close
autism
Contents hide
What is Autism

What is Autism

Autism also known as autism spectrum disorder (ASD), is the name for a group of complex developmental and neurological disorder that includes Asperger syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) that begins early in childhood and lasts throughout a person’s life and can impact a person’s social skills, communication, relationships, and self-regulation 1, 2. Autism spectrum disorder affects how a person acts and interacts with others, communicates, and learns. Autism includes what used to be known as Asperger syndrome and pervasive developmental disorders. Autism spectrum disorder is characterized by markedly impaired social interaction, impaired communication, and restricted/repetitive patterns of behavior, interests, and activities 3. In addition to challenges caused by core symptoms of the disorder, maladaptive behaviors such as aggression can be associated with autism spectrum disorder and can further disrupt functioning and quality of life 4.

Autism is called a “spectrum” disorder because people with autism spectrum disorder can have a range of symptoms skills, and levels of disability. There is often nothing about how people with autism spectrum disorder look that sets them apart from other people, but people with autism spectrum disorder may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with autism spectrum disorder can range from gifted to severely challenged. Some people with autism spectrum disorder need a lot of help in their daily lives; others need less.

In 2013, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) merged four separate autism diagnoses into one umbrella diagnosis of autism spectrum disorder (ASD). They included autistic disorder (classic autism), childhood disintegrative disorder (CDD), pervasive developmental disorder-not otherwise specified (PDD-NOS or atypical autism) and Asperger syndrome (high-functioning autism) 5, 6. The single label shifts the focus away from where your child falls on the autism spectrum to whether your child has autism spectrum disorder (ASD).

  • Asperger’s syndrome or Asperger syndrome is used by some people to describe autistic people with average or above average intelligence. Some people call this “high-functioning” autism. Unlike some people with autism, people with Asperger’s syndrome do not have a learning disability.
  • Childhood disintegrative disorder (CDD) also called disintegrative psychosis or Heller syndrome, is a rare disorder that is subsumed under autism spectrum disorder (ASD). Childhood disintegrative disorder has a relatively late onset and is characterized by regression of previously acquired skills in the areas of social, language, and motor functioning. Childhood disintegrative disorder is a condition in which children develop normally through age 3 or 4. Then, over a few months, they lose language, motor, social, and other skills that they already learned. It is not known what causes this disease, and it is often seen that children who have this disorder have achieved normal developmental milestones before the regression of skills. The age at which this disease manifests is variable, but it is typically seen after three years of reaching normal milestones. The regression can be so fast that the child may be mindful of it, and in the beginning, may even ask what is going on with them. Some children may appear to be responding to hallucinations, but the most common and distinct feature of this disease is that the attained skills are gone. Many children are already delayed when the childhood disintegrative disorder (CDD) becomes apparent, but these delays are not always evident in young children. Childhood disintegrative disorder (CDD) has been described as a devastating disease that affects both the individual’s life and the family 7.

The signs and symptoms of autism vary widely, as do its effects. Some children with autism have only mild impairments, while others have more obstacles to overcome. However, every child on the autism spectrum has problems, at least to some degree, in the following three areas:

  • Communicating verbally and non-verbally.
  • Relating to others and the world around them.
  • Thinking and behaving flexibly.

People with autism spectrum disorder often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with autism spectrum disorder also have different ways of learning, paying attention, or reacting to things. Signs of autism spectrum disorder begin during early childhood and typically last throughout a person’s life. For example, people with autism spectrum disorder might have problems talking with you, or they might not look you in the eye when you talk to them. They may also have restricted interests and repetitive behaviors. They may spend a lot of time putting things in order, or they may say the same sentence again and again. They may often seem to be in their “own world.”

People with autism spectrum disorder often have these characteristics 2:

  • Ongoing social problems that include difficulty communicating and interacting with others
  • Repetitive behaviors as well as limited interests or activities
  • Do or think the same things over and over
  • Find it hard to understand how other people think or feel
  • Find things like bright lights or loud noises overwhelming, stressful or uncomfortable
  • Get very upset when routines are changed
  • Be unusually attached to things
  • Symptoms that typically are recognized in the first two years of life
  • Get anxious or upset about unfamiliar situations and social events
  • Take longer to understand information
  • Symptoms that hurt the individual’s ability to function socially, at school or work, or other areas of life.

Children with autism spectrum disorder (ASD) often have problems with:

  • Pretend play
  • Social interactions
  • Verbal and nonverbal communication

Some children seem normal before age 1 or 2. They then suddenly lose language or social skills they already had.

Social Communication problems may include 5:

  • Decreased sharing of interests with others
  • Difficulty appreciating their own and others’ emotions
  • Doesn’t refer to self the right way (for example, says “you want water” when the child means “I want water”)
  • Uses gestures instead of words
  • Aversion to maintaining eye contact
  • Doesn’t adjust gaze to look at objects that others are looking at
  • Doesn’t point to show other people objects (normally occurs in the first 14 months of life)
  • Lack of proficiency with use of non-verbal gestures
  • Develops language slowly or not at all
  • Stilted or scripted speech
  • Interpreting abstract ideas literally
  • Can’t start or maintain a conversation
  • Repeats words or memorized passages, such as commercials

Social interaction problems may include:

  • Difficulty making friends or keeping them
  • Doesn’t play interactive games
  • Is withdrawn
  • May not respond to eye contact or smiles, or may avoid eye contact
  • May treat others as objects
  • Prefers to be alone rather than with others
  • Isn’t able to show empathy

Restricted interests and repetitive behaviors may include 5:

  • Inflexibility of behavior, extreme difficulty coping with change
  • Being overly focused on niche subjects to the exclusion of others
  • Expecting others to be equally interested in those subjects
  • Difficulty tolerating changes in routine and new experiences
  • Sensory hypersensitivity, e.g., aversion to loud noises
  • Stereotypical movements such as:
    • hand flapping,
    • rocking back and forth,
    • spinning in a circle,
    • finger flicking,
    • snapping fingers,
    • flicking light switches on and off,
    • head banging,
    • staring at lights,
    • moving fingers in front of the eyes,
    • tapping ears,
    • scratching,
    • lining up toys,
    • spinning objects,
    • wheel spinning,
    • watching moving objects,
    • repeating words or noises.
  • Arranging things, often toys, in a very particular manner.

Response to sensory information problems may include:

  • Doesn’t startle at loud noises
  • Has very high or very low senses of sight, hearing, touch, smell, or taste
  • May find normal noises painful and hold their hands over their ears
  • May withdraw from physical contact because it’s too stimulating or overwhelming
  • Rubs surfaces, mouths or licks objects
  • May have a very high or very low response to pain

Play problems may include:

  • Doesn’t imitate the actions of others
  • Prefers solitary or ritualistic play
  • Shows little pretend or imaginative play

Behavioral problems may include:

  • Acts out with intense tantrums
  • Gets stuck on a single topic or task
  • Has a short attention span
  • Has very narrow interests
  • Is overactive or very passive
  • Is aggressive toward others or self
  • Shows a strong need for things being the same
  • Repeats body movements

Some people are mildly impaired by their symptoms, while others are severely disabled. Treatments and services can improve a person’s symptoms and ability to function. Families with concerns should talk to their pediatrician about what they’ve observed and the possibility of autism spectrum disorder screening. According to the Centers for Disease Control and Prevention (CDC) around 1 in 68 children has been identified with some form of autism spectrum disorder 8.

At well-child checkups, your health care provider should check your child’s development. If there are signs of autism spectrum disorder, your child will have a comprehensive evaluation. It may include a team of specialists, doing various tests and evaluations to make a diagnosis.

  • The causes of autism spectrum disorder are not known. Research suggests that both genes and environment play important roles.
  • The characteristics of autism can present themselves in a wide variety of combinations. Two people with the same diagnosis can have a very different profile of needs and skills.
  • Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply “grow out of” their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.
  • Early intervention during the preschool years will improve your child’s chances for overcoming their developmental delays.
  • There is currently no one standard treatment for autism spectrum disorder. There are many ways to increase your child’s ability to grow and learn new skills. Starting them early can lead to better results. Treatments include behavior and communication therapies, skills training, and medicines to control symptoms.
  • Medical and psychiatric conditions that co-exist with autism spectrum disorder should be identified and treated by a suitably trained physician. These can include immune problems, digestive problems and ADHD.
  • Natural therapies or treatments are often advertised as being safe and effective. Unfortunately most of these treatments do not have high quality scientific evidence that supports either claim. Some parents have described improvements in their child by using specialized diets. The most important point here is to make sure the child receives enough calories and nutrients regardless of the dietary change.
  • Parents should be very cautious of treatments that are advertised as being able to “cure” autism; these claims are often of a dubious nature.

Prevalence of Autism spectrum disorder

  • About 1 in 68 children has been identified with autism spectrum disorder according to estimates from the Center for Disease Control and Prevention (CDC’s) Autism and Developmental Disabilities Monitoring Network 9.
  • Autism spectrum disorder is reported to occur in all racial, ethnic, and socioeconomic groups 9.
  • Autism spectrum disorder is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189) 9.
  • Studies in Asia, Europe, and North America have identified individuals with autism spectrum disorder with an average prevalence of between 1% and 2% 10.
  • About 1 in 6 children in the United States had a developmental disability in 2006-2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism 11.

Is there a cure for autism?

There is no known ‘cure’ for autism. Experts also believe that autism does not need a ‘cure’ and should be seen as a difference, not a disadvantage. Experts also warn people about fake cures and potentially harmful interventions 12.

Three dangerous products in particular have been peddled as ‘cures’ for autism 12:

  • GcMAF, an unlicensed blood product
  • MMS, a bleach banned for human consumption
  • CEASE, a ‘therapy’ without any scientific credibility which discourages vaccinations and recommends potentially dangerous levels of nutritional supplements.

Do not use these products in any circumstances. They have no benefit and could be very harmful 12.

Can children “grow out” of autism?

A small minority of children show considerable improvement in their ASD symptoms following diagnosis. While ASD has historically been considered a life-long condition, recent research has shown that the outcomes associated with an ASD diagnosis can vary considerably. Some people who were diagnosed with ASD in their youth may improve dramatically, and show little difference to people who have never had the diagnosis.

Whether these individuals “grew out” of autism, or simply responded exceptionally well to the therapeutic interventions, remains up for debate. One should also question if the initial diagnosis of ASD was accurate in these cases. At the moment it is difficult to identify which children will “grow out” of autism, although those who have less severe symptoms and those who obtain early access to the appropriate therapies appear to have better outcomes.

Are there therapies or treatments to help adults with autism?

There has been limited research into specific therapies for adults with ASD, and most treatment recommendations are based on research performed on children and teenagers. In my experience, many adults with autism also demonstrate symptoms of depression, anxiety or ADHD. Sometimes they will benefit from treatment with either psychotherapy, a medication or a combination of both.

While every adult with ASD also has their own individual challenges and needs, many of them encounter a common set of broader challenges. These include finding employment, housing, making friends and establishing close relationships.

If You’re Concerned Your Child Might have Autism spectrum disorder

If you think your child might have autism spectrum disorder or you think there could be a problem with the way your child plays, learns, speaks, or acts, contact your child’s doctor, and share your concerns.

If you or the doctor is still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include:

  • Developmental Pediatricians (doctors who have special training in child development and children with special needs)
  • Child Neurologists (doctors who work on the brain, spine, and nerves)
  • Child Psychologists or Psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

  • If your child is not yet 3 years old, contact your local early intervention system.
    • You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) or visit the ECTA website (https://ectacenter.org)
  • If your child is 3 years old or older, contact your local public school system.
    • Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
    • If you’re not sure who to contact, call the Early Childhood Technical Assistance Center (ECTA) or visit the ECTA website (https://ectacenter.org).

Research shows that early intervention services can greatly improve a child’s development 13, 14. In order to make sure your child reaches his or her full potential, it is very important to get help for an autism spectrum disorder as soon as possible.

Vaccines and autism

Measles, mumps and rubella (MMR) are all viral infections that caused widespread illness in the past. Vaccines to prevent each disease were first developed in the 1960s and then combined to form the measles, mumps and rubella (MMR) vaccine in the 1970s. Existing evidence on the safety and effectiveness of MMR or MMRV (chickenpox [varicella] vaccine with the MMR vaccine) vaccines support their use for mass immunization 15. Despite a lot of controversy on the topic, scientific research does not support the theory that vaccines or their ingredients cause autism. Despite extensive research and safety studies, scientists and doctors have not found a link between childhood vaccinations and autism or other developmental problems. Children who are not vaccinated do not have lower rates of autism spectrum disorders. However, some people think the MMR vaccine causes unwanted effects such as autism, swelling of the brain (encephalitis), meningitis, learning difficulties, type 1 diabetes, and other conditions 15. Two studies have been cited by those claiming that the measles, mumps and rubella (MMR) vaccine causes autism (First Study & Second Study). Although the hypothesis rested on an MMR vaccine–induced bowel disorder, a possible link between MMR vaccine and bowel pathology was never established.

First study

In 1998, the possibility that measles, mumps and rubella (MMR) vaccine may cause autism was first raised by Andrew Wakefield and colleagues in a paper published in the journal Lancet 16. Wakefield had earlier conducted studies of the possible role of measles in inflammatory bowel disease (IBD) and it was this work in bowel disease that led to a hypothesis about how MMR vaccine could cause a gut pathology that could predispose children to central nervous system toxicity and possibly autism 17. Wakefield’s hypothesis was that the measles, mumps and rubella (MMR) vaccine caused a series of events that include intestinal inflammation, entrance into the bloodstream of proteins harmful to the brain, and consequent development of autism. In support of his hypothesis, Dr. Wakefield described 12 children with developmental delay — 9 had autism. All of these children had intestinal complaints and developed autism within one month of receiving MMR 16. The only suggested link with MMR vaccination was that for eight of the children, a parent or physician reported worsening of the child’s behavioral problems shortly after receipt of MMR vaccine 16. Despite the limitations of Dr. Wakefield’s 1998 Lancet paper 18, it generated intense media and public attention resulting in decreased MMR vaccination coverage, particularly in the United Kingdom, with resultant re-emergence of measles disease and deaths 19. Dr. Wakefield’s 1998 Lancet paper has since been withdrawn 20.

Dr. Wakefield’s initial study 17 suggesting a possible link between measles vaccine and inflammatory bowel disease (IBD) was an epidemiologic investigation that suggested that measles-containing vaccines increased the risk of Crohn’s disease and ulcerative colitis. However, a subsequent study by some of the same authors did not find an association between measles vaccination and IBD 21. Other studies also did not find evidence that measles-containing vaccines are associated with an increased risk of IBD 22, 23, 24, 25. However, these studies involved a monovalent measles vaccine, and Wakefield would later argue that it is the combination MMR vaccine that is the real culprit in enabling the measles vaccine virus to infect the bowel and cause pathology. The most comprehensive study of a possible association between measles vaccines, including MMR vaccine, and inflammatory bowel disease (IBD) was a population-based study conducted in four large health-care organizations in the United States 26. The study subjects were born between 1959 and 1989, with follow-up as long as 25 years or more 26. The study identified 155 cases of IBD, and each was matched to up to five controls. No increased risk was found for Crohn disease, ulcerative colitis, or any IBD following MMR vaccine specifically or any measles-containing vaccine in general 26.

Laboratory studies also played into the debate about possible gastrointestinal pathology related to the measles virus or vaccines. Again, one of these was a study by Dr. Wakefield that reported finding measles virus nucleocapsid protein in 13 of 15 patients with Crohn disease 27. However, Dr. Wakefield and other investigators were unable to replicate these initial findings 28, 29, 30.

Dr. Wakefield paper published in 1998 was flawed for two reasons 16:

  1. About 90% of children in England received MMR at the time Dr. Wakefield’s paper was written. Because MMR is administered at a time when many children are diagnosed with autism, it would be expected that most children with autism would have received an MMR vaccine, and that many would have received the vaccine recently. The observation that some children with autism recently received MMR is, therefore, expected. However, determination of whether MMR causes autism is best made by studying the incidence of autism in both vaccinated and unvaccinated children. This wasn’t done.
  2. Although the authors claim that autism is a consequence of intestinal inflammation, intestinal symptoms were observed after, not before, symptoms of autism in all eight cases.

This study was subsequently retracted.

Dr. Wakefield has continued to develop and promote his hypothesis. He has claimed that the combination of developmental regression and gastrointestinal disorders following MMR vaccination is a new syndrome that he has called autistic enterocolitis 31. Studies that have attempted to evaluate the emergence of a new syndrome consistent with autistic enterocolitis, including developmental regression and gastrointestinal disorders, have not found links with MMR vaccination. An analysis using a large database of general medical practices in the United Kingdom found that children with autism were no more likely than children without autism to have gastrointestinal disorders requiring medical evaluation before their diagnosis of autism 32. One of the original authors of the autistic enterocolitis hypothesis subsequently reported seeing similar intestinal changes in children without developmental regression and in unvaccinated children 33. Two separate studies found that the proportion of autistic children with regression or with bowel symptoms was not different between time periods before and after the introduction of MMR vaccine 34, 35.

A study that detected persistent measles virus infection in the intestines of children with autism and bowel problems 36 also was promoted to support the autistic enterocolitis hypothesis. The study found that 75 of 91 children with developmental disorders and ileal lymphonodular hyperplasia and enterocolitis had evidence of persistent infection compared with 5 of 70 controls 36. Limitations of the study included uncertainty about the specific developmental disorders of the study participants (e.g., the proportion with autism) and unknown temporal relationships between measles virus infection and onset of gastrointestinal and developmental disorders. Furthermore, the study did not distinguish whether the virus particles were from vaccine or wild-type measles viruses. A replication study that attempted to overcome the limitations of the preceding study provided strong evidence that autism is not associated with persistent measles virus RNA in the gastrointestinal tract or with MMR vaccine exposure 37. The study examined ileal and cecal tissue specimens from 25 children with autism and gastrointestinal disturbances and 13 children with gastrointestinal disturbances alone using real-time reverse transcription-polymerase chain reaction to detect measles virus RNA 37. Assays were conducted in three laboratories blinded to diagnosis, including the laboratory that made the original findings of a possible link between measles virus and ASD. All three laboratories found no differences between the two groups in the presence of measles virus RNA in the bowel biopsy samples.

The association between measles vaccination and autism has been evaluated in other studies that used stronger epidemiologic designs, including case-control and cohort studies, that obtain individual-level data and are able to control for confounding factors that could bias the results. Case-control studies assessed the association between measles vaccination and autism by comparing the measles vaccination histories of children with autism with the measles vaccination histories of control children who did not have autism. Case-control studies have been conducted in the United Kingdom, the United States, Poland, and Japan 38, 39, 40, 41. None of these studies found an increased risk of autism following measles vaccination with either MMR vaccine or monovalent measles vaccine (see Table 1). The largest of the case-control studies 38, which included 1,294 cases of pervasive developmental disorder and 4,469 controls from the UK General Practice Research Database, found a relative risk of 0.86 (95% confidence interval) for the association between MMR vaccine and pervasive developmental disorder and no increased risk was found for autism specifically.

Two cohort studies have been conducted of MMR vaccination and autism. In the cohort studies, populations of children were identified from birth or early childhood and grouped according to whether they had received MMR vaccine 42, 43. Computerized record systems were used to determine which children were subsequently diagnosed with autism, and the rates of autism were compared between vaccinated and unvaccinated children. One of the cohort studies was conducted in Denmark 42. Using national population and health-care registries, the authors of a retrospective review of all children (>500,000) born in Denmark between 1991 and 1998, including nearly 100,000 who had not been vaccinated with MMR, found no association between MMR vaccination and the development of autism or ASDs 42. The relative risk associated with MMR was 0.92 for autistic disorder and 0.83 for other ASDs 42. A more recent study addressed the possibility that MMR vaccination is a risk factor only in certain high-risk children 43. The study included about 100,000 younger siblings of children who had been diagnosed with ASD 43. The study found that receipt of MMR vaccine was not associated with increased risk of ASD even among the higher risk children whose older siblings had ASD.

A meta-analysis of the published epidemiologic studies concluded that MMR vaccine is not associated with an increased risk of autism 44. The evidence for a possible association between MMR vaccine and autism also has been extensively reviewed by three committees of the National Academy of Medicine 45, 46, 47 and all have concluded that MMR vaccine does not cause autism.

Table 1. Epidemiologic studies of MMR vaccines and Autism

StudyDesignYearsPopulationComparisonOutcome(s)Finding(s)
41Ecological and case series1979–1998Children in eight UK health districts born during 1979–1992, including 498 cases of autismTrends in incidence before and after introduction of measles, mumps, and rubella (MMR) vaccination to the United Kingdom in 1988Annual trends in autism Temporal clustering of autism onset or developmental regressionNo sudden increase in autism cases after introduction of measles, mumps, and rubella (MMR) vaccination
No temporal clustering after vaccination
43Ecological1980–1994 birth cohortsCalifornia kindergartnersmeasles, mumps, and rubella (MMR) coverage and autism occurrenceAnnual trends in autism casesNo correlation between level measles, mumps, and rubella (MMR) coverage and large increase in autism cases
44Ecological1988–1996 birth cohortsYokohama, Japan, children up to age 7 yearsASD incidence before and after termination of measles, mumps, and rubella (MMR) vaccination programAnnual trends in ASD incidenceASD incidence continued to increase after withdrawal of measles, mumps, and rubella (MMR) vaccination
42Ecological1988–1999UK general practice patients 12 years and younger, with a focus on boys 2–5 years of ageTime trend analysis of measles, mumps, and rubella (MMR) vaccination coverage and autism incidenceFirst recorded diagnosis of autismAutism incidence increased fourfold while measles, mumps, and rubella (MMR) vaccination was steady at >95% in boys 2–5 years
45Ecological1987–1998 birth cohortsSchoolchildren in Montreal, Canada (N = 27,749)pervasive developmental disorder time trends relative to trends in measles, mumps, and rubella (MMR) vaccinationpervasive developmental disorder(n = 180), including autismpervasive developmental disorder rates increased while measles, mumps, and rubella (MMR) vaccination coverage decreased
46Case control1987–2001UK general practice patients born in 1973 or later
Cases (n = 1,294)
Controls (n = 4,469)
measles, mumps, and rubella (MMR) vaccinated versus unvaccinatedFirst recorded diagnosis of pervasive developmental disorder, with subgroup analysis of first diagnosis of autism (n = 991)measles, mumps, and rubella (MMR) vaccine was not associated with an increased risk of autism or other pervasive developmental disorders
47Case control1986–1993 birth yearsAtlanta, Georgia, schoolchildren 3–10 years old in 1996
Autism cases (n = 624)
School-matched controls (n = 1,824)
Age at first measles, mumps, and rubella (MMR) vaccinationAutism and autism subgroupsThe distribution of ages at measles, mumps, and rubella (MMR) vaccination was similar in the cases and controls
48Case controlNot stated (includes years before and after 2004 when measles, mumps, and rubella (MMR) was included in the Polish vaccination schedule)Children 2–15 years old in a region of Poland
Autism cases (n = 96)
Controls (n = 192)
Vaccinated versus unvaccinated with measles, mumps, and rubella (MMR) or single antigen measles vaccineDiagnosis of autism First symptoms of autismNo increased risk of autism found in any of the comparisons including after single antigen or measles, mumps, and rubella (MMR) vaccines”
49Case control1984–1992 birth yearsYokohama, Japan
Cases diagnosed with ASD by 1997
ASD cases (n = 189)
Matched controls (n = 224)
measles, mumps, and rubella (MMR) vaccinationASDNo increased risk of ASD associated with measles, mumps, and rubella (MMR) vaccination
50Retrospective cohort1991–1998 birth cohortsChildren in Denmark (N = 537,303)Vaccinated versus unvaccinatedAutistic disorder (n = 316)
Other ASD (n =422)
Risk of autistic disorder or other ASD was not increased by measles, mumps, and rubella (MMR) vaccination
51Retrospective cohort2001–2012Privately insured US children who had older siblings with or without ASD (N = 95,727)ASD diagnosis according to measles, mumps, and rubella (MMR) vaccination status and sibling ASD statusASD diagnosis up to age 5 years (n = 994)Measles, mumps, and rubella (MMR) not associated with increased risk of ASD, even among high-risk infants with an older sibling with ASD

Abbreviations: ASD = autism spectrum disorder

[Source 48 ]

Second study

In 2002, Wakefield and coworkers published a second paper examining the relationship between measles virus and autism. The authors tested intestinal biopsy samples for the presence of measles virus from children with and without autism. Seventy-five of 91 children with autism were found to have measles virus in intestinal biopsy tissue as compared with only 5 of 70 patients who didn’t have autism. On its surface, this was a concerning result. However, the second Wakefield paper was also critically flawed for the following reasons:

  • Measles vaccine virus is live and attenuated. After inoculation, the vaccine virus probably replicates (or reproduces itself) about 15 to 20 times. Measles vaccine virus is likely to be taken up by specific cells responsible for virus uptake and presentation to the immune system (termed antigen-presenting cells or APCs). Because all antigen-presenting cells (APCs) are mobile, and can travel throughout the body (including the intestine), it is plausible that a child immunized with MMR would have measles virus detected in intestinal tissues using a very sensitive assay. To determine if MMR is associated with autism, one must determine if the finding is specific for children with autism. Therefore, children with or without autism must be identical in two ways. First, children with or without autism must be matched for immunization status (i.e., receipt of the MMR vaccine). Second, children must be matched for the length of time between receipt of MMR vaccine and collection of biopsy specimens. Although this information was clearly available to the investigators and critical to their hypothesis, it was specifically omitted from the paper.
  • Because natural measles virus is still circulating in England, it would have been important to determine whether the measles virus detected in these samples was natural measles virus or vaccine virus. Although methods are available to distinguish these two types of virus, the authors chose not to use them.
  • The method used to detect measles virus in these studies was very sensitive. Laboratories that work with natural measles virus (such as the lab where these studies were performed) are at high risk of getting results that are incorrectly positive. No mention is made in the paper as to how this problem was avoided.
  • As is true for all laboratory studies, the person who is performing the test should not know whether the sample is obtained from a case with autism or without autism (blinding). No statements were made in the methods section to assure that blinding occurred.

Studies showing that MMR vaccine does not cause autism

Several studies have been performed that disprove the notion that MMR causes autism.

In 1999, Brent Taylor and co-workers 49 examined the relationship between receipt of MMR and development of autism in an excellent, well-controlled study. Taylor examined the records of 498 children with autism or autism-like disorder. Cases were identified by registers from the North Thames region of England before and after the MMR vaccine was introduced into the United Kingdom in 1988. Taylor then examined the incidence and age at diagnosis of autism in vaccinated and unvaccinated children. He found that 49:

  • The percentage of children vaccinated was the same in children with autism as in other children in the North Thames region.
  • No difference in the age of diagnosis of autism was found in vaccinated and unvaccinated children.
  • The onset of symptoms of autism did not occur within two, four, or six months of receiving the MMR vaccine.

One of the best studies was performed by Madsen and colleagues in Denmark between 1991 and 1998 and reported in the New England Journal of Medicine 42. The study included 537,303 children representing 2,129,864 person-years of study. Approximately 82% of children had received the MMR vaccine. The group of children was selected from the Danish Civil Registration System, vaccination status was obtained from the Danish National Board of Health, and children with autism were identified from the Danish Central Register. The risk of autism in the group of vaccinated children was the same as that in unvaccinated children 42. Furthermore, there was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autism.

Subsequent studies and meta-analysis have corroborated the findings that the MMR vaccine does not cause autism 15, 50, 51.

What is the difference between Asperger’s syndrome and autism spectrum disorder?

Asperger’s syndrome also called Asperger syndrome is often used by some people to describe autistic people with average or above average intelligence. Some people call Asperger syndrome a “high-functioning” autism. Unlike some people with autism, people with Asperger’s syndrome do not have a learning disability that many autistic people have, but they may have specific learning difficulties. People with Asperger syndrome may have fewer problems with speech but may still have difficulties with understanding and processing language. Asperger syndrome can lead to difficulty interacting socially, repeat behaviors, and clumsiness.

Doctors do not diagnose people with Asperger’s anymore. But if you were diagnosed with it before, this will stay as your diagnosis.

In the past, Asperger’s syndrome and Autistic Disorder were separate disorders. They were listed as subcategories within the diagnosis of “Pervasive Developmental Disorders.” However, this separation has changed. The latest edition of the manual from the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), does not highlight subcategories of a larger disorder. The manual includes the range of characteristics and severity within one category. People whose symptoms were previously diagnosed as Asperger’s syndrome or Autistic Disorder are now included as part of the category called Autism Spectrum Disorder (ASD).

Asperger syndrome was introduced to the world by British psychiatrist Lorna Wing in the 1980s. The term derives from a 1944 study by Austrian pediatrician Hans Asperger.

The characteristics of Asperger syndrome vary from one person to another, although there are some key traits that autistic people share. These are:

  • persistent difficulties with or differences in social communication and social interaction
  • restricted and repetitive patterns of behaviors, activities or interests since early childhood, to the extent that these impact negatively on day to day life.

The diagnosis process usually involves a multi-disciplinary diagnostic team – often including a speech and language therapist, pediatrician, psychiatrist and/or psychologist.

Because Asperger’s syndrome varies widely from person to person, making a diagnosis can be difficult. It is often diagnosed later in children than autism and sometimes symptoms may not be recognized and diagnosed until adulthood.

What causes autism?

Autism spectrum disorder is a developmental disability caused by differences in the brain. Scientists do not know yet exactly what causes these differences for most people with autism spectrum disorder. There are multiple causes of autism spectrum disorder, although most are not yet known. However, some people with autism spectrum disorder have a known difference, such as a genetic condition. Scientists have been attempting to identify which genes might be implicated in autism for some years. Autism is likely to have multiple genes responsible rather than a single gene. Moreover, autism is not caused by emotional deprivation or the way a person has been brought up.

Groundbreaking new research indicates that environmental factors may also be important in the development of autism. Environment in this context means anything outside the body. It’s not limited to things like pollution or toxins in the atmosphere. In fact, one of the most important environments appears to be the prenatal environment. Babies may be born with a genetic vulnerability to autism that is then triggered by something in the external environment, either while he or she is still in the womb or sometime after birth.

Prenatal factors that may contribute to autism:

  • Taking antidepressants during pregnancy, especially in the first 3 months.
  • Nutritional deficiencies early in pregnancy, particularly not getting enough folic acid.
  • The age of the mother and father.
  • Complications at or shortly after birth, including very low birth weight and neonatal anemia
  • Maternal infections during pregnancy.
  • Exposure to chemical pollutants, such as metals and pesticides, while pregnant.

More research on these prenatal risk factors is needed, but if you’re pregnant or trying to conceive, it can’t hurt to take steps now to reduce your baby’s risk of autism.

  • Taking 400 micrograms of folic acid daily helps prevent birth defects such as spina bifida. It’s not clear whether this will also help reduce risk of autism, but taking the vitamins can’t hurt.
  • Eating nutritious food, trying to avoid infections, and seeing a clinician for regular check-ups can increase the chances of giving birth to a healthy child.

In recent years, the number of children identified with autism spectrum disorder has increased. Experts disagree about whether this shows a true increase in autism spectrum disorder since the guidelines for diagnosis have changed in recent years as well. Also, many more parents and doctors now know about the disorder, so parents are more likely to have their children screened, and more doctors are able to properly diagnose autism spectrum disorder, even in adulthood.

One subtype of autism spectrum disorder (ASD), childhood disintegrative disorder, is associated with the following diseases, particularly if it is late-onset 52:

  • Subacute sclerosing panencephalitis: A chronic infection of the brain by a form of the measles virus. This disease leads to the inflammation of the brain and the death of nerve cells.
  • Tuberous sclerosis (TSC): A genetic disorder. Tumors formation in the brain, which is benign. It also affects other organs of the body like eyes, kidneys, heart, skin, and lungs.
  • Leukodystrophy: In leukodystrophy, there is maldevelopment of the myelin sheath, causing white matter in the brain to disintegrate.
  • Lipid storage diseases: Toxic accumulation of excessive fats (lipids) in the brain and nervous system

Risk Factors for Autism spectrum disorder

The current science suggests that several genetic factors may increase the risk of autism in a complex manner. Having certain specific genetic conditions such as Fragile X Syndrome and Tuberous Sclerosis has been identified as conferring a particularly increased risk for being diagnosed with autism. Certain medications, such as valproic acid and thalidomide, when taken during pregnancy, have been linked with a higher risk of autism as well 53. Having a sibling with autism also increases the likelihood of a child being diagnosed with autism. Parents being older at the time of pregnancy is additionally linked with greater risk of autism. Vaccines on the other hand have not been shown to increase the likelihood of an autism diagnosis, and race, ethnicity or socioeconomic status does not seem to have a link either. Male children tend to be diagnosed with autism more often than those assigned female sex at birth, albeit this ratio is changing over time.

  • Studies have shown that among identical twins, if one child has autism spectrum disorder, then the other will be affected about 36-95% of the time. In non-identical twins, if one child has autism spectrum disorder, then the other is affected about 0-31% of the time 54, 55, 56, 57.
  • Parents who have a child with autism spectrum disorder have a 2%–18% chance of having a second child who is also affected 58.
  • Autism spectrum disorder tends to occur more often in people who have certain genetic or chromosomal conditions. About 10% of children with autism are also identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders 59.
  • Almost half (about 44%) of children identified with autism spectrum disorder has average to above average intellectual ability 9.
  • Children born to older parents are at a higher risk for having autism spectrum disorder 60. Having older parents (a mother who was 35 or older, and/or a father who was 40 or older when the baby was born).
  • A small percentage of children who are born prematurely or with low birth weight are at greater risk for having autism spectrum disorder 61.
  • Autism spectrum disorder commonly co-occurs with other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses. The co-occurrence of one or more non-autism spectrum disorder developmental diagnoses is 83%. The co-occurrence of one or more psychiatric diagnoses is 10% 62.

Early signs of autism

A person with autism spectrum disorder might:

  • Not respond to their name by 12 months of age
  • Not point at objects to show interest (point at an airplane flying over) by 14 months
  • Not play “pretend” games (pretend to “feed” a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Have delayed speech and language skills
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel
Developmental red flags

The following delays warrant an immediate evaluation by your child’s pediatrician:

  • By 6 months: No big smiles or other warm, joyful expressions.
  • By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
  • By 12 months: Lack of response to name.
  • By 12 months: No babbling or “baby talk.”
  • By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving.
  • By 16 months: No spoken words.
  • By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating.

If your child is developmentally delayed, or if you’ve observed red flags for autism, schedule an appointment with your pediatrician or a clinical psychologist who specializes in diagnostic testing for a thorough evaluation right away. In fact, it’s a good idea to have your child screened by a doctor even if he or she is hitting the developmental milestones on schedule. The American Academy of Pediatrics recommends that all children receive routine developmental screenings, as well as specific screenings for autism at 9, 18, and 30 months of age.

Keep in mind that just because your child has a few autism-like symptoms, it doesn’t mean they have autism spectrum disorder (ASD). ASD is diagnosed based on the presence of multiple symptoms that disrupt a person’s ability to communicate, form relationships, explore, play, and learn.

Early signs and symptoms of autism in babies and toddlers

If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.

The earliest signs of autism involve the absence of typical behaviors—not the presence of atypical ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.

Some autistic infants don’t respond to cuddling, reach out to be picked up, or look at their mothers when being fed.

Your baby or toddler doesn’t:

  • Make eye contact, such as looking at you when being fed or smiling when being smiled at.
  • Respond to their name, or to the sound of a familiar voice.
  • Follow objects visually or follow your gesture when you point things out.
  • Point or wave goodbye, or use other gestures to communicate.
  • Make noises to get your attention.
  • Initiate or respond to cuddling or reach out to be picked up.
  • Imitate your movements and facial expressions.
  • Play with other people or share interest and enjoyment.
  • Notice or care if you hurt yourself or experience discomfort.

Social Skills

Social issues are one of the most common symptoms in all of the types of autism spectrum disorder. People with an autism spectrum disorder do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to autism spectrum disorder:

  • Does not respond to name by 12 months of age
  • Avoids eye-contact
  • Prefers to play alone
  • Does not share interests with others
  • Only interacts to achieve a desired goal
  • Has flat or inappropriate facial expressions
  • Does not understand personal space boundaries
  • Avoids or resists physical contact
  • Is not comforted by others during distress
  • Has trouble understanding other people’s feelings or talking about own feelings

Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye bye”. Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an autism spectrum disorder might have a very hard time learning to interact with other people.

Some people with an autism spectrum disorder might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an autism spectrum disorder have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.

People with an autism spectrum disorder might have problems with showing or talking about their feelings. They might also have trouble understanding other people’s feelings. Many people with an autism spectrum disorder are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an autism spectrum disorder. Anxiety and depression also affect some people with an autism spectrum disorder. All of these symptoms can make other social problems even harder to manage.

Communication

Each person with autism spectrum disorder has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an autism spectrum disorder do not talk at all. About 25%–30% of children with autism spectrum disorder have some words at 12 to 18 months of age and then lose them 63. Others might speak, but not until later in childhood.

Examples of communication issues related to autism spectrum disorder:

  • Delayed speech and language skills
  • Repeats words or phrases over and over (echolalia)
  • Reverses pronouns (e.g., says “you” instead of “I”)
  • Gives unrelated answers to questions
  • Does not point or respond to pointing
  • Uses few or no gestures (e.g., does not wave goodbye)
  • Talks in a flat, robot-like, or sing-song voice
  • Does not pretend in play (e.g., does not pretend to “feed” a doll)
  • Does not understand jokes, sarcasm, or teasing

People with autism spectrum disorder who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with autism spectrum disorder say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with autism spectrum disorder, “Do you want some juice?” he or she might repeat “Do you want some juice?” instead of answering your question. Although many children without an autism spectrum disorder go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an autism spectrum disorder can speak well but might have a hard time listening to what other people say.

People with autism spectrum disorder might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with autism spectrum disorder might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an autism spectrum disorder might smile while saying something sad.

People with autism spectrum disorder might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an autism spectrum disorder might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.

Unusual Interests and Behaviors

Many people with autism spectrum disorder have unusual interest or behaviors.

Examples of unusual interests and behaviors related to autism spectrum disorder:

  • Lines up toys or other objects
  • Plays with toys the same way every time
  • Likes parts of objects (e.g., wheels)
  • Is very organized
  • Gets upset by minor changes
  • Has obsessive interests
  • Has to follow certain routines
  • Flaps hands, rocks body, or spins self in circles

Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an autism spectrum disorder might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”

People with autism spectrum disorder often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with autism spectrum disorder. They might “lose control” and have a “melt down” or tantrum, especially if in a strange place.

Some people with autism spectrum disorder also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.

Other Symptoms

Some people with autism spectrum disorder have other symptoms. These might include:

  • Hyperactivity (very active)
  • Impulsivity (acting without thinking)
  • Short attention span
  • Aggression
  • Causing self injury
  • Temper tantrums
  • Unusual eating and sleeping habits
  • Unusual mood or emotional reactions
  • Lack of fear or more fear than expected
  • Unusual reactions to the way things sound, smell, taste, look, or feel

People with autism spectrum disorder might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an autism spectrum disorder limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.

People with autism spectrum disorder might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.

Development

Children with autism spectrum disorder develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an autism spectrum disorder might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a “b” makes.

Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life.

  • To learn more about developmental milestones, visit “Learn the Signs. Act Early” 64 a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible “red flags” for autism spectrum disorders.

Signs and Symptoms of Autism spectrum disorder

Autism spectrum disorder begins before the age of 3 and last throughout a person’s life, although symptoms may improve over time. Some children with autism spectrum disorder show hints of future problems within the first few months of life. In others, symptoms may not show up until 24 months or later. Some children with an autism spectrum disorder seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an autism spectrum disorder noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age.

Parents or doctors may first identify autism spectrum disorder behaviors in infants and toddlers. School staff may recognize these behaviors in older children. Not all people with autism spectrum disorder will show all of these behaviors, but most will show several. There are two main types of behaviors: “restricted / repetitive behaviors” and “social communication / interaction behaviors.”

It is important to note that some people without autism spectrum disorder might also have some of these symptoms. But for people with autism spectrum disorder, the impairments make life very challenging.

Children or adults with autism spectrum disorder might:

  • not point at objects to show interest (for example, not point at an airplane flying over)
  • not look at objects when another person points at them
  • have trouble relating to others or not have an interest in other people at all
  • avoid eye contact and want to be alone
  • have trouble understanding other people’s feelings or talking about their own feelings
  • prefer not to be held or cuddled, or might cuddle only when they want to
  • appear to be unaware when people talk to them, but respond to other sounds
  • be very interested in people, but not know how to talk, play, or relate to them
  • repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
  • have trouble expressing their needs using typical words or motions
  • not play “pretend” games (for example, not pretend to “feed” a doll)
  • repeat actions over and over again
  • have trouble adapting when a routine changes
  • have unusual reactions to the way things smell, taste, look, feel, or sound
  • lose skills they once had (for example, stop saying words they were using)

Autism spectrum disorder is unique in that it is common for people with autism spectrum disorder to have many strengths and abilities in addition to challenges.

Strengths and abilities may include:

  • Having above-average intelligence – the Centers for Disease Control and Prevention (CDC) reports 46% of autism spectrum disorder children have above average intelligence 8.
  • Being able to learn things in detail and remember information for long periods of time
  • Being strong visual and auditory learners
  • Excelling in math, science, music, or art.

Restrictive / repetitive behaviors

Restrictive or repetitive behaviors may include:

  • Repeating certain behaviors or having unusual behaviors
  • Having overly focused interests, such as with moving objects or parts of objects
  • Having a lasting, intense interest in certain topics, such as numbers, details, or facts.

Intense interests and repetitive behaviour can be a source of enjoyment for autistic people and a way of coping with everyday life. But they may be obsessions and limit people’s involvement in other activities and cause distress or anxiety.

With its unwritten rules, the world can seem a very unpredictable and confusing place to autistic people. This is why people with autism spectrum disorder often prefer to have routines so that they know what is going to happen. They may want to travel the same way to and from school or work, wear the same clothes or eat exactly the same food for breakfast.

People with autism spectrum disorder may also repeat movements such as hand flapping, rocking or the repetitive use of an object such as twirling a pen or opening and closing a door. Autistic people often engage in these behaviors to help calm themselves when they are stressed or anxious, but many autistic people do it because they find it enjoyable.

Change to routine can also be very distressing for autistic people and make them very anxious. It could be having to adjust to big events like Christmas or changing schools, facing uncertainty at work, or something simpler like a bus detour that can trigger their anxiety.

Social communication / interaction behaviors

Social communication / interaction behaviors may include:

  • Getting upset by a slight change in a routine or being placed in a new or overly stimulating setting
  • Making little or inconsistent eye contact
  • Having a tendency to look at and listen to other people less often
  • Rarely sharing enjoyment of objects or activities by pointing or showing things to others
  • Responding in an unusual way when others show anger, distress, or affection
  • Failing to, or being slow to, respond to someone calling their name or other verbal attempts to gain attention
  • Having difficulties with the back and forth of conversations
  • Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
  • Repeating words or phrases that they hear, a behavior called echolalia
  • Using words that seem odd, out of place, or have a special meaning known only to those familiar with that person’s way of communicating
  • Having facial expressions, movements, and gestures that do not match what is being said
  • Having an unusual tone of voice that may sound sing-song or flat and robot-like
  • Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions.

Social communication

People with autism spectrum disorder have difficulties with interpreting both verbal and non-verbal language like gestures or tone of voice. Some autistic people are unable to speak or have limited speech while other autistic people have very good language skills but struggle to understand sarcasm or tone of voice. Other challenges include:

  • taking things literally and not understanding abstract concepts
  • needing extra time to process information or answer questions
  • repeating what others say to them (this is called echolalia)

Social interaction

People with autism spectrum disorder often have difficulty ‘reading’ other people – recognising or understanding others’ feelings and intentions – and expressing their own emotions. This can make it very hard to navigate the social world. Autistic people may:

  • appear to be insensitive
  • seek out time alone when overloaded by other people
  • not seek comfort from other people
  • appear to behave ‘strangely’ or in a way thought to be socially inappropriate
  • find it hard to form friendships.

Over-sensitive or under-sensitive to lights, sounds, taste, smells or touch

People with autism spectrum disorder may experience over- or under-sensitivity to sounds, touch, tastes, smells, light, colors, clothing, temperatures or pain. For example, they may find certain background sounds like music in a restaurant, which other people ignore or block out, unbearably loud or distracting. Another example, they refuse to wear “itchy” clothes and get upset if they’re forced to wear the clothes. This can cause anxiety or even physical pain. Many autistic people prefer not to hug due to discomfort, which can be misinterpreted as being cold and aloof.

Many autistic people avoid everyday situations because of their sensitivity issues. Schools, workplaces and shopping centres can be particularly overwhelming and cause sensory overload. There are many simple adjustments that can be made to make environments more autism-friendly.

They may also experience sleep problems, digestion problems, and irritability.

Highly focused interests or hobbies

Many people with autism spectrum disorder have intense and highly focused interests, often from a fairly young age. These can change over time or be lifelong. Autistic people can become experts in their special interests and often like to share their knowledge. A stereotypical example is trains but that is one of many. Greta Thunberg’s intense interest, for example, is protecting the environment.

Like all people, autistic people gain huge amounts of pleasure from pursuing their interests and see them as fundamental to their wellbeing and happiness.

Being highly focused helps many autistic people do well academically and in the workplace but they can also become so engrossed in particular topics or activities that they neglect other aspects of their lives.

Extreme anxiety

Anxiety is a real difficulty for many autistic adults, particularly in social situations or when facing change. It can affect a person psychologically and physically and impact quality of life for autistic people and their families.

It is very important that people with autism spectrum disorder learn to recognize their triggers and find coping mechanisms to help reduce their anxiety. However, many autistic people have difficulty recognizing and regulating their emotions. Over one third of autistic people have serious mental health issues and too many autistic people are being failed by mental health services.

Meltdowns and shutdowns

When everything becomes too much for an autistic person, they can go into meltdown or shutdown. These are very intense and exhausting experiences.

A meltdown happens when someone becomes completely overwhelmed by their current situation and temporarily loses behavioural control. This loss of control can be verbal (eg shouting, screaming, crying) or physical (eg kicking, lashing out, biting) or both. Meltdowns in children are often mistaken for temper tantrums and parents and their autistic children often experience hurtful comments and judgmental stares from less understanding members of the public.

A shutdown appears less intense to the outside world but can be equally debilitating. Shutdowns are also a response to being overwhelmed, but may appear more passive – eg an autistic person going quiet or ‘switching off’. One autistic woman described having a shutdown as: ‘just as frustrating as a meltdown, because of not being able to figure out how to react how I want to, or not being able to react at all; there isn’t any ‘figuring out’ because the mind feels like it is past a state of being able to interpret.’

Signs and symptoms of autism in children

As children get older, the red flags for autism become more diverse. There are many warning signs and symptoms, but they typically revolve around impaired social skills, speech and language difficulties, non-verbal communication difficulties, and inflexible behavior. Basic social interaction can be difficult for children with autism spectrum disorder. Many kids on the autism spectrum seem to prefer to live in their own world, aloof and detached from others.

Signs of autism in young children

Signs of autism in young children include:

  • not responding to their name
  • avoiding eye contact
  • not smiling when you smile at them
  • appears disinterested or unaware of other people or what’s going on around them
  • getting very upset if they do not like a certain taste, smell or sound
  • repetitive movements, such as flapping their hands, flicking their fingers or rocking their body
  • not talking as much as other children
  • repeating the same phrases
  • prefers not to be touched, held, or cuddled
  • doesn’t seem to hear when others talk to them

Signs of autism in older children

Signs of autism in older children include:

  • not seeming to understand what others are thinking or feeling
  • has trouble understanding feelings or talking about them
  • doesn’t know how to connect with others, play, or make friends
  • doesn’t play “pretend” games, engage in group games, imitate others, or use toys in creative ways
  • doesn’t share interests or achievements with others (drawings, toys)
  • finding it hard to say how they feel
  • liking a strict daily routine and getting very upset if it changes
  • having a very keen interest in certain subjects or activities
  • getting very upset if you ask them to do something
  • finding it hard to make friends or preferring to be on their own
  • taking things very literally – for example, they may not understand phrases like “break a leg”

Children with autism spectrum disorder tend to be less spontaneous than other kids. Unlike a typical curious little kid pointing to things that catch their eye, children with ASD often appear disinterested or unaware of what’s going on around them. They also show differences in the way they play. They may have trouble with functional play, or using toys that have a basic intended use, such as toy tools or cooking set. They usually don’t “play make-believe,” engage in group games, imitate others, collaborate, or use their toys in creative ways.

Autism can sometimes be different in girls and boys. For example, autistic girls may be quieter, may hide their feelings and may appear to cope better with social situations. This means autism can be harder to spot in girls.

Signs of speech and language difficulties

  • Speaks in an atypical tone of voice, or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question).
  • Repeats the same words or phrases over and over, often without communicative intent.
  • Responds to a question by repeating it, rather than answering it.
  • Uses language incorrectly (grammatical errors, wrong words) or refers to him or herself in the third person.
  • Has difficulty communicating needs or desires.
  • Doesn’t understand simple directions, statements, or questions.
  • Takes what is said too literally (misses undertones of humor, irony, and sarcasm).

Children with autism spectrum disorder have difficulty with speech and language. Often, they start talking late.

Signs of nonverbal communication difficulties

  • Avoids eye contact.
  • Uses facial expressions that don’t match what they are saying
  • Doesn’t pick up on other people’s facial expressions, tone of voice, and gestures.
  • Makes very few gestures (such as pointing). May come across as cold or “robot-like.”
  • Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises. Can also be unresponsive to people entering/leaving, as well as efforts by others to attract the child’s attention.
  • Atypical posture, clumsiness, or eccentric ways of moving (e.g., walking exclusively on tiptoe).

Children with autism spectrum disorder have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.

Signs of inflexibility

  • Follows a rigid routine (e.g., insists on taking a specific route to school).
  • Has difficulty adapting to any changes in schedule or environment (e.g., throws a tantrum if the furniture is rearranged or bedtime is at a different time than usual).
  • Unusual attachments to toys or strange objects such as keys, light switches, or rubber bands. Obsessively lines things up or arranges them in a certain order.
  • Preoccupation with a narrow topic of interest, often involving numbers or symbols (e.g., memorizing and reciting facts about maps, train schedules, or sports statistics).
  • Spends long periods watching moving objects such as a ceiling fan, or focusing on one specific part of an object such as the wheels of a toy car.
  • Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behavior, or “stimming”). Some researchers and clinicians believe that these behaviors may soothe children with autism more than stimulate them.

Children with autism spectrum disorder are often restricted, inflexible, and even obsessive in their behaviors, activities, and interests.

Signs of autism in adults

Common signs of autism in adults include:

  • finding it hard to understand what others are thinking or feeling
  • getting very anxious about social situations
  • finding it hard to make friends or preferring to be on your own
  • seeming blunt, rude or not interested in others without meaning to
  • finding it hard to say how you feel
  • taking things very literally – for example, you may not understand sarcasm or phrases like “break a leg”
  • having the same routine every day and getting very anxious if it changes

Adults may also have other signs like:

  • not understanding social “rules”, such as not talking over people
  • avoiding eye contact
  • getting too close to other people, or getting very upset if someone touches or gets too close to you
  • noticing small details, patterns, smells or sounds that others do not
  • having a very keen interest in certain subjects or activities
  • liking to plan things carefully before doing them

Autism in women and men

Autism can sometimes be different in women and men. For example, autistic women may be quieter, may hide their feelings and may appear to cope better with social situations. This means it can be harder to tell you’re autistic if you’re a woman.

Diagnosis of Autism spectrum disorder

Since the diagnosis of autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area. Diagnosing autism spectrum disorder is not a brief process. There is no single medical test that can diagnose it definitively; instead, in order to accurately pinpoint your child’s problem, multiple evaluations and tests may be necessary.

Doctors diagnose autism spectrum disorder by looking at a child’s behavior and development. Clinicians look carefully at the way your child interacts with others, communicates, and behaves. Young children with autism spectrum disorder can usually be reliably diagnosed by age two.

Older children and adolescents should be evaluated for autism spectrum disorder when a parent or teacher raises concerns based on watching the child socialize, communicate, and play.

Diagnosing autism spectrum disorder in adults is not easy. In adults, some autism spectrum disorder symptoms can overlap with symptoms of other mental health disorders, such as schizophrenia or attention deficit hyperactivity disorder (ADHD). However, getting a correct diagnosis of autism spectrum disorder as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help.

  • Research has shown that a diagnosis of autism at age 2 can be reliable, valid, and stable 65, 66.
  • Even though autism spectrum disorder can be diagnosed as early as age 2 years, most children are not diagnosed with autism spectrum disorder until after age 4 years. The median age of first diagnosis by subtype is as follows 9.
    • Autistic disorder: 3 years, 10 months
    • Pervasive developmental disorder-not otherwise specified: 4 years, 1 month
    • Asperger syndrome: 6 years, 2 months
  • Studies have shown that parents of children with autism spectrum disorder notice a developmental problem before their child’s first birthday. Concerns about vision and hearing were more often reported in the first year, and differences in social, communication, and fine motor skills were evident from 6 months of age 67, 68.

Getting evaluated for autism spectrum disorder

  • Parent interview: In the first phase of the diagnostic evaluation, you will give your doctor background information about your child’s medical, developmental, and behavioral history. If you have been keeping a journal or taking notes on anything that’s concerned you, share that information. The doctor will also want to know about your family’s medical and mental health history.
  • Medical exam: The medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. Your child will undergo this full screening to determine the cause of their developmental problems and to identify any co-existing conditions.
  • Hearing test: Since hearing problems can result in social and language delays, they need to be excluded before an ASD can be diagnosed. Your child will undergo a formal audiological assessment where they are tested for any hearing impairments, as well as any other hearing issues or sound sensitivities that sometimes co-occur with autism.
  • Observation: Developmental specialists will observe your child in a variety of settings to look for unusual behavior associated with the ASD. They may watch your child playing or interacting with other people.
  • Lead screening: Because lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children with developmental delays be screened for lead poisoning.
  • Other testing: Depending on your child’s symptoms and their severity, the diagnostic assessment may also include speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs.
    • Speech and language evaluation: A speech pathologist will evaluate your child’s speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.
    • Cognitive testing: Your child may be given a standardized intelligence test or an informal cognitive assessment.
    • Adaptive functioning assessment: Your child may be evaluated for their ability to function, problem-solve, and adapt in real-life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding themselves.
    • Sensory-motor evaluation: Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child’s fine motor, gross motor, and sensory processing skills.

Diagnosis in young children is often a two-stage process:

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The Centers for Disease Control and Prevention (CDC) recommends specific autism spectrum disorder screening be done at the 18- and 24-month visits.

Earlier screening might be needed if a child is at high risk for autism spectrum disorder or developmental problems. Those at high risk include children who:

  • Have a sister, brother, or other family member with autism spectrum disorder
  • Have some autism spectrum disorder behaviors
  • Were born premature, or early, and at a low birth weight.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine this information with his or her observations of the child.

Children who show some developmental problems during this screening process will be referred for another stage of evaluation.

Stage 2: Additional Evaluation

This evaluation is with a team of doctors and other health professionals with a wide range of specialties who are experienced in diagnosing autism spectrum disorder. This team may include:

  • A developmental pediatrician—a doctor who has special training in child development
  • A child psychologist and/or child psychiatrist—a doctor who knows about brain development and behavior
  • A speech-language pathologist—a health professional who has special training in communication difficulties.

The evaluation may assess:

  • Cognitive level or thinking skills
  • Language abilities
  • Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.

Because autism spectrum disorder is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

  • Blood tests
  • Hearing test

The outcome of the evaluation will result in recommendations to help plan for treatment.

Diagnosis in older children and adolescents

Older children whose autism spectrum disorder symptoms are noticed after starting school are often first recognized and evaluated by the school’s special education team. The school’s team may refer these children to a health care professional.

Parents may talk with a pediatrician about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include understanding tone of voice, facial expressions, or body language. Older children may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers. The pediatrician can refer the child for further evaluation and treatment.

Diagnosis in adults

Adults who notice the signs and symptoms of autism spectrum disorder should talk with a doctor and ask for a referral for an autism spectrum disorder evaluation. While testing for autism spectrum disorder in adults is still being refined, adults can be referred to a psychologist or psychiatrist with autism spectrum disorder expertise. The expert will ask about concerns, such as social interaction and communication challenges, sensory issues, repetitive behaviors, and restricted interests. Information about the adult’s developmental history will help in making an accurate diagnosis, so an autism spectrum disorder evaluation may include talking with parents or other family members.

Treatments and Therapies for Autism spectrum disorder

No cure exists for autism spectrum disorder, and because of the very wide range of issues facing those on “autism spectrum disorder” means that there is no single best treatment for autism spectrum disorder and there is no one-size-fits-all treatment. Because autism is a ‘spectrum’ condition it affects different people in different ways. It is therefore very difficult to generalize about how an autistic person will develop over time. Each person is different, and an intervention or coping strategy which works well with one person may not be appropriate or effective with another.

The goal of treatment is to maximize your child’s ability to function by reducing autism spectrum disorder symptoms and supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional and behavioral skills.

The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child’s needs may change over time. Your health care provider can recommend options and help identify resources in your area. Working closely with a doctor or health care professional is an important part of finding the right treatment program.

If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child’s needs. There are many treatment options, social services, programs, and other resources that can help.

Early treatment for autism spectrum disorder and proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.

Several complementary and alternative interventions involving special diets and supplements have been tried over the years by parents/caregivers seeking ways to help their child with autism function better. To date compelling evidence has not been found to clearly recommend any such specific interventions. Research into these types of interventions continues, and parents/caregivers interested in them should discuss them with their child’s treating clinician.

Here are some tips.

  • Keep a detailed notebook. Record conversations and meetings with health care providers and teachers. This information helps when its time to make decisions.
  • Record doctors’ reports and evaluations in the notebook. This information may help an individual qualify for special programs.
  • Contact the local health department, school, or autism advocacy groups to learn about their special programs.
  • Talk with a pediatrician, school official, or physician to find a local autism expert who can help develop an intervention plan and find other local resources.
  • Find an autism support group. Sharing information and experiences can help individuals with autism spectrum disorder and/or their caregivers learn about options, make decisions, and reduce stress.

Treatment options may include:

  • Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and generalize these skills to multiple situations through a reward-based motivation system.
  • Educational therapies. Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
  • Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
  • Other therapies. Depending on your child’s needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.

ABA therapy

Applied behavioral analysis (ABA) involves systematic study of the child’s functional challenges, which is then used to create a structured behavioral plan for improving their adaptive skills and decreasing inappropriate behavior. For example, a therapist might offer praise when a child tries to politely ask for help. Because a reward follows the behavior, the child is more likely to repeat the action. On the other hand, if the child has an angry outburst, no reward is given.

  • Social skills training: Done in group or individual settings, this intervention helps children with autism improve their ability to navigate social situations.
  • Early Start Denver Model (ESDM): Early Start Denver Model (ESDM) is an approach that works best for 12- to 48-month-olds and follows the practices of ABA. The sessions revolve around natural play and joint activities with therapists and parents. Singing could be used to encourage a child with autism spectrum disorder to vocalize, or a mimicry game could be used to teach the child to identify body parts. Early Start Denver Model (ESDM) focuses on creating positive social interactions, enhancing communication and cognitive skills in the process. It’s important for you to be involved in your child’s ESDM sessions. Fortunately, the sessions are flexible enough to take place at a clinic or in your own home. A therapist can guide you through what you need to know. Studies, including brain scan research, suggest that ESDM improves language and communication skills as well as adaptive behavior.
  • Pivotal Response Treatment (PRT): Pivotal Response Treatment (PRT) is another play-based approach that follows ABA practices. Rather than honing in on specific behaviors, pivotal response treatment (PRT) focuses on broader areas, including motivation, self-management, response to multiple cues, and initiation of social interactions. By focusing on these pivotal areas, PRT helps children make broad improvements with social skills and communication. During a session, a therapist might put the child’s favorite food or toy within view but out of reach. A situation like this encourages the child to speak up and ask for the item. Pivotal Response Treatment (PRT) has been studied since the 1970s, and it’s been used in both one-on-one and group sessions. Studies suggest that it can be effective at building communication skills in children.
  • Discrete Trial Training (DTT): Discrete Trial Training (DTT) is an ABA-based approach that is more structured than pivotal response treatment (PRT). A skill is broken down into smaller pieces. When teaching a child with ASD to write their name, a DTT approach might break the process down letter by letter. And forming each letter might be broken down into a stroke-by-stroke process. As the child advances through each step, they receive positive reinforcement. Discrete Trial Training (DTT) is effective in teaching skills to children with ASD, and has been used since the 1970s. This type of training doesn’t involve as much natural play as Early Start Denver Model (ESDM) or pivotal response treatment (PRT).
  • Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism.
  • Special education services: Under an Individual Education Plan provided by their school, which accommodates for their social communication deficits, restricted interests, and repetitive behaviors, children with autism can achieve their fullest potential academically. This includes special day classes for very young children to address language, social, and life skills.
  • Treating co-occurring conditions: Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD. Children with autism may have intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition psychotherapy and/or medication treatment.
  • Medication: A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate medications can be helpful. For example, autism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child’s parents.

Speech and language therapy

If your child struggles with communication, speech-language therapy can help them improve their verbal and nonverbal skills. To improve verbal skills, a speech-language therapist may guide your child through exercises that involve describing feelings and identifying items and people. Other exercises improve the child’s speech rhythm, sentence structure, and vocabulary. For example, during an exercise your child might be instructed to clap as they speak to bring attention to syllable count and pace. When it comes to nonverbal communication skills, a speech-language therapist can teach your child about sign language, hand signals, or communication through pictures. Other nonverbal cues, such as making eye contact, can also be improved through speech-language therapy.

Physical therapy and occupational therapy

This address adaptive skills deficits with activities of daily living, as well as problems with handwriting. Some children with ASD experience difficulties with controlling physical actions. For example, they may have an unusual gait or trouble with handwriting. Physical therapy can build your child’s motor skills. A focus on posture, coordination, balance, and muscle control can improve a child’s social life and sense of well-being. Occupational therapy helps children with autism build everyday skills that are useful at school or around the home, such as feeding, grooming, and dressing themselves. Similar to physical therapy, occupational therapy can enhance motor skills. Sessions focus on an individual’s unique needs, so your child may also learn to use assistive devices to adapt to situations and complete tasks. Examples of such devices include a speech-to-text app for a child who struggles with handwriting and a dry-erase board for a child who has difficulty with verbal communication.

Cognitive behavior therapy (CBT)

Cognitive behavior therapy (CBT) can help children with autism spectrum disorder understand how thoughts influence behavior. A therapist shows the child how to recognize, reevaluate, and regulate emotions, such as anxiety. This type of therapy is useful for teaching children how to cope with difficult social situations and other challenges in life.

Like other autism treatment options, CBT sessions are personalized to meet the child’s needs. The approach may even be useful in addressing sleep issues, although more research is needed.

Music therapy

There is some evidence that music therapy may help to improve some social and behavioral skills in children with autism spectrum disorder.

  • A 2018 randomized controlled trial of 51 children (ages 6 to 12) with autism spectrum disorder found that 8 to 12 weeks of individual music intervention improved social communication and functional brain connectivity 69.
  • A 2014 Cochrane review of 10 studies involving a total of 165 children with autism spectrum disorder found that music therapy was superior to “placebo” therapy or standard care for social interaction, non-verbal and verbal communication skills, initiating behavior, and social-emotional reciprocity 70. The review concluded that music therapy may help children with autism spectrum disorder to improve their skills in areas such as social interaction and communication, and may also contribute to increasing social adaptation skills in children with autism spectrum disorder and to promoting the quality of parent-child relationships 70.
  • A 2017 randomized controlled trial of 364 children in 9 countries found that improvisational music therapy, when compared with enhanced standard care (i.e., usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about autism spectrum disorder), resulted in no significant difference in severity of symptoms based on the Autism Diagnostic Observation Schedule social affect domain over 5 months 71.

Safety

  • Music therapy for people with autism spectrum disorder appears to be safe. None of the studies included in the Cochrane review above reported any side effects caused by music therapy.

Camel milk and Autism

Autism spectrum disorder (ASD) is a severe neurodevelopment disorder characterized by impairments in social orientation, communication, and repetitive behaviors 72. Camel milk provides many benefits, especially for autistic children. Camel milk is traditionally used in autism treatment in some areas of the world. A study published in the 2005 observed the effects of camel milk consumption, instead of cow milk, on several cases of children and adults with autism. Researchers discovered that, when a 4-year-old female participant consumed camel milk for 40 days, a 15-year-old boy consumed camel milk for 30 days, and several 21-year-old autistics consumed camel milk for two weeks, their autism symptoms disappeared. The patients were also observed to be quieter and less self-destructive. The authors reported in another study that camel milk consumption in children under 15 has been effective in controlling some of the symptoms, especially in the group under 10 years 73. Some parents report that their children were suffering from autism; then the children used camel milk, some of their symptoms improved such as better sleep; increased motor planning and spatial awareness; increased eye contact; better language and improved gastrointestinal function. In a study 74 conducted on 60 patients with autism (2 to 12 years old) in Saudi Arabia, the effects of camel and cow’s milk were evaluated when 500 ml of milk twice daily for 2 weeks were given to children. In the analysis, the baseline level of antioxidants of all the children was low. Results after two weeks showed significant improvement in cognitive and behavioral tests due to camel milk and lowered effects of oxidative stress. The researchers showed that camel milk plays an important role and reduces the effects of oxidative stress by adjusting the antioxidant enzymes and nonenzymatic antioxidant materials levels and improves psychological symptoms 74. In a case report published in 2013, a boy had been introduced in the third year of his life to recognize autism. The mother of this boy started, from the age of nine years, to give him a glass of camel milk at night. He was observed for six years (2007–2013) to see if camel milk would control the symptoms of autism 75. This report agreed with the results reported by Y. Shabo 73 that camel milk is especially useful for autistic children (Autism Spectrum Disorder). Another clinical study investigated the effect of camel milk on biochemical markers. Forty-five children diagnosed with autism were randomly assigned to receive boiled camel milk for group I (n = 15), raw camel milk for group II (n = 15), and a placebo for group III (n = 15) for 2 weeks. Camel milk administered for 2 weeks significantly improved clinical symptoms of autism and decreased serum level of “thymus and activation-regulated chemokine” in autistic children 76.

These findings revealed that camel milk is safer for children and may be effective in the treatment of Autism Spectrum Disorder and improves general well-being. However, a large scale randomized double blind clinical trials are needed to support these early positive findings.

Acupuncture

Results of clinical trials on the effectiveness of acupuncture for autism spectrum disorder have been mixed, but there is currently no conclusive evidence to support the use of acupuncture for the treatment of autism spectrum disorder.

  • A 2012 systematic review of 11 randomized controlled trials found “mixed” evidence of acupuncture’s effectiveness as a treatment for autism spectrum disorder symptoms 77.
  • A 2011 Cochrane review of 10 randomized controlled trials involving 390 children ages 3 to 18, conducted in China and Egypt, concluded that there is no conclusive evidence that acupuncture is effective for treatment of autism spectrum disorder in children, and no randomized controlled trials have been conducted in adults 78.
  • A 2019 systematic review and meta-analysis of 14 trials with 968 participants (11 of the trials were included in the meta-analysis) found scalp acupuncture treatment may be an effective treatment for children with autism spectrum disorder 79. The reviewers noted, however, that given the heterogeneity and number of participants in the reviewed studies, randomized controlled trials of high quality and design are required before widespread application of this therapy 79.

Safety

  • Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of nonsterile needles and improper delivery of treatments.
  • A few studies in children with autism spectrum disorder included in the reviews above reported either no adverse events or minor side effects, but relevance between these reported adverse effects and acupuncture was unclear.

Nutritional therapy

Some children with autism struggle with digestive issues as well as bone density issues. On top of that, some children may show an aversion to specific flavors or textures, such as the soft squishiness of tomatoes or the lumpy texture of oatmeal. So, while meeting their nutritional needs is vital, it can also be a tricky endeavor.

If your child is a picky eater, nutritional therapy can help ensure they’re still following a healthy diet. A nutrition specialist can work with you and your child to create a meal plan that caters to their specific needs and preferences.

You can also take some steps at home to improve your child’s eating habits:

  • Consider your child’s favorite foods. Try offering them foods with similar tastes or textures. If they like French fries, for example, serve them a side of sweet potato fries for more variety.
  • Serve new dishes alongside current favorites. This allows you to add new ingredients while at the same time keeping some familiarity. Keep the portions small until your child actually shows a liking for the new food.
  • Give your child a sense of control by allowing them to select from several new food options. A possible lineup might include broccoli, asparagus, or green beans.

Medication

No medication can improve the core signs of autism spectrum disorder, but specific medications can help control symptoms. For example, certain medications may be prescribed if your child is hyperactive; antipsychotic drugs are sometimes used to treat severe behavioral problems; and antidepressants may be prescribed for anxiety. Keep all health care providers updated on any medications or supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

A doctor may use medication to treat some difficulties that are common with autism spectrum disorder. With medication, a person with autism spectrum disorder may have fewer problems with:

  • Irritability
  • Aggression
  • Repetitive behavior
  • Hyperactivity
  • Attention problems
  • Anxiety and depression.

Managing other medical and mental health conditions

In addition to autism spectrum disorder, children, teens and adults can also experience:

  • Medical health issues. Children with autism spectrum disorder may also have medical issues, such as epilepsy, sleep disorders, limited food preferences or stomach problems. Ask your child’s doctor how to best manage these conditions together.
  • Problems with transition to adulthood. Teens and young adults with autism spectrum disorder may have difficulty understanding body changes. Also, social situations become increasingly complex in adolescence, and there may be less tolerance for individual differences. Behavior problems may be challenging during the teen years.
  • Other mental health disorders. Teens and adults with autism spectrum disorder often experience other mental health disorders, such as anxiety and depression. Your doctor, mental health professional, and community advocacy and service organizations can offer help.

Planning for the future

Children with autism spectrum disorder typically continue to learn and compensate for problems throughout life, but most will continue to require some level of support. Planning for your child’s future opportunities, such as employment, college, living situation, independence and the services required for support can make this process smoother.

Coping and support

Raising a child with autism spectrum disorder can be physically exhausting and emotionally draining. These suggestions may help:

  • Find a team of trusted professionals. A team, coordinated by your doctor, may include social workers, teachers, therapists, and a case manager or service coordinator. These professionals can help identify and evaluate the resources in your area and explain financial services and state and federal programs for children and adults with disabilities.
  • Keep records of visits with service providers. Your child may have visits, evaluations and meetings with many people involved in his or her care. Keep an organized file of these meetings and reports to help you decide about treatment options and monitor progress.
  • Learn about the disorder. There are many myths and misconceptions about autism spectrum disorder. Learning the truth can help you better understand your child and his or her attempts to communicate.
  • Take time for yourself and other family members. Caring for a child with autism spectrum disorder can put stress on your personal relationships and your family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse or partner — even if it’s just watching a movie together after the children go to bed.
  • Seek out other families of children with autism spectrum disorder. Other families struggling with the challenges of autism spectrum disorder may have useful advice. Some communities have support groups for parents and siblings of children with the disorder.
  • Ask your doctor about new technologies and therapies. Researchers continue to explore new approaches to help children with autism spectrum disorder. See the Centers for Disease Control and Prevention website 80 on autism spectrum disorders for helpful materials and links to resources.

Alternative medicine

Because autism spectrum disorder can’t be cured, many parents seek alternative or complementary therapies, but these treatments have little or no research to show that they’re effective. You could, unintentionally, reinforce negative behaviors. And some alternative treatments are potentially dangerous.

Talk with your child’s doctor about the scientific evidence of any therapy that you’re considering for your child.

Examples of complementary and alternative therapies that may offer some benefit when used in combination with evidence-based treatments include:

  • Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy or music therapy, which focuses on reducing a child’s sensitivity to touch or sound. These therapies may offer some benefit when used along with other treatments.
  • Sensory-based therapies. These therapies are based on the unproven theory that people with autism spectrum disorder have a sensory processing disorder that causes problems tolerating or processing sensory information, such as touch, balance and hearing. Therapists use brushes, squeeze toys, trampolines and other materials to stimulate these senses. Research has not shown these therapies to be effective, but it’s possible they may offer some benefit when used along with other treatments.
  • Massage. While massage may be relaxing, there isn’t enough evidence to determine if it improves symptoms of autism spectrum disorder.
    Pet or horse therapy. Pets can provide companionship and recreation, but more research is needed to determine whether interaction with animals improves symptoms of autism spectrum disorder.

Some complementary and alternative therapies may not be harmful, but there’s no evidence that they’re helpful. Some may also include significant financial cost and be difficult to implement. Examples of these therapies include:

  • Special diets. There’s no evidence that special diets such as gluten-free, casein-free or ketogenic diets are an effective treatment for autism spectrum disorder. And for growing children, restrictive diets can lead to nutritional deficiencies. If you decide to pursue a restrictive diet, work with a registered dietitian to create an appropriate meal plan for your child.
  • Vitamin supplements and probiotics. Although not harmful when used in normal amounts, there is no evidence they are beneficial for autism spectrum disorder symptoms, and supplements can be expensive. Talk to your doctor about vitamins and other supplements and the appropriate dosage for your child.
  • Acupuncture. This therapy has been used with the goal of improving autism spectrum disorder symptoms, but the effectiveness of acupuncture is not supported by research.

Some complementary and alternative treatments do not have evidence that they are beneficial and they’re potentially dangerous. Examples of complementary and alternative treatments that are not recommended for autism spectrum disorder include:

  • Chelation therapy. This treatment is said to remove mercury and other heavy metals from the body, but there’s no known link with autism spectrum disorder. Chelation therapy for autism spectrum disorder is not supported by research evidence and can be very dangerous. In some cases, children treated with chelation therapy have died.
    • A 2015 Cochrane review of 1 randomized controlled trial of oral DMSA chelation involving 77 children with autism spectrum disorder found no evidence to suggest that pharmaceutical chelation is an effective intervention for autism spectrum disorder 81. The reviewers noted that before any more trials on chelation for autism spectrum disorder are conducted, evidence that supports a causal link between heavy metals and autism and methods that ensure the safety of participants are needed. There have been previous reports of serious adverse events from intravenous chelation, including hypocalcemia, renal impairment and reported death. The 2015 Cochrane review concluded that given these reports, the risks of chelation for autism spectrum disorder currently outweigh any possible (or potential) benefits 81.
  • Hyperbaric oxygen treatments. Hyperbaric oxygen therapy is a treatment that involves breathing oxygen inside a pressurized chamber. This treatment has not been shown to be effective in treating autism spectrum disorder symptoms and is not approved by the Food and Drug Administration (FDA) for this use.
  • Intravenous immunoglobulin (IVIG) infusions. There is no evidence that using IVIG infusions improves autism spectrum disorder, and the FDA has not approved immunoglobulin products for this use.
  • Bleaching also called chlorine dioxide (CD) or Mineral Miracle Solution (MMS)
  • GcMAF – an injection made from blood cells
  • Medicines including medicines to help with memory, change hormone levels or remove metal from the body (chelation)
  • Neurofeedback where brain activity is checked (usually by placing sticky pads on your head) and you’re taught how to change it.

Treatment of aggression in adults with autism spectrum disorder

Current clinical approaches to the management of aggression in adults with autism spectrum disorder largely reflect the limited scientific literature in this area to date. A previous review by Kwok 82 focused on the use of medications to treat certain symptoms in individuals with autism spectrum disorder. Although accumulating evidence was noted for the use of second-generation antipsychotics and selective serotonin reuptake inhibitors (SSRIs) to treat aggression and repetitive and self-injurious behavior in autism spectrum disorder, most (14 of 16) of the referenced studies pertained to children with autism spectrum disorder.

A review by Matson and colleagues 83 focused on applied behavior analysis (ABA) and pharmacotherapy to treat aggression and self-injury associated with autism spectrum disorder. The authors noted that because such behaviors usually have clear environmental antecedents, behavioral interventions, such as applied behavior analysis, should be used to address them, with concurrent pharmacotherapy employed when environmental factors are unidentifiable or when challenging behaviors are very severe. They noted that only risperidone and aripiprazole were Food and Drug Administration (FDA)–approved for treating irritability associated with autism spectrum disorder in children (not adults). They did not reference non-ABA-based, non-pharmacologic interventions for treating aggression in autism spectrum disorder, and, like the Kwok review 82, conclusions were based primarily on extrapolation from children’s studies.

Another literature review by Matson and Jang 84 examining treatment of aggression in autism spectrum disorder found that, of 27 papers reviewed, only 5 explored this issue in adults with autism spectrum disorder, and no comment was made on the findings of these studies. The authors noted that the literature seemed to support using functional assessments and efforts to improve coping skills and competing behaviors in individuals with autism spectrum disorder and aggression, though this recommendation was based mostly on studies of children with autism spectrum disorder.

Eight systematic reviews have also been published regarding the treatment of aggression in individuals with autism spectrum disorder 85. These reviews have suggested potential efficacy of atypical antipsychotics 86, selective serotonin reuptake inhibitors 87, beta blockers 88 and psychoeducational interventions 89 for this purpose. However, the limited number of randomized, controlled trials, small sample sizes, and bias risks make it difficult to draw firm conclusions regarding the efficacy of specific treatments based on these reviews.

To date, previous literature reviews have focused primarily on controlled treatment studies of aggression in children with autism spectrum disorder, and prior systematic reviews have limited their scope to either studies of medication interventions or non-pharmacologic interventions, but not both, for treating aggression in adults with autism spectrum disorder 85. Based on the available evidence and consideration of adverse effects and long-term risks, a practical approach could involve behavioral interventions and exercise as an initial measure in addressing aggression in adults with autism spectrum disorder, whenever possible, with pharmacotherapy employed if these interventions are unavailable or inadequate based on symptom acuity or the severity of aggression precludes their safe implementation 85. Pharmacotherapy can be employed, using the lowest possible dosages, with close monitoring for adverse effects, and with regular reevaluation of its need.  Pharmacotherapy interventions such as dopamine-modulating agents (e.g., risperidone), serotonergic agents (e.g., fluvoxamine, sertraline, yokukansan), beta-adrenergic blockers (e.g., propranolol) and anti-glutamatergic agents (e.g., dextromethorphan-quinidine) may exert beneficial effects on aggression in adults with autism spectrum disorder. If pharmacotherapy is utilized, adjunctive exercise is recommended to counteract possible metabolic side effects of medications.

References
  1. Autism Spectrum Disorder. https://autismsociety.org/the-autism-experience
  2. Autism Spectrum Disorder. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
  3. American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed Arlington, VA: APA, 2013.
  4. Carroll D, Hallett V, McDougle CJ, Aman MG, McCracken JT, Tierney E, Arnold LE, Sukhodolsky DG, Lecavalier L, Handen BL, Swiezy N, Johnson C, Bearss K, Vitiello B, Scahill L. Examination of aggression and self-injury in children with autism spectrum disorders and serious behavioral problems. Child Adolesc Psychiatr Clin N Am. 2014 Jan;23(1):57-72. doi: 10.1016/j.chc.2013.08.002
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Arlington, VA: American Psychiatric Association Publishing.
  6. Autism Spectrum Disorder (ASD). https://www.cdc.gov/ncbddd/autism/facts.html
  7. Yochum A. Autism Spectrum/Pervasive Developmental Disorder. Prim Care. 2016 Jun;43(2):285-300. doi: 10.1016/j.pop.2016.01.010
  8. Autism Spectrum Disorder (ASD). https://www.cdc.gov/ncbddd/autism/data.html
  9. https://www.cdc.gov/mmwr/volumes/65/ss/ss6503a1.htm
  10. https://www.cdc.gov/ncbddd/autism/documents/ASDPrevalenceDataTable2016.pdf
  11. https://www.cdc.gov/ncbddd/developmentaldisabilities/features/birthdefects-dd-keyfindings.html
  12. Warning: So-called cures and dodgy interventions. https://www.autism.org.uk/advice-and-guidance/what-is-autism/so-called-cures
  13. Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with Autism (2nd ed). Austin, TX: Pro-Ed. 2000.
  14. National Research Council. Educating Children with Autism. Washington, DC: National Academy Press, 2001.
  15. Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev. 2021 Nov 22;11(11):CD004407. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004407.pub5/full
  16. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41. doi: 10.1016/s0140-6736(97)11096-0. Retraction in: Lancet. 2010 Feb 6;375(9713):445. Erratum in: Lancet. 2004 Mar 6;363(9411):750. https://doi.org/10.1016/S0140-6736(97)11096-0
  17. Thompson NP, Montgomery SM, Pounder RE, Wakefield AJ. Is measles vaccination a risk factor for inflammatory bowel disease? Lancet. 1995 Apr 29;345(8957):1071-4. https://doi.org/10.1016/S0140-6736(95)90816-1
  18. Chen RT, DeStefano F. Vaccine adverse events: causal or coincidental? Lancet. 1998 Feb 28;351(9103):611-2. https://doi.org/10.1016/S0140-6736(05)78423-3
  19. Public Health England. UK measles and rubella elimination strategy 2019. assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/769970/UK_measles_and_rubella_elimination_strategy.pdf
  20. Dyer C. Lancet retracts Wakefield’s MMR paper. BMJ. 2010 Feb 2;340:c696. https://doi.org/10.1136/bmj.c696
  21. Morris DL, Montgomery SM, Thompson NP, Ebrahim S, Pounder RE, Wakefield AJ. Measles vaccination and inflammatory bowel disease: a national British Cohort Study. Am J Gastroenterol. 2000 Dec;95(12):3507-12. doi: 10.1111/j.1572-0241.2000.03288.x
  22. Feeney M, Ciegg A, Winwood P, Snook J. A case-control study of measles vaccination and inflammatory bowel disease. The East Dorset Gastroenterology Group. Lancet. 1997 Sep 13;350(9080):764-6. https://doi.org/10.1016/S0140-6736(97)03192-9
  23. Miller, E., & Waight, P. (1998). Measles, measles vaccination, and Crohn’s disease. Second immunisation has not affected incidence in England. BMJ (Clinical research ed.), 316(7146), 1745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113286/
  24. Pebody RG, Paunio M, Ruutu P. Measles, measles vaccination, and Crohn’s disease. Crohn’s disease has not increased in Finland. BMJ. 1998 Jun 6;316(7146):1745-6.
  25. Hermon-Taylor J, Ford J, Sumar N, Millar D, Doran T, Tizard M. Measles virus and Crohn’s disease. Lancet. 1995 Apr 8;345(8954):922-3. https://doi.org/10.1016/S0140-6736(95)90033-0
  26. Davis RL, Kramarz P, Bohlke K, et al. Measles-Mumps-Rubella and Other Measles-Containing Vaccines Do Not Increase the Risk for Inflammatory Bowel Disease: A Case-Control Study From the Vaccine Safety Datalink Project. Arch Pediatr Adolesc Med. 2001;155(3):354–359. doi:10.1001/archpedi.155.3.354
  27. Wakefield AJ, Pittilo RM, Sim R, Cosby SL, Stephenson JR, Dhillon AP, Pounder RE. Evidence of persistent measles virus infection in Crohn’s disease. J Med Virol. 1993 Apr;39(4):345-53. https://doi.org/10.1002/jmv.1890390415
  28. Chadwick N, Bruce IJ, Schepelmann S, Pounder RE, Wakefield AJ. Measles virus RNA is not detected in inflammatory bowel disease using hybrid capture and reverse transcription followed by the polymerase chain reaction. J Med Virol. 1998 Aug;55(4):305-11. https://doi.org/10.1002/(SICI)1096-9071(199808)55:4<305::AID-JMV9>3.0.CO;2-4
  29. Afzal MA, Minor PD, Begley J, Bentley ML, Armitage E, Ghosh S, Ferguson A. Absence of measles-virus genome in inflammatory bowel disease. Lancet. 1998 Feb 28;351(9103):646-7. https://doi.org/10.1016/S0140-6736(05)78429-4
  30. Iizuka M, Nakagomi O, Chiba M, Ueda S, Masamune O. Absence of measles virus in Crohn’s disease. Lancet. 1995 Jan 21;345(8943):199. https://doi.org/10.1016/S0140-6736(95)90207-4
  31. Wakefield AJ, Anthony A, Murch SH, Thomson M, Montgomery SM, Davies S, O’Leary JJ, Berelowitz M, Walker-Smith JA. Enterocolitis in children with developmental disorders. Am J Gastroenterol. 2000 Sep;95(9):2285-95. doi: 10.1111/j.1572-0241.2000.03248.x. Retraction in: Am J Gastroenterol. 2010 May;105(5):1214.
  32. Black, C., Kaye, J. A., & Jick, H. (2002). Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. BMJ (Clinical research ed.), 325(7361), 419–421. https://doi.org/10.1136/bmj.325.7361.419
  33. Murch S. Separating inflammation from speculation in autism. Lancet. 2003 Nov 1;362(9394):1498-9. https://doi.org/10.1016/S0140-6736(03)14699-5
  34. Taylor, B., Miller, E., Lingam, R., Andrews, N., Simmons, A., & Stowe, J. (2002). Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ (Clinical research ed.), 324(7334), 393–396. https://doi.org/10.1136/bmj.324.7334.393
  35. Fombonne E, Chakrabarti S. No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics. 2001 Oct;108(4):E58. https://doi.org/10.1542/peds.108.4.e58
  36. Uhlmann, V., Martin, C. M., Sheils, O., Pilkington, L., Silva, I., Killalea, A., Murch, S. B., Walker-Smith, J., Thomson, M., Wakefield, A. J., & O’Leary, J. J. (2002). Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Molecular pathology : MP, 55(2), 84–90. https://doi.org/10.1136/mp.55.2.84
  37. Hornig, M., Briese, T., Buie, T., Bauman, M. L., Lauwers, G., Siemetzki, U., Hummel, K., Rota, P. A., Bellini, W. J., O’Leary, J. J., Sheils, O., Alden, E., Pickering, L., & Lipkin, W. I. (2008). Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. PloS one, 3(9), e3140. https://doi.org/10.1371/journal.pone.0003140
  38. Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues LC, Smith PG, Hall AJ. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet. 2004 Sep 11-17;364(9438):963-9. https://doi.org/10.1016/S0140-6736(04)17020-7
  39. DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta. Pediatrics. 2004 Feb;113(2):259-66. https://doi.org/10.1542/peds.113.2.259
  40. Mrozek-Budzyn D, Kiełtyka A, Majewska R. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. Pediatr Infect Dis J. 2010 May;29(5):397-400. doi: 10.1097/INF.0b013e3181c40a8a
  41. Uno Y, Uchiyama T, Kurosawa M, Aleksic B, Ozaki N. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case-control study in Asia. Vaccine. 2012 Jun 13;30(28):4292-8. doi: 10.1016/j.vaccine.2012.01.093
  42. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477-82. https://www.nejm.org/doi/10.1056/NEJMoa021134
  43. Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. JAMA. 2015;313(15):1534–1540. Erratum in: JAMA. 2016 Jan 12;315(2):204. https://jamanetwork.com/journals/jama/fullarticle/2275444
  44. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 Jun 17;32(29):3623-9. doi: 10.1016/j.vaccine.2014.04.085
  45. IOM (Inst. Med. 2001. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: Natl. Acad.
  46. IOM (Inst. Med.). 2004. Immunization Safety Review: Vaccines and Autism. Washington, DC: Natl. Acad.
  47. IOM (Inst. Med.). 2012. Adverse Effects of Vaccines: Evidence and Causality. Washington, DC: Natl. Acad.
  48. DeStefano, F., & Shimabukuro, T. T. (2019). The MMR Vaccine and Autism. Annual review of virology, 6(1), 585–600. https://doi.org/10.1146/annurev-virology-092818-015515
  49. Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, Waight PA. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999 Jun 12;353(9169):2026-9. https://doi.org/10.1016/S0140-6736(99)01239-8
  50. The MMR Vaccine and Autism. Frank DeStefano and Tom T. Shimabukuro. Annual Review of Virology 2019 6:1, 585-600. https://www.annualreviews.org/doi/full/10.1146/annurev-virology-092818-015515
  51. Anders Hviid, Jørgen Vinsløv Hansen, Morten Frisch, et al. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med.2019;170:513-520. [Epub ahead of print 5 March 2019]. https://doi.org/10.7326/M18-2101
  52. Mughal S, Faizy RM, Saadabadi A. Autism Spectrum Disorder. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525976
  53. Dietert, R.R, Dietert, J. C., Dewitt, J. C (2011). Environmental Risk Factors for Autism, Emerg. Heath Threats J., 2011, 4:10:3402/ehtj.v4i0.7111
  54. Rosenberg RE, Law JK, Yenokyan G, McGready J, Kaufmann WE, Law PA. Characterisitics and concordance of autism spectrum disorders among 277 twin pairs. Arch Pediatr Adolesc Med. 2009; 163(10): 907-914.
  55. Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, Miller J, Fedele A, Collins J, Smith K, Lotspeich L, Croen LA, Ozonoff S, Lajonchere C, Grether JK, Risch N. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011; 68(11): 1095-1102.
  56. Ronald A, Happe F, Bolton P, Butcher LM, Price TS, Wheelwright S, Baron-Cohen S, Plomin R. Genetic heterogeneity between the three components of the autism spectrum: A twin study. J. Am. Acad. Child Adolesc. Psychiatry. 2006; 45(6): 691-699.
  57. Taniai H, Nishiyama T, Miyahci T, Imaeda M, Sumi S. Genetic influences on the board spectrum of autism: Study of proband-ascertained twins. Am J Med Genet B Neuropsychiatr Genet. 2008; 147B(6): 844-849.
  58. Ozonoff S, Young GS, Carter A, Messinger D, Yirmiya N, Zwaigenbaum L, Bryson S, Carver LJ, Constantino JN, Dobkins K, Hutman T, Iverson JM, Landa R, Rogers SJ, Sigman M, Stone WL. Recurrence risk for autism spectrum disorders: A Baby Siblings Research Consortium study. Pediatrics. 2011; 128: e488-e495.
  59. DiGuiseppi C, Hepburn S, Davis JM, Fidler DJ, Hartway S, Lee NR, Miller L, Ruttenber M, Robinson C. Screening for autism spectrum disorders in children with Down syndrome. J Dev Behav Pediatr. 2010; 31:181-191.
  60. Durkin MS, Maenner MJ, Newschaffer CJ, et al. Advanced Parental Age and the Risk of Autism Spectrum Disorder. American Journal of Epidemiology. 2008;168(11):1268-1276. doi:10.1093/aje/kwn250. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2638544/
  61. Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities. Pediatrics. 2008 Jun;121(6):1155-64. doi: 10.1542/peds.2007-1049. http://pediatrics.aappublications.org/content/121/6/1155
  62. Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Behav Pediatr. 2010 May;31(4):267-75. doi: 10.1097/DBP.0b013e3181d5d03b. https://www.ncbi.nlm.nih.gov/pubmed/20431403
  63. Johnson, C.P. Early Clinical Characteristics of Children with Autism. In: Gupta, V.B. ed: Autistic Spectrum Disorders in Children. New York: Marcel Dekker, Inc., 2004:85-123.
  64. https://www.cdc.gov/ncbddd/actearly/index.html
  65. Kleinman JM, Ventola PE, Pandey J, et al. Diagnostic Stability in Very Young Children with Autism Spectrum Disorders. Journal of autism and developmental disorders. 2008;38(4):606-615. doi:10.1007/s10803-007-0427-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625643/
  66. Catherine Lord, Susan Risi, Pamela S. DiLavore, Cory Shulman, Audrey Thurm, Andrew Pickles. Autism From 2 to 9 Years of Age. Arch Gen Psychiatry. 2006;63(6):694–701. doi:10.1001/archpsyc.63.6.694 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209669
  67. Parents’ first concerns of their child’s development in toddlers with autism spectrum disorders. Alison M. Kozlowski, Johnny L. Matson, Max Horovitz, Julie A. Worley & Daniene Neal. Developmental Neurorehabilitation Vol. 14 , Iss. 2,2011
  68. Autism Spectrum Disorder and Autistic Traits in the Avon Longitudinal Study of Parents and Children: Precursors and Early Signs. Bolton, Patrick F. et al. Journal of the American Academy of Child & Adolescent Psychiatry , Volume 51 , Issue 3 , 249 – 260.e25. http://www.jaacap.com/article/S0890-8567(11)01143-9/pdf
  69. Sharda, M., Tuerk, C., Chowdhury, R., Jamey, K., Foster, N., Custo-Blanch, M., Tan, M., Nadig, A., & Hyde, K. (2018). Music improves social communication and auditory-motor connectivity in children with autism. Translational psychiatry, 8(1), 231. https://doi.org/10.1038/s41398-018-0287-3
  70. Geretsegger M, Elefant C, Mössler KA, Gold C. Music therapy for people with autism spectrum disorder. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD004381. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004381.pub3/full
  71. Bieleninik L, Geretsegger M, Mössler K, Assmus J, Thompson G, Gattino G, Elefant C, Gottfried T, Igliozzi R, Muratori F, Suvini F, Kim J, Crawford MJ, Odell-Miller H, Oldfield A, Casey Ó, Finnemann J, Carpente J, Park AL, Grossi E, Gold C; TIME-A Study Team. Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. JAMA. 2017 Aug 8;318(6):525-535. doi: 10.1001/jama.2017.9478. Erratum in: JAMA. 2021 Apr 13;325(14):1473.
  72. Mc Pheeters Melissa L, Warren Z, Sathe N, Bruzek Jennifer L, Krishnaswami S, Jerome Rebecca N, Veenstra-VanderWeele J. A Systematic Review of Medical Treatments for Children With Autism Spectrum Disorders. Pediatrics J. 2011;127( 6):e1312–e1321. doi: 10.1542/peds.2011-0427. http://pediatrics.aappublications.org/content/127/5/e1312
  73. Shabo Y, Yagil R. Etiology of autism and camel milk as therapy. Journal of Endocrine Genetics. 2005;4( 2):67–70.
  74. AL-Ayadhi Laila Y. Camel Milk as a Potential Therapy as an Antioxidant in Autism Spectrum Disorder (ASD) Evidence-Based Complementary and Alternative Medicine. 2013:8. Article ID: 602834. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773435/
  75. Adams CM. Patient Report: Autism Spectrum Disorder Treated With Camel Milk. Global Advances in Health and Medicine. 2013;2(6):78-80. doi:10.7453/gahmj.2013.094. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865381/
  76. Bashir S, Al-Ayadhi L. Effect of camel milk on thymus and activation-regulated chemokine in autistic children: double-blind study. Pediatr Res. 2014;75(4):559–63. doi: 10.1038/pr.2013.248. https://www.ncbi.nlm.nih.gov/pubmed/24375082
  77. Lee MS, Choi TY, Shin BC, Ernst E. Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. J Autism Dev Disord. 2012 Aug;42(8):1671-83. doi: 10.1007/s10803-011-1409-4
  78. Cheuk DKL, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007849. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007849.pub2/full
  79. Liu, C., Li, T., Wang, Z., Zhou, R., & Zhuang, L. (2019). Scalp acupuncture treatment for children’s autism spectrum disorders: A systematic review and meta-analysis. Medicine, 98(13), e14880. https://doi.org/10.1097/MD.0000000000014880
  80. Autism Spectrum Disorder (ASD). https://www.cdc.gov/ncbddd/autism/index.html
  81. James S, Stevenson SW, Silove N, Williams K. Chelation for autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD010766. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010766.pub2/full
  82. Kwok HWM. Psychopharmacology in autism spectrum disorders. Curr Opin Psychiatry 2003;16:529–34.
  83. Matson JL, Sipes M, Fodstad JC, Fitzgerald ME. Issues in the management of challenging behaviours of adults with autism spectrum disorder. CNS Drugs. 2011 Jul;25(7):597-606. doi: 10.2165/11591700-000000000-00000
  84. Matson JL, Jang J. Treating aggression in persons with autism spectrum disorders: a review. Res Dev Disabil. 2014 Dec;35(12):3386-91. doi: 10.1016/j.ridd.2014.08.025
  85. Im D. S. (2021). Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review. Harvard review of psychiatry, 29(1), 35–80. https://doi.org/10.1097/HRP.0000000000000282
  86. Deb S, Farmah BK, Arshad E, Deb T, Roy M, Unwin GL. The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder–a systematic review. Res Dev Disabil. 2014 Mar;35(3):711-25. doi: 10.1016/j.ridd.2013.12.004
  87. Sawyer A, Lake JK, Lunsky Y, Liu SK, Desarkar P. Psychopharmacological treatment of challenging behaviours in adults with autism and intellectual disabilities: a systematic review. Res Autism Spectr Disord 2014;8:803–13.
  88. Ward F, Tharian P, Roy M, Deb S, Unwin GL. Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: a systematic review. Res Dev Disabil. 2013 Dec;34(12):4293-303. doi: 10.1016/j.ridd.2013.08.015
  89. Davis KS, Kennedy SA, Dallavecchia A, Skolasky RL, Gordon B. Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review. Cogn Behav Neurol. 2019 Sep;32(3):139-163. doi: 10.1097/WNN.0000000000000201
Health Jade Team

The author Health Jade Team

Health Jade