autism is a neurodevelopmental disorder characterized by two core patterns difficulties in social communication and restricted interests and activities in fact these two traits are so fundamental to the disorder that they were featured in the very first case reports on autism in 1938 using the terms an autistic aloneness and an insistence upon sameness notably these two patterns are evident during early childhood development rather than appearing later in a person's life like depression or addiction unlike many of the other disorders we've talked about which involve long lists of diagnostic criteria the dsm criteria for autism are so simple that we've actually covered them already in their entirety patients who have both difficulties in social communication and restricted interests and activities noticeable during early development can be diagnosed with autism with the usual caveats that these symptoms must cause significant impairment and that they cannot be better accounted for by other disorders provided that these conditions have been met however a diagnosis of autism is appropriate nevertheless within these seemingly simple criteria lies a wide range of variation in both symptoms severity and functional ability in fact this diagnosis is now referred to formally as autism spectrum disorder or asd to reflect the diversity of clinical presentations from one patient to the next handily you can pack the core diagnostic criteria directly into the acronym asd itself an autism spectrum disorder is defined by an autistic aloneness and an insistence upon sameness that are both present during early development while these two terms broadly capture what you need to know about diagnosing autism there are many more details packed into the two phrases that we'll talk about here in addition we'll also discuss a few other signs of symptoms which are not part of the core diagnostic criteria but are still commonly seen in this disorder let's go over each of these one by one first deficits in social communication can manifest in various ways use of language is generally impacted including both verbal and nonverbal communication in fact delayed speech development is the most common reason that children with autism come to clinical attention while most children begin speaking around the age of 1 and can use short sentences by the age of 2 children with autism often hit these milestones late or even never attain them at all in its most severe forms autism can rob patients of speech entirely rendering them non-verbal for the rest of their life while speech problems are common they are ultimately not required for a diagnosis of autism as many people with the disorder such as those with less severe forms have normal or only mildly impacted speaking abilities for these individuals the deficits in communication instead present in other ways many people with autism struggle with both understanding and using non-verbal communication such as body language and facial expressions for example most people understand that when someone points at something you should look at the object they are pointing at rather than looking at the finger itself in contrast someone with autism is more likely to miss the intended meaning of the gesture and instead look at the pointing finger when speaking people with autism are often overly literal and have difficulty understanding things like sarcasm that rely heavily on non-verbal aspects of communication like the context of the situation and the speaker's vocal intonation some people with autism have such difficulty recognizing facial expressions even seemingly basic ones like happy or sad that they must be taught how to interpret these expressions explicitly because these non-verbal aspects of language are just as important as the words being said if not even more deficits in this area can lead to significant problems in communicating and maintaining relationships finally the deficits in social communication associated with autism extend beyond just language and include difficulty with understanding and following the implicit rules of social interaction these rules are so deeply ingrained that most people follow them without even thinking about it to give a few examples most people know even from a very young age that when you meet someone you should say a greeting and introduce yourself by your name they know that when you're talking with someone it's polite to speak sometimes not so much that you dominate the entire conversation but not so little that you come across as unengaged they understand basic principles of social engagement such as reciprocity turn taking and sharing in contrast people with autism may not intuitively pick up on these rules and will often break them in both blatant and subtle ways they don't violate these rules on purpose to be selfish or bothersome instead they have difficulty understanding that they should behave this way to begin with this lack of an intuitive grasp on the rules of social engagement often makes people with autism feel like an anthropologist on mars trying to understand the laws of a society whose logic is opaque to them due to their difficulties interacting with others people with autism often report feeling lonely or isolated many still have a desire to be around others and engage in meaningful relationships but due to the deficits in social communication caused by this disorder they find themselves without the tools to do so the other domain of autism involves restricted or repetitive patterns of behavior interests and activities the phrase and insistence upon sameness captures the core pattern here very well as people with autism often need and will even demand of others a strict adherence to specific routines and patterns such as wanting to eat the same food for every meal of every day or having to perform the same list of activities before bed due to the concurrent difficulties in social communication someone with autism may be unable to express their desires verbally and will instead act out scream or otherwise show distress when these patterns are interrupted repetitive behaviors can often be traced back to highly specific fixations and fascinations people with autism may become immersed in a single hobby or activity to the extent that they don't give attention to anything else such as demanding to watch the same movie over and over for months on end playing the same game for hours each day without interruption or learning the scientific names of every insect in the world however repetitive behavior in autism is not always linked to a particular interest with many patients also engaging in seemingly purposeless repetitive or stereotyped movement such as lining up objects in a specific order flapping their hands in the air repeatedly or spinning the wheels on a toy car for some individuals this stereotype behavior can even include self-injurious behavior such as banging one's head against the wall repeatedly while the specific activities can differ from one case to the next what unites all of the behaviors is the patient's insistence upon doing them over and over again in a rigid and inflexible way many people with autism exhibit other signs and symptoms that while not required for a diagnosis are quite common a good example of this is a disturbance and sensory perception which can be seen in up to 80 percent of cases these disturbances can often involve a combination of hyper sensitivity to certain stimuli such as an aversion to certain sounds or textures as well as hyposensitivity to other stimuli such as a high tolerance for pain or extreme temperatures in addition a variety of motor signs are often seen in autism as well including poor coordination weak muscle tone and unusual patterns of gait such as walking on one's tiptoes finally a small percentage of people with autism have incredible cognitive abilities that far exceed normal human ability a phenomenon known as cervantism these abilities are often related to memory like being able to remember seemingly endless amounts of information or calculation such as performing highly complex mathematical equations instantly in one's head for example a person with cervantism might be able to tell you the day of the week and the weather for any specific date even going back many years the link between cevantism and autism is well known with islets of ability as well as deficits having been described from the very first reported cases of the disorder in the modern day studies show that over half of all savants meet criteria for autism a link that was further popularized in movies like rain man however it would be a mistake to assume that all people with autism have savant like abilities in fact people with autism are more likely to have intellectual disabilities than savantism nevertheless the higher than average prevalence of cervantism among people with autism suggests a mechanistic link between the two conditions so those are the main signs and symptoms to be aware of when diagnosing autism similar to adhd these patterns must be observed in multiple settings from early childhood unlike adhd however where only one symptom or the other is required deficits in social communication and restricted interest in activities must both be present to diagnose autism historically the dsm made a distinction between various types of autism most notably individuals with high functioning forms of autism were said to have asperger's syndrome a milder version of the disorder which featured deficits and socialization and some restricted interests and activities but lacked speech impairment or any comorbid intellectual disability however in the interest of bringing together all cases of autism under a single diagnostic banner these distinctions were dropped in the dsm-5 and all cases would now be referred to as just autism spectrum disorder now that we have a better understanding of how to diagnose autism let's look at the data behind the disorder including who gets it what happens once they're diagnosed and what forms of treatment are effective the prevalence of autism varies significantly from study to study ranging from 0.1 percent all the way up to 2 percent depending on the diagnostic standard used this is consistent with the idea that autism is a spectrum disorder that can encompass a wide variety of symptoms and severities the prevalence of autism appears to be increasing over the past several decades while some people claim that this represents a true epidemic of autism studies suggest that the biggest reason for the increase appears to be changes in diagnostic patterns including more screening in schools a greater awareness of the disorder among families and a tendency among health care providers to diagnose less severe cases for this reason autism should still be thought of as a relatively rare disorder with a similar prevalence to schizophrenia or bipolar disorder the causes of autism are still being worked out it is one of the most heritable disorders in psychiatry with first-degree relatives being much more likely to also be diagnosed with autism in addition autism appears to be more common in the children of older fathers nevertheless no single gene or environmental trigger has been found it's worth pointing out that despite common misconceptions there's no evidence that autism is linked to vaccines while the initial studies suggesting a link between the two have now been widely debunked the endurance of this theory likely comes from the fact that the period of immunization occurs around the same age that symptoms of autism are first noticed for children with autism abnormalities in speech and behavior are often noticeable by the age of two and almost always by the age of three even by people not formally trained in diagnosing autism [Music] diagnoses of children younger than two years should be given cautiously as diagnosing too early or based on minimal symptoms can lead to false positives however this should be balanced with the fact that earlier diagnosis and intervention are associated with improved outcomes so don't ignore signs of a disorder when they're present just make sure to evaluate cautiously a significant gender gap exists with autism as boys are diagnosed with autism more than four times as often as girls at least some of this gap may have to do with differences in how males and females with autism present as females with the disorder tend to show greater language abilities better social functioning and less aggression compared to males all of which may increase the risk of under diagnosis in girls nevertheless even when taking these factors into account there still seems to be a higher rate of autism in boys compared to girls autism does not occur in discrete episodes but rather has a chronic and persistent course as noted previously there is a wide variety in functional impairment seen in autism as the disorder can present in forms ranging from mild with only small deficits and social interaction and a few rigid behaviors all the way to complete lack of speech and profound intellectual disability leading to total dependence upon caregivers for survival in mild or moderate cases there is often a natural lessening of symptoms over time even without treatment as people with autism learn specific skills and strategies to overcome some of these limitations however the core patterns are still present across the lifespan treatment for autism involves behavioral training to teach specific adaptive skills to help patients better navigate the world such as rewarding the patient for doing things that they might not do naturally such as using words to communicate rather than gestures or successfully recognizing and responding to another person's emotions in addition speech and language therapy can be helpful for overcoming communication deficits while individualized education programs and family therapy can improve functional skills and decrease stress on caregivers while earlier treatment is associated with improved functional outcomes many individuals with autism remain dependent on others for support during adulthood although people with high functioning forms are often able to live work and maintain social relationships independently at this time no medications have been shown to be helpful for improving the core deficits seen in autism although medications are still used in many cases especially when there are comorbid disorders like adhd or when aggressive or self-injurious behaviors are present ultimately however medications should not be seen as a cornerstone of treatment for this disorder with behavioral intervention being the gold standard to wrap it all up let's review what we've learned cases of autism spectrum disorder feature both an autistic aloneness and an insistence upon sameness that begin during early development the impairments in social communication can present as both language deficits as well as problems with understanding social rules restricted interests and activities can be impairing as well with behavioral rigidity being a common source of frustration for family and other caregivers cases of autism show a wide variety of symptoms severity and functional ability which underscore the fact that this is a spectrum disorder in severe cases autism is among the most impairing of all psychiatric conditions with patients being unable to communicate or engage in purposeful activity leading to dependence upon others throughout their lives in other cases however autism is only mildly impairing and may even be a source of extraordinary cognitive abilities the term neurodiversity is increasingly being used to recognize that the core patterns of autism are not necessarily a cause of disability but can instead represent differences to be recognized or even celebrated keep this distinction in mind when encountering a patient with traits of autism as it serves as a helpful reminder that a clinical diagnosis should only be given when there's clear evidence of dysfunction or distress resulting from these traits thanks for watching despite the simplicity of its dsm criteria autism is a tricky diagnosis to get right so i hope that this video helped to shed some light on the disorder if you're interested in learning about autism at a higher level including how to differentiate it from other similar disorders as well as how to rule out other causes of speech delay please consider checking out my book memorable psychiatry on amazon until next time bye for now