Given ASD’s complexity, there are many causes, with two probable causes being:

Genetics

Different genes appear to be involved: 

• • Can be associated with genetic disorders that cause intellectual problems, such as fragile X syndrome or Rett syndrome (occurs in girls and causes slowing of head growth)
  • Genetic changes may increase risk. Some genetic mutations seem to be inherited, while others occur spontaneously
  • Other genes may affect brain development, severity of symptoms or how brain cells communicate

Environmental factors 

Researchers are currently exploring whether such factors as viral infections, medications, complications during pregnancy or air pollutants can trigger ASD.

No link between vaccines and ASD

Despite extensive research, there is no evidence of a link between ASD and childhood vaccines. The original study that ignited the debate was retracted due to poor design and questionable research methods.

ASD cases are rising, though it is unclear whether this is due to better detection and reporting, an actual increase or both. Certain factors increase risk: 

Family history. Families with one child with ASD have increased risk of having another child with the disorder. Parents or other relatives might have minor problems with social or communication skills themselves or engage in certain behaviors typical of the disorder.

Other medical conditions, such as tuberous sclerosis, in which benign tumors develop in the brain

Extremely preterm babies. Babies born before 26 weeks of gestation 

Parents’ ages. More research is necessary, but there may be a connection between ASD and children born to older parents

Social communication and interaction

• • Fails to respond to name or appears not to hear
  • Resists cuddling and holding. Seems to prefer playing alone, retreating into a private world
  • Does not speak, has delayed speech or loses previous ability to speak; only starts a conversation to request or label items
  • Speaks with an abnormal tone or rhythm; may use singsong voice or robot-like speech
  • Repeats words or phrases verbatim, but does not understand how to use them. Does not seem to understand simple questions or directions
  • Has poor eye contact and lacks facial expression. Does not express emotions or feelings. Appears unaware of others’ feelings
  • Inappropriately approaches a social interaction by being passive, aggressive or disruptive
  • Has difficulty recognizing nonverbal cues, such as interpreting other people’s facial expressions, body postures or tone of voice

Patterns of behavior

• • Moves repetitively: rocking, spinning or hand flapping. Has coordination problems or odd movement patterns, such as clumsiness or walking on toes. Has odd, stiff or exaggerated body language.
  • Performs activities that could cause self-harm, such as biting or head-banging.
  • Develops specific routines or rituals and becomes disturbed by change.
  • Fixates on an object or activity with abnormal intensity or focus. Is fascinated by a toy car’s spinning wheels without understanding their purpose or function, for example. 
  • Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature.
  • Does not engage in imitative or make-believe play.
  • Has specific food preferences, such as eating only a few foods or refusing foods with a certain texture.

For an ASD diagnosis, the following must be present:

Be present early in life: Some children show signs in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Others may develop normally for months or years, but then become withdrawn or aggressive or lose acquired language skills. Signs usually are seen by age 2.

Cause significant functional impairment: Because of the range of symptoms, determining severity is difficult and generally based on level of impairment and its impact on ability to function. Clinicians rate severity of impairment from level 1 (minimal support needed) to level 3 (substantial support needed).

Rule out another disability, such as developmental delay.

Some children with ASD have difficulty learning. Some have signs of lower than normal intelligence. Others, however, have normal to high intelligence—they learn quickly, yet have trouble communicating and applying what they know in everyday life and adjusting to social situations

Diagnosis might start at home by noting whether a child:

• • Responds with a smile or happy expression by 6 months
  • Mimics sounds or facial expressions by 9 months
  • Babbles or coos by 12 months
  • Mimics sounds or facial expressions by 9 months
  • Babbles or coos by 12 months
  • Gestures—such as point or wave—by 14 months
  • Says single words by 16 months
  • Plays “make-believe” or pretend by 18 months
  • Says two-word phrases by 24 months
  • Retains language skills or social skills at any age

After observing and determining whether the child has certain behaviors, a neuropsychologist may administer tests that focus on areas of difficulty with language or other areas of functioning. Additional medical tests might also be helpful. 

CFI’s highly specialized team of neuropsychologists (Pediatric Assessment Center) specialize in ASD evaluations, an important and hard-to-find service to evaluate and diagnose children with ASD.  Together with a team of medical, school and other experts, treatment includes integrated supports and skills building to help clients cope with the disorder and related challenges, including: 

• • Learning disorders / academic difficulties
  • Social skills difficulties 
  • School observation and consultation / IEP/504 planning / school placement issues

Early Intervention

While there is no way to prevent ASD, early diagnosis and intervention can improve behavior, skills and language development and lead to a better functioning life. 

As they mature, some children with ASD become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead well-adjusted and fulfilling lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral and emotional problems.

Treatment

Although ASD is a lifelong disorder, treatments and services can improve an individual’s symptoms and daily functioning–at any age. 

APPLIED BEHAVIORAL ANALYSIS

For children, adolescents and adults with ASD, applied behavioral analysis (ABA) can improve language, play and adaptive, social and vocational skills. It can also reduce problematic repetitive behaviors, sensory-seeking behaviors and aggression. The therapist interviews caregivers and observes the individual and environment to identify and mitigate triggers of unwanted behaviors. The therapist can also train caregivers to apply treatments at home.

SOCIAL SKILLS GROUPS

Social skills groups for 7-18 year olds can effectively teach social skills, such as starting a conversation and taking turns, nonverbal communication (eye contact, gestures) and play. Homework assignments help the child use these skills at home, in school and other social situations. They often include a parent training component.

COGNITIVE BEHAVIORAL THERAPY (CBT)

Therapists can modify cognitive behavioral therapy (CBT) to address other mental health problems, such as mood disorders and anxiety, by helping individuals change thoughts and behaviors. Visual supports are typically used for children with higher cognitive abilities, while more behavioral strategies (e.g., simple coping skills) are used for those with lower cognitive abilities. More research is needed to verify these therapeutic techniques for adults with ASD. 

BEHAVIORAL PARENT TRAINING

A behavioral parent training (PT) may be particularly effective for families of children with ASD to help them generalize skills to multiple settings, maintain gains made in treatment and be cost effective. Research shows including PT when working with children with ASD is related to improvements for both parents and children, such as decreased child behavior problems, ASD symptoms and parental distress.

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REFERENCES

Association for Behavioral and Cognitive Therapies (ABCT)

Mayo Clinic

National Institute of Mental Health (NIMH)