Autism FAQs
1
in 54 children are diagnosed with autism
4
times more commonly diagnosed in boys than girls
37%
of all adults with autism have never held a job or attended college
63%
of adults with autism do not have enough support to meet their needs
80%+
of adults with autism are unemployed or underemployed
What is autism?
What causes autism?
How is autism diagnosed?
How does autism affect an individual?
What is executive functioning?
What is sensory regulation and sensory processing disorder?
What are the challenges in social communication for individuals with autism?
Why is eye contact difficult for people with autism?
How is autism treated?
Brief history of the autism diagnosis
Do vaccines cause autism?
What is an Individual Education Plan (IEP) & Individual Transition Plan (ITP)?
What is the Americans with Disability Act (ADA)?
What is the Regional Center & the Self Determination Program?
What is an Individual Program Plan (IPP)?
What is autism?
Autism or autism spectrum disorder (ASD) refers to a broad range of conditions characterized by challenges in social skills, speech, and nonverbal communication. Autism occurs in all ethnic, racial, cultural, and socio-economic groups. It is considered a spectrum disorder due to the wide differences in which people with autism learn, think, and problem-solve ranging in functioning levels from highly skilled to severely challenged.
Autism is a developmental disorder. It is not an illness, and it can not be cured, but its effects can be remediated with supports, therapies, and services that are tailored to the needs of the individual. Autism can be diagnosed at any age, and symptoms usually start appearing during the first two years of life.
Many people with autism have one or more comorbid, or co-concurring, conditions. These include medical conditions like epilepsy, gastrointestinal issues or sleep disorders, mental-health conditions like ADHD, obsessive-compulsive disorder (OCD), or depression, and genetic conditions like fragile X syndrome or Rett Syndrome.
What causes autism?
There is no single factor known to cause autism, but it is believed that genetics and/or the environment play a role.
A higher incidence of autism has been linked to children born to older fathers as well as children with family members with a history of mental and neurological disorders. Children with a sibling with autism are also at higher risk.
Environmental factors may also contribute. Exposure to air pollution during pregnancy and early childhood has been linked to poor developmental outcomes. Exposure to auto emissions among 8 to 11 year-old children have been associated with decreased performance on intelligence and memory tasks. An increase in the autism diagnosis in early childhood has been tied to exposure to hazardous air pollutants, like arsenic and nickel.
A mother's exposure to risk factors during pregnancy may also contribute. Children born to mothers with diabetes, high blood pressure, infections, and birth complications have a higher incidence of autism.
While scientists don't know the direct cause of autism, they do believe that it is due to a difference in the wiring of the brain. These wired connections are also called neural pathways. Because the brain has millions of neural pathways, there are an infinite number of ways of how these can be altered and how the individual will be impacted. This could be one reason why the autism spectrum is so wide and diverse.
How is autism diagnosed?
Because it is a developmental disorder, an autism diagnosis is based on observations of trained mental health professionals. The Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-5) is the guide used by professionals to make an autism diagnosis.
In the DSM-4, the manual's previous version, autism was divided into four categories, and asperger's syndrome was one. When the DSM-5 was published in 2013, the subcategories were eliminated, and the diagnosis was split into three categories, levels 1 through 3. Level 1 "requires support" includes individuals previously considered to have aspergers syndrome and high functioning autism. Level 2 "requires substantial support" includes individuals that are minimally verbal, extremely adverse to change, and have narrow special interests. Level 3 "requiring very substantial support" includes individuals that are highly impacted, have extremely limited communication skills and have very inflexible behaviors.
Making an autism diagnosis can be difficult for a number of reasons. Because it is based on observations, the professional making the diagnosis may not have specialized autism training or experience, so they can misdiagnose based on their own implicit bias. Autism also presents in numerous and diverse ways so an individual can be misdiagnosed because their symptoms mirror another medical condition or disorder. If the individual has a comorbid condition, this can make the symptoms of autism more severe which can lead to a misdiagnosis or delay in receiving the autism diagnosis.
How does autism affect an individual?
The functioning level of individuals with autism varies greatly, and each person has their own unique set of strengths and challenges.
Some common strengths for individuals with autism include:
Attention to detail
Highly skilled and interest in one area
Logical thinking
Out-of-the box thinking
Visual processing of information, ie, thinks in images
Honest and loyal
Some common challenges include:
Difficulty grasping the big picture
Easily overwhelmed
Difficulty being motivated outside their areas of interest
Difficulty understanding verbal and non-verbal cues
Difficulty in understanding the emotional states of others
Easily taken advantage of by others
The most common challenges for individuals with autism are executive function, sensory regulation, and social communication.
What is executive functioning?
Executive functions are a set of mental skills that include working memory, flexible thinking, self control, planning and preparing, conflict resolution, and problem solving. We use executive-functioning skills everyday to manage our lives, learn new tasks, and adapt to new circumstances. Executive functions enable us to take the information we have, apply it to the situation at hand, and adjust our response according to what we need. Common challenges faced by people with impacted executive-functioning skills include difficulty in the ability to focus, follow directions and regulate emotions. Executive-functioning challenges are common for people with autism, attention-deficit disorder (ADD), and attention-deficit/hyperactivity disorder (ADHD).
What is sensory regulation and sensory processing disorder?
Our sensory system includes our ability to see, hear, touch, and smell. It also includes our ability to balance (also known as the vestibular system), and knowing how to position and orientate our body (also known as the proprioceptive system).
Sensory regulation involves monitoring and controlling our feelings, emotions, and behavior by reading cues within our bodies and our environment. It's how we make decisions on what to focus and prioritize in order to perform our daily activities. Sensory processing disorder is a condition in which the brain has problems receiving and responding to information that is received through our senses. It is not currently recognized as a distinct medical diagnosis.
Individuals with a sensory processing disorder can be over or under sensitivity to stimuli in their environment. Ordinary sounds can be overwhelmingly loud. Clothing rubbing against their skin can be extremely uncomfortable. The taste and texture of certain foods can be very unpleasant. Hugging or close physical contact can feel painful. People that are under sensitive to sensory input may seek out or crave sensory input. Children may display behaviors like bumping or crashing into things. Teens and adults may increase their sensory input by engaging in risk-taking behaviors like driving fast, gambling, or experimenting with drugs.
An occupational therapist with a specialization in sensory processing disorder can help by creating a sensory diet to help the individual better adapt to their environment, be more flexible and tolerant, and regulate their feelings and emotions.
What are the challenges in social communication for individuals with autism?
One of the core deficits of autism is the area of social communication.
Social communication disorder is characterized by difficulties in the use of verbal and nonverbal language for social purposes. Individuals with autism can have challenges in the use of grammar and pronouns, understanding facial expressions and body language, and staying on topic during a conversation.
Individuals with autism can have difficulties understanding the thoughts and feelings of others. This concept, called "Theory of Mind", was developed by researcher Simon Baron-Cohen, Professor of Developmental Psychology at the University of Cambridge.
Treatment strategies for social communication disorder focus on increasing active engagement in natural communication environments. These services are usually provided by a speech therapist in one-on-one interventions and in social skills groups.
For teens and adults with autism, social communication problems can prevent them from developing close friendships and romantic relationships, gaining meaningful employment, and accessing post-secondary education. The absence of appropriate supports to overcome social communication challenges are a big factor in the inability of autistic adults to successfully transition into adulthood.
Why is eye contact difficult for people with autism?
Eye contact is a way in which we communicate nonverbally with others. During a conversation, it's how we gauge the other person's interest in what we are saying. It's how we pick up on the person's social cues to appropriately respond in order to keep the conversation flowing.
Eye contact can be difficult for individuals with autism. Some describe the experience of making eye contact as unnatural, stress provoking, and can even make their eyes burn or water. Research has shown that for individuals with autism, avoiding eye contact is not due to lack of interest. It is a way to decrease an unpleasant excessive overactivation in a particular area of their brain. Neuroscience, June 2017
How is autism treated?
Treatment plans for individuals with autism must be tailored to the needs of the individual. There is no standard therapy for autism, and there are many from which to choose. It can be challenging to find treatments that are the best fit or locating a provider that specializes in providing that service. If the individual has a comorbid condition, these need to be individually addressed prior to starting an autism treatment plan.
Common therapies for children with autism include Developmental and Individual Differences Relationship Therapy (DIR - also called Floortime), Verbal Behavior Therapy (VBT), and cognitive behavior therapy (CBT). Other common therapies are speech and language, occupational therapy (OT), and music.
Applied Behavioral Therapy (ABA) is widely used for children with autism. An ABA treatment plan can include up to 40 hours a week of one-on-one therapy from a certified ABA therapist who 'shapes' the child's behavior by breaking down a desired behavior into smaller steps, then rewarding the child each time he or she successfully completes each one. ABA has come under criticism by autism advocates because they feel the premise of ABA is to make people with autism look 'normal'. Instead, they want acceptance of neurodiversity and respecting the individual rather than viewing them as someone needing to be fixed.
One challenge faced by individuals with autism is difficulty in generalizing the use of a learned skill. Generalization means taking a skill that is learned in one setting and applying it in other settings. When teaching a skill to someone with autism, it is important to practice the skill often and in a variety of places so the person can master that skill and understand how to use it under changing circumstances and in different situations.
Brief history of the autism diagnosis
1908: The word autism is used to describe a subset of schizophrenic patients who were especially withdrawn and self-absorbed.
1943: American child psychiatrist Leo Kanner publishes a paper describing 11 children who were highly intelligent but displayed "a powerful desire for aloneness" and "an obsessive insistence on persistent sameness". He later named the condition as "early infantile autism".
1944: Austrian pediatrician Hans Asperger describes a 'milder' form of autism in the cases of boys who were highly intelligent but had trouble with social interactions and had specific obsessive interests.
1967: Psychologist Bruno Bettelheim promotes the theory that "refrigerator mothers" cause autism in their children because they did not love their children enough. This theory is now considered completely false.
1980: "Infantile autism" is included in the Diagnostic and Statistical Manual of Mental Disorder for the first time and is officially separated from childhood schizophrenia.
1987: The DSM replaces "infantile autism" with a more expansive definition of "autism disorder" and includes a checklist of diagnostic criteria.
1987: UCLA psychologist Ival Lovaas, PhD publishes the first study showing how intensive behavior therapy can help children with autism. He calls this therapy Applied Behavior Analysis (ABA).
1990: The Individuals with Disabilities Education Act (IDEA) is enacted as federal legislation qualifying autism as a special education category. Public schools start identifying students with autism and providing special education services.
1994: Asperger's Syndrome is added to the DSM, expanding at the autism spectrum to include milder cases in which individuals tend to be more highly functioning.
2002: The Centers for Disease Control and Prevention (CDC) estimates that 1 in 110 children with autism spectrum disorder.
2008: The CDC estimates there are 1 in 88 children with autism spectrum disorder.
2013: The DSM-5 revises the autism subcategories under one umbrella, and Asperger's Syndrome is removed as a diagnosis.
Reprinted from the online publication Explore Parents, "The History of Autism" February 2014
Do vaccinations cause autism?
Numerous research studies have found that there is no direct link between vaccines and autism. One vaccine ingredient that has been specifically studied is thimerosal, a mercury-based preservative. Between 1999 and 2001, thimerosal was removed from almost all childhood vaccines. A 2008 study in California concluded that even after the removal of thimerosal, autism cases continued to rise.
The idea that vaccines were responsible for causing autism began with the publication of a 1998 study in the British publication, The Lancet, authored by U.K. doctor Andrew Wakefield. In his study, he reported a proposed "new syndrome" of regressive autism and that the MMR vaccine for measles, mumps and rubella was an "apparent precipitating event". A 2004 investigation identified undisclosed financial conflicts of interest by Wakefield as well as evidence that he altered numerous facts about his patients' medical histories to support his claims. After this became known, most of the study's co-authors withdrew their support. In 2010, the British General Medical Council (GMC) conducted their own inquiry and concluded that Wakefield was dishonest in his research and acted against his patients' best interests. The Lancet then retracted the study's publication, and the GMC revoked Wakefield's medical license and barred him from practicing medicine in the UK for life.
Even after his study was discredited and he was no longer able to practice medicine, Andrew Wakefield continues to be an anti-vaccine advocate by promoting the false theory of the link between vaccines and autism. Publicity generated from his work has caused a decline in childhood vaccinations. and this has led to a number of worldwide measles outbreaks.
What is an Individual Education Program & Individual Transition Plan?
An Individual Education Plan (IEP) is a document created during an annual meeting held each year by a student's school district to determine the services that the student will receive in the upcoming year. Every three years, the IEP team does a thorough assessment to measure the student's progress. IEPs are legally-binding documents, and a school district can be sued if they fail to provide the services as mandated by the IEP. Members of the IEP team are typically the student (when appropriate), the parent, one regular and one special education teacher, a school administrator, and the student's guidance counselor. Parents may also hire an advocate to attend the meeting. An advocate is someone that is well versed in the law and familiar in the services and accommodations that are available to the student. It can be an attorney, but it can also be someone that has extensive experience working with students with special needs.
An Individual Transition Plan (ITP) is part of a student's IEP that sets goals to help a student transition successfully after high school. By law, the ITP must be included in the first IEP after the student turns 16, and some school districts start the ITP process earlier. The ITP should include the student's goals for college, employment, residential preferences, and how much independence that student wants.
What is the Americans with Disability Act?
The Americans with Disabilities Act (ADA) of 1990 is a civil rights law that prohibits discrimination against people with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. Autism is one of the disabilities covered by the ADA. The ADA gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race,color, sex, national origin, age, and religion. In 2008, the ADA Amendment Act (ADAAA) was signed into law which made significant changes to the definition of "disability."
For more information on the ADA, click here for the link to ADA National Network's information page.
What is the Regional Center and the Self Determination Program?
Regional Centers are a statewide network of 21 community-based, non-profit agencies that are overseen by the California Department of Developmental Services (DDS) to help individuals with developmental and physical disabilities, also known as consumers. Serving more than 330,000 people, these agencies are responsible for developing, purchasing, managing and delivering services that best meet the needs of their consumers. Autism is one of the developmental disabilities served by regional centers.
For more information, click here for the DDS website.
The Self Determination Program will be rolled out to all regional center consumers starting in June 2021. Based on the principles of freedom, authority, support, responsibility, and confirmation, the Self Determination program provides individuals with authentic and meaningful choice and control over their services and supports.
Click here for the DDS website on Self Determination.
What is an Individual Program Plan?
An Individual Program Plan (IPP) is a regional center document that outlines what services and supports a consumer will receive for the upcoming year, much like the IEP for a high school student. The IPP describes the consumer's needs, preferences, choices, goals, and objectives. The consumer receives only the services listed in the IPP, and each year, the consumer meets with their regional center case manager to review their IPP and make any needed revisions. For more information about IPPs, click here for this link from The Lanterman Regional Center.
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