Autism Spectrum Disorder involves significant problems in social communication and social interactions such as problems in understanding other people’s emotions, reluctance to approach others, trouble with back-and-forth conversations, problems in maintaining eye contact, showing facial expressions, or using gestures to communicate with other people, and problems in forming and keeping peer relationships. Repeated and ritualistic behaviors patterns, interests, or activities such repeating the same speech, movements, or use of objects over and over again in a fairly fixed and stable manner, extreme desire to maintain routines or behavior rituals and become very upset if required to change, preoccupation with just a small number of interests or objects, and being very sensitive to sensory input or unusually interested in the sensory environment such as being enchanted by lights or spinning objects.
ASD presents with profound problems with the social world such as rarely approaching others and may look through people, problems in joint attention, and paying less attention to speaking faces particularly to the eyes and mouth regions. The theory of mind is understanding that people have different desires, beliefs, intentions, and emotions, crucial for successfully engaging in social interactions, typically develops between 2 ½ and 5 years of age, and children with ASD seem not to achieve this developmental milestone. People with ASD may recognize emotions with understanding them. Children with ASD show evidence towards early language disturbances. Echolalia is the immediate or delayed repeating of what was heard. Pronoun reversal is when they refer to themselves as “he” or “she.” The literal use of words is also apparent. Repetitive and ritualistic acts become extremely upset when routine is altered, are focused and preoccupied on specific things, engage stereotypical behavior, peculiar ritualistic hand movements, and other rhythmic movements, and become attached to inanimate objects such as keys or rocks. Onset occurs in early childhood with evidence in the first months of life. It effects 1 out of 54 children and has four times higher rates in boys than girls. The comorbidity includes intellectual disability, specific learning disorder, separation anxiety, social anxiety, general anxiety, and specific phobias. The diagnosis is stable over time. Children with higher IQs who learn to speak before age six have the best outcomes. Many independently functioning adults with ASD continue to show impairment in social relationships.
Autism Spectrum Disorder is characterized by both genetic and neurobiological factors. Genetic factors include heritability estimates, shared environmental factors, and genetic risk for other disorders. Neurobiological factors include brain size, enlarged cerebellum, and abnormally sized amygdalae. Heritability estimates are between .50 and .80 and are linked genetically to a broader spectrum of deficits in communication and social interaction. Shared environmental factors account for over half of risk for developing ASD. GWAS studies show 5 unique loci and 7 that overlap with genetic risk for schizophrenia and depression. Neurobiological factors of ASD include brain size, enlarged cerebellum, and abnormally sized amygdalae. Although brain size may be normal at birth, brains of autistic adults and children are larger than normal, and the pruning of neurons may not be occurring.
The treatment of Autism Spectrum Disorder includes both behavioral treatment and medications where behavioral involves intensive operant conditioning and medications involve antipsychotics. Intensive operant conditioning (Lovaas, 1987) involves 40 hours a week over more than 2 years where parents are trained that result in dramatic and encouraging results of a larger increase in IQ scores and advancing to the next grade. Medications or antipsychotics are less effective than behavioral treatment and are used to treat problem behaviors with side effects that include weight gain, fatigue, and tremors.