Autism

The term autism encompasses a range of developmental disorders with a variety of symptoms. Doctors therefore prefer to talk of autism spectrum disorders.

These disorders are characterized by difficulties understanding social interaction and adequately expressing oneself and behaving in a situation. People with autism thus have problems forming and maintaining interpersonal relationships from an early age. This applies both in the family and at school, or later in a job.

Also typical for autism are frequently repetitive (stereotyped) patterns of behavior and severely limited, intense interests. About half of people with autism moreover show mental (cognitive) impairments or a mental disability.

Autism spectrum disorders can be divided into the following categories:

• Early childhood autism, also called Kanner’s syndrome
• Atypical autism
• Asperger’s syndrome

Early childhood autism

With this form of autism, all the core symptoms of autism spectrum disorders exist: social interaction and communication via gestures, facial expressions and language are impaired. The behavior is characterized by repetitive patterns and limited interests. All these abnormalities appear before the age of three. When early childhood autism is combined with normal intelligence, it is called high-functioning autism.

Atypical autism

This form is detected when either only individual core symptoms occur before the age of three or all core symptoms occur after the age of three.

Asperger’s syndrome

Asperger’s syndrome differs from other autism spectrum disorders in that there are often no developmental delays or delays in speech or cognitive development. From pre-school age, increased abnormalities appear in relation to social interaction together with repetitive patterns of behavior (stereotyped behavior).

Developmental disorders with autistic traits that do not fit into any of the aforementioned categories are summarized as other profound developmental disorders of the autism spectrum.

Autism is characterized by three core symptoms:

• Problems with social interaction
• Communication and language difficulties
• Repetitive (stereotyped) patterns of behavior

Impaired social interaction

People with an autism spectrum disorder have difficulty understanding, forming and maintaining interpersonal relationships such as friendships. That not only affects the way they are with strangers but also with loved ones like family members.

Impaired communication

Children with an autism spectrum disorder often have delayed and altered language development. For example, they speak in a monotonous tone and do not recognize linguistic nuances like irony.

Repetitive behavior patterns

People with autism spectrum disorders maintain ritualized daily routines with recurrent activities. They usually react sensitively to change.

Along with the symptoms mentioned above, people with autism spectrum disorders can have a range of accompanying abnormalities. These are in turn associated with distinctive symptoms and impairments.

The most common accompanying symptoms include:

• motor skill disorders
• intellectual disability
• mental disorders such as anxiety disorders, phobias, ADHD, depression or obsessive-compulsive disorders
• neurological disorders like epilepsy
• functional disorders such as nutrition problems (imbalanced diet), bowel problems, sleep disorders, sight and hearing impairments

Special skills

Some people with an autism spectrum disorder have specific skills in a particular field such as arithmetic and mathematics, memory or learning and playing an instrument. This is referred to as “savantism” or “savant syndrome”. At the same time, they may have average, above-average or below-average intelligence.

The precise causes of autism are still unexplained. However, there are several known factors that can increase the risk of an autism spectrum disorder.

Genetic, i.e. hereditary, factors, specific pre-existing conditions of parents and particular incidents during pregnancy increase the risk of a person developing an autism spectrum disorder.

Hereditary factors

Many genetic risk factors for autism are already known. These are either passed on to the child in the genes or develop during the maturing process of the mother’s ovum or father’s sperm cell. Parents being older at conception also seems to play a role. The effect of hereditary factors on the development of autism spectrum disorders is currently estimated at 40 to 80% based on studies of twins and families.

Pre-existing conditions of parents

Certain conditions experienced by parents – especially the mother – also increase the risk of autism. These particularly include nervous system disorders such as epilepsy, psychiatric disorders and specific metabolic and autoimmune diseases like type 1 diabetes and psoriasis.

Factors during pregnancy

There are known factors that may increase the risk of autism spectrum disorders during pregnancy. In particular, these include an infection with rubella viruses. However, taking certain medication to treat depression and epilepsy can also increase the risk of autism.

1 to 1.5% of people around the world are estimated to have an autism spectrum disorder. Boys develop an autism spectrum disorder two to three times as often as girls.

The early detection of autism spectrum disorders is based mainly on the observation of indications that are typical of autism. In particular, these include an impaired ability or inability of the child to make contact via eye contact and gestures. Consequently, an autism spectrum disorder is much more difficult to detect in infants than older children. That applies most notably to Asperger’s syndrome, because its typical abnormalities such as ritualized behaviors are not yet apparent in infancy.

In addition to everyday observations by parents, daycare facilities and later at school, the medical check-ups performed within the scope of the pediatric health screenings known as U check-ups are essential for the early detection of autism spectrum disorders.

For example, children who show developmental abnormalities during the “U6” screening between the ages of 10 and 12 months should be re-examined for these abnormalities between the ages of 16 and 18 months.

Developmental abnormalities typical of autism include the following in particular:

• a lack of eye contact between the child and the person they’re in contact with
• a weakened or absent reaction to somebody addressing them
• a decline or loss of communication skills already acquired

As the child gets older, other criteria appear such as not bringing objects to show to parents. Disinterest in age-typical play can also be an indication.

The school entry health examination provides another opportunity for the early detection of behavioral abnormalities typical of autism. Special training courses for educators and teachers can help to enable the early detection of autism spectrum disorders and prevent misdiagnoses.

For specific treatment of an autism spectrum disorder to be possible, it is important for it to be correctly diagnosed as early as possible.

If parents or doctors notice initial abnormalities, special tests (screenings) can be carried out. A screening may also be expedient when there are specific risk factors for autism. For example, these include a viral infection during pregnancy or an autism spectrum disorder in an older sibling.

If the suspicion of an autism spectrum disorder is confirmed, a comprehensive psychological and medical diagnosis is carried out. For this, pediatricians collaborate with child and adolescent psychologists, for example. They initially observe the behavior of the children and adolescents and record autism-related symptoms. The current behavior of the child or adolescent in the family, among friends, at school or in a job is also factored in.

Just as important is a comprehensive interview about the case history. This process involves doctors, psychiatrists, relatives, teachers and educators.

Physical examinations are used to determine the presence of hearing or visual disorders for instance. In addition, neurological examinations are used to examine the development and function of the nervous system, as well as laboratory and imaging examinations.

The purpose of these examinations is not solely to detect or rule out an autism spectrum disorder. They are also used to record and classify any existing accompanying diseases.

Autism spectrum disorders are developmental disorders that affect people’s entire way of living. This is often very debilitating for people with autism and their families.

An essential goal of therapeutic measures is to reduce impairments like speech problems and difficulties interacting with other people. As a result, it should be possible to lead a more independent and happy life. The extent to which this succeeds depends on the form of autism, the individual characterization and the time the therapy started.

Behavior-oriented measures form the core of the treatment with the following aims:

• improving social and play skills
• improving communication skills
• encouraging versatility and learning abilities
• reducing problematic behaviors

A diagnosis of the autism spectrum disorder made as early as possible and targeted treatment can enable successful results. Parents and other guardians should be included in the treatment. They thus learn how they can contribute to the treatment success – for example by creating a low-stimulus living environment and regular structures.

As with the diagnosis, for long-term treatment it is advisable for specialists from various fields to coordinate and network. Depending on the individual symptoms, these can for instance be experts from the fields of behavioral therapy, speech therapy, occupational therapy, social education and various medical fields.

Autism is a developmental disorder that is present from very early childhood on and has a lifelong effect on the everyday life of the person and their loved ones.

The severity of the disorder depends on the form of autism and existing mental impairments, but also the specific circumstances and personal environment.

Comprehensive treatment can sometimes greatly improve the independence and quality of life of people with an autism spectrum disorder. It is important to regularly ask them about their desires and expectations for different areas of life.

Many people with autism need the support of their family and other caregivers throughout their life. As such, caregivers also need support in relation to both the care and how to meet their own needs.

For example, qualified psychotherapists offer special training courses where parents can learn strategies on how to encourage the development of their child with an autism spectrum disorder without putting constant stress on themselves or neglecting their own lives.

Self-help groups offer people with autism spectrum disorders and their relatives the opportunity to get informed and receive advice as well as share personal experiences.

You can find suitable self-help via a database on the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (NAKOS) website.