Autism Spectrum Disorder can be challenging, but understanding autism symptoms in time can help ASD individuals live better lives. Read further to know how.

Autism

Discover the autism meaning in Urdu and learn how understanding autism symptoms can positively impact the lives of individuals with Autism Spectrum Disorder (ASD). Gain valuable insights on supporting and empowering ASD individuals for a better quality of life.

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Syed Intisar Hussain

Overview

In simple words, autism is a developmental disorder of variable severity characterized by difficulty in social interaction and communication, and restricted or repetitive patterns of thought and behavior<a href="#accordion">[1]</a>.

Autism spectrum disorder (ASD) is a developmental and neurological disorder that affects how people reach out to others, communicate, learn, and behave. It can be diagnosed at any age. However, since it is a developmental disorder, symptoms of autism mostly appear in the first two years of life<a href="#accordion">[7]</a>.

A guide was created by the American Psychiatric Association, as per instructions from the&nbsp;Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It was developed to guide the healthcare staff to diagnose different conditions. According to these guidelines people with ASD often have: 
&nbsp;

<ul>
	<li>Restricted interests and repetitive behaviors</li>
	<li>Difficulty in interacting and communicating with other people&nbsp;</li>
	<li>Symptoms that affect their ability to function in school, work, etc. 
	&nbsp;</li>
</ul>

Autism is a spectrum disorder meaning that there are several types and the range of presenting symptoms is very vast. People of all races, ethnicities, economic backgrounds, and genders can be diagnosed with ASD. Treatment, services, and counseling can help improve the lives of people with autism. The American Academy of Pediatrics recommends that all children should receive screening for autism. Parents and caretakers of autistic patients should strongly communicate with their healthcare staff for accurate evaluation.

Autism spectrum disorder (ASD) is a group of complicated neuropsychiatric disorders and multifactorial neurodevelopment. Several genes, associated with single nucleotide polymorphisms (SNPs), have been identified for ASD. The associations between different SNPs and ASD vary from population to population<a href="#accordion">[3]</a>.&nbsp;According to the estimates of the Pakistan Autism Society, approximately 350,000 children are suffering from ASD in Pakistan<a href="#accordion">[4]</a>, while the global prevalence of autism is 1%. However, this 1% estimate represents an average figure and reported prevalence varies substantially across studies<a href="#accordion">[5]</a>. 
&nbsp;

Signs And Symptoms

Generally, people with ASD have difficulty with interaction and social communication, and repetitive behaviors. The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.

Social communication/interaction behaviors may include<a href="#accordion">[6]</a>: 
&nbsp;

<ul>
	<li>Stilted speech</li>
	<li>Decreased sharing of interests with others</li>
	<li>Difficulty making friends or keeping them</li>
	<li>Lack of proficiency with the use of nonverbal gestures</li>
	<li>Difficulty appreciating their own &amp; others&#39; emotions&nbsp;</li>
	<li>Difficulties in adjusting to different social situations</li>
	<li>Aversion to maintaining eye contact; making little and/or inconsistent eye contact</li>
	<li>Infrequently pointing at things, sharing emotions, and enjoying activities&nbsp;</li>
	<li>Being slow to respond to one&rsquo;s name or not responding at all or to verbal bids to get their attention</li>
	<li>Often, they talk for a long time about their favorite topic without bothering about whether others are interested or not. They continue to talk without giving others a chance to respond&nbsp;&nbsp;</li>
	<li>Demonstrating movements, gestures, and facial expressions different from their words&nbsp;</li>
	<li>Speaking in a monotonic way&nbsp;&nbsp;</li>
	<li>Having problems understanding the point of view of other people or being unable to understand the actions of other people</li>
	<li>Difficulties sharing in imaginative play or in making friends 
	&nbsp;</li>
</ul>

Restrictive/repetitive behaviors may include<a href="#accordion">[6]</a>: 
&nbsp;

<ul>
	<li>Touching/ adjusting their clothes&nbsp;</li>
	<li>Excelling in math, science, music, or art</li>
	<li>Being strong visual and auditory learners</li>
	<li>Sensory hypersensitivity, e.g., aversion to loud noises, lights, etc.</li>
	<li>Difficulty accepting new experiences and unable to tolerate changes in routine</li>
	<li>Displaying an inflexible attitude, and often have trouble coping with change</li>
	<li>Being extremely focused on a small range of subjects or specific topics&nbsp;</li>
	<li>Stereotypical movements such as hand flapping, spinning, and rocking,</li>
	<li>Showing extremely focused interest, in moving objects or things&nbsp;</li>
	<li>Being highly sensitive or extremely less sensitive than other people to sensory inputs</li>
	<li>Being able to learn things in extreme detail and remember that information for a very long time</li>
	<li>Having a long-lasting intense interest in some specific topics, such as numbers, facts, or details</li>
	<li>Repeating certain acts or having an unusual attitude, such as repeating phrases or words or phrases. This behavior is called&nbsp;echolalia.</li>
	<li>Arranging things, often toys, in a very particular manner 
	&nbsp;</li>
</ul>

Causes

The actual cause of ASD, unfortunately, remains unknown. However, some studies have indicated that genes together with certain environmental factors can affect the development of the child in a way that leads to ASD. Some factors associated with an increased possibility of developing ASD include<a href="#accordion">[7]</a>: 
&nbsp;

<ul>
	<li>Having older parents</li>
	<li>Having a sibling with ASD</li>
	<li>Having a very low birth weight</li>
	<li>Having genetic conditions like Fragile X syndrome/<a href="https://merisehat.pk/disease/down-syndrome">Down syndrome</a> 
	&nbsp;</li>
</ul>

Diagnosis

Healthcare providers diagnose ASD, by evaluating a person&rsquo;s development and behavior. ASD is usually reliably diagnosed by the age of two. It is important to seek an evaluation immediately, as an earlier diagnosis can help in the commencement of early treatment.&nbsp; 
&nbsp;

<h5 dir="ltr">Diagnosis In Young Children</h5>

Diagnosis in young children is often a process consisting of two stages. 
&nbsp;

Stage 1: Developmental Screening For ASD During Routine Check-Ups&nbsp;

All children need to have routine checkups by a child specialist.&nbsp;If developmental problems are seen in children at 9-, 18-, and 24- or 30 months, checkups are strongly recommended as per guidelines of the American Academy of Pediatrics. Specific autism screenings are recommended at 18- and 24 months. If he/she is at high risk for ASD or developmental problems, the child may receive additional screening tests. Children at high risk may include those who have a family member with ASD, show typical behaviors of ASD, have a very low birth weight, have older parents, or have certain genetic conditions.

The experiences and concerns of parents or caretakers are an important part of the screening process. The health care provider may ask questions about the child&rsquo;s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations. If a child shows developmental differences in behavior and/or functioning during this screening process, the doctor may refer the child for additional evaluation. 
&nbsp;

Stage 2: Additional Diagnostic Evaluation 
It is important to detect and diagnose children with ASD in the early stages, as this will shed light on their unique strengths and challenges. Early detection may also help caregivers to determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.

A team of healthcare providers who have experience in diagnosing ASD will conduct the diagnostic evaluation. This team may include developmental pediatricians, child neurologists, speech-language pathologists, psychiatrists, child psychologists, educational specialists, and occupational therapists.

The diagnostic evaluation is likely to include: 
&nbsp;

<ul>
	<li>Observation of the child&rsquo;s behavior</li>
	<li>Medical and neurological examinations</li>
	<li>Assessment of the child&rsquo;s language and cognitive abilities</li>
	<li>Detailed discussion about the development and behavior of the child with the parents or caretaker of the child</li>
	<li>Assessment of age-appropriate skills (like toileting, dressing, eating)&nbsp; 
	&nbsp;</li>
</ul>

ASD is a very complicated disorder, that can occur with other learning disorders and illnesses. So, a comprehensive evaluation must also include: 
&nbsp;

<ul>
	<li>Hearing tests</li>
	<li>Blood tests 
	&nbsp;</li>
</ul>

The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment. 
&nbsp;

<h5 dir="ltr">Diagnosis In Older Children And Adolescents</h5>

Caregivers and teachers are often the first people to recognize ASD symptoms in older children and adolescents. The school&rsquo;s special education team may perform an initial evaluation, and then recommend that the child goes for additional evaluation with their primary health care provider or a health care provider specialized in ASD.

A child&rsquo;s caregivers should discuss with the healthcare provider about their child&rsquo;s social difficulties, including problems with subtle communication. These subtle communication differences often include problems in understanding facial expressions, tone of voice, or body language. Older children and adolescents have trouble understanding figures of speech, humor, and sarcasm. They also have trouble forming friendships with peers. 
&nbsp;

<h5 dir="ltr">Diagnosis In Adults</h5>

Diagnosing ASD in adults is more difficult than diagnosing it in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety disorder.

Adults who noticed the signs and symptoms of ASD should talk with the health care provider and ask for a referral for an ASD evaluation. Evaluation for ASD in adults is still being refined; adults can be referred to a psychologist, psychiatrist, or neuropsychologist who has experience with ASD. The expert will ask about: 
&nbsp;

<ul>
	<li>Sensory issues</li>
	<li>Restricted interests</li>
	<li>Repetitive behaviors</li>
	<li>Social interaction and communication challenges 
	&nbsp;</li>
</ul>

The evaluation also includes a conversation with caregivers and other family members to know about the person&rsquo;s early developmental history, which can help to ensure an accurate diagnosis.

Obtaining a correct diagnosis of ASD as an adult can help to understand past challenges, find the right kind of help, and identify personal strengths. Studies are underway to determine the types of services and support that are most helpful for improving the functioning and community integration of autistic people. 
&nbsp;

Treatment

Treatment for ASD should begin immediately after diagnosis. Early treatment for ASD is important as proper care and services can reduce individuals&rsquo; difficulties as well as help them to learn new skills and build on their strengths.

People with ASD usually face a wide range of issues, which means that there is no single best treatment for ASD. Working closely with a healthcare provider is a very important part of finding the right combination of treatment and services<a href="#accordion">[7]</a>.

The following interventions could improve the functioning of a child: 
&nbsp;

<h5 dir="ltr">Applied Behavioural Analysis</h5>

It involves the systematic study of the child&#39;s functional challenges, which is used to create a behavioral plan to improve their adaptive skills and behavior 
&nbsp;

<ul>
	<li>Social skills training&nbsp;</li>
	<li>Speech and&nbsp;language therapy</li>
	<li>Occupational therapy involves therapies to improve activities of daily life and handwriting</li>
	<li>Parent management training: Parents learn effective ways of responding to problematic behavior and ways to encourage their children.&nbsp;</li>
	<li>Special education services: An Individual Education Plan can be used for a better understanding, of social communication deficits, restricted interests, and repetitive behaviors, which in turn can be used to create an academic plan accordingly. This can also help autistic children to achieve their full potential academically.&nbsp;</li>
	<li>Treating co-occurring conditions:&nbsp;Children with autism experience depression, insomnia, and anxiety more often than their peers without autism. Also, autistic children autism may have intellectual disabilities which need to be addressed. The impact of these conditions can be reduced with proper management strategies<a href="#accordion">[6]</a>. 
	&nbsp;</li>
</ul>

<h5>Medication</h5>

The child psychiatrist evaluates the child for co-morbid depression, impulsivity, and anxiety. A healthcare provider can prescribe medications to treat specific symptoms. For example, autism-related irritability can be reduced by medications such as risperidone and aripiprazole (the two medications approved by the Food and Drug Administration, FDA)<a href="#accordion">[6]</a>.

With medication, a person with ASD will have fewer problems with<a href="#accordion">[6]</a>: 
&nbsp;

<ul>
	<li>Aggression</li>
	<li>Irritability</li>
	<li>Hyperactivity</li>
	<li>Attention problems</li>
	<li>Repetitive behavior</li>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety</a> and <a href="https://merisehat.pk/disease/depression">depression&nbsp;</a> 
	&nbsp;</li>
</ul>

<h5>Behavioral, Psychological, And Educational Interventions</h5>

People with ASD should be referred to a healthcare provider, who specializes in providing behavioral, psychological, and skill-building interventions and education. These programs are highly structured and intensive, and they must involve caregivers, siblings, and other family members.&nbsp;

These programs may help people with ASD: 
&nbsp;

<ul>
	<li>Increase or build upon strengths</li>
	<li>Learn social, communication, and language skills</li>
	<li>Learn life skills necessary for living independently</li>
	<li>Reduce behaviors that interfere with daily functioning 
	&nbsp;</li>
</ul>

<h5>Other Resources&nbsp;</h5>

Many programs, services, and other resources are available to help people with ASD. Here are some tips for finding additional services<a href="#accordion">[6]</a>:

<ul>
	<li>Keep copies of health care reports and evaluations. This information will help people with ASD qualify for special programs.</li>
	<li>Contact your healthcare provider, local health department, school, or autism advocacy groups to learn about special programs or local resources.</li>
	<li>Find an autism support group. Sharing experiences and pieces of information will help persons with ASD and their parents. They will know more about ASD programs and treatment strategies.</li>
	<li>Record conversations during meetings with health care providers and teachers with their consent. This information will help when it&rsquo;s time to decide which programs and services are appropriate. 
	&nbsp;</li>
</ul>

<ul>
	<li>Provide your child with a consistent structure and routine</li>
	<li>Seek professional help for specific concerns</li>
	<li>Take time for family members and yourself</li>
	<li>Learn more about autism spectrum disorders (ASD)</li>
	<li>Contact other parents of children with autism 
	&nbsp;</li>
</ul>

Having a child with autism generally affects the whole family. It can be stressful, expensive, and time-consuming. Paying attention to the emotional and physical health of the whole family is very important. Many local advocacy and national organizations provide information, resources, and support to individuals with autism spectrum disorder and their families<a href="#accordion">[6]</a>. 
&nbsp;

The latest research has suggested that the risk of autism is increased by many genetic factors in a very complicated way. Some other risk factors are given below: 
&nbsp;

<ul>
	<li>Parents being older at the time of pregnancy are linked with a greater risk of autism.&nbsp;</li>
	<li>Certain medications, such as valproic acid and thalidomide, taken during pregnancy, have been linked with a higher risk of autism.</li>
	<li>Male children tend to be diagnosed with autism more than those assigned female sex at birth; albeit, this ratio is changing over time</li>
	<li>The chance of a child suffering from ASD is increased when he or she already has a sibling diagnosed with ASD</li>
	<li>Having certain specific genetic conditions, such as Fragile X Syndrome, have been identified with an increased risk of being diagnosed with autism<a href="#accordion">[6]</a>.&nbsp;</li>
	<li>It is important to note that vaccines have not been shown to increase the chances of autism. Moreover, race or socioeconomic status does not have a link with autism. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Persistent challenges and complicated development conditions with repetitive behavior, restricted interests, and social communication are characteristics of ASD.</li>
	<li>About one in 100 children has autism globally. In Pakistan, 350,000 children and people are diagnosed with ASD</li>
	<li>Characteristics of autism may be detected in earlier childhood.</li>
	<li>ASD patients have difficulty with social communication and interaction, restricted interests, and repetitive behaviors.</li>
	<li>Researchers don&rsquo;t know the exact cause of ASD; however, studies have shown that genes together with environmental factors can contribute to ASD.</li>
	<li>Health care providers diagnose ASD by evaluating a person&rsquo;s behavior and development. Generally, ASD can be diagnosed up to the age of two.</li>
	<li>Fragile X Syndrome and tuberous Sclerosis have been identified as conferring a particularly increased risk for autism. Parents being older at the time of pregnancy are additionally linked with a greater risk of autism. Certain medications, such as valproic acid and thalidomide, during pregnancy, have also been linked with a higher risk of autism.</li>
	<li>The abilities and needs of autistic people evolve with time and they may vary. Some people can live independently, while others might need care and support for their whole life.</li>
	<li>Psychosocial interventions can improve social skills and communication. It will also help improve the quality of life of autistic people and their caregivers.</li>
	<li>Actions at the social and community level for greater support, inclusivity, and accessibility are required for the better care of autistic people and their caretakers.</li>
	<li>Parents should learn as much as possible about autism spectrum disorder, connect with other parents of children with autism, seek professional help for specific concerns, and take time for themselves and other family members.</li>
	<li>It is important to note that vaccines have not been shown to increase the chances of autism. Moreover, race or socioeconomic status does not have a link with autism. 
	&nbsp;</li>
</ul>

[1] Oxford dictionary.

[2] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association Publishing.

[3] Khalid, M., Raza, H., M Driessen, T., J Lee, P., Tejwani, L., Sami, A., Nawaz, M., Mehmood Baig, S., Lim, J., & Kaukab Raja, G. (2020).

[4] Farrukh J., Anjum G. Coping with Autism spectrum disorder (ASD) in Pakistan: A phenomenology of mothers who have children with ASD. Cogent Psychol. 2020;7:1728108. DOI: 10.1080/23311908.2020.1728108.