Autism spectrum disorder (ASD)

Choose the content to read

• What causes autism?
• Symptoms
• How is autism diagnosed?
• How many levels of autism?
• What is virtual autism?
• What are the treatments for autism spectrum disorder?
• Comorbidities associated with autism
• How to prevent autism?

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a group of syndromes that cause delays in language and communication development, social interactions, repetitive attention, or a limited pattern of behavior. Autism is noticeable early in childhood. Children with autism have developmental delays, speech delays, communication and social interaction difficulties, and different behaviors from children of the same age. With appropriate and systematic medical treatment from the earliest stages, the autistic child can develop better learning and social skills.

What causes autism (ASD)?

There are various causes of autism. Even today, doctors and scientists cannot pinpoint the exact cause of the disease; many studies support the idea that genetic and environmental factors all play a role in the development of autism.

• Genetic factors: Approximately 10 - 20% of those diagnosed with autism have abnormalities in specific parts of their chromosome or genes, which correspond to certain genetic disorders, such as Fragile X syndrome or Rett syndrome. There is also a higher rate of autism in siblings of twins diagnosed with autism. According to research, children of older parents are more likely to have autism.
• Environmental factors are the main risk factors for autism in children, such as the mother's use of certain drugs during pregnancy or other complications while pregnant. Exposure to certain chemicals, such as pesticides, heavy metals, air pollution PM2.5, or nitrogen dioxide, could be causative factors of autism.

What are the symptoms of autism?

The symptoms of children with autism or the autistic spectrum vary in terms of the severity of the disability and symptoms, depending on the intelligence quotient (IQ) and other comorbidities, causing children with autism to exhibit differing symptoms. Autism symptoms are of two categories:

1. Language and communication impairments, as well as societal interactions with others, including
   • Language and communication impairments
     • Difficulty using verbal in conjunction with nonverbal language.
     • Begin speaking late or do not speak by the age at which most children begin.
     • Repeating what the parents, teachers, or others said.
     • Speaks or makes sounds that other people can't understand, have their inner languages.
     • Unable to complete communication and conversation.
   • Social interactions
     • No social interactions with friends or others; unable to make friends.
     • No eye contact, smiling at or back, greeting, or facial expressions
     • Not pointing fingers at the desired object, cry and pull an adult's hand toward it instead.
     • Inability to follow simple commands.
     • Do not share interesting thing with others, prefer playing alone, and dislikes doing activities with others.
     • When called by name, do not turn toward the caller, hardly make eye contact, or make only timid eye contact.
     • Pay no attention when talking to; indifferent and emotionless.
     • Would rather play with the objects than people
     • Do not mingle with parents, teachers, or classmates.
     • Clueless about an object's utility; sniffing or licking toys rather than playing with them.
     • Dislike playing with friends, acting out imaginations, and role-playing as fathers, mothers, or children.
     • Tend to have relationship problems with peers or teachers and have no close friends.
     • Inability to adjust to the social context of the event they participate in.

2. Displaying a regimented behavior pattern or showing repeated interest in the same topic
   • Enjoy repeating the same activities over and over. If forced to change, they will be sulky and unrestrained
   • Cry when having to do uninterested tasks or when meeting with unacquainted people.
   • Fixated on the same play activity, repeatedly gaze on the object of interest; intensely focus on its details.
   • Enjoy arranging things in neat order or aligning them in a long line.
   • Fixated on the same thoughts, locations, or behaviors, such as eating from the same table every time
   • No response to sensory stimuli, such as light, color, sound, texture, and temperature; for instance, one may or may not react to pain or be unresponsive to hot or cold weather. On the other hand, there could be overweening response.
   • Extreme reaction toward things disliked, such as loud noises, tight-fitting clothing, or being nit-picked.
   • Obsession with a particular topic, infatuation with lighted or moving objects, such as flashing toys, and toys with spinning parts, e.g., cars, or fans
   • Repetitive jumping, flapping arms, tiptoeing, and hand flicks

How is autism diagnosed?

The pediatrician diagnoses autism by taking a history of the child's behavior from the parents or guardians and the child's school teachers and carefully observing the child's behavior at the hospital to look for abnormalities. The doctor may perform the following examinations, including:

• Observe the response when called by name: face turning, eye contact, smiling back, or turning toward the sound.
• Make notice if the child asks the same questions over and over about the same subject of interest.
• Unable to point fingers to indicate needs.
• A deliberate, last-minute order change to check for a disagreeable mood change
• Observe for disproportionate interest in a specific toy when playing.
• Observe patterns of conversation that are rambling, repetitive, with a strange tone, or speaking in their private words.

The pediatrician may obtain additional tests to rule out other problems, such as audiology tests for hearing impairment. The earlier children with autism are identified and systematically treated with a combination of therapies under the supervision of a pediatrician, the faster and better their communication and socialization skills can progress.

How many levels of autism?

There are three levels of autism based on the severity of the symptoms and the need for support, from mild to high levels of differences in IQ and symptoms, with gradation like the colors of a rainbow. Therefore, the diagnostic concept of autism severity is called Spectrum. The three levels of autism spectrum disorder are as follows:

• Level 1: Requiring support: Communication deficiencies is easily observable with little social interaction, lack of flexibility in daily activities, and difficulties in planning and managing tasks systematically, causing obstacles in life and requiring support.
• Level 2 Requiring substantial support: There are impairments in verbal and gestural communication with almost no social interaction and very little response to others. There are strange ways of communicating and narrowed interest, trouble coping with change, and distinct repetitive behavior.
• Level 3 Requiring very substantial support: There are severe impairments in verbal and gesture communication, hardly any social interaction, speaking very little, becoming aggressive when subjected to behavioral changes, and doing the same things over and over, severely affecting life.

What is virtual autism?

Virtual autism is a condition in which children are not appropriately stimulated in their learning or playing, resulting in developmental delays that are not appropriate for their age. Children with virtual autism have symptoms similar to autism or autism spectrum disorder but not bought on by genetic or structural abnormalities in the brain. Virtual autism is caused by allowing children to spend too much screen time at a young age.

Pediatricians have found a higher rate of autism-like symptoms in preschool-age children before age three with screen time exposure. The more time a child spent in front of a screen, the more they were prone to virtual autism. Furthermore, children's lack of opportunities to play in groups is the reason for their lack of social skills and symptoms of virtual autism. However, if such a child receives behavioral adjustments and developmental stimulation, they can recover from virtual autism.

What are the treatments for autism spectrum disorder?

The most effective way to treat autism spectrum disorder is a holistic approach combining therapies for dominant symptoms and considering the type of autism and the level of need for help and support. The pediatrician will give parents of autistic children home and school instructions that emphasize developmental stimulation, increasing appropriate and decreasing inappropriate behavior in conjunction with hospital-based therapy to aid in stimulating the development of learning and communication, interactions with other people in society, to be able to live with others and reduce dependency, based on the following treatment recommendations:

• Speech therapy or speaking practice to memorize words, practice enunciation, pronunciation, and sentence structure, as well as practice communication skills and how to express needs to others
• Social skills therapy is training in approaching and responding to others. Practice communicating needs with words or gestures, such as getting to know other household members, teachers, and friends at school and engaging in role-play or group play with friends at home and school.  
• Behavioral therapy is a treatment to stop problematic behaviors and promote appropriate behaviors in living together with others in society, such as giving praise, clap hands, or a simple smile when the child can comply with instructions. To modify behavior, parents can use distractions to get the child to do something else or ignore the child's cries or demands. Parents should communicate succinctly, make it easy to understand, and refrain from scolding or making the child feel bad.
• Occupational therapy: If the pediatrician detects fine motor skills developmental delay in conjunction with autism, the pediatrician will recommend occupational therapy. This therapy is an activity to practice developing fine motor skills and working with other muscle groups.
• Medications are treatments to balance central nervous system neurotransmitters to minimize the symptoms of attention deficit hyperactivity disorder (ADHD), obsessive or aggressive behavior. Even though drug treatment does not cure autism, it helps children cooperate with training to develop their skills appropriately; when the child has a positive response that indicates a good effect of the drug, the pediatrician will consider gradually reducing the dosage or eventually stopping the medication.
• Group-based parent training is a therapy that teaches social and emotional skills by collaboration among parents at home, teachers at school, and pediatricians at the hospital using activities such as visual storytelling, symbolic communication, physical games with equipment, playing sports, music, or art therapy.

Comorbidities associated with autism

The comorbidities in those diagnosed with autism include:

• Sleep disorders are a common problem in 50–80% of those diagnosed with autism. Sleep disorders can also affect other behaviors during the day.
• Seizures: Children with autism are at increased risk, and those affected require ongoing systemic medical treatment to control seizures.
• ADHD in children (Attention deficit/Hyperactivity disorder) characterizes by restlessness, easily distracted, inability to concentrate on things they are not interested in, sensitivity to stimuli, color, and light, could not restrain and control behaviors. 
• Behavioral problems include an excessive preoccupation with particular objects or toys; obsessive compulsiveness; possessiveness of those objects; behaving violently and resentfully when preoccupied interests are interrupted.
• Anxiety: Those with autism frequently manifest as situational anxieties, grumpiness, irritability, rage, or other symptoms such as body aches, indigestion, headaches, or insomnia.
• Depression: When autistic children have difficulty communicating and socializing, they are more likely to experience stress, rapid weight gain or loss, restlessness, and other symptoms of depression or bipolar disorder.
• Intellectual disability: Approximately one in every three people diagnosed with autism develops global developmental delay or intellectual disabilities that affect learning and activity of daily living. This disability demands the most assistance from others for a living.

How to prevent autism?

There is no foolproof prevention for autism, but the following measures can lower the likelihood of having a child with autism:

• Pre-wedding checkup to check for the risk of latent genetic diseases and lessen the likelihood of passing the gene to offspring through pregnancy.
• Refrain from using all addictive substances, including alcohol, tobacco, and secondhand smoke.
• Avoid heavily polluted, high atmospheric PM2.5 or areas with the accumulation of toxic chemicals.
• When ill, see a physician as soon as possible.
• Exercise regularly.
• Eat nutritious foods.

Autism, the sooner the diagnosis, the faster return to usual life

Autism is treatable by stimulating language and communication development, including social interactions, which can help a child with autism develop into a better, well-rounded person. Though it can be hard to diagnose autism in young children, observing the symptoms of autism, bringing the child to the pediatrician early for an initial assessment, and closely monitoring the child's development will help the child be diagnosed and treated at an early age, allowing them to develop appropriately for their ages like a regular child.

According to the American Academy of Pediatrics (AAP), children at 9, 18, and 30 months of age should have standardized developmental screening to help diagnose autism and/or other developmental delays as soon as possible to channel the child into the appropriate treatment process for good treatment and continuing development outcomes.