Autism: signs, triggers, treatment options
Autism: short overview
- Description: Group of profound developmental disorders that can make social life difficult, among other things
- Forms: including early childhood autism, Asperger’s syndrome, atypical autism
- Symptoms: depending on the degree and severity, e.g. impaired social competence, language and communication disorders, stereotypical behaviour, reduced intelligence, but also isolated, outstanding mental abilities
- Causes: genetic causes, disturbed brain development, disturbed brain metabolism
- Treatment: Autism is not a disease, it is a condition, and in this sense does not require “curative” therapy. However, the symptoms can often be improved with different methods, e.g. behavioral therapy to improve social competence, speech training
- Prognosis: In mild cases (especially Asperger syndrome) an independent life is possible. People with more severe autism, on the other hand, are often dependent on help for life. In addition, the prognosis depends on possible concomitant diseases (e.g. depression, anxiety disorders).
What is autism?
Autism is a collective term for various profound developmental disorders – the exact name is Autism Spectrum Disorders (ASS). These include three different main forms of autism:
- Early childhood autism
- Asperger’s Syndrome
- Atypical autism
The appearance of autism varies greatly from person to person depending on the form and severity of the disorder. Some sufferers develop only mild autism, which has little impact on their everyday life. Others are severely disabled.
Among other things, intelligence and language skills are very differently developed: The greater part of autistic people is mentally limited. But there are also normal and even highly gifted people. In some cases, the various forms of autism also merge seamlessly into one another.
There are many indications of an autism spectrum disorder. However, there are also other possible reasons: Hearing and visual difficulties, psychiatric, neurological or motor diseases or other mental disorders. Talk to your pediatrician about this. He accompanies the babies from an early age and can assess whether an extended child and adolescent psychiatric or neuropaediatric examination is necessary.
Routines and rituals are often relaxing for autistic people. They provide security and safety. Behind routines or “quirks” can also be compulsive illnesses. You should get that checked out with a doctor. Not every need, for example, to put toy cars in a long line or to insist on certain procedures when dressing, is an explicit indication of autism or other disorders. This can also be quite normal, childish behavior.
One should keep in mind that the idea of when people are happy is not transferable 1:1 to autistic people. No need for friendships, an aversion to small talk, a pronounced need for rest and a quicker exhaustion should be respected. However, life with autistic people is also often a great enrichment. They have great qualities like reliability, rule stringency, love of justice and a great, dry humor.
Most autistic people show the following three main characteristics:
- Their social skills are impaired.
- Their communication and speech are impaired.
- They show repetitive, stereotypical behaviour and interests.
Caution: The type and severity of symptoms are individual and vary greatly depending on the form of autism. For example, in Asperger’s syndrome, the symptoms are generally less pronounced than in early childhood autism. The latter form also varies widely among those affected, ranging from mild to severe.
Autism symptoms: Social interaction
Many autistic people find it difficult to build relationships with their fellow human beings. This is often already noticeable in infancy. As a result, many autistic children are unable to develop a close relationship with their parents and are unable to respond to stimuli from their environment.
For example, babies usually seek the mother’s gaze and physical contact to build closeness. Autistic babies, on the other hand, usually actively avoid eye contact. Many also do not imitate the smile of their counterpart. This often makes them appear apathetic or rigid. Some parents even initially suspect that their child is deaf or blind because he or she shows little reaction to the environment.
Even in later childhood, adolescence and adulthood, autistic people often have problems making and maintaining eye contact.
In addition, in the case of a pronounced autistic disorder, those affected can hardly enter into friendly relationships. Affected children prefer to play alone. Their fellow human beings often only notice them when they are supposed to fulfil their needs (e.g. when they are hungry).
People with autism often find it difficult to understand other people’s feelings and to empathise with others. They are also often unable to express their own feelings well or at all. Thus they often show hardly any spontaneous emotions such as joy or interest in others and in different activities. In addition, autistic people are often unable to adapt their reaction to the general mood. It can happen, for example, that they have a laughing fit for no apparent reason.
Autism Symptoms: Communication
The speech of autistic people is also often disturbed. Thus, many children with early childhood autism cannot learn a normal language. If they do speak, they often repeat the same sentences. The speech melody is also missing. This sometimes creates a robot-like impression.
In patients with Asperger’s syndrome, on the other hand, the language is often very highly developed. But theye sometimes seem strangely monotonous and stilted.
Experts have also defined important general autism symptoms for language:
- Language development is lagging behind. The children do not try to express themselves through their gestures or body language.
- The children have problems starting or maintaining a conversation.
- The scope of the language is very limited and one-sided. Sentences or questions are often repeated.
Autism symptoms: Interests and behavior patterns
The third major symptom of autism is the often stereotypical behavior. Thus, many affected people persistently perform certain actions, rituals and habits. If they are interrupted or prevented from doing so, they sometimes react with screaming fits and panic attacks.
Often autistic people can’t part with their favourite things either and take them with them everywhere they go.
In addition, many autistic people seem to focus all of their interest on certain specific details or things that occupy them completely.
In summary, the following abnormalities are characteristic for autistic people:
- The persons concerned are mainly concerned with an unusual detail or have an unusual interest.
- They cannot give up certain actions or rituals.
- The actions are often stereotypical and monotonous.
- On a toy, they choose a very specific detail they are interested in. They rarely include the complete item in the game.
- The games of affected children tend to be unimaginative and stereotypical. Also imitative playing behaviour is missing.
Side effects in autism
Many autistic people also have Savant Syndrome. This means that they have a special talent for a specific knowledge. For example, some are true mathematical geniuses, others have a photographic memory or learn languages in record time. They devote themselves to their special talents with great perseverance, but often have few other interests.
Some Savants show reduced intelligence in areas outside their specialty. However, there are also both normally intelligent and highly gifted savants.
Autism: causes and risk factors
Several factors play a role in the development of autism.
Experts assume that autistic disorders are mainly caused by changes in the genetic material. Twin and sibling studies support this theory. For example, siblings of autistic children are 50 times more likely to develop an autistic disorder themselves.
In identical twins, both children were autistic in 90 percent of the cases studied. In fraternal twins, however, the second sibling also develops autism in only 23 percent of cases.
So it seems that certain genetic changes play a role in the development of autism. In 10 to 15 percent of autistic people, for example, the “fragile X chromosome” can be detected – here, a genetic change on the X chromosome is the cause of cognitive impairment.
So far, researchers have not been able to detect any change in the brain that is typical of autism. However, abnormalities were found in those parts of the brain that are responsible for social and communicative abilities. It is still unclear whether they are the result of autism or cause the symptoms.
Presumably the brain development of autistic children is already disturbed in the womb, which later affects normal brain development. For example, autistic children have a larger posterior segment of the brain and a larger head circumference in the first years of life. This probably influences the networking of information in the brain.
Disturbed brain chemistry
People with an autism spectrum disorder usually have higher levels of the messenger substances serotonin and dopamine. Doctors take advantage of this fact in autism therapy: so-called serotonin reuptake inhibitors are used, which also help with depression.
Autism: examinations and diagnosis
Up to the age of 18 months, the linguistic and motor skills of children generally develop very differently. Therefore, until that time, a clear autism diagnosis is difficult. Especially more intelligent children also manage to hide some symptoms. This is problematic: early detection is important for early support of the child.
Autism diagnosis by the doctor
Some symptoms can also be caused by physical illness. The doctor must first rule these out. Neurological, chemical laboratory and imaging methods help him in this process. He also checks the functionality of ears and eyes in hearing and vision tests. It is also important to measure the brain waves (EEG): this allows brain damage to be detected or ruled out.
Autism diagnosis by the psychiatrist
If no physical cause for the symptoms can be found, a specialist usually comes into play. Child and adolescent psychiatrists are very familiar with the symptoms and forms of autism. They have the necessary experience and diagnostic methods to make a reliable diagnosis.
The different expression of the symptoms can cause difficulties in the assessment. For example, the characteristic signs of autism can be so weak that they are hardly noticeable with good family support and integration. Thus, autism is often not diagnosed until adulthood.
With the help of questionnaires, specific symptoms are assessed in special autism tests. The focus is on the symptom complexes that are characteristic of autism spectrum disorders. For infants, parents answer the questions and assess the symptoms.
Frequently, specialized physicians use the “Diagnostic Observation Scale for Autistic Disorders” (ADOS) and the “Diagnostic Interview for Autism” (ADI-R). These methods can be used for patients from the age of two.
Autism test: intelligence tests
In particular, early childhood autism is associated with a mental disability in 70 percent of cases. If autism is suspected, the intelligence quotient (IQ) is also determined. Common tests are:
- Hamburg-Wechsler-Intelligence Test for Children (HAWK-IV): In addition to the total IQ, areas of language comprehension, logical thinking, processing speed and working memory are examined in about 60 minutes.
- Hannover-Wechsler-Intelligence Test for Preschool Age (HAWIVA): This test is used for children between the ages of 2 and 6.
- Changer intelligence test for adults
- further tests for language development
Mild autism in particular can go unnoticed for years and only manifest itself in adulthood under changed conditions. Many affected people then often report that they have always felt “different” from their fellow human beings. That is why there are now a number of autism self-tests that can be used to make an initial self-assessment.
Autism severity assessment tests
A so-called autism spectrum quotient (AQ) serves as a measure of the severity of an autism spectrum disorder. The AQ-Test developed by Simon Baron-Cohen attempts to provide an initial assessment in 50 questions.
Attention: Autism self-tests do not replace a visit to the doctor. However, they can confirm a first suspicion. The affected persons should then visit a specialist to have further examinations carried out.
Forms of Autism
Autism spectrum disorder includes various forms of autism and related disorders.
Early childhood autism
When we speak of autism, we usually mean early childhood autism. The first symptoms such as aversion to contact are already apparent in infants. However, the diagnosis is usually made around the 18th month of life.
Typical for children with early childhood autism are the classic symptoms of autism, i.e. lack of social competence, language and communication problems and stereotypical behaviour.
You can read more about this form of autism in the article Early childhood autism.
Asperger’s syndrome usually only becomes noticeable after the age of three. The children show some symptoms of early childhood autism, for example, disturbed social skills, a stereotypical behaviour pattern or a special interest in a particular thing. Many are also motorically clumsy and somewhat “clumsy”.
In Asperger syndrome, however, the symptoms are less pronounced than in early childhood autism. Many of those affected are normally intelligent. Through supportive group therapy, they can learn to cope very well with their “otherness” in everyday life and to lead an independent life. You can read more about this form of autism in the article Asperger syndrome.
Atypical autism (psychogenic autism) is also called early childhood autism with an atypical age or atypical symptoms.
It differs from early childhood autism in that affected children do not develop the autistic disorder until after the age of three or do not show all symptoms.
High-functioning autism is not an official diagnostic classification. It describes people with typical symptoms of early childhood autism who have a relatively high level of intelligence or special abilities in certain areas.
In addition, the term is also used for autistic people who were diagnosed with early childhood autism in childhood, but who have developed well and can live independently in adulthood.
Other developmental disorders with autistic features
In addition to the three typical forms of autism, there are other profound developmental disorders that have similar symptoms to autistic people but do not meet the diagnostic definition of “autism”.
Rett syndrome occurs almost exclusively in girls – in contrast to autistic disorders, which affect boys more frequently. First symptoms appear after an initially normal development between the 7th and 24th month of life.
The affected children seem to forget skills of hands and language they had already learned. With their hands they increasingly perform stereotypical, stroking “washing movements”.
At the same time, head growth decreases between the fifth month of life and the fourth year of life. The children completely lose their ability to speak again. Their intelligence is greatly diminished.
Other disintegrative disturbances
In addition to Rett syndrome, there are other childhood disorders in which acquired skills are lost after an initially normal development and which belong to the autistic form.
Disintegrative disorders include language, social interaction and communication skills. Those affected often lose control of the bladder and bowel. They show repeated, stereotypical patterns of behaviour and usually a severe mental retardation.
Hyperactive disorders with reduced intelligence and movement stereotypes
Hyperactive disorders are often difficult to distinguish from other forms of autism. There are behavioral problems associated with stereotypes, mental retardation and, in some cases, self-harming behaviour.
Such hyperactive disorders may also fall within the autistic spectrum. Typical for these disorders is that they cannot be treated with medication. In addition, during puberty the initial hyperactivity is reversed into hypoactivity – i.e. a reduced urge to move.
Every autism is individual. The therapy must be correspondingly individual. The holistic concept includes supporting the existing abilities of the child and developing new ones. The environment of the child is included in the therapy. In this way, the child can train his or her skills in the group, with the family and other children.
Focusing: In order to cope better in everyday life, people with early childhood autism learn through games and rewards to direct their perception to the important information. As a result, they understand their environment better and the fear of change decreases.
Behavioral Therapy: Behavioral therapy techniques can improve social skills and reduce stereotypical behaviour. Role playing and contact with children without autism are helpful, for example.
Language training: Language training (speech therapy) can explain the social meaning of linguistic elements to those affected and promote language understanding and active speaking. However, it should start before the age of eight, as the chances of success decrease with age.
Goals of Autism Therapy
The essential aim of the therapy is to promote the following skills:
- Readiness to contact
- people skills
- communicative skill
- Speaking and speech understanding
- Understanding of gestures
- Everyday behavior
There are also a number of treatment approaches that have been developed specifically for the work of people with autism.
TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) is a program specialized in autistic people. It is suitable for children as well as for adults.
The most important goal of the program is to improve the independence and quality of life of autistic people. To this end, an individual concept is developed for each client, taking into account their particular strengths and interests.
Clear structures are especially important for people with autism. They give them security and enable them to adapt better to new situations. This applies to everyday life as well as to learning. TEACCH relies on two central principles:
- Structured teaching: This involves the division of the teaching material and the learning environment into spatial and temporal structures. This gives those affected security, makes it easier for them to find their way around and helps them to learn.
- Visualization: Many autistic people have difficulty processing heard information. However, they often possess outstanding receptive abilities about seeing. These are used to prepare learning content accordingly and make it more easily accessible.
Examples for the practical application of these two principles: The classroom is visually divided into a learning and a rest area. The teaching material is sorted by colour and shape. The teaching time is temporally structured by signals such as ringing or start and end rituals.
Applied Behaviour Analysis (ABA)
Another therapeutic option is Applied Behaviour Analysis (ABA) and the complementary Verbal Behaviour (VB). This allows social and communicative skills to be trained.
Learning by conditioning
To do this, the therapist first determines which skills an autistic child already possesses and which ones he or she should still learn. Then complex behaviours are broken down into the smallest steps, which the child can then learn step by step. Desired behavior is rewarded and thus strengthened.
Inappropriate behaviour such as shouting, tantrums or running away are consistently ignored. In principle, ABA is thus based on the classic conditioning therapy.
Training of self-control and Theory of Mind
Two typical weaknesses make social contacts difficult for many autistic people: lack of self-control and lack of “Theory of Mind”
The Theory of Mind is the intuitive ability to understand the emotions, thoughts and intentions of others. Normally, this develops automatically and quite incidentally in children. Children with autism must learn to interpret facial expressions, looks or gestures. They also find it difficult to understand irony or metaphors.
Special exercises can help autistic people to distinguish between their own thoughts and those of their environment. The exercises can also train the understanding of other people’s feelings.
Conversely, people with autism also have problems in exploring their own emotional world. Here too, exercises help them to recognize their feelings, to classify them and to perceive them in time if they are overstrained or frustrated. In this way, emotional outbursts and crises can be defused in advance.
Help for the family
Parents of autistic children are exposed to much greater stress in everyday life than parents of normal children. Therefore, there are a number of programs to help them reduce stress and learn how to handle their autistic children properly. They are also taught methods to establish better contact with their child.
Autism spectrum disorders are often accompanied by other diseases that make behavior therapy difficult. These can be depression, anxiety disorders and epilepsy, for example. Such diseases can often be treated well with medication.
Repeated, stereotypical movements can be alleviated with special agents, the so-called selective serotonin reuptake inhibitors (SSRI), if necessary. Atypical neuroleptics can help with aggressiveness against oneself and others.
Attention: Autistic people often react particularly sensitively to medication. Therefore, side effects are often more pronounced in them. In addition, the use of such drugs is only intended to support, but not replace, behavioral therapies.
Autism therapy for adults
If mild autism is not diagnosed until adulthood, those affected can benefit from discussion groups and behavioural therapies under outpatient psychiatric care. They learn to understand feelings better and to put themselves in other people’s shoes. They also learn how to strengthen their social contacts.
Alternative treatment approaches
Many affected persons and their relatives also try alternative therapeutic approaches. Their effectiveness is often not proven, and in some cases the methods are even highly controversial. Furthermore, the costs are often high and are usually not covered by the insurance companies. You should therefore discuss with the treating therapist whether a complementary therapy is useful or could possibly cause harm.
The following, among others, are currently considered invalid:
- Psychodynamic, uncovering therapy: Research is carried out into pathogenic parenting influences and lack of parent-child relationships. This leads to recriminations.
- Holding therapy: Holding the child to break its resistance.
- Scotopic sensitivity training
- Dolphin therapy
- Aided communication
- Gluten-free nutrition
- Administration of high doses of vitamins, trace elements, secretin
Autism: course and prognosis
How an autistic disorder develops in an individual case cannot be predicted. The course of the disease depends, among other things, on the form of autism and any accompanying diseases (such as depression).
In early childhood autism, for example, the typical symptoms persist throughout the child’s life, such as problems with social interaction and relationship-building, and language impairment. The symptoms are usually most pronounced in childhood. For some of those affected, behaviour then improves in adolescence and early adulthood. However, there are also people in whom the autistic disorder remains unchanged into adulthood or in whom the symptoms increase again after initial improvement.
The majority of autistic people have a mental disability that limits their intelligence. Some also suffer from sleep disorders, anxiety or sometimes aggressive behaviour.
About 75 percent of autistic people are dependent on help for their entire lives. Most autistic young people today grow up in their families. They receive promotional measures and are intensively supported.
However, there are also people with mild autism who can cope well on their own. You are able to train a certain level of social competence. Some autistic people also have demanding professions. Especially island talents (such as a great talent for arithmetic) can often be used effectively at work.