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Autism / Asperger's syndrome

 

 

Autism is a pervasive developmental disorder that results in impaired functioning of social skills, communication, and flexibility in thought and behavior. If you or someone you know has an autism spectrum disorder (ASD) there are ways to get help. In this article you can learn about autism, and some of the options to get help.

Photo: by Caleb Woods on Unsplash


This information is based on an article on the Norwegian Health Library [Health Library, 2019][1] .

Children with autism have a brain that works a little differently than it does in normally developed children. This has consequences for how autistic children develop.

From the outside, autistic children look like any other child. However, children with autism do not develop the skills they need to function socially or at school. 

You may have noticed that your baby was different from the time it was an infant. Most children with autism often show clear signs of diagnosis before the age of three. Autism affects different children in different ways. Some children will need help throughout their lives. Others can fend for themselves and will be able to live an independent life as adults.

 

What are the symptoms of autism?

If your child is autistic, you will probably see signs of the diagnosis between 18 months and two years of age, or even earlier. People with autism will often have difficulty speaking, struggle in social situations and may behave strangely.

You may notice that your child:

 

  1. does not respond when you shout at him / her, even if he / she seems to hear sounds
  2. do not meet your gaze, smile at you or notice that you are leaving or entering the room
  3. often seems to be in their own world

Three main areas are affected in autism:

 

Deviant social interest

You may have noticed that your child plays a little differently than other children. Children with autism often prefer to play alone. Usually children play role-playing games from the age of two. This rarely applies to children with autism.

Children with autism often dislike social activities such as playing with other children. They often show little affection in the form of smiles and physical closeness, which can be sad for parents and relatives.

 

Communication difficulties

Difficulty in communication skills is an important symptom of autism. 

 

Rigidity in behavior and interests

Children with autism can also be constantly repetitive in relation to certain activities and show interest in only certain things. For example, they can drive a toy car back and forth over and over again, and get very angry if you try to participate in, or change the game. You may therefore want to have exactly the same routines every day.

 

Other frequent signs

Special interests / preoccupations: Some children with autism are preoccupied with a particular thing / toy / topic, and will carry it with them at all times.

Language difficulties: Most children can make simple (two word) sentences from the age of two. If your child is autistic, the language development will probably take longer. Children with autism will sometimes start talking by the time they are around five years old. Some say just a few words that they often repeat. Others learn to speak the first year, but stop speaking in their second year of life.

Tantrums: Children with autism may also have frequent tantrums.

Other signs of autism include learning disabilities, sound sensitivity, hyperactivity, writing problems and physical problems. Some children with autism also have epilepsy.

 

Diagnosing autism

Only a specialist can diagnose autism. If you experience that your child has any of the problems mentioned above, you can talk to your GP. He or she should be able to refer you to a specialist. Somewhat different diagnostic tools are developed for respectively children [Le Couteur et al., 2008][2] and adults [Bastiaansen et al., 2011][3] .

 

find-help-mental-health-problemsHow common is autism?

It has proved to be somewhat difficult to provide a solid estimate for how common autism is. The number of cases has risen dramatically in recent decades, and various hypotheses have been put forward to explain this phenomenon. Among the most frequently addressed possibilities are expanded diagnostic criteria, more awareness of the disorder, diagnosis at earlier ages, and the recognition that autism is a lifelong condition [Matson & Kozolowski, 2011][4] .

Previously, prevalence estimates of autism was very low, ranging from 0.4 to 2 per 1,000 inhabitants in the 1960's and 1970's - translating to only around 0.04 to 0.2% [Fombonne, 2018][5] .

In recent years the prevalence of autism spectrum disorders is established as around 1.5% [Xu et al., 2018][6] .

 

What causes autism?

Experts are not sure what causes autism, but there is evidence to suggest that genetics play the biggest part in explaining why someone develop autism [Bai et al., 2019][7] .

However, researchers have not found a specific gene for the condition, but it may seem that it is a combination of genes that contribute to the diagnosis. Some parents may worry that they could do something to prevent their children from becoming autistic. There is no evidence for such a mindset. 

 

find-help-mental-health-problemsWhat kind of treatment works for autism?

There are no drugs that help with autism. But behavioral therapy (specifically applied behavior analysis, ABA) can help your child communicate and perform better [Foxx, 2008][8] . The most important treatment methods use specialized techniques to improve the child's learning ability and behavior. These forms of treatment have the best effect the earlier you start. 

Different children need different types of treatment, depending on their abilities and problems. For example, a child who does not speak needs a different type of treatment than a child who speaks. A specialist will assess the child's strengths and weaknesses before deciding what kind of treatment is best. Most children with autism do not need medication. Some doctors will still choose to give medication if the child has additional child psychiatric problems.

 

Different forms of help

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][9] .

     

  2. Online therapy

     

    find-help-mental-health-problems

     

    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][10] .

     

  3. Support / self-help groups

     

    find-help-mental-health-problems

     

    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][11] .

     

  4. Helplines and chats

     

    find-help-mental-health-problems

     

    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][12] .

     

  5. Online communities and forums

     

    find-help-mental-health-problems

     

    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][13] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

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References & Footnotes
  1. Health Library, 2019: Helsebiblioteket [The Health Library] (2019). Autisme og autismespekterforstyrrelser [Autism and autism spectrum disorders]. Retrieved 9th of February 2021 from: https://www.helsebiblioteket.no/pasientinformasjon/nevrologi/autisme
  2. Le Couteur et al., 2008: Le Couteur, A., Haden, G., Hammal, D., & McConachie, H. (2008). Diagnosing autism spectrum disorders in pre-school children using two standardised assessment instruments: the ADI-R and the ADOS. Journal of autism and developmental disorders38(2), 362-372.
  3. Bastiaansen et al., 2011: Bastiaansen, J. A., Meffert, H., Hein, S., Huizinga, P., Ketelaars, C., Pijnenborg, M., ... & De Bildt, A. (2011). Diagnosing autism spectrum disorders in adults: the use of Autism Diagnostic Observation Schedule (ADOS) module 4. Journal of autism and developmental disorders41(9), 1256-1266.
  4. Matson & Kozolowski, 2011: Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders5(1), 418-425.
  5. Fombonne, 2018: Fombonne, E. (2018). The rising prevalence of autism. Wiley Online Library.
  6. Xu et al., 2018: Xu, G., Strathearn, L., Liu, B., & Bao, W. (2018). Prevalence of autism spectrum disorder among US children and adolescents, 2014-2016. Jama319(1), 81-82.
  7. Bai et al., 2019: Bai, D., Yip, B. H. K., Windham, G. C., Sourander, A., Francis, R., Yoffe, R., ... & Sandin, S. (2019). Association of genetic and environmental factors with autism in a 5-country cohort. JAMA psychiatry76(10), 1035-1043.
  8. Foxx, 2008: Foxx, R. M. (2008). Applied behavior analysis treatment of autism: The state of the art. Child and adolescent psychiatric clinics of North America17(4), 821-834.
  9. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  10. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  11. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  12. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  13. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.