5.2.7 Autism Spectrum Disorders

5.2.7 Autism Spectrum Disorders

Autism Spectrum Disorders

Autism spectrum disorders (ASD) are a group of neurodevelopmental conditions characterized by impairments in social communication and interaction, as well as restricted and repetitive behaviours and interests. In children and adolescents, ASD can have significant impacts on cognitive, behavioural, and social development.

DSM-5 and ICD-11 now use ‘Autism spectrum disorder’ as an umbrella term in the chapter on ‘Neurodevelopmental disorders’.

Prevalence/Incidence:

Prevalence and incidence rates of ASD have been increasing worldwide, with recent estimates suggesting a global prevalence of around 1 in 160 children (Baio et al., 2018). ASD is more common in boys than girls, with a male-to-female ratio of around 4:1.

Aetiology:

The aetiology of ASD is complex and multifactorial, with both genetic and environmental factors implicated in its development. Twin and family studies have shown a high degree of heritability, with genetic factors accounting for around 80% of the risk (Sandin et al., 2014). Environmental factors, such as prenatal exposure to certain toxins and infections, have also been associated with an increased risk of ASD (Gardener et al., 2011).

Presentation:

The presentation of ASD can vary widely but typically involves impairments in social communication and interaction, as well as restricted and repetitive behaviours and interests. Children and adolescents with ASD may have difficulty with social interactions, such as making and maintaining eye contact, understanding nonverbal cues, and developing friendships. They may also engage in repetitive behaviours, such as hand-flapping or lining up objects, and have highly focused interests in specific topics or objects.

Treatment:

The treatment of ASD in children and adolescents typically involves a multidisciplinary approach, with interventions aimed at addressing the core symptoms of ASD as well as associated problems such as anxiety and behavioural difficulties. Some of the commonly used interventions include behavioural therapy, social skills training, and medication management (Reichow et al., 2012). While there is no known cure for ASD, early intervention and ongoing support can lead to significant improvements in functioning and quality of life.

Outcome:

The outcome of ASD can vary widely, with some individuals experiencing significant improvements in functioning and others requiring ongoing support and care. With appropriate intervention and support, many children and adolescents with ASD can lead fulfilling and meaningful lives.

Key Information
Prevalence/IncidenceASD is a common neurodevelopmental disorder that affects more than one in 100 people and there are around 700,000 autistic adults and children in the UK. About 1 in 54 children in the US have ASD (CDC, 2021). Prevalence rates vary across different countries.
AetiologyThe exact causes of ASD are unknown, but genetic and environmental factors are believed to play a role (Baio et al., 2018).
PresentationASD is characterized by difficulties in social communication and interaction, and restricted and repetitive patterns of behaviour and interests (APA, 2013).
TreatmentsEarly and intensive behavioural intervention, such as Applied Behavioral Analysis (ABA), is effective in improving outcomes for children with ASD (Reichow et al., 2012). Other treatments include speech and occupational therapy, and medication for co-occurring conditions.
OutcomeOutcomes for individuals with ASD vary widely, but early intervention and ongoing support can improve outcomes in terms of communication, socialization, and adaptive functioning (Dawson et al., 2020).

An Understanding of How Autism Spectrum Disorder Relates to Behaviours (e.g. Self-harm, Refusal to Attend School etc.) and Contexts (e.g. Pre-school Behaviours)

Individuals with ASD may exhibit a range of behaviours that can vary widely depending on the individual and the specific context.

Some common behaviours associated with ASD include:

  • Self-harm: This can include behaviours such as head-banging, hand-biting, or scratching oneself. Self-harm can be a way for individuals with ASD to cope with sensory overload or emotional distress.
  • Refusal to attend school: This can be due to a variety of reasons, such as difficulty adjusting to new environments, sensory sensitivities, or social anxiety. Some individuals with ASD may struggle with changes to their routines and may find it difficult to adapt to new situations.
  • Repetitive behaviours: These can include behaviours such as hand-flapping, rocking back and forth, or lining up objects. Repetitive behaviours can be a way for individuals with ASD to regulate their emotions or manage sensory input.

In the context of preschool-aged children, some common behaviours associated with ASD can include delayed language development, difficulty with social interactions, and repetitive play behaviours. Children with ASD may also exhibit sensory sensitivities, such as aversion to certain textures or sounds.

It’s important to note that every individual with ASD is unique and may exhibit behaviours that are specific to them. Understanding the specific behaviours and contexts in which they occur is important for developing effective strategies to support individuals with ASD.

In addition, early intervention and ongoing support can help individuals with ASD develop skills to manage challenging behaviours and improve their ability to interact with others and participate in daily activities.

In summary, ASD is a complex neurodevelopmental condition that can have significant impacts on cognitive, behavioural, and social development in children and adolescents. A multidisciplinary approach to treatment and ongoing support is crucial in improving outcomes.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Robinson Rosenberg, C., White, T., Durkin, M. S., Imm, P., Nikolaou, L., Yeargin-Allsopp, M., Lee, L. C., Harrington, R. A., Lopez, M., Fitzgerald, R. T., … Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1–23. https://doi.org/10.15585/mmwr.ss6706a1
  3. Centers for Disease Control and Prevention. (2021). Data and statistics on autism spectrum disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html
  4. Dawson, G., Jones, E. J. H., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers, S. J., & Webb, S. J. (2020). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child & Adolescent Psychiatry, 59(2), 258–269. https://doi.org/10.1016/j.jaac.2019.03.034
  5. Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 10, CD009260. https://doi.org/10.1002/14651858.CD009260.pub2
  6. Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., … & Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Morbidity and Mortality Weekly Report. Surveillance Summaries, 67(6), 1-23.
  7. Gardener, H., Spiegelman, D., & Buka, S. L. (2011). Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis. Pediatrics, 128(2), 344-355.
  8. Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, (10). doi: 10.1002/14651858.CD009260.pub2