Onset Time (from "Autism speaks")
Is it possible that autism starts even earlier (before birth)? Research tells us “yes.”
“When does autism start?” is one of the most profound questions we face in our field. At
present, autism can’t be reliably diagnosed until around 2 years of age. However, parents
often notice symptoms before then. In fact, analysis of videotapes from children’s first-birthday
parties shows that signs of autism are already present for many children at that age, even
hen parents don’t become concerned until months or years later.
In most medical conditions, the underlying processes are triggered before their signs and
symptoms become obvious. Consider arthritis. The joints are breaking down and inflammation
is setting in years before the aches and pains appear. In dyslexia (reading disability), the
symptoms are not obvious until a child starts learning how to read. But the symptoms are
rooted in brain differences that are present much earlier in development.
A similar chain of events occurs in autism. We know that toxic exposures during pregnancy
and complications associated with delivery can disrupt brain processes before birth and
shortly afterwards. Mutations in the genes associated with autism can affect how the brain
develops and functions, starting well before birth.
Even though the outward symptoms of autism may not be apparent immediately after birth,
the underlying brain differences are accumulating. Sometimes the brain can compensate to
make up for the disrupted processes. Eventually though, if the disruption was sufficiently
severe, the compensatory processes are no longer enough, and symptoms emerge.
This may likewise explain many cases of autistic regression, in which a young child seems to
be developing normally, only to lose abilities, or regress, into autism. Perhaps the initial
disruption in brain development continued worsening. Or perhaps the compensatory
processes couldn’t keep up.
Given how complex the brain is, it can be very difficult to correct differences in brain
development and function that start so early in life.
One of the most common questions asked after a diagnosis of autism, is what caused the
disorder. We know that there’s no one cause of autism. Research suggests that autism develops
from a combination of genetic and nongenetic, or environmental, influences. These influences
appear to increase the risk that a child will develop autism. However, it’s important to keep in
mind that increased risk is not the same as cause. For example, some gene changes associated
with autism can also be found in people who don’t have the disorder. Similarly, not everyone
exposed to an environmental risk factor for autism will develop the disorder. In fact,
most will not.
Autism’s genetic risk factors
Research tells us that autism tends to run in families. Changes in certain genes increase the risk
that a child will develop autism. If a parent carries one or more of these gene changes, they may
get passed to a child (even if the parent does not have autism). Other times, these genetic
changes arise spontaneously in an early embryo or the sperm and/or egg that combine to create
the embryo. Again, the majority of these gene changes do not cause autism by themselves.
They imply increase risk for the disorder
Autism’s environmental risk factors
Research also shows that certain environmental influences may further increase – or reduce
– autism risk in people who are genetically predisposed to the disorder. Importantly, the
increase or decrease in risk appears to be small for any one of these risk factors:
Advanced parent age (either parent)
Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth
multiple pregnancies [twin, triplet, etc.])
Pregnancies spaced less than one year apart
Prenatal vitamins containing folic acid, before and at conception and through pregnancy
No effect on risk.
Vaccines. Each family has a unique experience with an autism diagnosis, and for some it
corresponds with the timing of their child’s vaccinations. At the same time, scientists have
conducted extensive research over the last two decades to determine whether there is any
link between childhood vaccinations and autism. The results of this research is clear: Vaccines
do not cause autism. The American Academy of Pediatrics has compiled a comprehensive list
of this research.
Differences in brain biology
How do these genetic and nongenetic influences give rise to autism? Most appear to affect
crucial aspects of early brain development. Some appear to affect how brain nerve cells, or
neurons, communicate with each other. Others appear to affect how entire regions of the
brain communicate with each other. Research continues to explore these differences with an
eye to developing treatments and supports that can improve quality of life.
Asperger syndrome, or Asperger’s, is a previously used diagnosis on the autism spectrum.
In 2013, it became part of one umbrella diagnosis of autism spectrum disorder (ASD) in the
Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5).
Though the diagnosis of Asperger syndrome is no longer used, many previously diagnosed
people still identify strongly and positively with being an “Aspie.”
* Cognitive behavioral therapy can help address anxiety and other personal challenges.
* Social skills training classes can help with conversational skills and understanding social cues.
* Speech therapy can help with voice control.
* Physical and occupational therapy can improve coordination.
* Psychoactive medicines can help manage associated anxiety, depression and attention deficit
and hyperactivity disorder (ADHD).
How has our understanding evolved?
1944: Austrian pediatrician Hans Asperger described four strikingly similar young patients.
They had normal to high intelligence. But they lacked social skills and had extremely narrow
interests. The children also shared a tendency to be clumsy.
1981: British psychiatrist Lorna Wing published a series of similar case studies. In it, she coined
the term “Asperger syndrome.”
1994: Asperger syndrome listed in the Diagnostic and Statistical Manual of Mental
2003: Asperger syndrome and other previously separate types of autism folded into
one umbrella diagnosis of “autism spectrum disorder” in DSM-5.
- - - - - - - - -
Do autistic toddlers smile & laugh?
A child at risk for autism may not smile or laugh in response to your smile or playfulness although
he/she may smile at you on their own and look very happy.
Sources and Resources:
Autism Speaks at www.autismspeaks.org/
Movie: Boy called Po.
Young girl with autism finds her voice at 11, and speaks about how it feels inside:
Watch the video: https://youtu.be/a1uPf5O-on0
For Additional Facts and Figures
Check this link: https://www.autismspeaks.org/autism-facts-and-figures
Onset and Developmental Progression see HERE
Sensory Awareness see HERE.
Social Communication see HERE
Traits, Characteristics and Symptoms see HERE
NOTES (raw) Temporary (What We Know - summary) Draft Version
Please Note: this section too, is going through revision and development
While it's handy to describe autistic people based on their similarity to typical people, such
descriptions can be misleading. That's because low functioning people may be successful
where high functioning people are not, and vice versa. For example, the "high functioning"
person who appears "normal" (or even exceptional) in a college classroom may find it
impossible to function at a party. Meanwhile, the "low functioning" person who can't use
spoken language to chat may be more than capable of leading a conversation online.
"Levels" of Autism from the DSM5 (not my favourite source).
To provide some type of differentiation in diagnosis, the DSM 5 (the newest diagnostic
manual) now includes three levels of autism based on necessary levels of support.
* People with level one autism need the least support, while people with
level three autism need the most
While this diagnostic approach sounds logical, it has not proved to be particularly
useful. That's in part because the need for support varies for so many reasons. For
example, the same individual may need minimal support in the home, significant
support at school, and a great deal of support in a novel, unstructured social situation.
Klaas Tuinman M.A.
Life Self-Empowerment Facilitation
at Dawn Cove Abbey
Comments and Questions are welcomed