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Content WP:SPLIT from Autism, as part of a complicated merge/split situation outlined across multiple sections on Talk:Autism spectrum. If you want to see how I refined it down to this content, see the revision history of User:Xurizuri/sandbox.
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{{Infobox medical condition (new)
#REDIRECT [[Autism]]
| name = Autism
| image = Autism-stacking-cans 2nd edit.jpg
| alt = Boy stacking cans
| caption = Repetitively stacking or lining up objects is commonly associated with autism.
| field = [[psychiatry]], [[pediatrics]], [[occupational medicine]]
| symptoms = Trouble with [[Interpersonal relationship|social interaction]], [[Spoken language|verbal]] and [[nonverbal communication]], and presence of restricted interests and repetitive behavior<ref name=Land2008/>
| complications = Social isolation, employment problems, stress
| onset = By age two or three<ref name=NIH2016>{{cite web |title= NIMH " Autism Spectrum Disorder |url= https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |website= nimh.nih.gov |access-date= 20 April 2017 |date= October 2016}}</ref><ref name=DSM5/>
| duration = Lifelong<ref name=NIH2016/>
| causes = [[Heritability of autism|Genetic]] and environmental factors<ref name=Ch2012/>
| diagnosis = Based on behavior and developmental history<ref name=NIH2016/>
| differential = [[Reactive attachment disorder]], [[intellectual disability]], [[schizophrenia]]<ref>{{cite book |vauthors=Corcoran J, Walsh J |title=Clinical Assessment and Diagnosis in Social Work Practice |url={{Google books|y28kokLoe78C|page=72|plainurl=yes}} |publisher=Oxford University Press, New York |date=9 February 2006 |isbn=978-0-19-516830-3 |oclc=466433183 |lccn=2005027740 |page=72 }}</ref>
| treatment = [[Occupational therapy]], [[speech therapy]], [[psychotropic medication]]<ref name=CCD2007/><ref>{{cite journal | vauthors = Sukhodolsky DG, Bloch MH, Panza KE, Reichow B | title = Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis | journal = Pediatrics | volume = 132 | issue = 5 | pages = e1341–e1350 | date = November 2013 | pmid = 24167175 | pmc = 3813396 | doi = 10.1542/peds.2013-1193 }}</ref>
| medication = [[Atypical antipsychotics|Antipsychotics]], [[antidepressants]], [[stimulants]] (associated symptoms)<ref>{{cite journal | vauthors = Ji N, Findling RL | title = An update on pharmacotherapy for autism spectrum disorder in children and adolescents | journal = Current Opinion in Psychiatry | volume = 28 | issue = 2 | pages = 91–101 | date = March 2015 | pmid = 25602248 | doi = 10.1097/YCO.0000000000000132 | s2cid = 206141453 }}</ref>
| frequency = 24.8 million (2015)<ref name=GBD2015Pre/>
}}

<!-- Definition and symptoms -->
'''Kanner autism''', or '''classic autism''', is a [[neurodevelopmental disorder]] characterized by challenges with social communication, and by restricted and repetitive behaviors.<ref name=DSM5/> It is now considered part of the wider autism spectrum.<ref name=":3">{{cite journal | vauthors = Rosen NE, Lord C, Volkmar FR | title = The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond | journal = Journal of Autism and Developmental Disorders | volume = 51 | issue = 12 | pages = 4253–4270 | date = December 2021 | pmid = 33624215 | pmc = 8531066 | doi = 10.1007/s10803-021-04904-1 }}</ref> The term 'autism' was historically used to refer specifically to Kanner autism,<ref>{{cite journal | vauthors = Rosen NE, Lord C, Volkmar FR | title = The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond | journal = Journal of Autism and Developmental Disorders | volume = 51 | issue = 12 | pages = 4253–4270 | date = December 2021 | pmid = 33624215 | doi = 10.1007/s10803-021-04904-1 | pmc = 8531066 }}</ref> which is the convention used in much of this entry, but it is now more commonly used for the spectrum at large.<ref>{{Cite web |title=Autism |url=https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/autism |access-date=2022-03-17 |website=[[National Institute for Health and Care Excellence]] |place=UK}}</ref><ref>{{Cite book | vauthors = Fletcher-Watson S |url=https://www.worldcat.org/oclc/1073035060 |title=Autism: a new introduction to psychological theory and current debates |date=2019 |others=Francesca Happé |isbn=978-1-315-10169-9 |edition=[New edition; Updated edition] |location=Abingdon, Oxon |oclc=1073035060}}</ref>

Parents often notice signs of autism during the first three years of their child's life.<ref name="Land2008">{{cite journal | vauthors = Landa RJ | title = Diagnosis of autism spectrum disorders in the first 3 years of life | journal = Nature Clinical Practice. Neurology | volume = 4 | issue = 3 | pages = 138–147 | date = March 2008 | pmid = 18253102 | doi = 10.1038/ncpneuro0731 | doi-access = free }}</ref><ref name="DSM5">{{cite book | title = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) | chapter = Autism Spectrum Disorder, 299.00 (F84.0) | author = American Psychiatric Association | year = 2013 | publisher = American Psychiatric Publishing | pages = 50–59}}</ref>

<!-- Associations and diagnosis -->
Autism was hypothesized to be caused by a combination of [[Heritability of autism|genetic]] and [[environmental factors]],<ref name="Ch2012">{{cite journal | vauthors = Chaste P, Leboyer M | title = Autism risk factors: genes, environment, and gene-environment interactions | journal = Dialogues in Clinical Neuroscience | volume = 14 | issue = 3 | pages = 281–292 | date = September 2012 | pmid = 23226953 | pmc = 3513682 | doi = 10.31887/DCNS.2012.14.3/pchaste }}</ref> with genetic factors thought to heavily predominate.<ref>{{cite journal | vauthors = Tick B, Bolton P, Happé F, Rutter M, Rijsdijk F | title = Heritability of autism spectrum disorders: a meta-analysis of twin studies | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 57 | issue = 5 | pages = 585–595 | date = May 2016 | pmid = 26709141 | pmc = 4996332 | doi = 10.1111/jcpp.12499 }}</ref> [[Controversies in autism|Controversies]] surround other proposed environmental [[Causes of autism|causes]]; for example, the [[MMR vaccine and autism|vaccine hypothesis]], which although disproven, continues to hold sway in certain communities.<ref>{{cite journal | vauthors = Taylor LE, Swerdfeger AL, Eslick GD | title = Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies | journal = Vaccine | volume = 32 | issue = 29 | pages = 3623–3629 | date = June 2014 | pmid = 24814559 | doi = 10.1016/j.vaccine.2014.04.085 }}</ref><ref>{{cite journal | vauthors = Rutter M | title = Incidence of autism spectrum disorders: changes over time and their meaning | journal = Acta Paediatrica | volume = 94 | issue = 1 | pages = 2–15 | date = January 2005 | pmid = 15858952 | doi = 10.1111/j.1651-2227.2005.tb01779.x | s2cid = 79259285 }}</ref> Contemporary diagnostic manuals include only one diagnosis - [[autism spectrum disorder]] (ASD) - which includes classic autism along with [[Asperger syndrome]] and [[pervasive developmental disorder not otherwise specified]] (PDD-NOS).<ref name=DSM5/>

<!-- Epidemiology -->
Globally, classic autism was estimated to affect 24.8 million people {{as of|2015|lc=y}}.<ref name=GBD2015Pre>{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | last1 = Vos | first1 = Theo | last2 = Allen | first2 = Christine | last3 = Arora | first3 = Megha | last4 = Barber | first4 = Ryan M. | last5 = Bhutta | first5 = Zulfiqar A. | last6 = Brown | first6 = Alexandria | last7 = Carter | first7 = Austin | last8 = Casey | first8 = Daniel C. | last9 = Charlson | first9 = Fiona J. | last10 = Chen | first10 = Alan Z. | last11 = Coggeshall | first11 = Megan | last12 = Cornaby | first12 = Leslie | last13 = Dandona | first13 = Lalit | last14 = Dicker | first14 = Daniel J. | last15 = Dilegge | first15 = Tina | last16 = Erskine | first16 = Holly E. | last17 = Ferrari | first17 = Alize J. | last18 = Fitzmaurice | first18 = Christina | last19 = Fleming | first19 = Tom | last20 = Forouzanfar | first20 = Mohammad H. | last21 = Fullman | first21 = Nancy | last22 = Gething | first22 = Peter W. | last23 = Goldberg | first23 = Ellen M. | last24 = Graetz | first24 = Nicholas | last25 = Haagsma | first25 = Juanita A. | last26 = Hay | first26 = Simon I. | last27 = Johnson | first27 = Catherine O. | last28 = Kassebaum | first28 = Nicholas J. | last29 = Kawashima | first29 = Toana | last30 = Kemmer | first30 = Laura | display-authors = 1 }}</ref>

{{TOC limit}}

==Characteristics==
Classic autism is a highly variable [[neurodevelopmental disorder]]<ref>{{cite journal | vauthors = Geschwind DH | title = Autism: many genes, common pathways? | journal = Cell | volume = 135 | issue = 3 | pages = 391–395 | date = October 2008 | pmid = 18984147 | pmc = 2756410 | doi = 10.1016/j.cell.2008.10.016 }}</ref> whose symptoms first appear during infancy or childhood, and generally follows a steady course without [[Remission (medicine)|remission]].<ref name=ICD-10-F84.0/> Autistic people may be severely impaired in some respects but average, or even superior, in others.<ref>{{cite book |vauthors=Pinel JP |title=Biopsychology |year=2011 |publisher=Pearson |location=Boston, Massachusetts |edition=8th |isbn=978-0-205-03099-6 |oclc=1085798897 |page=235}}</ref> Overt symptoms gradually begin after the age of six months and become established by age two or three years.<ref>{{cite journal | vauthors = Rogers SJ | title = What are infant siblings teaching us about autism in infancy? | journal = Autism Research | volume = 2 | issue = 3 | pages = 125–137 | date = June 2009 | pmid = 19582867 | pmc = 2791538 | doi = 10.1002/aur.81 }}</ref> Some autistic children experience [[Regressive autism|regression]] in their communication and social skills after reaching [[developmental milestones]] at a normal pace.<ref>{{cite journal | vauthors = Stefanatos GA | title = Regression in autistic spectrum disorders | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 305–319 | date = December 2008 | pmid = 18956241 | doi = 10.1007/s11065-008-9073-y | s2cid = 34658024 }}</ref>
It was said to be distinguished by a characteristic triad of symptoms: impairments in social interaction, impairments in communication, and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.<ref name="Geschwind-2009"/> Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.<ref name=London/>



===Social development===

Autistic people have social impairments and often lack the intuition about others that many people take for granted. Unusual social development becomes apparent early in childhood.<!-- <ref name=Volkmar/> --> Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic [[toddler]]s differ more strikingly from [[social norms]]; for example, they have less [[eye contact]] and [[turn-taking]], and do not have the ability to use simple movements to express themselves, such as pointing at things.<ref name=Volkmar/> Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate [[nonverbal autism|nonverbal]]ly, and take turns with others. However, they do form [[Attachment (psychology)|attachments]] to their primary caregivers.<ref>{{cite journal | vauthors = Sigman M, Dijamco A, Gratier M, Rozga A | title = Early detection of core deficits in autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 10 | issue = 4 | pages = 221–233 | year = 2004 | pmid = 15666338 | doi = 10.1002/mrdd.20046 | citeseerx = 10.1.1.492.9930 }}</ref> Most autistic children displayed moderately less [[Attachment in children#Secure attachment|attachment security]] than neurotypical children, although this difference disappears in children with higher mental development or less pronounced autistic traits.<ref>{{cite journal | vauthors = Rutgers AH, Bakermans-Kranenburg MJ, van Ijzendoorn MH, van Berckelaer-Onnes IA | title = Autism and attachment: a meta-analytic review | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 45 | issue = 6 | pages = 1123–1134 | date = September 2004 | pmid = 15257669 | doi = 10.1111/j.1469-7610.2004.t01-1-00305.x }}</ref> Children with high-functioning autism have more intense and frequent loneliness compared to non-autistic peers, despite the common belief that autistic children prefer to be alone. Making and maintaining friendships often proves to be difficult for autistic people. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.<ref name=Burgess/>

===Communication===
Differences in communication may be present from the first year of life, and may include delayed onset of [[babbling]], unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words ([[echolalia]])<ref name=Landa/> or [[Pronoun reversal|reverse pronouns]].<ref name=Kanner1943/> Deficits in joint attention may be present - for example, they may look at a pointing hand instead of the object to which the hand is pointing.<ref name=Volkmar/> Autistic children may have difficulty with imaginative play and with developing symbols into language.<ref name="Landa"/>

===Repetitive behavior===
[[File:Autistic-sweetiepie-boy-with-ducksinarow.jpg|thumb|alt=Sleeping boy beside a dozen or so toys arranged in a line|A young autistic boy who has arranged his toys in a row]]
Autistic individuals can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.<ref>{{cite journal | vauthors = Lam KS, Aman MG | title = The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 37 | issue = 5 | pages = 855–866 | date = May 2007 | pmid = 17048092 | doi = 10.1007/s10803-006-0213-z | s2cid = 41034513 }}</ref>{{better citation needed|date=June 2022|reason= A source specific to classic autism is needed}}
* [[Stereotypy|Stereotyped behaviors]]: Repetitive movements, such as hand flapping, head rolling, or body rocking.
* [[Compulsive behavior]]s: Time-consuming behaviors intended to reduce the anxiety that an individual feels compelled to perform repeatedly or according to rigid rules, such as placing objects in a specific order, checking things, or handwashing.
* Sameness: Resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
* [[Ritual#Psychology|Ritualistic behavior]]: Unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual.
* Restricted interests: Interests or fixations that are abnormal in theme or intensity of focus, such as preoccupation with a single television program, toy, or game.

No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors.<ref>{{cite journal | vauthors = Bodfish JW, Symons FJ, Parker DE, Lewis MH | title = Varieties of repetitive behavior in autism: comparisons to mental retardation | journal = Journal of Autism and Developmental Disorders | volume = 30 | issue = 3 | pages = 237–243 | date = June 2000 | pmid = 11055459 | doi = 10.1023/A:1005596502855 | s2cid = 16706630 }}</ref>

===Other symptoms===
Autistic individuals may have symptoms that are independent of the diagnosis.<ref name="Geschwind-2009"/> An estimated 0.5% to 10% of individuals with classic autism show unusual abilities, ranging from [[splinter skill]]s such as the memorization of trivia to the extraordinarily rare talents of prodigious [[Savant syndrome|autistic savants]].<ref>{{cite journal | vauthors = Treffert DA | title = The savant syndrome: an extraordinary condition. A synopsis: past, present, future | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 364 | issue = 1522 | pages = 1351–1357 | date = May 2009 | pmid = 19528017 | pmc = 2677584 | doi = 10.1098/rstb.2008.0326 }}</ref> [[Sensory system|Sensory]] abnormalities are found in over 90% of autistic people, and are considered core features by some,<ref name="Geschwind-2009"/> although there was no good evidence that sensory symptoms differentiate autism from other developmental disorders.<ref>{{cite journal | vauthors = Rogers SJ, Ozonoff S | title = Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 46 | issue = 12 | pages = 1255–1268 | date = December 2005 | pmid = 16313426 | doi = 10.1111/j.1469-7610.2005.01431.x }}</ref> An estimated 60–80% of autistic people have motor signs that include [[Hypotonia|poor muscle tone]], [[Apraxia|poor motor planning]], and [[toe walking]].<ref name=Geschwind-2009/>

==Causes==
{{Main|Causes of autism}}

It was presumed initially that there was a common cause at the genetic, cognitive, and neural levels for classic autism's characteristic triad of symptoms.<ref name="Fractionable"/> However, over time, there was increasing evidence that autism was instead a complex and [[Heritability of autism|highly heritable]] disorder whose core aspects have distinct causes which often often co-occur.<ref name="Fractionable">{{cite journal | vauthors = Happé F, Ronald A | title = The 'fractionable autism triad': a review of evidence from behavioural, genetic, cognitive and neural research | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 287–304 | date = December 2008 | pmid = 18956240 | doi = 10.1007/s11065-008-9076-8 | s2cid = 13928876 }}</ref><ref name="HappeTime"/><ref name=Beaudet/>

[[File:Single Chromosome Mutations.svg|thumb|alt=Three diagrams of chromosome pairs A, B that are nearly identical. 1: B is missing a segment of A. 2: B has two adjacent copies of a segment of A. 3: B's copy of A's segment is in reverse order.|Deletion (1), duplication (2), and inversion (3) are all [[chromosome abnormalities]] that have been implicated in autism.<ref name=Beaudet>{{cite journal | vauthors = Beaudet AL | title = Autism: highly heritable but not inherited | journal = Nature Medicine | volume = 13 | issue = 5 | pages = 534–536 | date = May 2007 | pmid = 17479094 | doi = 10.1038/nm0507-534 | s2cid = 11673879 }}</ref>]]

Although theories regarding vaccines lack convincing scientific evidence, are biologically implausible,<ref>{{cite journal | vauthors = Gerber JS, Offit PA | title = Vaccines and autism: a tale of shifting hypotheses | journal = Clinical Infectious Diseases | volume = 48 | issue = 4 | pages = 456–461 | date = February 2009 | pmid = 19128068 | pmc = 2908388 | doi = 10.1086/596476 }}</ref> and [[Lancet MMR autism fraud|originated from a fraudulent study]],<ref>{{cite journal | vauthors = Godlee F, Smith J, Marcovitch H | title = Wakefield's article linking MMR vaccine and autism was fraudulent | journal = BMJ | volume = 342 | pages = c7452 | date = January 2011 | pmid = 21209060 | doi = 10.1136/bmj.c7452 | url = http://www.bmj.com/content/342/bmj.c7452.full | s2cid = 43640126 | archive-url = https://web.archive.org/web/20131111093448/http://www.bmj.com/content/342/bmj.c7452.full | archive-date = 11 November 2013 }}</ref> parental concern about a potential vaccine link with autism (and subsequent concern about ASD) has led to lower rates of [[childhood immunizations]], [[MMR vaccine and autism#Disease outbreaks|outbreaks of previously controlled childhood diseases]] in some countries, and the preventable deaths of several children.<ref name="vaccines">Vaccines and autism:
* {{cite journal | vauthors = Doja A, Roberts W | title = Immunizations and autism: a review of the literature | journal = The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques | volume = 33 | issue = 4 | pages = 341–346 | date = November 2006 | pmid = 17168158 | doi = 10.1017/s031716710000528x | doi-access = free }}
* {{cite journal | vauthors = Gerber JS, Offit PA | title = Vaccines and autism: a tale of shifting hypotheses | journal = Clinical Infectious Diseases | volume = 48 | issue = 4 | pages = 456–461 | date = February 2009 | pmid = 19128068 | pmc = 2908388 | doi = 10.1086/596476 }}
* {{cite journal | vauthors = Gross L | title = A broken trust: lessons from the vaccine--autism wars | journal = PLOS Biology | volume = 7 | issue = 5 | pages = e1000114 | date = May 2009 | pmid = 19478850 | pmc = 2682483 | doi = 10.1371/journal.pbio.1000114 }}
* {{cite journal | vauthors = Paul R | title = Parents ask: Am I risking autism if I vaccinate my children? | journal = Journal of Autism and Developmental Disorders | volume = 39 | issue = 6 | pages = 962–963 | date = June 2009 | pmid = 19363650 | doi = 10.1007/s10803-009-0739-y | s2cid = 34467853 }}
* {{cite journal | vauthors = Poland GA, Jacobson RM | title = The age-old struggle against the antivaccinationists | journal = The New England Journal of Medicine | volume = 364 | issue = 2 | pages = 97–99 | date = January 2011 | pmid = 21226573 | doi = 10.1056/NEJMp1010594 | doi-access = free }}</ref><ref name="dublin">{{cite journal | vauthors = McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey MT | title = Measles outbreak in Dublin, 2000 | journal = The Pediatric Infectious Disease Journal | volume = 22 | issue = 7 | pages = 580–584 | date = July 2003 | pmid = 12867830 | doi = 10.1097/00006454-200307000-00002 }}</ref>

==Diagnosis==
[[Medical diagnosis|Diagnosis]] of classic autism was based on behavioral symptoms, not cause or mechanism.<ref name="London">{{cite journal | vauthors = London E | title = The role of the neurobiologist in redefining the diagnosis of autism | journal = Brain Pathology | volume = 17 | issue = 4 | pages = 408–411 | date = October 2007 | pmid = 17919126 | pmc = 8095627 | doi = 10.1111/j.1750-3639.2007.00103.x | s2cid = 24860348 }}</ref><ref>{{cite journal | vauthors = Baird G, Cass H, Slonims V | title = Diagnosis of autism | journal = BMJ | volume = 327 | issue = 7413 | pages = 488–493 | date = August 2003 | pmid = 12946972 | pmc = 188387 | doi = 10.1136/bmj.327.7413.488 }}</ref>

===Classification===
Classic autism was listed as ''autistic disorder'' in the fourth edition of the [[American Psychiatric Association]]'s diagnostic manual, as one of the five [[pervasive developmental disorder]]s (PDDs).<ref name=":3"/> However, the PDDs were collapsed into the single diagnosis of [[Autism spectrum|Autism Spectrum Disorder]] in 2013,<ref name=":3"/> and the [[World Health Organization|WHO]]'s diagnostic manual [[ICD-11]] (which had listed it as ''childhood autism'' in its previous edition<ref>{{Cite web |title=ICD-10 Version:2016 |url=https://icd.who.int/browse10/2016/en#/F84.0 |access-date=2022-04-28 |website=icd.who.int}}</ref>) followed suit a few years later.<ref>{{Cite web |title=World Health Organisation updates classification of autism in the ICD-11 – Autism Europe |url=https://www.autismeurope.org/blog/2018/06/21/world-health-organisation-updates-classification-of-autism-in-the-icd-11/ |access-date=2022-04-28 |language=en-US}}</ref> Classic autism was said to be characterized by widespread abnormalities of social interactions and communication, severely restricted interests, and highly repetitive behavior.<ref name=ICD-10-F84.0/>

Of the PDDs, [[Asperger syndrome]] was closest to classic autism in signs and likely causes; [[Rett syndrome]] and [[childhood disintegrative disorder]] share several signs with it, but were understood to potentially have unrelated causes; [[PDD not otherwise specified]] (PDD-NOS; also called ''atypical autism'') was diagnosed when the criteria are not met for one of the other four PDDs.<ref>{{cite journal | vauthors = Volkmar FR, State M, Klin A | title = Autism and autism spectrum disorders: diagnostic issues for the coming decade | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 50 | issue = 1–2 | pages = 108–115 | date = January 2009 | pmid = 19220594 | doi = 10.1111/j.1469-7610.2008.02010.x }}</ref> People would usually attract a diagnosis of Asperger syndrome rather than classic autism if they showed no substantial delay in [[language development]],<ref name="DSM-IV-TR-299.00">{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-IV |chapter=Diagnostic criteria for 299.00 Autistic Disorder |publisher=American Psychiatric Association |year=2000 |edition=4th |location=Washington, D.C. |isbn=978-0-89042-025-6 |oclc=768475353 |lccn=00024852 |chapter-url=http://cdc.gov/ncbddd/autism/hcp-dsm.html |archive-url= https://web.archive.org/web/20131029080544/http://www.cdc.gov/ncbddd/autism/hcp-dsm.html |archive-date=29 October 2013 |via=Centers for Disease Control}}</ref> but early language ability was found to be a poor predictor of outcomes in adulthood.<ref>{{Cite journal | vauthors = Howlin P |date=2003-02-01 |title=Outcome in High-Functioning Adults with Autism with and Without Early Language Delays: Implications for the Differentiation Between Autism and Asperger Syndrome |journal=Journal of Autism and Developmental Disorders |language=en |volume=33 |issue=1 |pages=3–13 |doi=10.1023/A:1022270118899 |pmid=12708575 |s2cid=35817450 |issn=1573-3432}}</ref>

==Prognosis and management==
{{Main|Autism therapies}}
[[File:Opening a window to the autistic brain.jpg|thumb|alt=A young child points, in front of a woman who smiles and points in the same direction.|An autistic three-year-old points to fish in an aquarium, as part of an experiment on the effect of intensive shared-attention training on language development.<ref name="Powell">{{cite journal | vauthors = Powell K | title = Opening a window to the autistic brain | journal = PLOS Biology | volume = 2 | issue = 8 | pages = E267 | date = August 2004 | pmid = 15314667 | pmc = 509312 | doi = 10.1371/journal.pbio.0020267 }}</ref>]]

There is no known cure for autism,<ref name=CCD2007/> and very little research addressed long-term [[prognosis]] for classic autism.<ref>{{cite journal | vauthors = Seltzer MM, Shattuck P, Abbeduto L, Greenberg JS | title = Trajectory of development in adolescents and adults with autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 10 | issue = 4 | pages = 234–247 | year = 2004 | pmid = 15666341 | doi = 10.1002/mrdd.20038 }}</ref> Many autistic children lack [[social support]], future employment opportunities or [[Self-determination theory|self-determination]].<ref name="Burgess"/>

The main goals when treating autistic children are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes.<ref>{{cite journal | vauthors = Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S | title = Meta-analysis of Early Intensive Behavioral Intervention for children with autism | journal = Journal of Clinical Child and Adolescent Psychology | volume = 38 | issue = 3 | pages = 439–450 | date = May 2009 | pmid = 19437303 | doi = 10.1080/15374410902851739 | s2cid = 205873629 | citeseerx = 10.1.1.607.9620 }}</ref> Services should be carried out by [[Professional practice of behavior analysis|behavior analysts]], [[special education]] teachers, [[speech–language pathology|speech pathologists]], and licensed [[psychologists]].

Intensive, sustained [[special education]] programs and behavior therapy early in life often improves functioning and decreases symptom severity and maladaptive behaviors;<ref name="Rogers"/> claims that intervention by around age three years is crucial are not substantiated.<ref>{{cite journal | vauthors = Howlin P, Magiati I, Charman T | title = Systematic review of early intensive behavioral interventions for children with autism | journal = American Journal on Intellectual and Developmental Disabilities | volume = 114 | issue = 1 | pages = 23–41 | date = January 2009 | pmid = 19143460 | doi = 10.1352/2009.114:23-41 }}</ref>

No known medication relieves autism's core symptoms of social and communication impairments.{{medcn|date=February 2021}}

===Education===
[[File:Code of practice on provision of autism services.webm|thumb|[[Welsh Government]]'s code of practice on provision of autism services.]]

[[Discrete trial training|Early, intensive ABA therapy]] has demonstrated effectiveness in enhancing communication and adaptive functioning in preschool children;<ref name="Eikeseth">{{cite journal | vauthors = Eikeseth S | title = Outcome of comprehensive psycho-educational interventions for young children with autism | journal = Research in Developmental Disabilities | volume = 30 | issue = 1 | pages = 158–178 | year = 2009 | pmid = 18385012 | doi = 10.1016/j.ridd.2008.02.003 | citeseerx = 10.1.1.615.3336 }}</ref> it is also well-established for improving the intellectual performance of that age group.<ref name=Rogers/><ref name="Eikeseth"/> It is not known whether treatment programs for children lead to significant improvements after the children grow up,<ref name=Rogers/> and the limited research on the effectiveness of adult residential programs shows mixed results.<ref>{{cite journal | vauthors = Van Bourgondien ME, Reichle NC, Schopler E | title = Effects of a model treatment approach on adults with autism | journal = Journal of Autism and Developmental Disorders | volume = 33 | issue = 2 | pages = 131–140 | date = April 2003 | pmid = 12757352 | doi = 10.1023/A:1022931224934 | s2cid = 30125359 }}</ref>

===Alternative medicine===
Although many [[Alternative therapies for developmental and learning disabilities|alternative therapies and interventions]] were used, few are supported by scientific studies.<ref name=Sigman/> Treatment approaches have little empirical support in [[Quality of life|quality-of-life]] contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.<ref name=Burgess/> Some alternative treatments placed autistic individuals at risk.<ref>{{cite journal | vauthors = Tye C, Runicles AK, Whitehouse AJ, Alvares GA | title = Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review | journal = Frontiers in Psychiatry | volume = 9 | pages = 751 | year = 2019 | pmid = 30733689 | pmc = 6354568 | doi = 10.3389/fpsyt.2018.00751 | doi-access = free | type = Review }}</ref> For example, in 2005, a five-year-old child with autism was killed by botched [[chelation therapy]] (which is not recommended for autism as risks outweigh any potential benefits).<ref>{{cite journal | vauthors = Levy SE, Hyman SL | title = Complementary and alternative medicine treatments for children with autism spectrum disorders | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 17 | issue = 4 | pages = 803–20, ix | date = October 2008 | pmid = 18775371 | pmc = 2597185 | doi = 10.1016/j.chc.2008.06.004 | type = Review }}</ref><ref>{{cite journal | vauthors = Brown MJ, Willis T, Omalu B, Leiker R | title = Deaths resulting from hypocalcemia after administration of edetate disodium: 2003-2005 | journal = Pediatrics | volume = 118 | issue = 2 | pages = e534–e536 | date = August 2006 | pmid = 16882789 | doi = 10.1542/peds.2006-0858 | url = http://pediatrics.aappublications.org/cgi/content/full/118/2/e534 | s2cid = 28656831 | archive-url = https://web.archive.org/web/20090727080307/http://pediatrics.aappublications.org/cgi/content/full/118/2/e534 | archive-date = 27 July 2009 }}</ref><ref><!-- This one is specifically for the statement about risks outweighing benefits -->{{cite journal | vauthors = James S, Stevenson SW, Silove N, Williams K | title = Chelation for autism spectrum disorder (ASD) | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD010766 | date = May 2015 | pmid = 26106752 | doi = 10.1002/14651858.CD010766 | veditors = James S | type = Review }}</ref>

==Epidemiology==
{{Main|Epidemiology of autism}}
[[File:US-autism-6-17-1996-2007.png|thumb|alt=Bar chart versus time. The graph rises steadily from 1996 to 2007, from about 0.7 to about 5.3. The trend curves slightly upward.|Reports of autism cases per 1,000 children rose considerably in the US from 1996 to 2007.]]

Globally, classic autism was understood to affect an estimated 24.8 million people {{as of|2015|lc=y}}.<ref name=GBD2015Pre/> After it was recognised as a distinct disorder, reports of autism cases substantially increased, which was largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness<ref>{{cite journal | vauthors = Fombonne E | title = Epidemiology of pervasive developmental disorders | journal = Pediatric Research | volume = 65 | issue = 6 | pages = 591–598 | date = June 2009 | pmid = 19218885 | doi = 10.1203/PDR.0b013e31819e7203 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gernsbacher MA, Dawson M, Goldsmith HH | title = Three Reasons Not to Believe in an Autism Epidemic | journal = Current Directions in Psychological Science | volume = 14 | issue = 2 | pages = 55–58 | date = April 2005 | pmid = 25404790 | pmc = 4232964 | doi = 10.1111/j.0963-7214.2005.00334.x }}</ref> (particularly among women).<ref>{{cite journal | vauthors = Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T | display-authors = 6 | title = Time trends in autism diagnosis over 20 years: a UK population-based cohort study | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | date = August 2021 | volume = 63 | issue = 6 | pages = 674–682 | pmid = 34414570 | doi = 10.1111/jcpp.13505 | quote = The figure starkly illustrates an overall 787% increase in recorded incidence of autism diagnosis over 20 years. | s2cid = 237242123 }}</ref>

Several [[Conditions comorbid to autism spectrum disorders|other conditions]] were commonly seen in children with autism. They include:
* '''[[Intellectual disability]]'''. The percentage of autistic individuals who also met criteria for intellectual disability has been reported as anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing [[Controversies in autism#Intelligence|intelligence of individuals on the autism spectrum]].<ref>{{cite book |chapter=Learning in autism |vauthors=Dawson M, Mottron L, Gernsbacher MA |title=Learning and Memory: A Comprehensive Reference |volume=2 |pages=759–772 |veditors=Byrne JH, Roediger HL |publisher=[[Elsevier]] |year=2008 |doi=10.1016/B978-012370509-9.00152-2 |isbn=978-0-12-370504-4 |oclc=775005136 |chapter-url=http://psych.wisc.edu/lang/pdf/Dawson_AutisticLearning.pdf |access-date=26 July 2008 |archive-url=https://web.archive.org/web/20120303191513/http://psych.wisc.edu/lang/pdf/Dawson_AutisticLearning.pdf |archive-date=3 March 2012}}</ref> In comparison, for PDD-NOS the association with intellectual disability was much weaker,<ref>{{cite journal | vauthors = Chakrabarti S, Fombonne E | title = Pervasive developmental disorders in preschool children | journal = JAMA | volume = 285 | issue = 24 | pages = 3093–3099 | date = June 2001 | pmid = 11427137 | doi = 10.1001/jama.285.24.3093 | doi-access = free }}</ref> and by definition, the diagnosis of Asperger's excluded intellectual disability.<ref>{{cite book | title=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) | publisher=American Psychiatric Association |place=Washington, D.C. | year=2000 | page=80}}</ref>
* '''[[Minor physical anomalies]]''' are significantly increased in the autistic population.<ref>{{cite journal | vauthors = Ozgen HM, Hop JW, Hox JJ, Beemer FA, van Engeland H | title = Minor physical anomalies in autism: a meta-analysis | journal = Molecular Psychiatry | volume = 15 | issue = 3 | pages = 300–307 | date = March 2010 | pmid = 18626481 | doi = 10.1038/mp.2008.75 | doi-access = free }}</ref>
* '''Preempted diagnoses'''. Although the DSM-IV ruled out the concurrent diagnosis of many other conditions along with autism, the full criteria for [[Attention deficit hyperactivity disorder]] (ADHD), [[Tourette syndrome]], and other of these conditions were often present. As a result, modern ASD allows for these diagnoses.<ref name="DSM5" />

==History==
{{Further|History of Asperger syndrome}}
[[File:Victor of Aveyron, 1800.jpg|thumb|left|upright=0.8|Portrait of [[Victor of Aveyron]], a [[feral child]] caught in 1798 who displayed possible symptoms of autism<ref name="Wolff">{{cite journal | vauthors = Wolff S | title = The history of autism | journal = European Child & Adolescent Psychiatry | volume = 13 | issue = 4 | pages = 201–208 | date = August 2004 | pmid = 15365889 | doi = 10.1007/s00787-004-0363-5 | s2cid = 6106042 }}</ref>]]
[[File:Leo-Kanner.jpeg|thumb|upright|alt=Balding man in his early 60s in coat and tie, with a serious but slightly smiling expression|[[Leo Kanner]] introduced the label ''early infantile autism'' in 1943.]]

The [[New Latin]] word ''autismus'' (English translation ''autism'') was coined by the [[Swiss people|Swiss]] psychiatrist [[Eugen Bleuler]] in 1910 as he was defining symptoms of [[schizophrenia]]. He derived it from the Greek word ''autós'' (αὐτός, meaning "self"), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".<ref>{{cite journal | vauthors = Kuhn R | title = Eugen Bleuler's concepts of psychopathology | journal = History of Psychiatry | volume = 15 | issue = 59 Pt 3 | pages = 361–366 | date = September 2004 | pmid = 15386868 | doi = 10.1177/0957154X04044603 | s2cid = 5317716 }} The quote is a translation of Bleuler's 1910 original.</ref> The word ''autism'' first took its modern sense in 1938 when [[Hans Asperger]] of the [[Vienna General Hospital|Vienna University Hospital]] adopted Bleuler's terminology ''autistic psychopaths'' in a lecture in German about [[child psychology]].<ref>{{cite journal | journal=Wien Klin Wochenschr |year=1938 |volume=51 |pages=1314–1317 | title = Das psychisch abnormale Kind |trans-title=The psychically abnormal child | vauthors = Asperger H | author-link1 = Hans Asperger | language=de}}</ref> Asperger was investigating [[Asperger syndrome]] which, for various reasons, was not widely considered a separate diagnosis until 1981,<ref name="Wolff"/> although both are now considered part of ASD. [[Leo Kanner]] of the [[Johns Hopkins Hospital]] first used ''autism'' in English to refer to classic autism when he introduced the label ''early infantile autism'' in a 1943 report.<ref name="Kanner1943"/> Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders.<ref name="HappeTime">{{cite journal | vauthors = Happé F, Ronald A, Plomin R | title = Time to give up on a single explanation for autism | journal = Nature Neuroscience | volume = 9 | issue = 10 | pages = 1218–1220 | date = October 2006 | pmid = 17001340 | doi = 10.1038/nn1770 | doi-access = free }}</ref> Starting in the late 1960s, classic autism was established as a separate syndrome.<ref>{{cite journal | vauthors = Fombonne E | title = Modern views of autism | journal = Canadian Journal of Psychiatry | volume = 48 | issue = 8 | pages = 503–505 | date = September 2003 | pmid = 14574825 | doi = 10.1177/070674370304800801 | s2cid = 8868418 | doi-access = free }}</ref>

It took until 1980 for the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-III]] to differentiate autism from childhood schizophrenia. In 1987, the [[DSM-III-R]] provided a checklist for diagnosing autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorder.<ref>{{cite journal | vauthors = Baker JP | title = Autism at 70--redrawing the boundaries | journal = The New England Journal of Medicine | volume = 369 | issue = 12 | pages = 1089–1091 | date = September 2013 | pmid = 24047057 | doi = 10.1056/NEJMp1306380 | url = http://pdfs.semanticscholar.org/daf7/ff077eb74aa9a1afdc70c101581e1b128ca3.pdf | url-status = dead | s2cid = 44613078 | archive-url = https://web.archive.org/web/20190307045533/http://pdfs.semanticscholar.org/daf7/ff077eb74aa9a1afdc70c101581e1b128ca3.pdf | archive-date = 3 March 2019 }}</ref>

== References ==
{{Reflist|refs=
<ref name="Kanner1943">{{cite journal | vauthors = Kanner L | title = Autistic disturbances of affective contact | journal = Acta Paedopsychiatrica | volume = 35 | issue = 4 | pages = 100–136 | year = 1943 | pmid = 4880460 | author-link1 = Leo Kanner }} Reprinted in {{cite journal | vauthors = Kanner L | title = Autistic disturbances of affective contact | journal = Acta Paedopsychiatrica | volume = 35 | issue = 4 | pages = 100–136 | year = 1968 | pmid = 4880460 }}</ref>
<ref name="Rogers">{{cite journal | vauthors = Rogers SJ, Vismara LA | title = Evidence-based comprehensive treatments for early autism | journal = Journal of Clinical Child and Adolescent Psychology | volume = 37 | issue = 1 | pages = 8–38 | date = January 2008 | pmid = 18444052 | pmc = 2943764 | doi = 10.1080/15374410701817808 }}</ref>
<ref name="CCD2007">{{cite journal | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–1182 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free }}</ref>
<ref name="Burgess">{{cite journal | vauthors = Burgess AF, Gutstein SE | title = Quality of Life for People with Autism: Raising the Standard for Evaluating Successful Outcomes | journal = Child and Adolescent Mental Health | volume = 12 | issue = 2 | pages = 80–86 | date = May 2007 | pmid = 32811109 | doi = 10.1111/j.1475-3588.2006.00432.x | url = http://kingwoodpsychology.com/recent_publications/camh_432.pdf | url-status = dead | access-date = 24 November 2013 | archive-url = https://web.archive.org/web/20131203011037/http://kingwoodpsychology.com/recent_publications/camh_432.pdf | archive-date = 3 December 2013 }}</ref>
<ref name="Geschwind-2009">{{cite journal | vauthors = Geschwind DH | title = Advances in autism | journal = Annual Review of Medicine | volume = 60 | pages = 367–380 | year = 2009 | pmid = 19630577 | pmc = 3645857 | doi = 10.1146/annurev.med.60.053107.121225 | author-link = Daniel Geschwind }}</ref>
<ref name="Landa">{{cite journal | vauthors = Landa R | title = Early communication development and intervention for children with autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 13 | issue = 1 | pages = 16–25 | year = 2007 | pmid = 17326115 | doi = 10.1002/mrdd.20134 }}</ref>
<ref name="Volkmar">{{cite book |veditors=Volkmar FR, Paul R, Pelphrey KA, Rogers SJ |title=Handbook of Autism and Pervasive Developmental Disorders: Volume Two: Assessment, Interventions, and Policy |volume=2 |edition=4th |year=2014 |publisher=[[John Wiley & Sons]] |location=Hoboken, New Jersey |url={{Google books|4yzqAgAAQBAJ|page=301|plainurl=yes}} |isbn=978-1-118-28220-5 |oclc=946133861 |lccn=2013034363 |page=301 |access-date=1 March 2019 }}</ref>
<ref name="ICD-10-F84.0">{{cite web|url=http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f84 |year=2007 |access-date=10 October 2009 |website=ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision |publisher=World Health Organization |title=F84. Pervasive developmental disorders |archive-url=https://web.archive.org/web/20130421042448/http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm%20f84 |archive-date=21 April 2013 |url-status=dead }}</ref>
<ref name="Sigman">{{cite journal | vauthors = Sigman M, Spence SJ, Wang AT | title = Autism from developmental and neuropsychological perspectives | journal = Annual Review of Clinical Psychology | volume = 2 | pages = 327–355 | year = 2006 | pmid = 17716073 | doi = 10.1146/annurev.clinpsy.2.022305.095210 }}</ref>
}}

== External links ==
{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Autism}}

{{Medical resources
| DiseasesDB = 1142
| ICD10 = {{ICD10|F|84|0|f|80}}
| ICD9 = {{ICD9|299.00}}
| OMIM = 209850
| MedlinePlus = 001526
| eMedicineSubj = med
| eMedicineTopic = 3202
| eMedicine_mult = {{eMedicine2|ped|180}}
| MeshID = D001321
| GeneReviewsNBK = NBK1442
| GeneReviewsName = Autism overview
}}
{{Subject bar|c=y|b=y|q=y|d=Q38404|n=Category:Autism|wikt=autism}}
{{Pervasive developmental disorders}}
{{Mental and behavioral disorders|selected = childhood}}
{{Autism resources}}
{{Nonverbal communication}}
{{Authority control}}

[[Category:Autism|*]]
[[Category:1910s neologisms]]
[[Category:Articles containing video clips]]
[[Category:Communication disorders]]
[[Category:Neurological disorders in children]]
[[Category:Pervasive developmental disorders]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Autism spectrum disorders|*]]

Revision as of 02:04, 25 June 2022

Autism
Boy stacking cans
Repetitively stacking or lining up objects is commonly associated with autism.
SpecialtyPsychiatry, pediatrics, occupational medicine
SymptomsTrouble with social interaction, verbal and nonverbal communication, and presence of restricted interests and repetitive behavior[1]
ComplicationsSocial isolation, employment problems, stress
Usual onsetBy age two or three[2][3]
DurationLifelong[2]
CausesGenetic and environmental factors[4]
Diagnostic methodBased on behavior and developmental history[2]
Differential diagnosisReactive attachment disorder, intellectual disability, schizophrenia[5]
TreatmentOccupational therapy, speech therapy, psychotropic medication[6][7]
MedicationAntipsychotics, antidepressants, stimulants (associated symptoms)[8]
Frequency24.8 million (2015)[9]

Kanner autism, or classic autism, is a neurodevelopmental disorder characterized by challenges with social communication, and by restricted and repetitive behaviors.[3] It is now considered part of the wider autism spectrum.[10] The term 'autism' was historically used to refer specifically to Kanner autism,[11] which is the convention used in much of this entry, but it is now more commonly used for the spectrum at large.[12][13]

Parents often notice signs of autism during the first three years of their child's life.[1][3]

Autism was hypothesized to be caused by a combination of genetic and environmental factors,[4] with genetic factors thought to heavily predominate.[14] Controversies surround other proposed environmental causes; for example, the vaccine hypothesis, which although disproven, continues to hold sway in certain communities.[15][16] Contemporary diagnostic manuals include only one diagnosis - autism spectrum disorder (ASD) - which includes classic autism along with Asperger syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS).[3]

Globally, classic autism was estimated to affect 24.8 million people as of 2015.[9]

Characteristics

Classic autism is a highly variable neurodevelopmental disorder[17] whose symptoms first appear during infancy or childhood, and generally follows a steady course without remission.[18] Autistic people may be severely impaired in some respects but average, or even superior, in others.[19] Overt symptoms gradually begin after the age of six months and become established by age two or three years.[20] Some autistic children experience regression in their communication and social skills after reaching developmental milestones at a normal pace.[21] It was said to be distinguished by a characteristic triad of symptoms: impairments in social interaction, impairments in communication, and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.[22] Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.[23]


Social development

Autistic people have social impairments and often lack the intuition about others that many people take for granted. Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers differ more strikingly from social norms; for example, they have less eye contact and turn-taking, and do not have the ability to use simple movements to express themselves, such as pointing at things.[24] Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.[25] Most autistic children displayed moderately less attachment security than neurotypical children, although this difference disappears in children with higher mental development or less pronounced autistic traits.[26] Children with high-functioning autism have more intense and frequent loneliness compared to non-autistic peers, despite the common belief that autistic children prefer to be alone. Making and maintaining friendships often proves to be difficult for autistic people. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.[27]

Communication

Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia)[28] or reverse pronouns.[29] Deficits in joint attention may be present - for example, they may look at a pointing hand instead of the object to which the hand is pointing.[24] Autistic children may have difficulty with imaginative play and with developing symbols into language.[28]

Repetitive behavior

Sleeping boy beside a dozen or so toys arranged in a line
A young autistic boy who has arranged his toys in a row

Autistic individuals can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.[30][better source needed]

  • Stereotyped behaviors: Repetitive movements, such as hand flapping, head rolling, or body rocking.
  • Compulsive behaviors: Time-consuming behaviors intended to reduce the anxiety that an individual feels compelled to perform repeatedly or according to rigid rules, such as placing objects in a specific order, checking things, or handwashing.
  • Sameness: Resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
  • Ritualistic behavior: Unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual.
  • Restricted interests: Interests or fixations that are abnormal in theme or intensity of focus, such as preoccupation with a single television program, toy, or game.

No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors.[31]

Other symptoms

Autistic individuals may have symptoms that are independent of the diagnosis.[22] An estimated 0.5% to 10% of individuals with classic autism show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.[32] Sensory abnormalities are found in over 90% of autistic people, and are considered core features by some,[22] although there was no good evidence that sensory symptoms differentiate autism from other developmental disorders.[33] An estimated 60–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking.[22]

Causes

Main article: Causes of autism

It was presumed initially that there was a common cause at the genetic, cognitive, and neural levels for classic autism's characteristic triad of symptoms.[34] However, over time, there was increasing evidence that autism was instead a complex and highly heritable disorder whose core aspects have distinct causes which often often co-occur.[34][35][36]

Three diagrams of chromosome pairs A, B that are nearly identical. 1: B is missing a segment of A. 2: B has two adjacent copies of a segment of A. 3: B's copy of A's segment is in reverse order.
Deletion (1), duplication (2), and inversion (3) are all chromosome abnormalities that have been implicated in autism.[36]

Although theories regarding vaccines lack convincing scientific evidence, are biologically implausible,[37] and originated from a fraudulent study,[38] parental concern about a potential vaccine link with autism (and subsequent concern about ASD) has led to lower rates of childhood immunizations, outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.[39][40]

Diagnosis

Diagnosis of classic autism was based on behavioral symptoms, not cause or mechanism.[23][41]

Classification

Classic autism was listed as autistic disorder in the fourth edition of the American Psychiatric Association's diagnostic manual, as one of the five pervasive developmental disorders (PDDs).[10] However, the PDDs were collapsed into the single diagnosis of Autism Spectrum Disorder in 2013,[10] and the WHO's diagnostic manual ICD-11 (which had listed it as childhood autism in its previous edition[42]) followed suit a few years later.[43] Classic autism was said to be characterized by widespread abnormalities of social interactions and communication, severely restricted interests, and highly repetitive behavior.[18]

Of the PDDs, Asperger syndrome was closest to classic autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with it, but were understood to potentially have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) was diagnosed when the criteria are not met for one of the other four PDDs.[44] People would usually attract a diagnosis of Asperger syndrome rather than classic autism if they showed no substantial delay in language development,[45] but early language ability was found to be a poor predictor of outcomes in adulthood.[46]

Prognosis and management

Main article: Autism therapies
A young child points, in front of a woman who smiles and points in the same direction.
An autistic three-year-old points to fish in an aquarium, as part of an experiment on the effect of intensive shared-attention training on language development.[47]

There is no known cure for autism,[6] and very little research addressed long-term prognosis for classic autism.[48] Many autistic children lack social support, future employment opportunities or self-determination.[27]

The main goals when treating autistic children are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes.[49] Services should be carried out by behavior analysts, special education teachers, speech pathologists, and licensed psychologists.

Intensive, sustained special education programs and behavior therapy early in life often improves functioning and decreases symptom severity and maladaptive behaviors;[50] claims that intervention by around age three years is crucial are not substantiated.[51]

No known medication relieves autism's core symptoms of social and communication impairments.[medical citation needed]

Education

Welsh Government's code of practice on provision of autism services.

Early, intensive ABA therapy has demonstrated effectiveness in enhancing communication and adaptive functioning in preschool children;[52] it is also well-established for improving the intellectual performance of that age group.[50][52] It is not known whether treatment programs for children lead to significant improvements after the children grow up,[50] and the limited research on the effectiveness of adult residential programs shows mixed results.[53]

Alternative medicine

Although many alternative therapies and interventions were used, few are supported by scientific studies.[54] Treatment approaches have little empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.[27] Some alternative treatments placed autistic individuals at risk.[55] For example, in 2005, a five-year-old child with autism was killed by botched chelation therapy (which is not recommended for autism as risks outweigh any potential benefits).[56][57][58]

Epidemiology

Main article: Epidemiology of autism
Bar chart versus time. The graph rises steadily from 1996 to 2007, from about 0.7 to about 5.3. The trend curves slightly upward.
Reports of autism cases per 1,000 children rose considerably in the US from 1996 to 2007.

Globally, classic autism was understood to affect an estimated 24.8 million people as of 2015.[9] After it was recognised as a distinct disorder, reports of autism cases substantially increased, which was largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness[59][60] (particularly among women).[61]

Several other conditions were commonly seen in children with autism. They include:

History

Further information: History of Asperger syndrome
Portrait of Victor of Aveyron, a feral child caught in 1798 who displayed possible symptoms of autism[66]
Balding man in his early 60s in coat and tie, with a serious but slightly smiling expression
Leo Kanner introduced the label early infantile autism in 1943.

The New Latin word autismus (English translation autism) was coined by the Swiss psychiatrist Eugen Bleuler in 1910 as he was defining symptoms of schizophrenia. He derived it from the Greek word autós (αὐτός, meaning "self"), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".[67] The word autism first took its modern sense in 1938 when Hans Asperger of the Vienna University Hospital adopted Bleuler's terminology autistic psychopaths in a lecture in German about child psychology.[68] Asperger was investigating Asperger syndrome which, for various reasons, was not widely considered a separate diagnosis until 1981,[66] although both are now considered part of ASD. Leo Kanner of the Johns Hopkins Hospital first used autism in English to refer to classic autism when he introduced the label early infantile autism in a 1943 report.[29] Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders.[35] Starting in the late 1960s, classic autism was established as a separate syndrome.[69]

It took until 1980 for the DSM-III to differentiate autism from childhood schizophrenia. In 1987, the DSM-III-R provided a checklist for diagnosing autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorder.[70]

References

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Classic autism
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