What Causes Autism Spectrum Disorders

autism

Autism: Quick Reference

  • Description: Group of profound developmental disorders which, among other things, can make social life difficult
  • To shape: e.g. early childhood autism, Asperger's syndrome, atypical autism
  • Symptoms: Depending on the degree and severity, e.g. impaired social skills, language and communication disorders, stereotypical behavior, reduced intelligence, but also isolated, outstanding mental abilities
  • Causes: genetic causes, disturbed brain development, disturbed brain metabolism
  • Treatment: Autism is not a disease and in that sense does not require "curative" therapy. The symptoms can often be improved with various methods, e.g. behavior therapy to improve social skills, speech training
  • Forecast: If it is mild (especially Asperger's Syndrome), an independent life is possible. People with more pronounced autism, on the other hand, are often dependent on help for life. In addition, the prognosis depends on any 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 (ASD). This includes three different main forms of autism:

  • Early childhood autism
  • Asperger syndrome
  • Atypical autism

The appearance of autism varies greatly depending on the form and severity of the disorder. Some sufferers only develop mild autism, which has little impact on their everyday life. Others are severely disabled.

Among other things, intelligence and language skills are very different: The majority of autistic people are mentally limited. But there are also normal and even highly gifted people affected. In some cases, the different forms of autism also flow into one another.

  • "Autistic people are often a great asset"

    Three questions to

    Dr Miriam Bachmann,
    Child and youth psychiatrist
  • My baby is not making eye contact - do I have to worry?

    In general, this can be a first indication of an autism spectrum disorder. However, there are also possible other reasons: hearing and vision difficulties, psychiatric, neurological or motor diseases or other mental disorders. Talk to your pediatrician about it. He accompanies the babies from an early age and can assess whether an extended child and adolescent psychiatric or neuropediatric examination is required.

  • Why are routines so important for autistic people?

    Routines and rituals are often relaxing for autistic people. They provide security and security. But behind routines or “quirks” there can also be obsessive-compulsive illnesses. This should be clarified by a doctor. Not every need, e.g. to put toy cars in a long row or to insist on certain procedures when getting dressed, are an explicit indication of autism or other disorders. This can also be completely normal, childlike behavior.

  • As an expert, do you have any tips on how to deal with autistic people?

    One should keep in mind that the idea of ​​when people are happy cannot be transferred 1: 1 to autistic people. You should respect no need for friendships, an aversion to small talk, a pronounced need for rest and a faster exhaustion. But life with autistic people is also often a great enrichment. They have great qualities like reliability, strict rules, a love of justice and a great, dry sense of humor.

  • Dr Miriam Bachmann,
    Child and adolescent psychiatrist

    Dr. In her own practice in Hamburg, Bachmann mainly deals with ADHD, gifted people, autism and analytical couple and family therapy.

Symptoms

Most autistic people show three main characteristics:

  • Your social skills are impaired.
  • Your communication and language are impaired.
  • They show repetitive, stereotypical behaviors and interests.

Attention: The type and severity of the symptoms are individual and very different depending on the type of autism. In Asperger's syndrome, for example, the symptoms are generally less pronounced than in early childhood autism. In the latter form, there are also big differences among those affected - the spectrum ranges from only mild impairment to severe disorders.

Autism Symptoms: Social Interaction

Many autistic people find it difficult to develop relationships with others. This is often noticeable in infancy. Many autistic children cannot develop a close bond with their parents and cannot react to stimuli from the environment.

For example, babies typically seek their mother's gaze and physical contact to create 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 it shows little reaction to the environment.

Even in later childhood as well as in adolescence and adulthood, autistic people often have problems establishing and maintaining eye contact.

With a pronounced autistic disorder, those affected can hardly enter into friendly relationships. Affected children prefer to play alone. Often people only notice them when they are supposed to meet their needs (e.g. when they are hungry).

Confusing world of emotions

People with autism often find it difficult to understand other people's feelings and to empathize with others. They are also often unable to express their own feelings either poorly or not at all. They often show hardly any spontaneous emotions such as joy or interest in others and in different activities. In addition, autistic people often cannot adapt their reaction to the general mood. It can happen, for example, that they start laughing for no apparent reason.

Autism Symptoms: Communication

The speech of autistic people is also often disturbed. For example, 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 robotic impression.

In contrast, in patients with Asperger's Syndrome, the language is often very highly developed. But it sometimes seems strangely monotonous and stilted.

Experts have also defined important general symptoms of autism for language:

  • Language development lags behind. The children do not try to express themselves through their gestures or body language.
  • The children have trouble starting or maintaining a conversation.
  • The scope of the language is very limited and one-sided. Often sentences or questions are repeated.

Autism Symptoms: Interests and Behavioral Patterns

The third major major symptom in autism is often stereotypical behavior. Many affected people persistently carry out certain actions, rituals and habits. If you are interrupted or prevented from doing so, you sometimes react with screaming fits and panic attacks.

Often, autistic people cannot part with their favorite things and take them with them wherever they go.

In addition, many autistic people seem to have all of their interest focused on certain specific details or things that occupy them fully.

In summary, the following abnormalities are characteristic of autistic people with this complex of symptoms:

  • Those affected are primarily 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.
  • They choose a very specific detail on a toy to deal with. They rarely include the entire object in the game.
  • The games played by affected children are rather unimaginative and stereotypical. Imitative gaming behavior is also absent.
Autism: The Lives of Others
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Concomitant phenomenon: island talent

Many autistic people also have savant syndrome. That means: You have a special gift for insemination. For example, some are real arithmetic geniuses, others have a photographic memory or learn languages ​​in record time. They dedicate themselves to their special talent with great perseverance, but often have hardly any other interests.

Some savants have decreased intelligence in areas outside of their specialty. However, there are also both normally intelligent and highly gifted savants.

Autism: causes and risk factors

Various factors play a role in the development of autism.

Genetic causes

Experts assume that autistic disorders are primarily caused by changes in the genetic make-up. Twin and sibling studies support this theory. 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 examined. In the case of dizygotic twins, on the other hand, the second sibling also develops autism in only 23 percent of cases.

Obviously, 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 - a genetic change on the X chromosome is the cause of a cognitive disability.

Brain development

So far, researchers have not been able to detect any changes in the brain that are typical of autism. However, abnormalities were found in those parts of the brain that are responsible for social and communication skills. It is still unclear whether they arose as a result of autism or whether they caused the symptoms.

The brain development of autistic children is probably already disturbed in the womb, which later affects normal brain development. Autistic children, for example, have a larger rear part of the brain and a larger head circumference in the first few years of life. This probably affects the networking of information in the brain.

Dysfunctional 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 18th month of life, the language and motor skills of children generally develop very differently. Therefore, a clear diagnosis of autism is difficult up to this point. More intelligent children in particular manage to hide some symptoms. This is problematic: early detection is important for early support for the child.

Autism diagnostics at the doctor

Some symptoms can also be due to physical illnesses. The doctor must first rule this out. Neurological, laboratory chemistry and imaging methods help him in this. In addition, he checks the functionality of ears and eyes in hearing and eye tests. It is also important to measure the brain waves (EEG): this can be used to detect or exclude brain damage.

Autism diagnosis from a 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 be able to make a reliable diagnosis.

The different severity of the symptoms can cause difficulties in the assessment. The characteristic signs of autism can appear so weak that they are hardly noticeable with good family support and integration. Autism is often only diagnosed in adulthood.

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Autism: test

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. In the case of small children, parents answer the questions and assess the symptoms.

Often, specialist doctors use the “Diagnostic Observation Scale for Autistic Disorders” (ADOS) and the “Diagnostic Interview for Autism” (ADI-R). These methods can be used on those affected from the age of two.

Autism test: intelligence tests

In particular, early childhood autism is 70 percent associated with an intellectual disability. If autism is suspected, the intelligence quotient (IQ) is determined among other things. Common tests are:

  • Hamburg-Wechsler Intelligence Test for Children (HAWK-IV): In addition to the overall IQ, areas of speech comprehension, logical thinking, processing speed and working memory are also examined in about 60 minutes.
  • Hanover Wechsler Intelligence Test for Pre-School Age (HAWIVA): This test is used for children between the ages of 2 and 6.
  • Wechsler intelligence test for adults
  • further tests for language development

Mild autism in particular can go unnoticed for years and only show up in adulthood under changed conditions. It is not uncommon for many of those affected to 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.

Tests to assess the severity of autism

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 tries to provide an initial assessment in 50 questions.

Warning: Autism self-tests are not a substitute for a visit to the doctor. But you can confirm an initial suspicion. Those affected should then see a specialist for further examinations.

Read more about the examinations

Find out here which examinations can be useful for this disease:

Forms of autism

Autism spectrum disorder includes various forms of autism and related disorders.

Early childhood autism

When one speaks of autism, what is usually meant is early childhood autism. The first symptoms such as avoidance of contact can already be seen in the infant. The diagnosis is usually only made around the age of 18 months.

Typical for children with early childhood autism are the classic symptoms of autism, i.e. a lack of social skills, language and communication problems and stereotypical behaviors.

You can find out more about this form of autism in the article Early Childhood Autism.

Asperger syndrome

Asperger's syndrome usually only becomes noticeable after the age of three. The children show some symptoms of early childhood autism, for example impaired social skills, a stereotypical behavior pattern, or a special interest in a particular cause. In addition, many of them have poor motor skills and are a bit "clumsy".

In Asperger's syndrome, however, the symptoms are less pronounced than in early childhood autism. Many of those affected have normal intelligence. Through supportive group therapies, you can learn to cope very well with your “otherness” in everyday life and to lead an independent life. You can read more about this form of autism in the article Asperger's Syndrome.

Atypical autism

Atypical autism (psychogenic autism) is also called early childhood autism with atypical age of onset or atypical symptoms.

It differs from early childhood autism in that affected children do not develop the autistic disorder until they are three years old or do not show all symptoms.

High-Functioning Autism

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 skills in individual 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 symptoms similar to those of autism, but do not meet the diagnostic definition of “autism”.

Rett Syndrome

Rett syndrome occurs almost exclusively in girls - in contrast to autistic disorders, which are more common in boys. The first symptoms appear after an initially normal development between the 7th and 24th month of life.

The affected children seem to forget the skills of the hands and language that 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 language skills again. Your intelligence is severely reduced.

Other disintegrative disorders

In addition to the Rett syndrome, there are other disorders in childhood in which acquired skills are lost after an initially normal development and which belong to the autistic group of forms.

Language, social interaction and communication skills suffer from disintegrative disorders. People often lose control of their bladder and bowel. They show repetitive, stereotypical behavior patterns and mostly severe intellectual disabilities.

Hyperactive disorders with intellectual disabilities and movement stereotypes

Hyperactive disorders are often difficult to distinguish from other forms of autism. There are behavioral problems associated with stereotypes, intellectual disabilities and, in some cases, self-harming behavior.

Such hyperactive disorders may also fall into the autistic spectrum. Typical of these disorders is that they cannot be treated with medication. In addition, during puberty, the initial hyperactivity turns into hypoactivity - i.e. a reduced urge to move.

Autism: treatment

Every autism is individual. The therapy must also be correspondingly individual. The holistic concept includes supporting the child's existing skills and developing new ones. The child's environment is included in the therapy. In this way, the child can train their skills in a group, with the family and with other children.

Focus: In order to cope better in everyday life, people with early childhood autism learn in games and through rewards to direct their perception to the important information. This helps them understand their environment better and the fear of change decreases.

Behavior Therapy: Behavioral therapy techniques can improve social skills and reduce stereotypical behaviors. For example, role play and contact with children without autism are helpful.

Language training: Language training (speech therapy) can explain the social significance 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 main goal of therapy is to promote the following skills:

  • independence
  • Willingness to contact
  • social competence
  • communicative competence
  • empathy
  • Speaking and understanding language
  • Understanding of gestures
  • Everyday behavior

There are also a number of treatment approaches that are specifically designed to work for people with autism.

TEACCH

TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) is a program specializing in autistic people. It is just as suitable for children as it is for adults.

The main goal of the program is to improve the independence and quality of life of autistic people. For this purpose, an individual concept is developed for each client, which takes into account their particular strengths and interests.

Clear structures are particularly 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 is about 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 learn.
  • Visualization: Many autistic people have difficulty processing information they hear. However, they often have excellent perception abilities. These are used to prepare learning content accordingly and to make it more easily accessible.

Examples of the practical application of these two principles: The classroom is visually divided into a study and a relaxation area. The teaching material is sorted by color and shape. The lesson time is structured in terms of time using signals such as ringing or opening and closing rituals.

Applied Behavior Analysis (ABA)

Another therapy option is the Applied Behavior Analysis (ABA), in English "Applied Behavior Analysis", and the supplementary Verbal Behavior (VB). This can be used to train social and communication skills.

Learning through conditioning

To do this, the therapist first determines which skills an autistic child already has and which ones it should still learn. Then complex behaviors are broken down into the smallest sub-steps, which the child can then learn step by step. Desired behavior is rewarded and thus reinforced.

Inappropriate behavior such as screaming, tantrums or running away are consistently ignored. In principle, the ABA is based on the classic conditioning therapy.

Training in self-control and the theory of mind

Two typical weaknesses make social contacts difficult for many autistic people: a lack of self-control and a lack of "theory of mind."

The theory of mind is the intuitive ability to understand other people's emotions, thoughts and intentions. Usually in children this develops automatically and quite incidentally. Children with autism, on the other hand, have to learn how to interpret facial expressions, looks, or gestures with great difficulty. They also find it difficult to understand irony or metaphors.

Special exercises can help autistic people to differentiate between their own thoughts and those of those around them. In addition, the exercises can train the understanding of other people's feelings.

Conversely, people with autism also have problems exploring their own emotional world. Here, too, exercises help them to recognize their feelings, to classify them and to notice them in good time if they are overwhelmed or frustrated. In this way, emotional outbreaks 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 that are designed to help them relieve stress and learn how to properly deal with their autistic children. They are also taught methods of establishing better contact with their child.

Medication

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 active ingredients, the so-called selective serotonin reuptake inhibitors (SSRIs). Atypical neuroleptics can help if you are aggressive towards yourself or others.

Caution: Autistic people are often particularly sensitive to medication. Therefore, side effects are often more pronounced with them. In addition, taking such drugs should only support behavioral therapies, not replace them.

Autism Therapy in Adults

If mild autism is only discovered in adulthood, those affected can benefit from discussion groups and behavioral therapies under outpatient psychiatric care. You will learn to understand feelings better and to empathize with other people. They also learn how to strengthen their social contacts.

Alternative approaches to treatment

Many sufferers and their relatives also try alternative therapeutic approaches. Their effectiveness has often not been proven, and in some cases the methods are even very controversial. In addition, the costs are often high and are usually not covered by the health insurers. You should therefore discuss with the treating therapist whether additional therapy would be useful or whether it could possibly cause damage.

The following are currently considered to be ineffective:

  • Psychodynamic, revealing therapy: Research is carried out into pathogenic influences on upbringing and a lack of parent-child relationship. That leads to blame.
  • Holding therapy: holding the child to break their resistance.
  • Training according to Delacato
  • Scotopic sensitivity training
  • Dolphin therapy
  • Supported communication
  • Gluten free diet
  • Administration of high-dose vitamins, trace elements, secretin

Read more about the therapies

Read more about therapies that can help here:

Autism: course and prognosis

How an autistic disorder will develop in individual cases cannot be predicted. The course depends, among other things, on the type of autism and any accompanying illnesses (such as depression).

For example, in early childhood autism, the typical symptoms persist throughout life, such as problems with social interaction and relationship building, as well as speech impairments. Symptoms are usually most pronounced in childhood. In some of those affected, behavior improves in adolescence and early adulthood. But there are also people in whom the autistic disorder remains unchanged into adulthood or in whom the symptoms increase again after an initial improvement.

The majority of autistic people have an intellectual disability that limits their intelligence. Some also suffer from sleep disorders, fears or sometimes aggressive behavior.

Around 75 percent of autistic people depend on help for their entire life. Most autistic adolescents today grow up in their families. You will receive funding and intensive support.

But there are also people with milder autism who can get along well on their own. You are able to develop a certain level of social competence. Some autistic people also have demanding jobs. Especially island talents (such as a great arithmetic talent) can often be used effectively at work.

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