combined with DSP.<sup id="cite_ref-Smith_111-3">[111]

Another evidence-based intervention that has demonstrated efficacy is a parent training model, which teaches parents how to implement various ABA and DSP techniques themselves.<sup id="cite_ref-Smith_111-4">[111]  Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation.

A multitude of unresearched alternative therapies have also been implemented. Many have resulted in harm to autistic people and should not be employed unless proven to be safe.<sup id="cite_ref-Myers_112-2">[112]

In October 2015, the American Academy of Pediatrics (AAP) proposed new evidence-based recommendations for early interventions in ASD for children under 3.<sup id="cite_ref-APP2015_115-0">[115]  These recommendations emphasize early involvement with both developmental and behavioral methods, support by and for parents and caregivers, and a focus on both the core and associated symptoms of ASD.<sup id="cite_ref-APP2015_115-1">[115]  Studies on pet therapy have shown positive effects.<sup id="cite_ref-116">[116]

Epidemiology[edit]
Main article: Epidemiology of autism

The U.S. Center for Disease Control's most recent estimate is that 1 out of every 68 children, or 14.7 per 1,000, are affected by some form of ASD as of 2010.<sup id="cite_ref-117">[117]  Reviews tend to estimate a prevalence of 6 per 1,000 for autism spectrum disorders as a whole,<sup id="cite_ref-Newschaffer_2007_118-0">[118]  although prevalence rates vary for each of the developmental disorders in the spectrum. Autism prevalence has been estimated at 1-2 per 1,000, Asperger syndrome at roughly 0.6 per 1,000, childhood disintegrative disorder at 0.02 per 1,000, and PDD-NOS at 3.7 per 1,000.<sup id="cite_ref-Newschaffer_2007_118-1">[118]  These rates are consistent across cultures and ethnic groups, as autism is considered a universal disorder.<sup id="cite_ref-Mash_&_Barkley_38-3">[38]

While rates of autism spectrum disorders are consistent across cultures, they vary greatly by gender, with boys affected far more frequently than girls. The average male-to-female ratio for ASDs is 4.2:1,<sup id="cite_ref-119">[119]  affecting 1 in 70 boys, but only 1 in 315 girls.<sup id="cite_ref-120">[120]  Girls, however, are more likely to have associated cognitive impairment. Among those with an ASD and intellectual disability, the sex ratio may be closer to 2:1.<sup id="cite_ref-121">[121]  Prevalence differences may be a result of gender differences in expression of clinical symptoms, with women and girls with autism showing less atypical behaviors and, therefore, less likely to receive an ASD diagnosis.<sup id="cite_ref-Tsakanikos_Underwood_2011_122-0">[122]

Rates of ASD are approximately 4% higher based on the historical DSM-IV-TR case definition compared to the DSM-5 case definition from 2013. Relatively mild forms of autism, such as Aspergers as well as other developmental disorders were included in the recent DSM-5 diagnostic criteria.<sup id="cite_ref-123">[123]  ASD rates were constant between 2014 and 2016 but twice the rate compared to the time period between 2011 and 2014 (1.25 vs 2.47%). A Canadian meta-analysis from 2019 confirmed these effects as the profiles of people diagnosed with autism became less and less different from the profiles of the general population.<sup id="cite_ref-124">[124]  In the US, the rates for diagnosed ASD have been steadily increasing since 2000 when records began being kept.<sup id="cite_ref-125">[125]

History[edit]
Further information: Autism § History

Controversies have surrounded various claims regarding the etiology of autism spectrum disorders. In the 1950s, the "refrigerator mother theory" emerged as an explanation for autism. The hypothesis was based on the idea that autistic behaviors stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanor of a child's mother.<sup id="cite_ref-Kanner_1949_126-0">[126]  Naturally, parents of children with an autism spectrum disorder suffered from blame, guilt, and self-doubt, especially as the theory was embraced by the medical establishment and went largely unchallenged into the mid-1960s. The "refrigerator mother" theory has since continued to be refuted in scientific literature, including a 2015 systematic review which showed no association between caregiver interaction and language outcomes in ASD.<sup id="cite_ref-127">[127]

Another controversial claim suggests that watching extensive amounts of television may cause autism. This hypothesis was largely based on research suggesting that the increasing rates of autism in the 1970s and 1980s were linked to the growth of cable television at this time.<sup id="cite_ref-Waterhouse_2008_64-1">[64]

Society and culture[edit]
Further information: Societal and cultural aspects of autism

Caregivers[edit]
Families who care for an autistic child face added stress from a number of different causes. Parents may struggle to understand the diagnosis and to find appropriate care options. Parents often take a negative view of the diagnosis, and may struggle emotionally. In the words of one parent whose two children were both diagnosed with autism, "In the moment of diagnosis, it feels like the death of your hopes and dreams."<sup id="cite_ref-128">[128]  More than half of parents over the age of 50 are still living with their child as about 85% of people with ASD have difficulties living independently.<sup id="cite_ref-Kar2012_129-0">[129]

Autism rights movement[edit]
The autism rights movement is a social movement within the context of disability rights that emphasizes the concept of neurodiversity, viewing the autism spectrum as a result of natural variations in the human brain rather than a disorder to be cured.<sup id="cite_ref-Solomon_130-0">[130]  The autism rights movement advocates for including greater acceptance of autistic behaviors; therapies that focus on coping skills rather than imitating the behaviors of those without autism;<sup id="cite_ref-Bigthink_131-0">[131]  and the recognition of the autistic community as a minority group.<sup id="cite_ref-Bigthink_131-1">[131] <sup id="cite_ref-Jaarsma2012_132-0">[132]  Autism rights or neurodiversity advocates believe that the autism spectrum is genetic and should be accepted as a natural expression of the human genome. This perspective is distinct from two other likewise distinct views: the medical perspective, that autism is caused by a genetic defect and should be addressed by targeting the autism gene(s), and fringe theories that autism is caused by environmental factors such as vaccines.<sup id="cite_ref-Solomon_130-1">[130]  A common criticism against autistic activists is that the majority of them are "high-functioning" or have Asperger syndrome and do not represent the views of "low-functioning" autistic people.<sup id="cite_ref-Jaarsma2012_132-1">[132]

Academic performance[edit]
The number of students identified and served as eligible for autism services in the United States has increased from 5,413 children in 1991-1992 to 370,011 children in the 2010-2011 academic school year.<sup id="cite_ref-:0_133-0">[133]  The United States Department of Health and Human Services reported approximately 1 in 68 children at age 8 are diagnosed with autism spectrum disorder (ASD) although onset is typically between ages 2 and 4.<sup id="cite_ref-:0_133-1">[133]

The increasing number of students with ASD in the schools presents significant challenges to teachers, school psychologists, and other school professionals.<sup id="cite_ref-:0_133-2">[133]  These challenges include developing a consistent practice that best support the social and cognitive development of the increasing number of students with ASD.<sup id="cite_ref-:0_133-3">[133]  Although there is considerable research addressing assessment, identification, and support services for children with ASD, there is a need for further research focused on these topics within the school context.<sup id="cite_ref-:0_133-4">[133]  Further research on appropriate support services for students with ASD will provide school psychologists and other education professionals with specific directions for advocacy and service delivery that aim to enhance school outcomes for students with ASD.<sup id="cite_ref-:0_133-5">[133]

Attempts to identify and use best intervention practices for students with autism also pose a challenge due to overdependence on popular or well-known interventions and curricula.<sup id="cite_ref-:0_133-6">[133]  Some evidence suggests that although these interventions work for some students, there remains a lack of specificity for which type of student, under what environmental conditions (one-on-one, specialized instruction or general education) and for which targeted deficits they work best.<sup id="cite_ref-:0_133-7">[133]  More research is needed to identify what assessment methods are most effective for identifying the level of educational needs for students with ASD.

A difficulty for academic performance in students with ASD, is the tendency to generalize learning.<sup id="cite_ref-:2_49-1">[49]  Learning is different for each student, which is the same for students with ASD. To assist in learning, accommodations are commonly put into place for students with differing abilities. The existing schema of these students works in different ways and can be adjusted to best support the educational development for each student.<sup id="cite_ref-134">[134]

The cost of educating a student with ASD in the US is about $8,600 a year.<sup id="cite_ref-135">[135]

Employment[edit]
About half of people with autism are unemployed, and one third of those with graduate degrees may be unemployed.<sup id="cite_ref-Ohl_136-0">[136]  Among those on the autism spectrum who find work, most are employed in sheltered settings working for wages below the national minimum.<sup id="cite_ref-137">[137]  While employers state hiring concerns about productivity and supervision, experienced employers of autistics give positive reports of above average memory and detail orientation as well as a high regard for rules and procedure in autistic employees.<sup id="cite_ref-Ohl_136-1">[136]  A majority of the economic burden of autism is caused by lost productivity in the job market.<sup id="cite_ref-138">[138]  Some studies also find decreased earning among parents who care for autistic children.<sup id="cite_ref-139">[139] <sup id="cite_ref-140">[140]  Adding content related to autism in existing diversity training can clarify misconceptions, support employees, and help provide new opportunities for autistics.[citation needed]

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Categories:
 * Autism spectrum at Curlie
 * Autism
 * Developmental psychology
 * Developmental neuroscience
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