Autism spectrum condition (ASC) is a development disorder characterized by a range of conditions and challenges with social skills, repetitive behaviors, speech and overall communication.
Autism spectrum condition (ASC) is a neurodevelopmental condition that “is characterized by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication” (1). The condition is characterised by a range of restricted, repetitive and inflexible patterns of behaviour and interests. The degrees of ASC are extremely diverse and individuals along the spectrum exhibit a full range of intellectual functioning and language abilities. ASC affects brain anatomy, functioning, and connectivity that all affects the behaviour across the individual’s lifespan. ASC can cause severe impairment in personal, family, social, educational, occupational or other important areas of functioning. Additionally, the capacities are usually “a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context” (1).
Individuals with autism often have a co-morbid diagnosis such as atypical language development, sensory hypo or hypersensitivity and difficulties in motor coordination, including dyspraxia. Additionally, there is high comorbidity with ADHD, depression and suicidal ideation (2). However, on average, individuals with on the spectrum “tend to perform better on measures of ‘systemising’ drive that is, the drive to analyse and build systems, based on identifying the laws that govern the particular system, in order to predict how that system will work” (2). Individuals on the spectrum also perform better on tests of attention to detail. Often individuals who are in the science-technology-engineering-maths fields are more likely to be diagnosed with ASC or have autistic traits.
The causes of ASC are complex and include genetic and environmental risk factors (3). Often, autism occurs during the developmental period, typically in early childhood but may not manifest fully until later in life, when social demands exceed the capacities of the individual (1). While parents typically report concerns in the first year of life, many children do not receive diagnoses until much later. It is estimated that 1 out of 160 children has an autistic spectrum disorder, though recent studies report a significantly higher number (4). Moreover, boys are four times more likely to be diagnosed with ASC than girls (2). An imbalance that can be due to both biological gender differences, or under- or misrecognition of autism in females.
Until recently, experts talked about different types of autism, such as Aspergers, Pervasive developmental disorder (PDD-NOS) and autistic condition. But now, with the new ICD-11, the different types have been gathered under the term “autism spectrum disorders”. Within this category there are six distinctive expressions:
Autism spectrum disorder without a disorder of the intellectual functioning or adaptive behaviour and with a mild impairment or no impairment in the individual's capacity to use functional language.
Autism spectrum disorder with a mild or no impairment in the individual's capacity to use functional language.
Autism spectrum disorder without a disorder of the intellectual functioning or adaptive behaviour and with a marked impairment in functional language.
Autism spectrum disorder with a disorder of the intellectual functioning or adaptive behaviour and with a marked impairment in functional language.
Autism spectrum disorder without a disorder of the intellectual functioning or adaptive behaviour and with acomplete, or almost complete, absence of ability relative to the individual’s age to use functional language.
Autism spectrum disorder with a disorder of the intellectual functioning or adaptive behaviour and with a complete, or almost complete, absence of ability relative to the individual’s age to use functional language.
As mentioned ASC has a wide range of symptoms. Here the symptoms and signs of ASC (5):
The exact cause of ASC hasn’t been scientifically proven. Although, the cause is thought to be complex and includes genetic and environmental risk factors. “For instance, on the genetic level alone, more than 100 genetic and genomic loci* have been implicated in autism. However, the ways in which these risk factors lead to the biological differences underpinning ASD or whether they could provide crucial clues to help in the development of new treatments is unknown” (3). ASC is though a heritable condition where genes inherited from one or both parents can impact the development of an autistic brain. Regardless, there is some environmental - yet unknown - component interacting with the risk genes for autism as the heritability isn’t 100 percent (6).
It isn’t easy to diagnose ASC as doctors or specialist have to observe a child’s behaviour and development over a period to make a diagnosis. The diagnosis process can vary depending on the age of the individual who is under observation. However, the diagnosis process is usually based on a combination of behavioural observations and clinical interviews that assess deficits in social communication, social reciprocity, and repetitive and stereotyped behaviours and interests.
The ASC diagnosis will stay with the individual throughout their life, though many will make progress with their condition as they grow. There has been no scientific proof that ASC can be cured, however, there are studies showing improvements of the condition through diet, routines and therapies like Early Intensive Behavioral Intervention, Picture Exchange Communication System, Cognitive Behavioral Therapy, an Music therapy (6). Especially routines play an important role in the daily lives of people with autism. Unfamiliarity and uncertainty with new acitivities or places can be overwhelming. Routines help to create stability through predictability and order. Assistive tools are great at creating routines and ensure predictability throughout the day, hereby educing stress and meltdowns. Additionally, assistive tools can promote independence and improve quality of life for individuals with autism.
In the ASC community there “there is growing consensus that the most effective interventions for children with ASC is to target core deficits (i.e., social communication); focus on individualized child goals; actively engage the child in multiple, planned learning opportunities throughout the day; incorporate the child’s interests; and involve multiple social-interaction partners, including parents“ (7). Moreover, early identification of ASC and treatment of autism is important as specifically targeting early social communication behaviours, such as imitation in young children with ASC is beneficial.
Until recently, experts talked about different types of autism, such as Aspergers, Pervasive developmental disorder (PDD-NOS) and autistic disorder. But now, with the new ICD-11, the different types have been gathered under the term “Autism spectrum disorders”. Diagnoses such as Aspergers, Atypical autism etc. from the ICD-10 are hereby old definitions of the autism spectrum and will cease the 1. January 2022 when ICD-11 takes effect.
*) A loci is plural for locus. Locus is a specific physical location of a gene or DNA sequence on a chromosome - like a genetic street address.
ICD-11 for Mortality and Morbidity Statistics, World Health Organization. Retrieved from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/437815624.
Baron-Cohen, S. (2017). The Genetics of Autism, Autism Research Centre. Retrieved from http://docs.autismresearchcentre.com/papers/2017WarrierThe-Genetics-of-Autism.pdf.
Ecker, C., Bookheimer, S.Y. and Murphy, D.G.M., (2015). Neuroimaging in autism spectrum disorder: brain structure and function across the lifespan. The Lancet Neurology, 14(11), 1121-1134. https://doi.org/10.1016/s1474-4422(15)00050-2.
Questions and answers about autism spectrum disorders (ASD), World Health Organization. Retrieved from https://www.who.int/features/qa/85/en/.
Symptoms Autism, nhs.uk, https://www.nhs.uk/conditions/autism/symptoms/.
Jaarsma, P. (2014). Reflections on Autism: Ethical Perspectives on Autism Spectrum Disorder in Health Care and Education. Linköping Studies in Arts and Science no. 606. Retrieved from https://www.diva-portal.org/smash/get/diva2:696956/FULLTEXT01.pdf.
Ingersoll, B. (2011). Recent Advances in Early Identification and Treatment of Autism. Current Directions in Psychological Science, 20, 335. https://doi.org/10.1177/0963721411418470