Autism

Autism or autism spectrum disorder^[a] (ASD), is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as persistent difficulties in social communication and interaction. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the underlying spectrum. For example, some are nonverbal, while others have proficient spoken language.

A formal diagnosis of ASD according to either the DSM-5 or the ICD-11 criteria requires not merely the presence of ASD symptoms, but symptoms that cause significant impairment in multiple domains of functioning, in addition to being atypical or excessive for the individual's age and sociocultural context.^[11][12]

Common signs of ASD include difficulty with social interaction and verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hypo-reactivity to sensory input.

The World Health Organization (WHO), UK National Institute for Health and Care Excellence (NICE), and American Psychological Association classify autism as a neurodevelopmental disorder,^[11][13][12] but the autism rights movement (and some researchers) see autistic people as part of humanity's natural neurodiversity.^[14][15] From this point of view, autistic people may also be diagnosed with a disability of some sort, but that disability may be rooted in the systemic structures of a society rather than in the person;^[16] thus, proponents argue that autistic people should be accommodated rather than cured.^[17] On the contrary, other scientists argue that ASD impairs functioning in many ways that are inherent to the disorder itself and unrelated to society.^[18][19] The neurodiversity perspective has led to significant controversy among those who are autistic and advocates, practitioners, and charities.^[20][21]

There are many theories about the causes of autism; it is highly heritable and mainly genetic, but many genes are involved, and environmental factors may also be relevant.^[22] Autism frequently co-occurs with attention deficit hyperactivity disorder (ADHD), epilepsy and intellectual disability, and research indicates that autistic people have significantly higher rates of LGBTQ+ identities and feelings than the general population.^[23][24][25] Disagreements persist about what should be included as part of the diagnosis, whether there are meaningful subtypes or stages of autism,^[26] and the significance of autism-associated traits in the wider population.^[27][28] The combination of broader criteria, increased awareness, and the potential increase of actual prevalence, has led to considerably increased estimates of autism prevalence since the 1990s.^[29][30] The WHO estimates about 1 in 100 children had autism between 2012 and 2021, as that was the average estimate in studies during that period, with a trend of increasing prevalence over time.^[b][9][10] This increasing prevalence has reinforced the myth perpetuated by anti-vaccine activists that autism is caused by vaccines.^[31] Boys are also significantly far more frequently diagnosed than girls.^[32]

There is no cure for autism. Some advocates of autistic people argue that efforts to find a cure are misguided and even harmful.^[33] Early intervention services based on applied behavior analysis (ABA) aim to teach children self-care and normative social and language skills.^{[34][35][36][37]} Some in the autism rights movement consider ABA therapy unethical and unhelpful due to a perception that it emphasizes normalization instead of acceptance and its potential for causing harms.^[38][39][40] Curtailing self-soothing behaviors is potentially classifiable as a form of abuse.^[41] Speech and occupational therapy, as well as augmentative and alternative modes of communication, are effective adjunctive therapies. Pharmacological treatments may also be useful; the atypical antipsychotics risperidone and aripiprazole have shown to alleviate comorbid irritability, though they tend to be associated with sedation and weight gain.^[42] Melatonin supplementation has been shown to improve insomnia related to autism.^[43] Stimulant therapy may improve mental processing speed when there is comorbid ADHD.^[44]

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