autism research paper examples

Autism - List of Essay Samples And Topic Ideas

Autism, or Autism Spectrum Disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. Essays could explore the causes, symptoms, and treatment of autism, the experiences of individuals with autism, and societal understanding and acceptance of autism. We’ve gathered an extensive assortment of free essay samples on the topic of Autism you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Rain Man and Autism

The film Rain man was released into theaters in 1988 and was awarded many awards along with an Academy Award. The movie starts off by showing Charlie who works as a car salesman, attempting to close on a deal involving four Lamborghinis. Charlie decides to drive with his girlfriend Susanna to ensure that this deal goes through. On the drive over Charlie receives a call telling him that his father has just passed away. Charlie and his girlfriend go his […]

Applied Behavior Analysis and its Effects on Autism

Abstract During my research i have found several studies that have been done to support the fact that Applied Behavioral Analysis (ABA) does in fact make a positive impact on children with Autism through discrete trials. It is based on the thought that when a child is rewarded for a positive behavior or correct social interaction the process will want to be repeated. Eventually one would phase out the reward. Dr Lovaas, who invented this method, has spent his career […]

The Unique Parenting Challenges are Faced by the Parents of Special Children

Introduction For typical children, parenting experiences are shared by other parents whereas the unique parenting challenges are faced by the parents of special children. Mobility and Inclusion of the parents as well as children are affected many a times. Even though careful analysis often reveals abilities, habitual tendency to perceive the disabilities from society’s part often hinders effective normalization and proper rehabilitation. All impose severe identity crisis and role restrictions even in knowledgeable parents.. In some conditions, as in the […]

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Autism in Japanese Manga and its Significance on Current Progression in J-pop Culture

Abstract In this paper I will explore and examine Autism in Manga, the social and cultural context of Autism in Manga, its movement, and importance of Tobe Keiko’s, “With the Light.” Manga is a huge part of Japanese culture and can be appreciated by so many different people. There are different types of Manga that have been specifically produced for that type of audience. In this paper, I will address the less talked about, women’s Manga or also known as […]

Speech Therapist for Autism

Abstract Autism Spectrum Disorder is a condition that consists of various challenges to an individual such as social skills, nonverbal communication, repetitive behaviors and difficulties with speech. So far doctors have not been able to find out what causes autism although it is believed that it involves both environmental and genetic factors. Autism can usually be detected at an early age, therefore giving the patient and therapist an early start to improve their verbal skills. Speech language pathologists also known […]

Virtual Reality in Regards to Health and how it Can be Life-Changing

        Exploring Virtual Reality in Health Diego Leon Professor Ron Frazier October 29, 2018, Introduction When most individuals think of technology involving computers, they think it can solely involve two of the five senses we humans have – vision (sight) and hearing (audition). But what if we could interact with more than two sensorial channels? Virtual reality deals with just that. Virtual reality is defined as a “high-end user interface that involves real-time simulation and interaction through […]

Growing up with Autism

Autism is a profound spectrum disorder; symptoms, as well as severity, range. It is one of the fastest-growing developmental disorders in America. For every 68 children born in the United States, 1 is diagnosed with a neurological development disorder that impairs their ability to interact and communicate on what we constitute as normal levels. Autism is multifaceted; it affects the brain development of millions worldwide. Not only are those diagnosed on the Autism Spectrum facing difficulties, but the family members […]

Kids with Autism

In this earth we have many different lifeforms. Animals, plants, insects, and people. Humans have populated the earth all throughout it. Some people are born healthy and some are born will disorders and illnesses and diseases. One of the disorders is Autism. Autism is constantly affecting the people who have it and the people around them all over the world. So what is Autism? Autism is a disorder that impairs the ability for social interaction and communication. It is very […]

My Personal Experience of Getting to Know Asperger’s Syndrome

The beginning of this paper covers the history of Asperger’s Syndrome, followed by an explanation of what Asperger’s is. The history provides detailed insights into Hans Asperger and Leo Kanner, and their relationship to each other. Their work has significantly enriched our understanding of the research surrounding Autism and Asperger’s Syndrome. The paper also discusses the process leading to Asperger’s becoming a recognized diagnosis, including the contributions of Lorna Wing and Ulta Frita. Furthermore, it traces Asperger’s entry into the […]

Cultural Stereotypes and Autism Disorder

“It’s the fastest growing developmental disability, autism” (Murray, 2008, p.2). “It is a complex neurological disorder that impedes or prevents effective verbal communication, effective social interaction, and appropriate behavior” (Ennis-Cole, Durodoye, & Harris, 2013). “Autism spectrum disorder (ASD) is a lifelong disorder that may have comorbid conditions like attention deficit disorder (ADD)/attention deficit/hyperactivity disorder (ADHD), anxiety disorder, stereotypical and self-stimulatory behaviors, insomnia, intellectual disabilities, obsessive compulsive disorder, seizure disorder/epilepsy, Tourette syndrome, Tic disorders, gastrointestinal problems, and other conditions. Another certainty, […]

Understanding Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a cognitive disability that affects a person’s “communication, social, verbal, and motor skills” . The umbrella term of ASD created in 2013 by the American Psychiatric Association that covered 5 separate autism diagnosis and combined them into one umbrella term, the previous terms being Autistic Disorder, Rett syndrome, Asperger’s Disorder, Childhood disintegrative Disorder, and Pervasive Developmental Disorders. The word spectrum in the diagnosis refers to the fact that the disability does not manifest itself in […]

Defining Altruism Issue

In current society, it can be justified that the level of autonomy directly influences the amount of altruism an autistic adolescent implements. Defining Altruism: When it comes to the comprehension of socialization within the development of behaviors in adolescents, altruism is vital. Although there is no true altruism, more or less altruism can be determined based upon the involuntary actions and behaviors of an individual. In the absence of motivation, altruism cannot transpire. An altruist must have the inherent belief […]

911 Telecommunicators Response to Autism

Autism is becoming more prevalent every day. The Center for Disease Control and Prevention released new statistics in 2018. Nationally, 1 in 59 children have autism spectrum disorder (ASD) and boys are 4 (four) times more likely to have autism than girls. 1 in 37 boys and 1 in 151 girls were found to have autism. These are incredibly high statistics that will affect our communities across the United States We, as Telecommunicators, need to know how to understand and […]

Representation of Autism in the Netflix TV Show “Atypical”

In the first season of the TV show “Atypical”, the viewer meets the Gardner family, a seemingly normal family with an autistic teenage son, Sam, as the focus. This show failed initially to deviate from typical portrayals of autistic people on screens, as a white male, intellectually gifted, and seemingly unrelatable, although it seemed to try. Sam acts in ways that seem almost unbelievable for even someone with autism to, such as when he declares his love for someone else […]

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a group of developmental disorders that challenges a child’s skills in social interaction, communication, and behavior. ASD’s collective signs and symptoms may include: making little eye contact, repetitive behaviors, parallel play, unexplainable temper tantrums, misunderstanding of nonverbal cues, focused interests, and/or sensory overload. Positive symptoms of ASD may reflect above-average intelligence, excellence in math, science, or art, and the ability to learn things in detail. A question that many parent has is whAlthough an individual […]

The Complexity of Autism

Autism spectrum disorder is a complex disease that affects the developmental and speech capabilities of adolescents that carries with them to adulthood. It is distinctly apparent when the child is still very young and able to be diagnosed from about a year and a half old onwards. Although the disease cannot be pinpointed to one specific area of the brain, it is believed to stem from a glitchy gene that makes the child more susceptible to developing autism, oxygen deprivation […]

An Overview of the Five Deadly Diseases that Affect the Human Brain

There are hundreds of diseases that affect the brain. Every day, we fight these diseases just as vehemently as they afflict their carriers. Parkinson's disease, Alzheimer's, depression, autism, and strokes are just five of the most lethal and debilitating diseases that afflict human brains. Parkinson's disease alone claims up to 18,000 lives a year (Hagerman 1). But what is it? Parkinson's disease occurs when a brain chemical called dopamine begins to die in a region that facilitates muscle movement. Consequently, […]

Autism Genes: Unveiling the Complexities

“Autism is a brain disorder that typically affects a person’s ability to communicate, form relationships with others and respond appropriately to the environment (www.childdevelopmentinfo.com).” There are different levels of autism. “There is the autistic disorder, Asperger's syndrome and pervasive developmental syndrome (www.asws.org).” According to (www.everydayhealth.com/autism/types), “Each situation is unique as there are many levels and severities of it. Many cases also include sensory difficulties. These can range from imaginary sights and sounds to other sensations.” There are many different characteristics […]

Autism and Assistive Technology for Autistic Children

Autism is a complex neurobehavioral condition that is found in a person from early childhood days where the person faces difficulty in communicating with another person. It is also known as ASD or Autism Spectrum Disorder. It is a spectrum disorder because its effect varies from person to person. This is caused due to some changes that happen during early brain development. It is suggested that it may arise from abnormalities in parts of the brain that interpret sensory input […]

The Evolution of Autism Diagnosis: from Misunderstanding to Scientific Approach

Autism has come a long way from the early 1980s when it was rarely diagnosed to today where 100 out 10,000 kids are diagnosed. Autism is defined as a developmental disorder that affects communication and behavior (NIMH 2018). There are many aspects surrounding Autism and the underlying effects that play a role in Autism. According to the Diagnostic and Statistical Manual of Mental Disorders, people with Autism have “Difficulty with communication and interaction with other people Restricted interests and repetitive […]

Do Vaccines Cause Autism

In a world of medicines and “mommy bloggers”, there is a controversy between pro-vaxxers and anti-vaxxers. The vaccination controversy cause an uproar for many people, understandably, it’s very polarized- you strongly believe in them or you strongly do not. For me, at the age of 15, I strongly believe in the Pro-Vaccine movement and I have data that can back me up. For starters, you may wonder ‘what is a vaccine’ or ‘how to do they work’. For a general […]

Autism: Characteristics, Diagnosis, and Understanding

The prevalence of Autism Spectrum Disorder has nearly doubled in recent years, and the numbers are staggering: nearly 1 in every 59 children are diagnosed with autism in the United States alone. Yet, there are so many questions surrounding the complexity and increase in diagnoses of this condition that affects so many in such diverse ways. (Autism Speaks) How autism originates in the first place and its impact on communication, both verbal and nonverbal, are questions that need to be […]

Autism Spectrum Disorder and its Positive Effects

 What would it feel like if you were constantly ignored or treated as though you have little usefulness? Many people experience this kind of treatment their entire lives. Long has it been assumed that people with mental disabilities such as Autism, were meant to be cared for but to never expect any value from them. Evil men such as Hitler even went so far as to kill them because he thought they had no use to society. However, there is […]

Adolescents with Autism Spectrum Disorders and ADHD

Autism spectrum disorder (ASD) is a complex lifelong neurodevelopmental disorder that affects communication and behavior, generally diagnosed within the early stages of life. No two individuals living with Autism experience the same symptoms, as the type and severity varies with each case (Holland, 2018.). Autism has been around for hundreds of years, but the definition has evolved immensely. In 1943, scientists Leo Kanner and Hans Asperger conducted research on individuals with social and emotional deficits to better refine the definition […]

Raising a Child with Autism

All impose severe identity crisis and role restrictions even in knowledgeable parents.. In some conditions, as in the case of physical challenges, the child needs physical reassurance and support from the parents against those conditions of cognitive deficits in which the demands are always parent’s constant attention and feedback. As far as autism is concerned, the child’s deficits are many namely social, emotional, communicational, sensual, as well as behavioral. Symptoms are usually identified between one and two years of age. […]

Is Autism a Kind of Brain Damage

Many people have different views about autism. Autism may be only one simple word, but with this one word comes many forms in the way it could affect people with this disability. Autism should not be looked down on as much as this disability is from others in society. It may seem as if it has more “cons” than “pros” as some call them, but if looked at from a better perspective, there could be more pros than cons and […]

Trouble with Social Aspects and People on the Autism Spectrum

Autism in childhood starts as early as age two, and symptoms will become more severe as children continue into elementary school. When a child goes to a psychiatrist, they will work on social development. Adolescence with autism struggle when attempting to project others pain. For example, my brother has Asperger's and when I have a bone graph done on my hand, he could not stop touching my hand. He needed constant reminders to not touch and remind him of when […]

Effects of Autism

When he was eight years old, the parents of Joshua Dushack learned that their son was different. He had been diagnosed with Autism. According to the doctors, Joshua would never be able to read, write, talk, or go to school on his own. This might have been the case, had his parents accepted it. But his mother saw her son as a normal boy, and treated him as such. He did need some extra help in school, but because of […]

How Different Types of Assistive Technology Can Help Children with Autism

I. Introduction An anonymous speaker once said, “some people with Autism may not be able to speak or answer to their name, but they can still hear your words and feel your kindness.” Approximately thirty percent of people diagnosed with Autism Spectrum Disorder never learn to speak more than a few words (Forman & Rudy, 2018). Fortunately in today’s society, new technologies have made it possible for these individuals to communicate and socialize with others. Purpose The primary focus of […]

Searching Employment Autism

Over the last 20 years, there has been an alarming increase for children who have been diagnosed with Autism Spectrum Disorder (ASD) in the United States. According to the Centers for Disease Control, in the year 2000 1 in 159 children would be diagnosed with ASD. In the latest version of the study, the number has been reduced to 1 in 59 children will be diagnosed with ASD (Centers for Disease Control and Prevention, 2018). This is a subject that […]

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How To Write an Essay About Autism

Understanding autism.

Before writing an essay about autism, it's essential to understand what autism is and the spectrum of conditions it encompasses. Autism, or Autism Spectrum Disorder (ASD), is a complex developmental disorder that affects communication and behavior. It is characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. Start your essay by explaining the nature of autism, its symptoms, and the spectrum concept, which acknowledges a range of strengths and challenges experienced by individuals with autism. It's also important to discuss the causes and diagnosis of autism, as well as the common misconceptions and stereotypes surrounding it. This foundational knowledge will set the stage for a more in-depth exploration of the topic.

Developing a Focused Thesis Statement

A strong essay on autism should be centered around a clear, focused thesis statement. This statement should present a specific angle or argument about autism. For example, you might discuss the importance of early intervention and therapy, the representation of autism in media, or the challenges faced by individuals with autism in education and employment. Your thesis will guide the direction of your essay and ensure that your analysis is structured and coherent.

Gathering and Analyzing Data

To support your thesis, gather relevant data and research from credible sources. This might include scientific studies, statistics, reports from autism advocacy organizations, and personal narratives. Analyze this data critically, considering different perspectives and the quality of the evidence. Including a range of viewpoints will strengthen your argument and demonstrate a comprehensive understanding of the topic.

Discussing Implications and Interventions

A significant portion of your essay should be dedicated to discussing the broader implications of autism and potential interventions. This can include the impact of autism on individuals and families, educational strategies, therapeutic approaches, and social support systems. Evaluate the effectiveness of these interventions, drawing on case studies or research findings. Discussing both the successes and challenges in managing and understanding autism will provide a balanced view and demonstrate a comprehensive understanding of the topic.

Concluding the Essay

Conclude your essay by summarizing the key points of your discussion and restating your thesis in light of the evidence and examples provided. Your conclusion should tie together your analysis and emphasize the significance of understanding and supporting individuals with autism. You might also want to highlight areas where further research or development is needed or the potential for societal changes to improve the lives of those with autism.

Final Review and Editing

After completing your essay, it's important to review and edit your work. Ensure that your arguments are clearly articulated and supported by evidence. Check for grammatical accuracy and ensure that your essay flows logically from one point to the next. Consider seeking feedback from peers or experts in the field to refine your essay further. A well-crafted essay on autism will not only inform but also engage readers in considering the complexities of this condition and the collective efforts required to support those affected by it.

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Autism Research Paper

This sample autism research paper features: 5600 words (approx. 18 pages), an outline, and a bibliography with 6 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

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Get 10% off with 24start discount code, i. historical development of the concept of autism, ii. dsm-iv criteria, iii. behavioral and cognitive characteristics, a. behavioral characteristics in autism, 1. social behavior, 2. communication and play, 3. preoccupations, perseverations, and resistance to change, b. cognitive characteristics, 1. language, 2. social cognition, 3. attention, 5. executive functions, iv. developmental course and prognosis, v. epidemiology, vi. boundary conditions and comorbidity, vii. biological factors, a. associated biomedical conditions and genetic factors, b. neuroanatomical findings, c. neurophysiological findings, d. neurochemical findings, viii. clinical assessment, a. medical assessment, b. neuropsychological assessment, c. behavioral assessment, ix. treatment, a. pharmacological treatments, b. behavioral and educational treatments.

X. Bibliography

Autism was first described by Leo Kanner in 1943 and became known as Infantile Autism or Autistic Disorder. The concept has expanded since that date, and the term “Kanner autism” is sometimes used to refer to cases with symptoms similar to those of Kanner’s original sample; such cases are a subset of PDD. Kanner’s original description remains influential, and there is a tendency in the literature to assume that persons with “Kanner autism” represent the “nuclear” or “core” form of PDD, an assumption that may not be warranted. Kanner identified symptoms in three main groups: an autistic aloneness, a failure to use language communicatively, and an obsessive insistence on sameness in the environment; these are still the three areas of symptomatology used in current diagnostic systems. Although Kanner originally viewed the autistic aloneness as probably representing a constitutional defect, the two decades following his original work were marked by an unfortunate shift toward a psychodynamic/environmental view of the causation of autism. This served to derail any significant progress in understanding the disorder, as well as to cause a great deal of additional anguish to parents of autistic children.

Beginning with Rimland’s seminal work on autism in 1964, psychology and psychiatry began to explore seriously the biological foundations of autism, and theories of autism as resulting from disturbances in attention, language, sensory integration, perceptual constancy, and other neurological functions were promulgated and tested. Beginning in the early to mid-1980s, research attention also began to focus seriously on the social and affective aspects of autism, both to clarify the range of heterogeneity in autistic children’s functioning, and to posit new core deficits in these areas. Currently, researchers stressing both cognitive and social/affective deficits as primary are in agreement that the fundamental problem is a neurological, and not an environmental, one.

Differential diagnosis was a conceptual problem for early autism research. Some clinicians believed that autism was a variant of or precursor to schizophrenia. Only in the 1970s came an awareness that disorders beginning in infancy must be regarded as separate in kind from those with onset in later childhood, adolescence, or adulthood. Autistic-like disorders virtually always begin before age 3, while schizophrenic-like disorders virtually never begin before age 7. This realization revitalized interest in infantile autism as a distinct nosologic entity, leading to the development of more operationally precise diagnostic criteria and a reconceptualization of the syndrome as a pervasive developmental disorder, under which label it was incorporated by the American Psychiatric Association in the third edition of that body’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III ); this conceptualization has been retained in DSM-III-R and DSM-IV.

Current diagnostic practice, as reflected in the DSM-IV, classifies Autistic Disorder as one of four specific entities within Pervasive Developmental Disorder. Autistic Disorder is marked by the presence of symptomatology in three areas: (1) qualitative impairment in social interaction, as manifested by such behaviors as abnormal or reduced eye contact with others, failure to develop peer relationships, lack of spontaneous sharing of interests with others (e.g., showing or pointing out objects of interest to the caregiver), (2) qualitative impairment in communication, as manifested by delayed or deviant language without attempts to compensate through nonverbal communication, poor conversational skills if speech is present, and repetitive and stereotyped language and play, and (3) a restricted and repetitive repertoire of behaviors and interests, including preoccupations and rituals, or severe resistance to environmental changes.

The specific behavioral manifestations of these traits differ by degree of accompanying retardation and age. A high-functioning, older autistic individual, for example, may attempt to be social, but violate implicit rules of social behavior and be insensitive to unspoken social signals, while a low-functioning or much younger autistic individual may react to other people as if they were little different from inanimate objects. Similarly, a high-functioning, older autistic individual may have perseverative interests in such topics as constellations, train schedules, or dinosaurs, and attempt to engage others in conversations on these subjects, while a lower functioning or younger autistic individual might engage in repetitive motor rituals.

The other specific syndromes classified as Pervasive Developmental Disorders include Rett’s Disorder, Asperger’s Disorder, and Childhood Disintegrative Disorder. Rett’s Disorder has marked behavioral commonalities with Autistic Disorder, including poor social engagement and mental retardation, but differs from Autistic Disorder in several ways: in Rett’s Disorder, the retardation is more invariant and more typically severe, the disorder seems to present only in girls, it is marked by a characteristic pattern of head growth deceleration and loss of purposeful hand movements, sometimes accompanied by hand wringing behavior, following a period of normal development. Many girls with Rett syndrome also have epilepsy and other neurologic abnormalities. Asperger’s Disorder is often considered a mild form of Autistic Disorder, and there is still controversy about how distinct it is from autism; diagnostically, it can be distinguished from autism by normal development of language. Childhood Disintegrative Disorder differs from Autistic Disorder in that the former is marked by a distinctive pattern of developmental regression following at least two years of normal development. This disorder is much rarer than autism, and controversy exists here, too, about the etiological and phenomenological distinctiveness between Childhood Disintegrative Disorder and Autistic Disorder.

Social behavior is considered by many as the hallmark of autism. As with all features of autism, social impairment is highly heterogeneous; it varies with age, with IQ, with setting, and with interactive partner, and is modifiable by treatment.

Social impairment is generally most severe in the preschool years; it is in early childhood that genuine aloofness is seen. Older children may initiate interaction to get their needs met, or may be responsive but noninitiating to others. Older or higher-functioning autistic individuals may approach others in an idiosyncratic, intrusive, and socially insensitive way. These three general styles (aloof, passive, active-but-odd) form the basis of a social typology described by Lorna Wing, and validated by several later studies.

Highly structured settings with enforced proximity to peers may elicit the best peer interactions. Relationships with other children are almost always more impaired than the corresponding behavior with adults; other children may be ignored when adults are not.

Behavioral deficits in social interaction are varied; among the most important, especially in early life, are (1) poor spontaneous imitation of others’ language and behavior, (2) gaze avoidance or other deficits in the use of eye-to-eye gaze to modulate or initiate interaction, and (3) deficits in various joint attention skills, including drawing an adult’s attention to an object of interest by showing or pointing, and following an adult’s attentional focus in order to share it. On the other hand, the “pervasive lack of responsiveness” described in DSM-III is actually uncommon; many young autistic children are selectively attached to their parents, derive comfort from their presence, and enjoy physical affection.

Older studies were composed primarily of clinical descriptions of language features such as pronoun reversal, echolalia, and metaphorical language. More systematic studies have appeared, based on modern understanding of the separable components of language. The more severely affected autistic child may remain nonverbal or minimally verbal and poorly intelligible. In those who develop more language, phonology, syntax, and (more arguably) semantics are relatively spared, although still often at a lower level than nonverbal skills. Verbal memory, prosody, and pragmatics, on the other hand, represent areas of particular difficulty for the average autistic child. In the domain of pragmatics, it is noted that communicative functions are generally more need-oriented and less affiliative, and that violations of language use rules are common, such as violations of implicit rules concerning interpersonal distance while speaking, and the rules of turn-taking in conversational exchange, as well as word selection which is overly formal or pedantic.

Symbolic play is also often observed to be lacking in young autistic children, who sometimes prefer nonsymbolic play activities such as puzzles or other manipulatives. When symbolic play develops, it can be unusually repetitive and inflexible in nature. Some recent evidence suggests that high-functioning autistic children may be not so much incapable as uninterested in engaging in frequent or complex symbolic play.

These constitute the third symptom group. These behaviors range from simple or complex motor stereotypies, to “self-stimulatory” sensory behaviors such as watching fans or water, to long-term perseverative interests. The resistance to change is manifested by tantrums or other extreme reactions to changes in environmental features or in routines. Despite the equal role assigned to perseverations/preoccupations and resistance to change in diagnostic criteria, some recent data suggest that resistance to change is a less common feature of autism than perseverations/preoccupations.

Overall cognitive level, or presence of mental retardation, is an important feature of the individual autistic child, and powerfully predicts the functional outcome that can be expected for the child. Recent work by several research groups, such as the group headed by Rapin (see Bibliography) suggests that high- and low-functioning autism may be significantly different in behavioral manifestations, history, and prognosis, that approximately half of the autistic population falls into each group, and that an IQ cutoff of about 65 makes the most appropriate division between highand low-functioning autism. Beyond studies of overall cognitive level, many investigators have examined typical cognitive profiles in autism, that is, areas of relative sparing and impairment. Some autistic children, both those with severe impairment and those who are higher functioning, display unusual gifts, especially in rote memory, calculations, and music. A majority of autistic children are known to have relative strengths in visuospatial abilities, while tasks requiring verbal reasoning, social cognition, or flexibility pose relative difficulty for the autistic child. Although this description suggests a typical cognitive profile, studies have shown that there is great heterogeneity in the autistic population, and that no single cognitive deficit is universal in autistic individuals.

The autistic child’s language profile is arguably the syndrome’s most distinctive cognitive feature, which has earned it a central position in some theories of the etiology of autism. Many aspects of verbal functioning are impaired in autistic children, as many as 40 to 50% of whom are mute, although this figure is declining with the advent of aggressive early intervention. Those with speech often display echolalia, difficulties with prepositions and pronouns, and inappropriate conversational behaviors. Verbal autistic children generally are able to acquire normal grammatical morphology and syntax, although onset and development are delayed. Some autistic children learn grapheme-phoneme correspondence, leading to early decoding of words; comprehension, however, lags far behind. Comprehension of oral language is significantly impaired relative to expression, and deficits in the semantic and pragmatic aspects of language are common. They are also deficient in interactive communication, including conversational behavior, nonverbal communication and speech prosody. In general, the more linguistic aspects of communication, including especially phonology and syntax, are spared relative to the pragmatic aspects; pragmatic deficits can be seen in the failure to use language functionally to share or request information, or perform other speech functions that serve social, rather than instrumental, functions.

A decade of research has documented substantial deficits in autistic children’s ability to understand the behavior, emotions, and cognitive states of other people. They have difficulty in matching pictures of emotional facial expressions to emotion words, to emotional situations, to similar expressions, and to vocal expressions of the same emotion.

Much recent interest has been stimulated by exploration of autistic performance on “theory of mind” tasks; in a typical theory of mind task, the subject is asked to predict behavior of a doll in a social scenario. The behavior can only be correctly predicted if the subject has a true theory of mind, that is, truly understands the concept of others’ minds, with their own representational capacities, and their own limits on available knowledge. Autistic subjects have been shown to be impaired on these tasks in several studies.

A cautionary note here, however, about all of these social cognitive tasks is that many higher functioning autistic individuals do well on them; the deficits are far from universal. Furthermore, verbal IQ explains much of the variance in performance. Therefore, it remains to be demonstrated that deficits in social cognition, including theory of mind, occupy a key causal role in the syndrome; they may be more a concomitant deficit related to the overall social impairment, although opinions differ widely on this.

Unusual attentional processes are characteristic of autistic children. Autistic children are generally able to sustain attention in tasks adequately when given potent reinforcement or when the task is of interest to them, and higher functioning individuals are able to perform well on standard neuropsychological tests of sustained attention. In contrast, many autistic children appear to have difficulty with tasks requiring the focusing and shifting of attention. They are found to be overselective in their attention to particular parts of stimuli, and studies indicate that they may have difficulties in shifting attention between stimuli, especially across sensory modalities, perhaps contributing to the perseveration so characteristic of their behavior.

Memory abilities in autism have not been as fully investigated as other cognitive functions. Anecdotally, amazing feats of memory have been reported, where autistic individuals recall distant episodes with great clarity and detail; hyperdeveloped memory for stimuli such as routes, spatial arrays, schedules and calendars, and music have also been frequently reported. Tested memory for visual material in high-functioning autistic individuals is often normal. In contrast, memory for linguistic and social material is usually impaired. Autistic individuals appear not to be able to use the intrinsic semantic structure of discourse or stories to aid recall, and in this regard, are more impaired than children with specific language disorders.

Executive functioning refers to the higher level cognitive processes of abstract conceptualization, planning, problem solving, and self-monitoring, self-correction and self-control. These processes are thought to be localized to prefrontal cortex, and are assessed with standardized neuropsychological tests developed for evaluation of frontal functions. Some autistic individuals have great difficulty with these tasks, especially in switching from incorrect strategies during tasks. Some researchers have noted similarities between certain symptoms of autism and those of patients with frontal lobe damage (e.g., perseveration, lack of inhibition), and have proposed that frontal executive system impairment causes distinct social cognitive deficits. Furthermore, some findings suggest that executive system adequacy may predict outcome for autistic adolescents better than measures of IQ.

Autism, as a developmental disorder, cannot be fully described at a single developmental point. The typical description of the autistic child is that he or she lacks interest in relating to others and lacks communicative language. These symptoms are most characteristic of autistic children in the preschool years. Even during this period, there are often signs of increasing social relatedness, especially to caretakers. On the other hand, stereotypies and especially resistance to change, may appear in the preschool years or somewhat later. During middle childhood, autistic children often master some daily living and academic skills and make behavioral adjustments to their parents and teachers. Their behavior may come to resemble that of hyperactive and/or retarded children, or they may develop into socially motivated children, who relate in an odd or idiosyncratic way, with deficits in emotional reciprocity.

Early and middle adolescence can be particularly difficult. Besides the onset of seizures that sometimes occurs in early adolescence, a significant minority of PDD children regress behaviorally and even cognitively at this time. Some autistic adolescents show increasing interest in developing peer relationships during these years. Higher functioning individuals with PDD are prone to psychiatric problems, especially anxiety and depression, as they realize the extent of their difference from peers. On the positive side, both social and language skills often continue to improve during adolescence, and even those children who regress during early adolescence may recover and make developmental progress toward the middle or end of adolescence. Increasing interest in relating to other people can also set the stage for psychosocial interventions or behavioral skill training to be more effective.

Long-term follow-up studies indicate great variability in adult outcomes, but a generally guarded prognosis for good adjustment must be the rule. About half of all autistic adults require residential care; many of the remainder depend on relatives for daily assistance. Gainful employment and fully independent living may be achieved by about one in five. Even for the best-outcome group, social difficulties remain common, marriage or sexual relationships rare, and many social relationships revolve around work or structured activities and interests. It should be noted, however, that the generation of children who have received the benefit of modern special education and behavioral interventions have not yet reached adulthood, and their outcomes, it is hoped, will be significantly better.

Follow-up studies are consistent in demonstrating that higher IQ and communicative language by the age of 5 are strong predictors of better outcome, associated neurological signs and symptoms are predictors of poorer outcome.

Prevalence rates vary according to the definition of the syndrome. Earlier and more restrictive definitions of autism yielded prevalence estimates of 2-4/10,000. Broader definitions encompassing the full PDD spectrum suggested rates three or more times greater. Recent estimates have increased. This may be attributable to improved detection, more lenient diagnoses, or actual increases in prevalence. Most recent estimates are approximately 10/10,000 for PDD disorder, including autism, and another 10/10,000 with a more broadly defined triad of deficits in social relatedness, communication, and stereotyped behavior plus mental retardation. PDD spectrum disorders are more common in males than in females, with ratios found between 2:1 and 10:1, the higher ratios applying more to the Asperger-type clinical picture.

Specifying the boundary between autism and other PDD spectrum disorder (such as Rett’s and Asperger’s Disorder), mixed language disorder, or severe mental retardation can be problematic, and differential diagnoses among these conditions can be difficult. Although diagnostic definitions of autism and language disorder appear distinct, in practice, the differential diagnosis can be unclear, especially in preschool children. Studies from Rutter and colleagues in the 1970’s and from Rapin’s group indicate that the diagnostic groups can be distinguished not only by the presence of autism-related behaviors, but by differences in the language domain itself. The autistic children tend to have greater delays and deficits in language comprehension than the language-disordered children; in the expressive domain, delayed appearance of Wh-questions is highly discriminating. Regression of acquired language skills is also much more typical of autism, but also characterizes children with Landau-Kleffner syndrome. Landau-Kleffner syndrome, also referred to as acquired epileptic aphasia, refers to loss of language in a child in the context of clinical seizures or a frankly epileptiform EEG. There is disagreement as to whether the term should be reserved for children who have no serious associated behavior or cognitive disorders, or whether the term should be broadened so as to include those children who also develop autistic behaviors or become frankly autistic.

Autism may also have increased comorbidity with specific additional disorders. Although still controversial, some investigators present evidence that there is a greater than chance coincidence of autism and Tourette’s disorder. When tics occur in autism, they tend to occur in high-functioning autism.

The relationship between autism and schizophrenia also remains a matter of debate. At one time, the two disorders were believed to be related, but different ages of onset, patterns of symptomatology, and family histories have convinced many investigators that they are unrelated. Nevertheless, reports exist of schizophrenia developing in previously autistic individuals at a greater than chance rate, and a small number of researchers believe that autism is a particularly early and severe form of childhood schizophrenia.

Autism is also related to the presence of seizure disorders. About half of autistic individuals have clinical seizures and/or abnormal EEGs. Infancy and adolescence are high-risk periods for the appearance of seizures. All types of seizures occur; generalized tonicclonic are the most common.

Several specific medical conditions are associated with autism, including phenylketonuria, rubella embryopathy, herpes encephalitis, fragile X syndrome, and neurocutaneous disorders such as tuberous sclerosis. Some studies estimate that between one-eighth and one-fourth of autistic children have an associated medical condition, but it is not known whether these conditions play a causal role in the development of autistic symptoms. Of possible prenatal factors, maternal rubella is most commonly associated with autism, the prevalence for which is 100 times that for the general population. Other obstetrical factors are found more frequently in autistic children than in other populations, particularly midpregnancy maternal bleeding.

The fragile X genetic syndrome has been identified in an estimated 2 to 10% of the autistic population. Fragile X is a rare X-linked syndrome (most prevalent in boys) that involves intellectual impairment, attention deficits, and identifying physical features (prominent ears, long and narrow face, and macroorchidism). Within the fragile X population, it is estimated that 15 to 30% have autistic features, which are qualitatively distinct compared with those seen in the “typical” autistic child. Fragile X autistic children have been found to show perseverative speech as opposed to echolalia, and display active-but-odd social behaviors rather than aloofness. The specific route of pathology connecting fragile X to the expression of autistic symptoms is unknown.

A genetic basis for at least some forms of autism has been demonstrated by family studies. Approximately 3 % of families with an autistic child will produce another child with autism, a prevalence rate which equals 50 to 100 times that of the general population. In addition, the concordance rate for autism in monozygotic twins has been found to range from 40 to 96%. Further support for genetic involvement is found in studies of characteristics in families of autistic children. Siblings of autistic children may be more likely to show superiority in visuospatial over verbal abilities (analogous to the autistic profile), cognitive difficulties such as language disorder, and social disengagement. A few studies have found that some parents of autistic children may be more likely to show unusual social behaviors. The search for specific genetic markers for autism thus far has uncovered two prospects: a marker for a gene that regulates neuron development, and abnormalities of chromosome 15.

Taken together, studies suggest that at least a subset of autistic cases are attributable to genetic origin, either familial or mutational. The incidence of autistic symptoms in medical conditions that are not genetic, however, suggests that the PDD spectrum may represent a variety of etiologies ultimately affecting common brain systems.

Studies of neuroanatomical abnormalities in autistic patients have relied mainly upon postmortem neuropathology examinations and imaging techniques such as positron emission tomography (PET), computerized tomography (CT) and magnetic resonance imaging (MRI). They have generally focused on cortex, brainstem, limbic areas and cerebellum, and have found great variability in brain pathology. Gross cortical and ventricular abnormalities, for example, have been found in some cases and not others. Two structures of great interest are the amygdala and hippocampus, which are limbic structures involved in social/emotional behaviors and in memory. Abnormalities in limbic areas of the brain have been implicated in several studies, most notably in detailed postmortem examinations performed by Bauman and Kemper. These and other studies have also found abnormalities in the cerebellum, although the nature of these cerebellar abnormalities is not consistent across studies.

Findings from PET studies of regional cerebral blood flow have suggested diminished temporal lobe activity, and possible delayed frontal lobe maturation in autistic children. PET studies of regional glucose metabolism, which reflects brain energy utilization, have indicated abnormal patterns of regional activation. Several others have found global glucose hypermetabolism in autistic patients, which was thought to reflect inefficient processing. This feature, however, is not unique to autism.

Studies examining brain waves and oculomotor activity in REM sleep have suggested a developmental immaturity of brain mechanisms controlling sleep and an abnormally suppressed inhibition of sensory responding in autistic children. Brainstem dysfunction has been suggested for a subgroup of autistic individuals by findings of abnormalities in brainstem ERPs, although some studies have failed to support this. Many ERP studies offer support for abnormalities of attention and information processing in autism. High-functioning autistic subjects of varying ages usually show abnormally small amplitudes for a longer latency wave of the ERP thought to reflect the detection and classification of stimuli. Deficiencies in voluntary selective attention and orientation to novel stimuli also have been shown by diminished amplitudes in waves associated with these functions. Several other neurophysiological studies relying on cerebral electrical recording have indicated disruptions in normal hemispheric lateralization in autism.

Investigations of neurotransmitter function have produced inconsistent findings. The most replicated finding among autistic patients is that of elevated blood levels of the neurotransmitter serotonin, which occurs in an estimated one-third of this population, but also is observed in other patient populations. The reason for this elevation is not yet known. Treatments with the drug fenfluramine can greatly reduce levels of serotonin, and sometimes result in improvements in stereotypies and hyperactivity. Studies of the neurotransmitter dopamine are not in agreement, despite reported improvements in many symptoms after treatments with drugs that block dopamine. Overactivity of the opiate peptide beta-endorphin has been suggested by some studies, and supported by findings that opiate blockade improves autistic symptoms in some patients. The peptide oxytocin, shown to promote affiliation in animals, also may be reduced in autistic children. It has been suggested that excess opiates may render social contact unrewarding by producing a state of intrinsic contentment, and may also serve to dysregulate oxytocin.

If the diagnosis is made by a nonphysician and the child has not yet had a medical work-up relative to his/her autism, the following referrals should be considered. Assessment of hearing is important for successful language treatment; if behavior and cooperation are problematic, a brainstem evoked potential assessment should be done. Motor abnormalities are common; these should be assessed by a pediatric neurologist and a pediatric OT. Some physicians believe that a full medical work-up, including EEG, genetic and chromosomal testing, CT scan, and so on, is indicated; others feel that these investigations have a low yield unless there is a specific indication for their use.

Children and adolescents with autism or PDD should also have periodic neuropsychological evaluations. These will describe the child’s current level and profile of cognitive and language abilities, which will have implications for current education and for long-range goals. Periodic reevaluations to monitor the child’s progress will help to detect any deterioration that might signal negative medical or psychological events, and will document the success of treatment and education.

Thorough behavioral description is equally important. Included in the behavioral description should be a profile of the individual’s adaptive abilities and problem behaviors, including those central to the syndrome (such as social incapacity and resistance to change), those associated with the syndrome (such as self-injury and abnormal motor behaviors) and those sometimes found in association with it (such as hyperactivity, aggressiveness, and passivity). Analysis of antecedent conditions and consequences of the behaviors may clarify the role or function of the behavior for the particular autistic individual, and may dictate changes in stimulus conditions and reinforcements to ameliorate problem behaviors, as well as to foster positive behaviors.

Pharmacotherapy can be an effective tool in improving the behavior of some autistic children. Serotonergic agents are often used. Fenfluramine is sometimes prescribed, and has been found to reduce hyperactivity and stereotypies in some, but not all, studies. Clomipramine has been found to enhance social relatedness and decrease obsessional behavior and aggression. Fluoxetine and other serotonin reuptake inhibitors are also used with some autistic children.

Opiate antagonists may help to diminish selfinjury, and reduce social withdrawal and stereotypies. Self-injury and aggression have also reported to be improved by fluoxetine, clomipramine, buspirone and beta-blockers. Neuroleptics, such as haloperidol, and chlorpromazine, have also been found to reduce agitation, aggression and emotional lability, but most physicians are reluctant to use these agents in young children because they can produce movement disorders that may not regress even when the medication is stopped. Lithium is sometimes used to decrease aggressive, perseverative, and hyperactive behavior, and may be tried especially when a family history of bipolar disorder is present.

Other common pharmacological treatments are tricyclic antidepressants, which sometimes enhance language and social behavior. Stimulants have been administered for hyperactivity, but some autistic children experience a worsening of stereotypies or thought disorganization. Stimulants may work best in high-functioning autistic children with absent or mild stereotypies.

Natural treatments, such as dietary interventions or high-dose vitamin regimens have been advocated by some. Empirical support for the claims rests on a small number of studies, and mainstream physicians generally do not advocate their use.

Special education services and behavioral treatments are crucial in producing an optimal outcome. Recent work indicates that aggressive early intervention (as early as 15 to 18 months)can produce the best outcome. The leading proponent of intensive (ca. 40 hours/week) behavioral “drills” (O. I. Lovaas) has reported highly successful outcomes~almost half of the children being successfully included without support in a typical grade-school class. Others using his methods report results that do not replicate his degree of success, but that are nonetheless highly effective. These behavioral programs can be carried out in an educational setting or, especially for preschoolers, in the home. Other preschool programs emphasize a child-centered, developmentally oriented approach, which attempts to stimulate the child to move along a typical developmental trajectory. Any successful program must address each of the behavioral, social, language, and cognitive needs of the children specifically. To be effective, programs should be highly structured and should teach parents behavior management techniques that can be used in the home.

Individual differences in the children partly predict outcome: higher IQ, and the presence of communicative language by the age of 5 are positive prognostic signs.

The recent trend in special education has been strongly in favor of various forms of “mainstreaming, . . . . integration,” and “inclusion,” in which the child attends a class that is composed of a mixed group of special needs and typical peers, or of mainly typical peers, for part or all of the school day, sometimes with a one-on-one aide to facilitate participation. Although research has shown that exposure to normal peers can promote social behavior, the degree to which a severely autistic child can benefit from inclusion in a regular classroom remains to be demonstrated. It is clinically obvious that at least some autistic children need more intensive one-on-one teaching than is available in a mainstream setting before they can benefit from the teaching and social opportunities in a regular class.

In addition to special education or behavioral treatment, the autistic child often needs additional speech and language therapy, occupational therapy, and adapted physical education.

Clinicians must also help families to obtain other necessary services, such as respite care, extended day programs, and summer programs to prevent the behavioral and cognitive regression that can occur. They may also be able to suggest appropriate leisure activities, such as gymnastics, swimming, or play or social groups, that can provide constructive ways to spend after-school hours and opportunities for social interaction with typical children, and can promote self-esteem.

Prescription of therapies and services for the autistic individual must always include sensitivity to the often devastating effect of the disability on the family. Social support from other affected families, and keeping abreast of the latest developments in treatment and other research can help families manage their affected children and their own emotional reactions. The Autism Society of America publishes a regular newsletter with much information useful to parents; another good source of information for parents and professionals on recent developments in autism is Rimland’s newsletter Autism Research Review International.

Bibliography:

• Bauman, M. L., & Kemper, T. L. (Eds.). (1994). The neurobiology of autism. Baltimore: The Johns Hopkins University Press.
• Dawson, G. (Ed.). (1989). Autism: Nature, diagnosis and treatment. New York: Guilford Press.
• Gillberg, C., & Coleman, M. (1992). The biology of the autistic syndromes (2nd ed.). Clinics in Developmental Medicine, 126. London: Mac Keith Press.
• Rapin, I. (Ed.). (1996). Preschool children with inadequate communication: Developmental language disorder, autism, low IQ. Clinics in Developmental Medicine, 139. London: Mac Keith Press.
• Schopler, E., & Mesibov, G. (Eds.). (1995). Learning and cognition in autism. New York: Plenum Press.
• Schopler, E., Van-Bourgondien, M. E., & Bristol, M. (Eds.). (1993). Preschool issues in autism. New York: Plenum Press.

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Educating Children with Autism (2001)

Chapter: 16 conclusions and recommendations.

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16 Conclusions and Recommendations This chapter summarizes the committee’s conclusions about the state of the science in early intervention for children with autistic spectrum disorders and its recommendations for future intervention strategies, pro- grams, policy, and research. The chapter is organized around seven key areas pertaining to educational interventions for young children with autistic spectrum disorders: how the disorders are diagnosed and as- sessed and how prevalent they are; the effect on and role of families; appropriate goals for educational services; characteristics of effective in- terventions and educational programs; public policy approaches to en- suring access to appropriate education; the preparation of educational personnel; and needs for future research. DIAGNOSIS, ASSESSMENT, AND PREVALENCE Conclusions Autism is a developmental disorder of neurobiologic origin that is defined on the basis of behavioral and developmental features. Autism is best characterized as a spectrum of disorders that vary in severity of symptoms, age of onset, and association with other disorders (e.g., mental retardation, specific language delay, epilepsy). The manifestations of au- tism vary considerably across children and within an individual child over time. There is no single behavior that is always typical of autism and no behavior that would automatically exclude an individual child from a 211 

212 EDUCATING CHILDREN WITH AUTISM diagnosis of autism, even though there are strong and consistent com- monalities, especially relative to social deficits. The large constellation of behaviors that define autistic spectrum dis- orders—generally representing deficits in social interaction, verbal and nonverbal communication, and restricted patterns of interest or behav- iors—are clearly and reliably identifiable in very young children to expe- rienced clinicians and educators. However, distinctions among classical autism and atypical autism, pervasive developmental disorder-not other- wise specified (PDD-NOS), and Asperger’s disorder can be arbitrary and are often associated with the presence or severity of handicaps, such as mental retardation and severe language impairment. Identifying narrow categories within autism is necessary for some research purposes; however, the clinical or educational benefit to subclas- sifying autistic spectrum disorders purely by diagnosis is debated. In contrast, individual differences in language development, verbal and non- verbal communication, sensory or motor skills, adaptive behavior, and cognitive abilities have significant effects on behavioral presentation and outcome, and, consequently, have specific implications for educational goals and strategies. Thus, the most important considerations in pro- gramming have to do with the strengths and weaknesses of the indi- vidual child, the age at diagnosis, and early intervention. With adequate time and training, the diagnosis of autistic spectrum disorders can be made reliably in 2-year-olds by professionals experi- enced in the diagnostic assessment of young children with autistic spec- trum disorders. Many families report becoming concerned about their children’s behavior and expressing this concern, usually to health profes- sionals, even before this time. Research is under way to develop reliable methods of identification for even younger ages. Children with autistic spectrum disorders, like children with vision or hearing problems, re- quire early identification and diagnosis to equip them with the skills (e.g., imitation, communication) to benefit from educational services, with some evidence that earlier initiation of specific services for autistic spectrum disorders is associated with greater response to treatment. Thus, well meaning attempts not to label children with formal diagnoses can deprive children of specialized services. There are clear reasons for early identifi- cation of children, even as young as two years of age, within the autism spectrum. Epidemiological studies and service-based reports indicate that the prevalence of autistic spectrum disorders has increased in the last 10 years, in part due to better identification and broader categorization by educators, physicians, and other professionals. There is little doubt that more children are being identified as requiring specific educational inter- ventions for autistic spectrum disorders. This has implications for the provision of services at many levels. Analysis of data from the Office of 

CONCLUSIONS AND RECOMMENDATIONS 213 Special Education Programs, gathered for school-age children since the autism category was recognized in 1991, would support investigation of whether the dramatic increases in the numbers of children served with autistic spectrum disorders are offset by commensurate decreases in other categories in which children with autistic spectrum disorders might have previously been misclassified or whether these dramatic increases have come about for other reasons. Although children with autistic spectrum disorders share some char- acteristics with children who have other developmental disorders and may benefit from many of the same educational techniques, they offer unique challenges to families, teachers, and others who work with them. Their deficits in nonverbal and verbal communication require intense effort and skill even in the teaching of basic information. The unique difficulties in social interaction (e.g., in joint attention) may require more individual guidance than for other children in order to attract and sustain their children’s attention. Moreover, ordinary social exchanges between peers do not usually occur without deliberate planning and ongoing struc- turing by the adults in the child’s environment. The absence of typical friendships and peer relationships affects children’s motivation systems and the meaning of experiences. Appropriate social interactions may be some of the most difficult and important lessons a child with autistic spectrum disorders will learn. In addition, the frequency of behavior problems, such as tantrums and self-stimulatory and aggressive behavior, is high. The need for sys- tematic selection of rewards for many children with autistic spectrum disorders, whose motivation or interests can be limited, requires creativ- ity and continued effort from teachers and parents to maximize the child’s potential. Although general principles of learning and behavior analysis apply to autistic spectrum disorders, familiarity with the specific nature of the disorder should contribute to analysis of the contexts (e.g., commu- nicative and social) of behaviors for individual children and result in more effective programming. For example, conducting a functional as- sessment that considers contexts, and then replacing problem behaviors with more appropriate ways to communicate can be an effective method for reducing problem behaviors. Recommendations 1-1 Because of their shared continuities and their unique social diffi- culties, children with any autistic spectrum disorder (autistic disorder, Asperger’s disorder, atypical autism, PDD-NOS, child- hood disintegrative disorder), regardless of level of severity or function, should be eligible for special educational services within the category of autistic spectrum disorders, as opposed to other 

214 EDUCATING CHILDREN WITH AUTISM terminology used by school systems, such as other health im- paired, social emotionally maladjusted, significantly developmen- tally delayed, or neurologically impaired. 1-2 Identification of autistic spectrum disorders should include a for- mal multidisciplinary evaluation of social behavior, language and nonverbal communication, adaptive behavior, motor skills, atypi- cal behaviors, and cognitive status by a team of professionals experienced with autistic spectrum disorders. An essential part of this evaluation is the systematic gathering of information from parents on their observations and concerns. If the school system cannot carry out such an assessment, the local education author- ity should fund the assessment through external sources. Early diagnosis should be emphasized. Because of variability in early development, younger children with autistic spectrum disorders should receive a follow-up diagnostic and educational assess- ment within one to two years of initial evaluation. 1-3 Professional organizations, with the support of the National Insti- tutes of Health (NIH) and the Department of Education’s Office of Special Education Programs (OSEP), should disseminate infor- mation concerning the nature and range of autistic spectrum dis- orders in young children to all professionals who have contact with children, particularly those who work with infants, toddlers, and preschool children. This information should include the vari- able presentations and patterns of behavior seen in autistic spec- trum disorders from toddlers to school age children. Members of “child find” teams within the early intervention systems, as well as primary care providers, should be trained in identifying the “red flags of autistic spectrum disorders” and the importance and means of early referral for comprehensive diagnostic evaluation. Advocacy groups and relevant federal agencies, as well as profes- sional organizations, should use effective media resources, in- cluding the Internet, to provide information concerning the range of behaviors in autistic spectrum disorders. ROLE OF FAMILIES Conclusions Having a child with an autistic spectrum disorder is a challenge for any family. Involvement of families in the education of young children with autistic spectrum disorders can occur at multiple levels, including advocacy, parents as participating partners in and agents of education or 

CONCLUSIONS AND RECOMMENDATIONS 215 behavior change, and family-centered consideration of the needs and strengths of the family as a unit. Nearly all empirically supported treat- ments reviewed by the committee included a parent component, and most research programs used a parent-training approach. More informa- tion is needed about the benefits of a family-centered orientation or com- bined family-centered and formalized parent training in helping parents. It is well established that parents can learn and successfully apply skills to changing the behavior of their children with autistic spectrum disorders, though little is known about the effects of cultural differences, such as race, ethnicity, and social class, nor about the interactions among family factors, child characteristics, and features of educational interven- tion. For most families, having a child with an autistic spectrum disorder creates added stress. Parents’ use of effective teaching methods can have a significant effect on that stress, as can support from within the family and the community. Parents need access to balanced information about autistic spectrum disorders and the range of appropriate services and technologies in order to carry out their responsibilities. They also need timely information about assessments, educational plans, and the avail- able resources for their children. This information needs to be conveyed to them in a meaningful way that gives them time to prepare to fulfill their roles and responsibilities. In the last ten years the widespread availability of the Internet and media attention to autistic spectrum disorders have increased parents’ knowledge but often conveyed perspectives that were not balanced nor well-supported scientifically. Of crucial importance is the question of how to make information available to parents and to ensure their active role in advocacy for their children’s education. Recommendations 2-1 Parents’ concerns and perspectives should actively help to shape educational planning. Specifically: a. In order for a family to be effective members of the Indi- vidualized Education Plan (IEP) team that plans a child’s educa- tion, the local school system should provide to the parents, at the beginning of the assessment process, written information con- cerning the nature of autistic spectrum disorders and eligibility categories, the range of alternatives within best practices in early education of autistic spectrum disorders, sources of funding and support (e.g., a support guide and bibliography), and their child’s rights. b. Prior to the IEP meeting, the local school system should provide to each family the written results of their child’s assess- 

216 EDUCATING CHILDREN WITH AUTISM ment, and a contact person to explain the findings if they wish, and should indicate that they will have the opportunity to present their concerns. Early during the IEP meeting, parents should be given an opportunity to voice their questions, concerns, and per- spectives about their child’s development and educational pro- gramming. 2-2 As part of local educational programs and intervention programs for children from birth to age 3, families of children with autistic spectrum disorders should be provided the opportunity to learn techniques for teaching their child new skills and reducing prob- lem behaviors. These opportunities should include not only di- dactic sessions, but also ongoing consultation in which individu- alized problem-solving, including in-home observations or training, occur for a family, as needed, to support improvements at home as well as at school. 2-3 Families that are experiencing stress in raising their children with an autistic spectrum disorder should be provided with mental health support services. Under Part C of the Individuals with Disabilities Education Act (IDEA), which addresses family sup- port and service coordination, including private service provid- ers, services should be extended to include families of children at least up to age 8 years. GOALS FOR EDUCATIONAL SERVICES Conclusions At the root of questions about the most appropriate educational inter- ventions lie differences in assumptions about what is possible and what is important to give students with autistic spectrum disorders through edu- cation. The appropriate goals for educational services are the same as those for other children: personal independence and social responsibility. These goals imply continuous progress in social and cognitive abilities, verbal and nonverbal communication skills, adaptive skills, amelioration of behavioral difficulties, and generalization of abilities across multiple environments. In some cases, reports have suggested that particular treat- ments can foster permanent “recovery”. However, as with other develop- mental disabilities, the core deficits of autistic spectrum disorders have generally been found to persist, to some degree, in most individuals. Research concerning outcomes can be characterized by whether the goal of intervention is broadly defined (e.g., “recovery” or “best out- 

CONCLUSIONS AND RECOMMENDATIONS 217 come”) or more specifically defined (e.g., increasing vocabulary or peer- directed social behavior); whether the design involves reporting results in terms of group or individual changes; and whether the goals are short term (i.e., to be achieved in a few weeks or months) or longer term (i.e., over years). A large body of single-subject research has demonstrated substantial progress in individual responses to specific intervention tech- niques in relatively short periods of times (e.g., several months) in many specific areas, including gains in social skills, language acquisition, non- verbal communication, and reductions in challenging behaviors. Studies over longer periods of time have documented joint attention, symbolic play, early language skills, and imitation as core deficits and hallmarks of the disorder that are predictive of longer term outcome in the domains of language, adaptive behaviors, and academic skills. Many treatment studies report postintervention placement as an out- come measure. While successful participation in regular classrooms is an important goal for some children with autistic spectrum disorders, the usefulness of placement in regular education classes as an outcome mea- sure is limited, because placement may be related to many variables other than the characteristics of the child (e.g., prevailing trends in inclusion, availability of other services). The most commonly reported outcome measure in group treatment studies of children with autistic spectrum disorders has been changes in IQ scores, which also have many limita- tions. Studies have reported substantial changes in large numbers of chil- dren in intervention studies and longitudinal studies in which children received a variety of interventions. Even in the treatment studies that have shown the strongest gains, children’s outcomes are variable, with some children making substantial progress and others showing very slow gains. The needs and strengths of young children with autistic spectrum disorders are very heterogeneous. Although there is evidence that many interventions lead to improvements and that some children shift in spe- cific diagnosis along the autism spectrum during the preschool years, there does not appear to be a simple relationship between any particular intervention and “recovery” from autistic spectrum disorders. Thus, while substantial evidence exists that treatments can reach short-term specific goals in many areas, gaps remain in addressing larger questions of the relationships between particular techniques, child characteristics, and outcomes. Recommendations The IEP and Individual Family Service Plan (IFSP) should be the vehicles for planning and implementing educational objectives. 

218 EDUCATING CHILDREN WITH AUTISM 3-1 Appropriate educational objectives for children with autistic spec- trum disorders should be observable, measurable behaviors and skills. These objectives should be able to be accomplished within 1 year and expected to affect a child’s participation in education, the community, and family life. They should include the devel- opment of: a. Social skills to enhance participation in family, school, and community activities (e.g., imitation, social initiations and re- sponse to adults and peers, parallel and interactive play with peers and siblings); b. Expressive verbal language, receptive language, and non- verbal communication skills; c. A functional symbolic communication system; d. Increased engagement and flexibility in developmentally appropriate tasks and play, including the ability to attend to the environment and respond to an appropriate motivational system; e. Fine and gross motor skills used for age appropriate func- tional activities, as needed; f. Cognitive skills, including symbolic play and basic con- cepts, as well as academic skills; g. Replacement of problem behaviors with more conven- tional and appropriate behaviors; and h. Independent organizational skills and other behaviors that underlie success in regular education classrooms (e.g., complet- ing a task independently, following instructions in a group, ask- ing for help). 3-2 Ongoing measurement of educational objectives must be docu- mented in order to determine whether a child is benefiting from a particular intervention. Every child’s response to the educational program should be assessed after a short period of time. Progress should be monitored frequently and objectives adjusted accord- ingly. CHARACTERISTICS OF EFFECTIVE INTERVENTIONS Conclusions In general, there is consistent agreement across comprehensive inter- vention programs about a number of features, though practical and, some- times, ethical considerations have made well-controlled studies with ran- dom assignment very difficult to conduct without direct evaluation. Characteristics of the most appropriate intervention for a given child must 

CONCLUSIONS AND RECOMMENDATIONS 219 be tied to that child’s and family’s needs. However, without direct evalu- ation, it is difficult to know which features are of greatest importance in a program. Across primarily preschool programs, there is a very strong consensus that the following features are critical: • entry into intervention programs as soon as an autism spectrum diagnosis is seriously considered; • active engagement in intensive instructional programming for a minimum of the equivalent of a full school day, 5 days (at least 25 hours) a week, with full year programming varied according to the child’s choronological age and developmental level; • repeated, planned teaching opportunities generally organized around relatively brief periods of time for the youngest children (e.g., 15- 20 minute intervals), including sufficient amounts of adult attention in one-to-one and very small group instruction to meet individualized goals; • inclusion of a family component, including parent training; • low student/teacher ratios (no more than two young children with autistic spectrum disorders per adult in the classroom); and • mechanisms for ongoing program evaluation and assessments of individual children’s progress, with results translated into adjustments in programming. Curricula across different programs differ in a number of ways. They include the ways in which goals are prioritized, affecting the relative time spent on verbal and nonverbal communication, social activities, behav- ioral, academic, motor, and other domains. Strategies from various pro- grams represent a range of techniques, including discrete trials, incidental teaching, structured teaching, “floor time”, and individualized modifica- tions of the environment, including schedules. Some programs adopt a unilateral use of one set of procedures, and others use a combination of approaches. Programs also differ in the relative amount of time spent in homes, centers, or schools, when children are considered ready for inclu- sion into regular classrooms, how the role of peers as intervention agents is supported, and in the use of distraction-free or natural environments. Programs also differ in the credentials that are required of direct support and supervisory staff and the formal and informal roles of collateral staff, such as speech language pathologists and occupational therapists. Overall, many of the programs are more similar than different in terms of levels of organization, staffing, ongoing monitoring, and the use of certain techniques, such as discrete trials, incidental learning, and struc- tured teaching. However, there are real differences in philosophy and practice that provide a range of alternatives for parents and school sys- tems considering various approaches. The key to any child’s educational program lies in the objectives specified in the IEP and the ways they are 

220 EDUCATING CHILDREN WITH AUTISM addressed. Much more important than the name of the program attended is how the environment and educational strategies allow implementation of the goals for a child and family. Thus, effective services will and should vary considerably across individual children, depending on a child’s age, cognitive and language levels, behavioral needs, and family priorities. Recommendations The committee’s recommendations for effective treatment are made on the basis of empirical findings, information from selected representa- tive programs, and findings in the general education and developmental literature. In particular, it is well established that children with autism spend much less time in focused and socially directed activity when in unstructured situations than do other children. Therefore, it becomes crucial to specify time engaged in social and focused activity as part of a program for children with autistic spectrum disorders. 4-1 Based on a set of individualized, specialized objectives and plans that are systematically implemented, educational services should begin as soon as a child is suspected of having an autistic spec- trum disorder. Taking into account the needs and strengths of an individual child and family, the child’s schedule and educational environment, in and out of the classroom, should be adapted as needed in order to implement the IEP. Educational services should include a minimum of 25 hours a week, 12 months a year, in which the child is engaged in systematically planned, develop- mentally appropriate educational activity aimed toward identi- fied objectives. Where this activity takes place and the content of the activity should be determined on an individual basis, de- pending on characteristics of both the child and the family. 4-2 A child must receive sufficient individualized attention on a daily basis so that individual objectives can be effectively implemented; individualized attention should include individual therapies, de- velopmentally appropriate small group instruction, and direct one-to-one contact with teaching staff. 4-3 Assessment of a child’s progress in meeting objectives should be used on an ongoing basis to further refine the IEP. Lack of objec- tively documentable progress over a 3 month period should be taken to indicate a need to increase intensity by lowering stu- 

CONCLUSIONS AND RECOMMENDATIONS 221 dent/teacher ratios, increasing programming time, reformulat- ing curricula, or providing additional training and consultation. 4-4 To the extent that it leads to the specified educational goals (e.g., peer interaction skills, independent participation in regular edu- cation), children should receive specialized instruction in settings in which ongoing interactions occur with typically developing children. 4-5 Six kinds of interventions should have priority: a. Functional, spontaneous communication should be the pri- mary focus of early education. For very young children, pro- gramming should be based on the assumption that most children can learn to speak. Effective teaching techniques for both verbal language and alternative modes of functional communication, drawn from the empirical and theoretical literature, should be vigorously applied across settings. b. Social instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals (e.g., with very young children, response to maternal imitation; with preschool children, cooperative activities with peers). c. The teaching of play skills should focus on play with peers, with additional instruction in appropriate use of toys and other materials. d. Other instruction aimed at goals for cognitive develop- ment should also be carried out in the context in which the skills are expected to be used, with generalization and maintenance in natural contexts as important as the acquisition of new skills. Because new skills have to be learned before they can be general- ized, the documentation of rates of acquisition is an important first step. Methods of introduction of new skills may differ from teaching strategies to support generalization and maintenance. e. Intervention strategies that address problem behaviors should incorporate information about the contexts in which the behaviors occur; positive, proactive approaches; and the range of techniques that have empirical support (e.g., functional assess- ment, functional communication training, reinforcement of alter- native behaviors). f. Functional academic skills should be taught when appro- priate to the skills and needs of a child. 

222 EDUCATING CHILDREN WITH AUTISM PUBLIC POLICIES Conclusions The Individuals with Disabilities Education Act (IDEA) contains the necessary provisions for ensuring rights to appropriate education for chil- dren with autistic spectrum disorders. However, the implementation and specification of these services are variable. Early intervention for young children with autistic spectrum disorders is expensive, and most local schools need financial help from the state and federal programs to pro- vide appropriate services. The large number of court cases is a symptom of the tension between families and school systems. Case law has yielded an inconsistent pattern of findings that vary according to the characteristics of the individual cases. The number of challenges to decision-making for programming within school systems reflects parents’ concerns about the adequacy of knowledge and the expertise of school systems in determining their children’s education and implementing appropriate techniques. The treatment of autistic spectrum disorders often involves many disciplines and agencies. This confuses lines of financial and intellectual responsibility and complicates assessment and educational planning. When communication between families and school systems goes awry, it can directly affect children’s programming and the energy and financial resources that are put into education rather than litigation. Support sys- tems are not generally adequate in undergirding local service delivery programs and maximizing the usefulness of different disciplines and agencies, and transitions between service delivery agencies are often prob- lematic. A number of states have successful models for providing services to children with autism, and mechanisms are becoming increasingly effi- cient and flexible in some states. In most cases, existing agencies at state and federal levels can develop appropriate programs without restructur- ing—with the possible addition of special task forces or committees de- signed to deal with issues particular to children with autistic spectrum disorders. Recommendations The committee recommends that a variety of steps be taken to ensure that policies are effectively carried out at the state and local levels. 5-1 At the federal level, the National Institutes of Health’s Autism Coordinating Committee and the Federal Interagency Coordinat- ing Council should jointly appoint a clinical research oversight 

CONCLUSIONS AND RECOMMENDATIONS 223 task force of professionals knowledgeable in the field of autistic spectrum disorders, to review and periodically report on basic and applied research programs to the parent agencies and to track program implementation through the State Interagency Coordi- nating Councils or relevant state agencies. Administrative sup- port for these efforts should be provided by the appropriate de- partment of the Secretary’s office. 5-2 States should have regional resource and training centers with expertise in autistic spectrum disorders to provide training and technical support to local schools. States should also have a mechanism to evaluate the adequacy of current support systems to local schools and recommend ways for improvement. One such mechanism could be an autistic spectrum disorders support systems task force that would examine the relevant provisions for personnel preparation, technical assistance, and demonstration of exemplary programs and would make recommendations as to what would be needed to bring a state’s support systems into alignment with quality education for children with autistic spec- trum disorders. States should monitor coordination among and transitions between service delivery systems and should develop ways to facilitate these processes. 5-3 Families should have access to consultation and legal knowledge such as provided by an ombudsman who is independent of the school system and who could be a standard part of Individual- ized Educational Plan planning and meetings. The ombudsman should be knowledgeable about autistic spectrum disorders and about relevant law and court decisions. The ombudsman’s role should include attending IEP meetings, interpreting the school system’s communications about a child to parents, and propos- ing, at the parents’ request, alternatives to those presented by the school system. Professional and advocacy groups should work together to provide this service, with the Governor’s Council for Developmental Disabilities or the Autistic Spectrum Disorders Support Systems Task Force responsible for ensuring funding for training and support of this service. 5-4 State and federal agencies should consider ways to work with and support professional and advocacy groups to provide up-to- date, practical, scientifically valid information to parents and practitioners. 

224 EDUCATING CHILDREN WITH AUTISM 5-5 States should have clearly defined minimum standards for per- sonnel in educational settings for children with autistic spectrum disorders. For example, at a minimum, teachers should have some special preparation (e.g., preservice course work, equiva- lent inservice training, workshops, and supervised practice in re- search-based practices in autistic spectrum disorders) and should have well-trained, experienced support personnel available to provide ongoing training and additional consultation. 5-6 States should develop a systematic strategy to fund the interven- tions that are necessary for children with autistic spectrum disor- ders in local schools, so that this cost is not borne primarily by the parents or local school systems. State education departments should develop interagency collaborations to pool support for local systems. A state fund for intensive intervention, or more systematic use of Medicaid waivers or other patterns of funding currently in place in some states, should be considered. Families should not be expected to fund or provide the majority of educa- tional programming for their children. 5-7 An updated, accurate summary of case law, consultation services, and mediation mechanisms in autistic spectrum disorders should be made accessible by the Office of Special Education Programs so that schools and parents can understand the options available to them when conflicts arise. 5-8 Since levels of information about autistic spectrum disorders vary greatly within the groups and agencies that make funding and policy decisions about autistic spectrum disorders, including state task forces in education and review panels in federal agencies, it is crucial that persons knowledgeable in the range of needs and interventions associated with autistic spectrum disorders be in- cluded in those decision-making activities. PERSONNEL PREPARATION Conclusions The nature of autistic spectrum disorders and other disabilities that frequently accompany them has significant implications for approaches to education and intervention at school, in the home, and in the commu- nity. Approaches that emphasize the use of specific “packages” of mate- rials and methods associated with comprehensive intervention programs 

CONCLUSIONS AND RECOMMENDATIONS 225 may understate the multiple immediate and long-term needs of children for behavior support and for instruction across areas. Teachers are faced with a huge task. They must be familiar with theory and research concerning best practices for children with autistic spectrum disorders, including methods of applied behavior analysis, naturalistic learning, assistive technology, socialization, communication, inclusion, adaptation of the environment, language interventions, assess- ment, and the effective use of data collection systems. Specific problems in generalization and maintenance of behaviors also affect the need for training in methods of teaching children with autistic spectrum disorders. The wide range of IQ scores and verbal skills associated with autistic spectrum disorders, from profound mental retardation and severe lan- guage impairments to superior intelligence, intensify the need for person- nel training. To enable teachers to adequately work with parents and with other professionals to set appropriate goals, teachers need familiar- ity with the course of autistic spectrum disorders and the range of pos- sible outcomes. Teachers learn according to the same principles as their students. Multiple exposures, opportunities to practice, and active involvement in learning are all important aspects of learning for teachers, as well as stu- dents. Many states and community organizations have invested substan- tial funds in teacher preparation through workshops and large-audience lectures by well-known speakers. While such presentations can stimulate enthusiasm, they do not substitute for ongoing consultation and hands- on opportunities to observe and practice skills working with children with autistic spectrum disorders. Personnel preparation remains one of the weakest elements of effec- tive programming for children with autistic spectrum disorders and their families. Ways of building on the knowledge of teachers as they acquire experience with children with autistic spectrum disorders, and ways of keeping skilled personnel within the field, are critical. This is particularly true given recent trends for dependence on relatively inexperienced assis- tants for in-home programs. Providing knowledge about autistic spec- trum disorders to special education and regular education administra- tors, as well as to specialized providers with major roles in early intervention (e.g., speech language pathologists) will be critical in effect- ing change that is proactive. Findings concerning change in educational and other opportunities suggest that administrative attitudes and sup- port are critical in improving schools. Recommendations The committee recommends that relevant state and federal agencies institute an agenda for upgrading personnel preparation for those who 

226 EDUCATING CHILDREN WITH AUTISM work with, and are responsible for, children with autistic spectrum disor- ders and their families. These efforts should be part of a larger effort to coordinate and collaborate with the already established infrastructure of special education, regional resource centers, technical assistance pro- grams, personnel preparation, communication sharing, and other relevant aspects of the existing infrastructure. Professionals aware of the special nature of these children are already carrying out many of these recom- mendations in a limited fashion. The committee urges agencies to pro- vide the personnel preparation resources needed for intensified efforts to build a viable support structure for educating children with autistic spec- trum disorders. 6-1 The Office of Special Education Programs should establish a 5- year plan to provide priority funds for preservice and inservice preparation for teachers, paraprofessionals, and other personnel providing services for children with autistic spectrum disorders, including children under age 3 years. 6-2 The need for a team approach involving many professions should be addressed by personnel preparation and practicum work within multidisciplined organizations and teams. 6-3 A special emphasis should be placed on training of trainers. There is a short supply of expertise and experience in the field of educa- tion for children with autistic spectrum disorders, and special attention should be paid to rapidly increase the capabilities of the trainers, who may have experience in special education or related fields, but not in the special skills and practices for children with autistic spectrum disorders. 6-4 The existing support systems that provide short-term training (e.g., technical assistance systems, resource centers, etc.) should include people with special expertise in autistic spectrum disor- ders on their staff. 6-5 The content of the curriculum for children with autistic spectrum disorders should be based on sound research. A continuing pro- gram should be established from such agencies as the National Institute of Mental Health and the National Institute of Child Health and Human Development to translate their research into usable information for practitioners. Work on family research is particularly relevant. 

CONCLUSIONS AND RECOMMENDATIONS 227 NEEDED RESEARCH Conclusions There are several distinct and substantial bodies of research relevant to young children with autistic spectrum disorders. One body identifies neurological, behavioral, and developmental characteristics. Another body of research addresses diagnostic practices and related issues of prevalence. Another has examined the effects of comprehensive early treatment programs on the immediate and long-term outcomes of chil- dren and their families. These treatment studies tended to use some form of group experimental design. An additional body of research has ad- dressed individual instructional or intervention approaches, with many studies in this literature using single-subject experimental methodology. Altogether, a large research base exists, but with relatively little integra- tion across bodies of literature. Highly knowledgeable researchers in one area of autistic spectrum disorders may have minimal information from other perspectives, even about studies with direct bearing on their find- ings. Most researchers have not used randomized group comparison de- signs because of the practical and ethical difficulties in randomly assign- ing children and families to treatment groups. In addition, there have been significant controversies over the type of control or contrast group to use and the conditions necessary for demonstrating effectiveness. Al- though a number of comprehensive programs have provided data on their effectiveness, and, in some cases, claims have been made that certain treatments are superior to others, there have been virtually no compari- sons of different comprehensive interventions of equal intensity. Across several of the bodies of literature, the children and families who have participated in studies are often inadequately described. Stan- dardized diagnoses, descriptions of ethnicity, the social class, and associ- ated features of the children (such as mental retardation and language level) are often not specified. Fidelity of treatment implementation has not been consistently assessed. Generalization, particularly across set- tings, and maintenance of treatment effects are not always measured. Though there is little evidence concerning the effectiveness of discipline- specific therapies, there is substantial research supporting the effective- ness of many specific therapeutic techniques. Recommendations 7-1 Funding agencies and professional journals should require minimium standards in design and description of intervention projects. All intervention studies should provide the following information: 

228 EDUCATING CHILDREN WITH AUTISM a. Adequate information concerning the children and fami- lies who participated, and who chose not to participate or with- drew from participation, including chronological age, develop- mental assessment data (including verbal and nonverbal IQ levels), standardized diagnoses, gender, race, family characteris- tics, socioeconomic status, and relevant health or other biological impairments; b. description of the intervention in sufficient detail so that an external group could replicate it; detailed documentation is crucial especially if no treatment manual is available; c. fidelity of treatment and degree of implementation; d. specific objective measures of expected outcomes, assessed at regular intervals; and e. measures of outcome that are independent of the interven- tion, in terms of both the evaluators and the measures, and in- clude broad immediate and long-term effects on children and families, particularly generalization and maintenance effects. 7-2 Funders and performers of research should recognize that valu- able information can be provided by a variety of approaches to research in intervention, including group experimental and single-subject designs. 7-3 In order to help educators and consumers make informed deci- sions about appropriate methods of intervention for particular children, federal agencies involved in autistic spectrum disorders initiatives (including the Office of Special Education Programs, the Office of Educational Research and Improvement, the Na- tional Institute of Child Health and Human Development, the National Institute of Mental Health, the National Institute of Neu- rological Disorders and Stroke, and the National Institute on Deaf- ness and Other Communication Disorders) and nonprofit agen- cies with similar national missions (such as Autism Society of America Foundation, Cure Autism Now, and National Alliance for Autism Research) should form a research task force and spe- cifically allocate federal responsibilites for recruiting and funding a comprehensive program of research related to intervention and treatment. This program should include: a. development of more specific, precise measures of impor- tant areas of outcome, such as social functioning, peer relation- ships, spontaneous communication and language, and the acqui- sition of competence in natural contexts (e.g., classroom, home); 

CONCLUSIONS AND RECOMMENDATIONS 229 b. definition of appropriate educational skills and sequences in social and cognitive development, informed by normal devel- opmental literature; c. measurement of the effects of the interactions between fam- ily variables (e.g., family structure, family supports, socioeco- nomic status), child factors (such as degree of language impair- ment), and responses to educational interventions (including family-centered, parent training, and other approaches) on out- comes. d. longitudinal treatment studies, where feasible, built on a clinical model with randomly assigned samples of sufficient size to assess the effectiveness of differing modes of treatment. 7-4 Treatment studies should recognize the common components of many comprehensive programs (e.g., standardized curriculum, family training, presence of typically developing peers) and should target and measure, longitudinally when feasible, “active ingredients” and mediating variables that influence the effects of intervention (e.g., communication and interaction opportunities for engagement, levels of interaction and initiation, specific teach- ing techniques, proportion of time in close proximity of peers). The concomitant development of innovative treatments building on these “active ingredients” should be supported. 7-5 In response to amendments in IDEA to make education more outcome oriented, a federal initiative should solicit and fund stud- ies in the following areas, not easily supported under the current review system: a. the development of instruments for measurement of diag- nosis and critical aspects of development, particularly tools for early screening of autistic spectrum disorders and for measure- ment of response to interventions; b. the development and application of sophisticated statisti- cal methods of analysis of change and growth, particularly multi- variate designs and those applicable to small samples; and c. the development and dissemination of novel research de- signs that combine individual and group approaches in ways that minimize biases and maximize the power of small samples. 7-6 Competitively funded initiatives in early education in autistic spectrum disorders should require plans and contain sufficient funding for short- and long-term assessment of child outcomes and measures of program efficacy. 

Autism is a word most of us are familiar with. But do we really know what it means?

Children with autism are challenged by the most essential human behaviors. They have difficulty interacting with other people—often failing to see people as people rather than simply objects in their environment. They cannot easily communicate ideas and feelings, have great trouble imagining what others think or feel, and in some cases spend their lives speechless. They frequently find it hard to make friends or even bond with family members. Their behavior can seem bizarre.

Education is the primary form of treatment for this mysterious condition. This means that we place important responsibilities on schools, teachers and children's parents, as well as the other professionals who work with children with autism. With the passage of the Individuals with Disabilities Education Act of 1975, we accepted responsibility for educating children who face special challenges like autism. While we have since amassed a substantial body of research, researchers have not adequately communicated with one another, and their findings have not been integrated into a proven curriculum.

Educating Children with Autism outlines an interdisciplinary approach to education for children with autism. The committee explores what makes education effective for the child with autism and identifies specific characteristics of programs that work. Recommendations are offered for choosing educational content and strategies, introducing interaction with other children, and other key areas.

This book examines some fundamental issues, including:

• How children's specific diagnoses should affect educational assessment and planning
• How we can support the families of children with autism
• Features of effective instructional and comprehensive programs and strategies
• How we can better prepare teachers, school staffs, professionals, and parents to educate children with autism
• What policies at the federal, state, and local levels will best ensure appropriate education, examining strategies and resources needed to address the rights of children with autism to appropriate education.

Children with autism present educators with one of their most difficult challenges. Through a comprehensive examination of the scientific knowledge underlying educational practices, programs, and strategies, Educating Children with Autism presents valuable information for parents, administrators, advocates, researchers, and policy makers.

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Home — Essay Samples — Nursing & Health — Neurology & Nervous System Diseases — Autism

Essays About Autism

What makes a good autism essay topics.

When it comes to writing an essay on autism, it's important to choose a topic that is not only interesting but also relevant and impactful. The topic you choose can make or break your essay, so it's crucial to select one that is both engaging and thought-provoking. Here are some recommendations on how to brainstorm and choose an essay topic, what to consider, and What Makes a Good essay topic.

When brainstorming for autism essay topics, it's important to consider the audience and the purpose of the essay. Think about what you want to achieve with your essay and who will be reading it. Consider the impact you want to make and the message you want to convey. It's also important to choose a topic that is manageable and can be effectively explored within the constraints of the essay.

A good autism essay topic should be relevant and timely. Consider current issues and debates surrounding autism and choose a topic that is both current and significant. It's also important to choose a topic that is unique and original. Avoid cliché topics and instead focus on something that has not been extensively explored or discussed. A good essay topic should also be specific and focused. Avoid broad and generic topics and instead narrow down your focus to a specific aspect or issue related to autism.

Best Autism Essay Topics

• The impact of early intervention on children with autism
• The role of sensory processing in autism
• The link between autism and genetics
• The portrayal of autism in popular media
• The challenges of parenting a child with autism
• The benefits of music therapy for individuals with autism
• The use of technology in autism interventions
• The importance of inclusive education for children with autism
• The impact of autism on the family dynamics
• The experiences of adults with autism in the workplace
• The connection between autism and co-occurring conditions
• The role of speech therapy in treating autism
• The challenges of accessing autism services in rural communities
• The intersection of race and autism diagnosis
• The potential of animal-assisted therapy for individuals with autism
• The link between autism and mental health
• The experiences of girls and women with autism
• The impact of autism on social relationships
• The role of advocacy in the autism community
• The potential of alternative therapies for individuals with autism

Autism essay topics Prompts

• Imagine a world where autism acceptance is the norm. How would society be different?
• Write a letter to a parent of a newly diagnosed child with autism, offering support and guidance.
• Create a fictional story that explores the experiences of a teenager with autism navigating high school.
• Imagine a future where a cure for autism is discovered. What are the potential implications and consequences?
• Write a reflective essay on your own experiences with autism, whether as an individual on the spectrum or as a caregiver or advocate.

Choosing a topic for an autism essay can be a daunting task, but with careful consideration and creativity, you can choose a topic that is not only engaging but also impactful. Whether you're exploring the latest research on autism interventions or delving into the personal experiences of individuals with autism, there are endless possibilities for compelling and thought-provoking essay topics. So, take your time, brainstorm, and choose a topic that will captivate your audience and leave a lasting impression.

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Autism spectrum disorder is a condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication.

Trouble with social interaction, verbal and nonverbal communication, and presence of restricted interests and repetitive behavior.

Autism spectrum disorder has no single known cause. Given the complexity of the disorder, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.

Autism is about 4 times more likely in boys than girls. Autism affects children of all racial, ethnic, and socioeconomic groups. Autism can be reliably diagnosed by age 2, but children may be diagnosed at earlier ages. ASD affects about 1 in 68 children Visit disclaimer page in the United States.

Relevant topics

• Sleep Deprivation
• Post Traumatic Stress Disorder
• Postpartum Depression
• Drug Addiction
• Healthy Food
• Vaccination

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Autism Spectrum Disorder Research Paper

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As human beings grow up, they are bound to develop various behaviors that they carry on with, even in their adulthood. The behaviors could be of any type ranging from deviance to anti-social dispositions. Parents become worried when they realize that their children have any of these abnormalities.

To some parents, they may realize the behavior early enough for treatment while to others; they take too long to decipher the strange behaviors with their children. Although intervention is still viable in the latter case, full development is highly unlikely.

While there are many causes that can be associated to these anomalies of child development, or even peculiar adult conducts, one of the key contributors to these is autism spectrum disorder. This research paper provides an insight into the principal aspects of autism spectrum disorder including its causes, symptoms, treatment, and myths surrounding it.

Living with autism spectrum disorder is challenging to the patient and their surroundings that can differ widely from person to person. In many cases, normal development is more or less hindered in all spheres of life. Autism is, therefore, a permanent disability that affects societal and communication skills.

Autistics fail to comprehend the operation of their surroundings (Boutot & Tincani, 2009). They also find it difficult to interact. In particular, such people have difficulties in learning, grasping accepted rules of social intermingling that normal people take for granted. What exactly is this autism spectrum disorder?

The term ‘autism’ was first coined by Eugene Bleuler in 1912. It originates from the Greek word ‘autos’ meaning self. Bleuler used it to describe the schizophrenic’s apparent difficulty in interacting with other people. Although the term was used to describe people showing the autistic tendency to detach from personal contact, the disorder was not fully defined until the mid 19 th century.

Leo Kanner is considered the first physician to focus on autism in his seminal paper entitled ‘Autistic disturbances of affective contact’. Kanner suggested that the term ‘autism’ describe the fact that children seemed to lack interest in other people (Exkom, 2006).

His paper on the autism contained almost every trait still considered as typical of ASD. Since the publication of the Kanner’s paper on autism, other scholars have joined the trade and made various contributions to the issue. These included Hans Asperger, a German scientist of whom the Asperger’s syndrome is named after (Gallo, 2010).

Scientists have, for long, debated on autism, owing to a difficult in the consensus in the name for the handicap. Nevertheless, autism is unanimously considered as a sever form of Pervasive Developmental Disorders (PDD) or Autism Spectrum Disorders (ASD).

Autism is a neurological syndrome with predominantly behavioral manifestations. Many children with autism show neurological symptoms and signs including seizures, dyspraxia, hypotonia, mental retardation, gait anomalies, and macrocephaly. As such, in this paper, autism will be used interchangeably with ASD (Matson, 2008).

Given that autism is puzzling even to experts, this phenomenon has given rise to a couple of myths and misconceptions concerning the disorder. For instance, it is widely believed that children with autism can perform amazing metal feats like multiplying multiple numbers in their heads.

However, the reality is that the number of children with autism and having high intelligence is insignificant. Another myth surrounding ASD is that dissocial or secluded mothering causes autism. (Sicira-Kira, 2004).

The reality is that autism is a biological handicap. However, some fathers and mothers of autistic children who seem very introverted, socially discomfited, or isolated may themselves be autistic.

Another widely held misconception about ASD is that it can be caused. This is, however, not the case. In the real sense, autism commonly appears within the first two years of life. This is the time when children are being vaccinated.

Nevertheless, the emergence of autistic symptoms preceding an immunization is only by coincidence. It is also believed that there are behavioral programs that can cure autism. This is not true because autism is not curable. Behavioral programs are meant to aid the autistic person handle the disorder, but not to cure it (Gupta, 2004).

Having looked at some of the myths and misconceptions surrounding ASD, this paper now shifts focus to the symptoms associated with the disorder. There are three major symptoms that people with Autism spectrum disorder exhibit.

They show flaws in social interaction, oral and nonverbal communication, and recurring conducts or interests. Autistics find it difficult to express emotions, empathy, and conversing with others. They may insist on following certain routines in a repetitive manner, or rigid organization of objects.

As evident from these symptoms, ASD is made of a triad of impairments with each having the two extremes of severe degree and mild degree.

It is very easy to identify children with ASD because they do not follow the normal patterns of development. In most cases, between the ages of one year and three years, the distinction in the way the children react to people and other unusual behaviors becomes apparent.

These behaviors include failure to coo, babble, point, or make meaningful gestures at the age of one year, failure to speak one word by 16 months, or inability to combine two words by two years. Other abnormal behaviors include inability to respond to name, loss of language or social skills, poor eye contact, and an occasional hearing impairment (Le Blanc & Volkers, 2007).

Despite its profound symptoms, there is no specifically cause of autism recognized yet. The only conventional ideas concerning the basis of autism are that it is considered to be present at birth, in spite of its appearance later in life. It is caused by anomalies in the brain and may be genetic.

However, the cause of the brain anomalies and the gene affected by the disorder are still up for debate. Another certainty concerning the causes of ASDs is that they are not a psychological disorder by poor parenting, unconsciously rejecting a child, or failing to bond emotionally.

As such, while studying the causes, the scope of the scope of this paper will be limited to the possible causes of ASD (Matson, 2008).

There are four possible causes of ASD. These are biological basis, genetic, pregnancy or birth injury, and vaccinations. Under biological basis, researches have not been able to venture into the study of the human brain anatomy due to its inaccessibility.

However, with the innovative emergence of new brain imaging tools such as computerized tomography (CT), and position emission tomography (PET), study of the structure and the functioning of the brain are now possible.

Post mortem and magnetic resonance imaging (MRI) studies have indicated that many major brain structures are implicated in autism. It is apparent that, in autism, a disorder is found in the structure of the brain.

There is a disorder localized in the frontal lobes. Reduced blood flow to some parts of the brain and decreased numbers of certain brain cells also seem to appear along autism traits (Matson & Minshawi, 2006).

Under hereditary, it is widely known that genetics are instrumental in the nature of holistic traits of human beings. This is the same for autism. Studies in the past have suggested an underlying genetic vulnerability to ASD. It is apparent that congenital factors play an important part.

Recent neuroimaging studies have shown that a cause for autism may be anomalous brain growth start from the infant’s first months. The idea that autism is caused by difficulties occurring during pregnancy, or birth process is also under investigation.

It is only in very exceptional cases that illness during pregnancy can cause autism (Sicira-Kira, 2004). A number of opinions exist concerning this cause with the most recent suggesting that laborious pregnancies are a consequence of autism in the child rather than a cause of it.

Another cause of ASD under investigation is toxins ingested by the mother during pregnancy. There is little evidence for the supposition that vaccinations cause autism.

In conclusion, there is no known cure for ASD. However, there are interventions that children or adults with this disorder.

The treatment is divided into a number of categories. These are nutritional-biologically based treatment, relational-socially based, sensory or neural based treatment, pharmacological-medically based treatment, and educational or behavioral skill based treatment (Williams & Williams, 2011). Since that ASD has no precise treatment, parents should pay attention to their growth and development patterns of their children.

Boutot, A. E., & Tincani, M. (2009). Autism Encyclopedia: the complete guide to Autism Spectrum Disorders . London: Sourcebooks, Inc.

Exkom, K. S. (2006). The Autism Sourcebook: Everything you need to know about diagnosis, treatment, coping, and healing–from a mother whose child recovered . New York: HarperCollins.

Gallo, D. P. (2010). Diagnosing Autism Spectrum Disorders: a lifespan perspective . New York: John Wiley and Sons.

Gupta, V. D. (2004). Autistic spectrum disorders in children . New York: CRC Press.

Le Blanc, R., & Volkers, H. (2007). What you should know about Autism Spectrum Disorders . New York: Cranendonck Coaching.

Matson, J. L. (2008). Clinical assessment and intervention for Autism Spectrum Disorders . Amsterdam: Academic Press.

Matson, J. L., & Minshawi, N. F. (2006). Early intervention for autism spectrum disorders: a critical analysis . London: Elsevier.

Sicira-Kira, C. (2004). Autism spectrum disorders: the complete guide to understanding autism, Asperger’s syndrome, pervasive developmental disorder, and other ASDs . London: Penguin.

Williams, B. F., & Williams, R. L. (2011). Effective programs for treating autism spectrum disorder: applied behavior analysis models . London: Taylor & Francis.

• Upton Sinclair’s “Living and Dying in Packingtown, Chicago”
• Public Policy: Obesity and Aging Society
• Autism Spectrum Disorder: Diagnosis, Impact, Treatment
• Autism Spectrum Disorder in Children and Its Impact on the Family
• ASD: Diagnostic and Statistical Manual of Mental Disorders
• The Rate of Smoking Among HIV Positive Cases.
• The Qualitative and Quantitative Research Strategies: Drug Addiction
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Research Paper on Autism

Autism, also known as an autism spectrum disorder (ASD), is a neurodevelopmental illness that significantly impacts a person’s ability to communicate, interact socially, and behave appropriately. Autism is also known as Asperger syndrome and pervasive developmental impairment (Lord et al. pp. 508-520). Despite rising public and scholarly interest in the illness, the causes and mechanisms of autism remain unknown. This essay aims to assess the current state of autism research. This evaluation covers diagnosis, prevalence, heredity, environmental effects, brain correlates, and therapeutic approaches. This research paper will look at the most recent advances in our understanding of the neurological underpinnings of autism. Among these achievements are changing in brain circuitry and synapse function and the likely impact of epigenetic factors and the microbiome. The study also looks into the possible effects of employing genetically modified bacteria. Considering the findings of this research, it is evident that a multidisciplinary approach to understanding autism, including genetics, neurology, and clinical psychology, is required. This is critical in developing improved therapies and resources for autistic persons and their families.

  Introduction

One in 68 American children has autism, a form of developmental disorder, according to the Centers for Disease Control and Prevention (CDC) (CDC). The inability to communicate and interact socially and confined and repetitive patterns of behavior, interests, or hobbies are diagnostic criteria for autism spectrum disorder (Lord et al. pp. 508-520). People with this disorder are also more likely to obsess about unimportant matters. Because autism is a spectrum condition, those diagnosed with it may experience many symptoms. While some with milder signs of autism may be able to live independently, those with more severe symptoms may always need assistance. Despite the increased study, very little is understood about the neurobiology of autism. This study aims to provide a comprehensive analysis of recent studies about autism, the new insights into autism’s underpinnings, hallmarks, and potential remedies for the disorder. The importance of a multidisciplinary approach to autism research is highlighted by this study, which brings together data from various sources to assist people with autism and their families better.

Causes of Autism

Autism is a developmental disorder marked by significant social interaction and communication difficulties rooted in a complex interplay between hereditary and environmental factors. Autism is thought to have heritable solid components. The risk of developing the disease is estimated to be as high as 90% due to genetic factors (Hodges et al. n.p). Genes involved in synapse function, brain development, and immune system regulation have all been proposed as possible causes of autism.

Some research suggests that autism may result from genetic and environmental causes. Maternal infection, early birth, and low birth weight have all been related to an increased risk of autism in their offspring. According to some research, long-term exposure to environmental toxins, including pesticides and heavy metals, may also increase susceptibility to the disease.

Recent research has also focused on the potential role of epigenetic factors in autism development. Epigenetic modifications, such as DNA methylation and modifications to histones, can affect gene expression, contributing to alterations in how the nervous system forms and functions. Epigenetic abnormalities may influence the development of autism, and there is some evidence that environmental factors play a role in this process.

Symptoms of Autism

There is a wide variety of symptoms associated with autism, and each one might present itself somewhat differently depending on the individual. Restrictive and repetitive interests and behaviors are hallmarks of autism spectrum disorder (ASD), as are social communication and interaction impairments. These signs and symptoms almost always show early in a person’s development, typically between six and twelve months old (Shuster et al. pp. 90-110). Some of the most common autistic symptoms include:

• Issues related to interpersonal and social communication and interaction, such as but not limited to:
• Having difficulty reading nonverbal cues like facial expressions, tone of voice, and body language.
• Challenges in making and keeping social connections
• A marked reluctance to engage in retrospective conversation
• Friendship formation and maintenance are complex processes.
• Habits and hobbies that are limited and monotonous, such as
• Rocking back and forth or flapping one’s hands are repetitive movements.
• Reluctance to change or break with established practices; rigid ritualism.
• Obsessive focus on one or a few topics, excluding other interests or activities.
• Sense-based aversions or sensitivities, such as to certain types of light, sounds, or textures

The following are some other indicators of autism:

• Problems with language acquisition or linguistic pragmatism
• Problems with motor skills or coordination development due to a lack of imaginative play.
• Difficulties in the areas of planning and arranging one’s actions (known as “executive functioning deficits”)

It is important to remember that not everyone with autism will show all of these symptoms and that the severity of symptoms can vary widely from one person to the next. In addition, some people with autism may also suffer from conditions including anxiety, depression, or ADD/ADHD (ADHD). An accurate diagnosis of autism requires a comprehensive evaluation by a healthcare professional with the relevant training.

Diagnosis of Autism

A clinical psychologist, child psychiatrist, or developmental pediatrician can perform the necessary evaluations to diagnose autism. Diagnosis is typically made using a combination of clinical observation, standardized tests, and interviews with the patient’s parents and teachers (Constantino et al. pp. 279-291). The criteria for a diagnosis of autism spectrum disorder are laid forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (ASD). The DSM-5 specifies the following criteria for making an ASD diagnosis:

• Persistent problems with social communication and engagement include difficulties with socio-emotional reciprocity, nonverbal communication, and the development, maintenance, and comprehension of relationships.
• Behavioral interest or activity limitations characterized by at least two of the following characteristics: stereotypical or repetitive speech, motor movements, or object use; rigid adherence to routines or ritualized patterns of behavior; excessive concentration on a single interest; hyper- or hypo-reactivity to sensory input; and avoidance of change.
• Yet, symptoms may not become apparent until early childhood, when social demands surpass limited capacities.

Co-occurring disorders screening for diseases like anxiety, depression, or ADHD is commonly a part of the diagnostic procedure with cognitive, linguistic, and adaptive functioning assessments. A physical exam and genetic tests may also be a part of the evaluation to rule out other diseases with comparable symptoms. Early diagnosis and identification are crucial for ensuring that people with autism can access appropriate interventions and support. If you suspect that your kid or a loved one may have autism, it is crucial to have them evaluated by a qualified healthcare professional.

Treatment for Autism

Standard therapy aims for autism include reducing the severity of core symptoms and controlling related comorbidities. There is presently no therapy or cure for autism. However, a variety of interventions and therapies can help persons with autism improve in a variety of areas, such as friendliness, behavior, and communication. Even though there is presently no cure or therapy for autism, many treatments and therapies are helpful.

Applied Behavior Analysis (ABA)

ABA-based therapies are becoming increasingly popular as a viable therapy option for autistic people. By examining and altering a person’s environment, Applied Behavior Analysis (ABA) aims to promote desirable skills while decreasing harmful ones (Alves et al. pp. 118664-118672). Customized applied behavioral analysis (ABA) therapy is often more effective for autistic people. The therapist will use techniques such as prompting, shaping, and reinforcing to aid the adoption of new behaviors. The therapist monitors the patient’s progress and makes any necessary changes to the treatment plan. Communication, socialization, play, self-help, and academic skills are just a few areas where ABA therapy can help children and adults. (Nicolaidis pp. 1-3). Some troublesome behaviors that can be effectively treated with ABA include aggression, self-injury, and non-compliance.

The adaptability of ABA in meeting individual needs is a benefit. As new information becomes available, ABA therapists modify their patients’ treatment plans. The treatment can be personalized to the patient’s needs and altered using this strategy. Although ABA effectively supports individuals with autism in improving various abilities and behaviors, it is critical to remember that it is not a cure for autism. Early intervention and ABA therapy generate the best results. Sadly, due to the high cost and lengthy duration of ABA therapy, not all people with autism have access to it.

Speech and Language Therapy

As a result of their difficulties in speaking, many persons with autism benefit greatly from speech and language therapy (Adams et al. pp.233-244). This is because many persons with autism struggle to put their emotions into words. Language skills (the ability to articulate one’s thoughts in words) and people skills (the capability to understand and utilize the language of others) fall under this category (the ability to use language in social contexts). Individual sessions are the norm for speech-language pathologists when working with patients (SLP) as the initial step in providing effective speech and language therapy, an evaluation of the client’s strengths and weaknesses is performed by the speech-language pathologist (SLP).

Speech therapists tailor their services to each individual’s needs and objectives. Procedures will vary from patient to patient. The following are examples of methods frequently used in speech and language therapy for autistic patients:

• Augmentative and Alternative Communication (AAC): A more formal term for this concept is supplementary and alternative forms of communication. Augmentative and alternative communication (AAC) systems may include sign language, visual communication, and computer communication devices.
• Talk therapy for social interaction: Social communication therapy aims to help people with autism improve their social and interpersonal abilities through language. Children of all ages can benefit from learning to connect constructively with others, which is why social skills training is necessary.
• Language-based Linguistically-oriented: CBT is a common abbreviation for cognitive behavioral therapy. Conversational therapy incorporates cognitive behavioral strategies. Individuals who have been given an autism diagnosis may benefit from this method in their efforts to gain self-control.
• Articulation treatment: This type of speech treatment helps people with speech problems speak more clearly and precisely.
• Treatment for Fluency: The goal of speech therapy’s fluency component is to help the patient’s speech sound more fluid and regular. Fluency treatment is another name for this kind of psychotherapy. Those with autism who stutter or have other communication challenges may benefit significantly from this treatment.

Occupational Therapy

Occupational therapy, sometimes known as OT, is a form of treatment for persons who have autism that focuses on assisting them in building the skills necessary to take part in meaningful work (Como et al. p. 135). It is common practice to conduct one-on-one sessions with an autistic patient’s occupational therapist while the therapist provides occupational therapy (OT). The OTR/L will evaluate the patient and devise a customized treatment strategy based on the patient’s particular requirements.

Occupational therapy for children diagnosed with autism typically employs several strategies, including the following:

• Integration of Sensory Modalities: Helping autistic patients improve their ability to absorb and make sense of the information they receive from their senses is the primary goal of the treatment modality known as sensory integration. It has been demonstrated that engaging in beneficial activities such as swinging, spinning, and using weighted blankets can be helpful.
• Fine Motor Skill Improvement: Learning how to use one’s smaller muscles effectively for specific activities like writing or cutting means “developing one’s fine motor talents.” People with autism may benefit from occupational therapy in which they participate in activities that help them develop their fine motor skills. Some examples of these activities include sketching, coloring, and playing with small toys.
• Gross Motor Skill Development: The term “large motor skill development” refers to exercising the body’s larger muscles through performing activities such as running and jumping. People with autism can benefit from occupational therapy in several ways, including improving their gross motor skills by being encouraged to participate in activities such as playing catch or being instructed on how to utilize playground equipment.
• Adaptive Skill Development: Some examples of adaptive talents are the capacity to dress, feed, and groom oneself without assistance from another person. Occupational therapy (OT) can benefit people on the autism spectrum by allowing them to perform skills such as dressing and grooming themselves.
• Environmental Modification: Improving one’s local environment to be more agreeable and present fewer challenges is an environmental modification. It may be beneficial to put up visual schedules or to cut down on the number of things distracting in the home or the classroom.

Social Skills Training

Social skills training is occasionally used as a treatment for autism; its goal is to teach people with autism appropriate methods to interact with others. Greeting others, keeping conversations going, detecting nonverbal clues, and comprehending social context are all areas where people with autism may have difficulty (Soares et al. pp.166-180). One systematic approach to teaching social skills is one-on-one or small-group sessions with a certified therapist. Together, the therapist and patient will determine which aspects of interpersonal communication need improvement, and the therapist will offer recommendations for training in those areas. Social skills training can take several forms, depending on the learner and the objectives they wish to achieve. The following are a few more typical approaches to help those with autism learn social skills.

• Social Stories: Those who have trouble comprehending social contexts and behaviors deemed appropriate in those settings may benefit from reading “social stories,” which are condensed versions of broader narratives (Karkhaneh et al. pp.641-662).
• Role-playing: Role-playing allows you to practice interactions with others safely and nonthreateningly. Autistic person can improve their social skills by role-playing with a therapist or other individual who assumes the role of a conversation partner or social situation.
• Video Modeling: To engage in video modeling, one must observe people in various films before attempting to mimic their real-life behavior (Kurnaz et al. pp. 455-469).
• Group Therapy: People with autism can benefit from group therapy because it provides a safe and supportive setting to hone their social skills. Peer support and feedback are two potential extra gains from group therapy.

Training in social skills can help autistic people gain the sociability they need to have fulfilling relationships with others. It’s essential to remember that while social skills training may help some people with autism, it’s not a cure for the disorder and won’t necessarily help everyone who could benefit from it. When treating autistic people, it’s essential to have a wide range of interventions and therapies at your disposal so that you may find the ones that work best for each individual.

Medications

Pharmaceuticals are just one form of treatment that can help certain autistic persons. Treatment with medication is frequently used to control the aggressive, anxious, and hyperactive behaviors of autistic people. Medication should be combined with other approaches because it is not a standalone treatment for autism. Medicines must only be taken as directed and under the guidance of a trained medical professional (a psychiatrist or pediatrician). Specific drugs used to treat conditions on the autistic spectrum include:

• Antipsychotics are frequently used to address the aggressiveness, irritability, and other problematic behaviors of autistic people. Risperidone and aripiprazole are two standard antipsychotics.
• The hyperactivity and difficulty focusing that autistic people experience routinely treated with stimulants. Dextroamphetamine and methylphenidate are two common stimulants.
• Inhibitors of selective serotonin reuptake (SSRIs) are frequently prescribed to treat anxiety and depression in autistic individuals. Popular antidepressants like fluoxetine and sertraline are examples of SSRIs.
• Antidepressants are a typical treatment for autism, which frequently manifests as mood swings and violence. Examples include mood stabilizers and anticonvulsants like carbamazepine and valproic acid.
• Using sleeping pills: Many people with autism say they have trouble falling or staying asleep. Some persons with autism may find falling and remaining asleep easier when using sleep aids like melatonin.

In conclusion, autism is a severe developmental disease that can affect a person’s life. Yet, it is also believed that environmental causes cause autism. The key to providing individuals with autism the support and care they need to thrive is early diagnosis and intervention. Medication, occupational therapy, social skills training, and speech and language therapy are some options for patients with autism. These methods can considerably improve the lives of autistic people by assisting them with communication, socialization, and behavioral regulation. A person’s specific constellation of symptoms and life circumstances dictate an individual approach to treating autism. Effective treatment plans can only be developed and implemented with input from healthcare experts, educators, and family members. Better treatments and therapies become available to people with autism as autism research develops. The ultimate aim is to build a society where people from all walks of life can thrive. Those with autism spectrum disorders are included in this category.

Adams, Catherine, et al. “The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school‐age children who have pragmatic and social communication problems with or without autism spectrum disorder.” International Journal of Language & Communication Disorders 47.3 (2012): 233-244.

Alves, Fábio Junior, et al. “Applied behavior analysis for the treatment of autism: A systematic review of assistive technologies.” IEEE Access 8 (2020): 118664-118672.

Como, Dominique H., et al. “Oral health and autism spectrum disorders: A unique collaboration between dentistry and occupational therapy.” International journal of environmental research and public health 18.1 (2021): 135.

Constantino, John N., and Tony Charman. “Diagnosis of autism spectrum disorder: reconciling the syndrome, its diverse origins, and variation in expression.” The Lancet Neurology 15.3 (2016): 279-291.

Hodges, Holly, Casey Fealko, and Neelkamal Soares. “Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation.” Translational pediatrics 9. Suppl 1 (2020): S55.

Karkhaneh, Mohammad, et al. “Social Stories™ to improve social skills in children with autism spectrum disorder: A systematic review.” Autism 14.6 (2010): 641-662.

Kurnaz, Erkan, and Mehmet Yanardag. “The effectiveness of video self-modeling in teaching active video game skills to children with autism spectrum disorder.” Journal of Developmental and Physical Disabilities 30 (2018): 455-469.

Lord, Catherine, et al. “autism spectrum disorder.” The Lancet 392.10146 (2018): 508-520.

Nicolaidis, Christina. “Autism in adulthood: The new home for our emerging field.” Autism in Adulthood 1.1 (2019): 1-3.

Shuster, Jill, et al. “Review of factor analytic studies examining symptoms of autism spectrum disorders.” Journal of Autism and Developmental Disorders 44 (2014): 90-110.

Soares, Erin E., et al. “Social skills training for autism spectrum disorder: A meta-analysis of in-person and technological interventions.” Journal of Technology in Behavioral Science 6 (2021): 166-180.

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• Systematic Review
• Published: 11 August 2024

Examining the association between autism spectrum disorder and atopic eczema: meta-analysis of current evidence

• Anas Elgenidy 1 ,
• Eman F. Gad 2 ,
• Islam Shabaan 3 ,
• Hasnaa Abdelrhem 4 ,
• Paula Gamal Wassef 1 ,
• Taher Elmozugi 5 ,
• Mohanad Abdelfattah 1 ,
• Hisham Mousa 1 ,
• Mohamed Nasr 6 ,
• Mostafa Salah-Eldin 7 ,
• Ahmed Altaweel 8 ,
• Abdelrahman Hussein 1 ,
• Mohammad Bazzazeh 8 ,
• Mohamed Atef Elganainy 8 ,
• Ahmed M. Ali 2 ,
• Mohamed Ezzat 9 ,
• Amira Elhoufey 10 , 11 ,
• Abdulrahman A. Alatram 12 ,
• Ahmed Hammour 9 &
• Khaled Saad   ORCID: orcid.org/0000-0002-8473-6116 2  

Pediatric Research ( 2024 ) Cite this article

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This study aims to investigate the association between autism spectrum disorder (ASD) and atopic eczema (AE), shedding light on potential associations and underlying mechanisms.

A comprehensive review of literature was conducted to identify relevant studies published up to August 2023. Various electronic databases, including PubMed, Embase, Scopus, Web of Science, and Cochrane, were searched using specific keywords related to ASD and AE.

The meta-analysis covered a total of 30 studies. The first analysis included 23 studies with a combined total of 147430 eczema patients in the ASD group and 8895446 eczema patients in non-ASD group. We calculated the risk ratio of eczema in ASD and non-ASD groups, which revealed a significantly higher risk of eczema in patients with ASD (RR 1.34; 95% CI 1.03, 1.76). The second analysis included seven studies with a combined total of 3570449 ASD patients in the AE group and 3253973 in the non-Eczema group. The risk ratio of ASD in the Eczema and Non-Eczema groups showed a significantly increased risk of ASD in patients with eczema (RR 1.67; 95% CI 0.91, 3.06).

This study underscores the possible link between ASD and atopic eczema, shedding light on their potential association.

Our study conducted a meta-analysis on the association between autism spectrum disorder (ASD) and atopic eczema (AE), shedding light on potential associations and underlying mechanisms.

The review we conducted covered a total of 30 studies.

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The datasets used and/or analyzed during the current study are available from the corresponding author.

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Anas Elgenidy, Paula Gamal Wassef, Mohanad Abdelfattah, Hisham Mousa & Abdelrahman Hussein

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Eman F. Gad, Ahmed M. Ali & Khaled Saad

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AE, KS, EFG, IS, HAHA, PGW, TE, MA, HM, MN, MSE, MB, Ahmed M Ali, BAE, Ahmed Altaweel and Abdelrahman Hussein designed the study and analyzed the data. ME, KHM, AAA, and Ahmed Hammour. drafted the manuscript. All authors were involved in the critical analysis of the final version of the manuscript. All authors approved the manuscript as submitted and agreed to be accountable for all aspects of the work.

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Elgenidy, A., Gad, E.F., Shabaan, I. et al. Examining the association between autism spectrum disorder and atopic eczema: meta-analysis of current evidence. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03456-1

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CONCEPTUAL ANALYSIS article

Research, clinical, and sociological aspects of autism.

• ESPA Research, Unit 133i Business Innovation Centre, The Robert Luff Laboratory, Education & Services for People With Autism Research, Sunderland, United Kingdom

The concept of autism continues to evolve. Not only have the central diagnostic criteria that define autism evolved but understanding of the label and how autism is viewed in research, clinical and sociological terms has also changed. Several key issues have emerged in relation to research, clinical and sociological aspects of autism. Shifts in research focus to encompass the massive heterogeneity covered under the label and appreciation that autism rarely exists in a diagnostic vacuum have brought about new questions and challenges. Diagnostic changes, increasing moves towards early diagnosis and intervention, and a greater appreciation of autism in girls and women and into adulthood and old age have similarly impacted on autism in the clinic. Discussions about autism in socio-political terms have also increased, as exemplified by the rise of ideas such as neurodiversity and an increasingly vocal dialogue with those diagnosed on the autism spectrum. Such changes are to be welcomed, but at the same time bring with them new challenges. Those changes also offer an insight into what might be further to come for the label of autism.

Introduction

Although there is still debate in some quarters about who first formally defined autism ( 1 ), most people accept that Kanner ( 2 ) should be credited as offering the first recognised description of the condition in the peer-reviewed scientific literature. The core diagnostic features covering issues in areas of social and communicative interaction alongside the presence of restricted and/or repetitive patterns of behaviour ( 3 ) described in his small caseload still remain central parts of the diagnosis today. The core issue of alterations in social cognition affecting emotion recognition and social attention ( 4 ) remain integral to the diagnosis of autism. The additional requirement for such behaviours to significantly impact on various areas of day-to-day functioning completes the diagnostic criteria.

From defining a relatively small group of people, the evolution of the diagnostic criteria for autism has gone hand-in-hand with a corresponding increase in the numbers of people being diagnosed. Prevalence figures that referred to 4.5 per 10,000 ( 5 ) in the 1960s have been replaced by newer estimates suggesting that 1 in 59 children (16 per 1,000) present with an autism spectrum disorder (ASD) in 2014 ( 6 ). The widening of the definition of autism has undoubtedly contributed to the significant increase in the numbers of people being diagnosed. It would be unacceptably speculative however, to define diagnostic changes as being the sole cause of the perceived prevalence increases.

Alongside the growth in numbers of people being diagnosed with autism so there have been changes in other areas related to autism; specifically those related to the research, clinical practice and sociological aspects of autism. Many of the changes have centred on key issues around the acceptance that autism is an extremely heterogeneous condition both in terms of presentation and also in relation to the genetic and biological complexity underlying its existence. That autism rarely exists in some sort of diagnostic vacuum is another part of the changes witnessed over the decades following the description of autism.

In this paper we highlight some of the more widely discussed changes in areas of research, clinical practice and sociological terms in relation to autism. We speculate on how such changes might also further develop the concept of autism in years to come.

Autism Research

As the definition of autism has subtly changed over the years, so ideas and trends in autism research have waxed and waned. The focus on psychology and behaviour as core descriptive features of autism has, in many respects, guided research and clinical views and opinions about the condition. Social cognition, including areas as diverse as social motivation, emotion recognition, social attention and social learning ( 4 ), remains a mainstay of research in this area. The rise of psychoanalysis and related ideas such as attachment theory in the early 20th century for example, played a huge role in the now discredited ideas that maternal bonding or cold parenting were a cause of autism. The seemingly implicit need for psychology to formulate theories has also no doubt played a role in perpetuating all-manner of different grand and unifying reasons on why autism comes about and the core nature of the condition.

As time moved on and science witnessed the rise of psychiatric genetics, where subtle changes to the genetic code were correlated with specific behavioural and psychiatric labels, so autism science also moved in the same direction. Scientific progress allowing the genetic code to be more easily and more cost-effectively read opened up a whole new scientific world in relation to autism and various other labels. It was within this area of genetic science that some particularly important discoveries were made: (a) for the vast majority of people, autism is not a single gene “disorder,” and (b) genetic polymorphisms whilst important, are not the only mechanism that can affect gene expression. Mirroring the role of genetics in other behavioural and psychiatric conditions ( 7 ), the picture that is emerging suggests that yes, there are genetic underpinnings to autism, but identifying such label-specific genetic issues is complicated and indeed, wide-ranging.

What such genetic studies also served to prove is that autism is heterogeneous. They complemented the wide-ranging behavioural profiles that are included under the diagnostic heading of autism. Profiles that ranged from those who are profoundly autistic and who require almost constant attention to meet their daily needs, to those who have jobs, families and are able to navigate the world [seemingly] with little or minimal support for much of the time.

It is this heterogeneity that is perhaps at the core of where autism is now from several different perspectives. A heterogeneity that not only relates to the presentation of the core traits of autism but also to how autism rarely manifests in a diagnostic vacuum ( 8 ). Several authors have talked about autism as part of a wider clinical picture ( 9 , 10 ) and how various behavioural/psychiatric/somatic issues seem to follow the diagnosis. Again, such a shift mirrors what is happening in other areas of science, such as the establishment of the Research Domain Criteria (RDoC) project ( 11 ). RDoC recognised that defining behavioural and psychiatric conditions on the basis of presented signs and symptoms does not necessarily “reflect” the relevant underlying processes and systems that might be important. It recognised that in order to deliver important clinical information about how and why a condition manifests, or the best strategies to intervene, research cannot just singularly start with the label. Science and clinical practice need more information rather than just a blanket descriptive label such as autism.

To talk about autism as a condition that also manifests various over-represented comorbid labels also asks a fundamental question: is the word “comorbidity” entirely accurate when referring to such labels? ( 12 ). Does such comorbidity instead represent something more fundamental to at least some presentations of autism or is it something that should be seen more transiently? Numerous conditions have been detailed to co-occur alongside autism. These include various behavioural and psychiatric diagnoses such as depression, anxiety and attention-deficit hyperactivity disorder (ADHD) ( 13 ). Other more somatic based conditions such as epilepsy ( 14 ), sleep ( 15 ) and various facets of gastrointestinal (GI) functioning ( 16 ) have also been discussed in the peer-reviewed science literature. Some of these co-occurring conditions have been described in the context of specific genetic conditions manifesting autism. Issues with the BCKDK (Branched Chain Ketoacid Dehydrogenase Kinase) gene for example, have been discussed in the context of autism, intellectual (learning) disability and epilepsy appearing together ( 17 ). Such a diagnostic combination is not unusual; autism often being described as the primary diagnosis with epilepsy and learning disability seen as “add-ons.” But should this be the case? Other evidence pointing to the possibility that epilepsy might under some circumstances beget autism ( 18 ) suggests that under some circumstances, such co-occurring conditions are so much more than just co-occurring or comorbid.

Other evidence for questioning the label “comorbid” comes from various animal models of autism. Accepting that one has to be particularly careful about extrapolating from animal models of autism to the more complex presentation of autism in humans ( 19 ), various models have suggested that autism may for some, fundamentally coexist with GI or bowel issues ( 20 , 21 ). Such observations have been noted across different animal models and cover important issues such as gut motility for example, that have been talked about in the context of autism ( 22 ).

Similarly, when one talks about the behavioural and psychiatric comorbidity in the context of autism, an analogous question arises about whether comorbidity is the right term. Anxiety and depression represent important research topics in the context of autism. Both issues have long been talked about in the context of autism ( 1 , 13 , 23 ) but only in recent years have their respective “links” to autism been more closely scrutinised.

Depression covers various different types of clinical presentations. Some research has suggested that in the context of autism, depressive illnesses such as bipolar disorder can present atypically ( 24 ). Combined with other study ( 25 ) suggesting that interventions targeting depressive symptoms might also impact on core autistic features, the possibility that autism and depression or depressive symptoms might be more closely linked than hitherto appreciated arises. Likewise with anxiety in mind, similar conclusions could be drawn from the existing research literature that anxiety may be a more central feature of autism. This on the basis of connections observed between traits of the two conditions ( 26 ) alongside shared features such as an intolerance of uncertainty ( 27 ) exerting an important effect.

A greater appreciation of the heterogeneity of autism and consideration of the myriad of other conditions that seem to be over-represented alongside autism pose serious problems to autism research. The use of “autism pure” where research participants are only included into studies on the basis of not having epilepsy or not possessing a diagnosis of ADHD or related condition pose a serious problem when it comes to the generalisation of research results to the wider population. Indeed, with the vast heterogeneity that encompasses autism, one has to question how, in the context of the current blanket diagnosis of autism or ASD, one could ever provide any universal answers about autism.

Autism in the Clinic

As mentioned previously, various subtle shifts in the criteria governing the diagnosis of autism have been witnessed down the years. Such changes have led to increased challenges for clinicians diagnosing autism from several different perspectives. One of the key challenges has come about as a function of the various expansions and contractions of what constitutes autism from a diagnostic point of view. This includes the adoption of autism as a spectrum disorder in more recent diagnostic texts.

The inclusion of Asperger syndrome in the DSM-IV and ICD-10 diagnostic schedules represented an expansion of the diagnostic criteria covering autism. Asperger syndrome defined by Hans Asperger ( 28 ) as autistic features without significant language impairment and with intelligence in the typical range, was included in the text for various different reasons. Allen Frances, one of the architects of the DSM-IV schedule, mentioned the importance of having a “ specific category to cover the substantial group of patients who failed to meet the stringent criteria for autistic disorder, but nonetheless had substantial distress or impairment from their stereotyped interests, eccentric behaviors, and interpersonal problems ” ( 29 ). It is now widely accepted that the inclusion of Asperger syndrome in diagnostic texts led to an increase in the number of autism diagnoses being given.

More recent revisions to the DSM criteria covering autism—DSM-5—included the removal of Asperger syndrome as a discrete diagnosis on the autism spectrum ( 30 ). Instead, a broader categorisation of autism spectrum disorder (ASD) was adopted. The reasons for the removal of Asperger syndrome from DSM-5 are complex. The removal has however generally been positively greeted as a function of on-going debates about whether there are/were important differences between autism and Asperger syndrome to require a distinction ( 31 ) alongside more recent revelations about the actions of Asperger during World War II ( 32 ). Studies comparing DSM-IV (and its smaller revisions) with DSM-5 have also hinted that the diagnostic differences between the schedules may well-impact on the numbers of people in receipt of a diagnosis ( 33 ).

Shifts in the diagnostic text covering autism represent only one challenge to autism in the clinical sense. Other important factors continue to complicate the practice of diagnosing autism. Another important issue is a greater realisation that although the presence of observable autistic features are a necessary requirement for a diagnosis of autism, such features are also apparent in various other clinical labels. Autistic features have been noted in a range of other conditions including schizophrenia ( 34 ), personality disorders ( 35 ) and eating disorders ( 36 ) for examples. Coupled with the increasingly important observation that autism rarely exists in a diagnostic vacuum, the clinical challenges to accurately diagnosing autism multiply as a result.

The additional suggestion of “behavioural profiles” within the autism spectrum adds to the complexity. Terms such as pathological demand avoidance (PDA) coined by Newson and colleagues ( 37 ) have started to enter some diagnostic processes, despite not yet being formally recognised in diagnostic texts. Including various autistic traits alongside features such as “resisting and avoiding the ordinary demands of life” and the “active use of various strategies to resist demands via social manipulation,” debate continues about the nature of PDA and its diagnostic value ( 38 ).

Early diagnosis and intervention for autism have also witnessed some important clinical changes over the years. Driven by an acceptance of the idea that earlier diagnosis means that early intervention can be put in place to “ameliorate” some of the more life-changing effects of autism, there has been a sharp focus on the ways and means of identifying autism early and/or highlighting those most at risk of a diagnosis. It's long been known that there is a heritable aspect to autism, whether in terms of traits or diagnosis ( 39 ). In this respect, preferential screening for autism in younger siblings when an older child has been diagnosed is not an uncommon clinical sentiment ( 40 ). Other work looking at possible “red flags” for autism, whether in behaviour ( 41 ) or in more physiological terms still continue to find popularity in both research and clinical terms.

But still however, autism continues to confound. As of yet, there are only limited reliable red flags to determine or preclude the future presence of autism ( 42 ). Early behavioural interventions for autism have not yet fulfilled the promise they are said to hold ( 43 ) and autism is not seemingly present in the earliest days of development for all ( 44 , 45 ). There is still a way to go.

Autism in a modern clinical sense is also witnessing change in several other quarters. The traditional focus of autism on children, particularly boys, is being replaced by a wider acceptance that (a) autism can and does manifest in girls and women, and (b) children with autism age and mature to become adults with autism. Even the psychological mainstay of autism—issues with social cognition—is undergoing discussion and revision.

On the issue of autism presentation in females, several important themes are becoming more evident. Discussions about whether there may be subtle differences in the presentation of autism in females compared to males are being voiced, pertinent to the idea that there may be one or more specific female phenotypes of autism ( 46 ). Further characterisation has hinted that sex differences in the core domain of repetitive stereotyped behaviours ( 47 ) for example, may be something important when it comes to assessing autism in females.

Allied to the idea of sex differences in autism presentation, is an increasing emphasis on the notion of camouflaging or masking ( 48 ). This masking assumes that there may active or adaptive processes on-going that allow females to hide some of their core autistic features and which potentially contributes to the under-identification of autism. Although some authors have talked about the potentially negative aspects of masking in terms of the use of cognitive resources to “maintain the mask,” one could also view such as adaptation in a more positive light relating to the learning of such a strategy as a coping mechanism. Both the themes of possible sex differences in presentation and masking add to the clinical complexity of reliably assessing for autism.

Insofar as the growing interest in the presentation of autism in adulthood, there are various other clinical considerations. Alongside the idea that the presentation of autism in childhood might not be the same as autism in adulthood ( 49 ), the increasing number of people receiving a diagnosis in adulthood is a worthy reminder that autism is very much a lifelong condition for many, but not necessarily all ( 50 ). The available research literature also highlights how autism in older adults carries some unique issues ( 51 ) some of which will require clinical attention.

Insofar as the issue of social cognition and autism, previous sweeping generalisations about a deficit in empathy for example, embodying all autism are also being questioned. Discussions are beginning debating issues such as how empathy is measured and whether such measurements in the context of autism are as accurate as once believed ( 52 ). Whether too, the concept of social cognition and all the aspects it encompasses is too generalised in its portrayal of autism, including the notion of the “double empathy problem” ( 53 ) where reciprocity and mutual understanding during interaction are not solely down to the person with autism. Rather, they come about because experiences and understanding differ from an autistic and non-autistic point of view. Such discussions are beginning to have a real impact on the way that autism is perceived.

Autism in Sociological Terms

To talk about autism purely through a research or clinical practice lens does not do justice to the existing peer-reviewed literature in its entirety. Where once autism was the sole domain of medical or academic professionals, so now there is a growing appreciation of autism in socio-political terms too, with numerous voices from the autism spectrum being heard in the scientific literature and beyond.

There are various factors that have contributed to the increased visibility of those diagnosed with autism contributing to the narrative about autism. As mentioned, the fact that children with autism become autistic adults is starting to become more widely appreciated in various circles. The expansion of the diagnostic criteria has also played a strong role too, as the diagnostic boundaries of the autism spectrum were widened to include those with sometimes good vocal communicative abilities. The growth in social media and related communication forms likewise provided a platform for many people to voice their own opinions about what autism means to them and further influence discussions about autism. The idea that autistic people are experts on autism continues to grow ( 54 ).

For some people with autism, the existing narrative about autism based on a deficit model (deficits in socio-communicative abilities for example) is seemingly over-emphasised. The existing medical model of autism focusing such deficits as being centred on the person does not offer a completely satisfying explanation for autism and how its features can disable a person. Autism does not solely exist in a sociological as well as diagnostic vacuum. In this context, the rise and rise of the concept of neurodiversity offered an important alternative to the existing viewpoint.

Although still the topic of some discussion, neurodiversity applied to autism is based on several key tenets: (a) all minds are different, and (b) “ neurodiversity is the idea that neurological differences like autism and ADHD are the result of normal, natural variation in the human genome ” ( 55 ). The adoption of the social model of disability by neurodiversity proponents moves the emphasis on the person as the epicentre of disability to that where societal structures and functions tend to be “ physically, socially and emotionally inhospitable towards autistic people ” ( 56 ). The message is that subtle changes to the social environment could make quite a lot of difference to the disabling features of autism.

Although a popular idea in many quarters, the concept of neurodiversity is not without its critics both from a scientific and sociological point of view ( 57 ). Certain key terms often mentioned alongside neurodiversity (e.g., neurotypical) are not well-defined or are incompatible with the existing research literature ( 58 ). The idea that societal organisation is a primary cause of the disability experienced by those with the most profound types of autism is also problematic in the context of current scientific knowledge and understanding. Other issues such as the increasing use of self-diagnosis ( 59 ) and the seeming under-representation of those with the most profound forms of autism in relation to neurodiversity further complicate the movement and its aims.

The challenges that face the evolving concept of neurodiversity when applied to autism should not however detract from the important effects that it has had and continues to have. Moving away from the idea that autistic people are broken or somehow incomplete as a function of their disability is an important part of the evolution of autism. The idea that autism is something to be researched as stand-alone issue separate from the person is something else that is being slowly being eroded by such a theory.

The concept of autism continues to evolve in relation to research, clinical practice and sociological domains. Such changes offer clues as to the future directions that autism may take and the challenges that lie ahead.

The continuing focus on the huge heterogeneity and comorbidity clusters that define autism are ripe for the introduction of a new taxonomy for describing the condition. A more plural definition—the autisms—could represent one starting position ( 60 ) encompassing a greater appreciation that (a) there is variety in the presentation of the core features of autism, (b) there are seemingly several different genetic and biological pathways that bring someone to a diagnosis of autism, (c) different developmental trajectories are an important facet of the autism spectrum, and (d) the various “comorbidities” that variably present alongside autism may offer important clues about the classification of autism. Some authors have stressed that a multi-dimensional conceptualisation may be more appropriate than a categorical concept ( 61 ) but further investigations are required.

In relation to the proposed pluralisation of the label, several long held “beliefs” about autism are also ripe for further investigation. The idea that autism is innate and presents in the earliest days in all does not universally hold ( 45 ). The finding that some children experience a period of typical development and then regress into autism ( 62 ) is becoming more readily discussed in research and clinical circles, albeit not universally so. Similarly, the belief that autism is a lifelong condition for all is also not borne out by the peer-reviewed literature ( 63 ). Terms such as optimal outcome ( 64 ) might not be wholly appropriate, but do nonetheless, shed light on an important phenomenon noted in at least some cases of autism where diagnostic cut-off points are reached at one point but not another. These and other important areas provide initial support for the adoption of the idea of the plural autisms.

Allied to the notion of “the autisms” is the requirement to overhaul the terminology around the use of the “level of functioning” phrase ( 65 ). “High functioning” is typically used to describe those people on the spectrum who present with some degree of communicative language, possess typical or above-average intelligence and who can seemingly traverse the world with only minimal levels of support. “Low functioning”, conversely, is used to describe those with significant support needs who may also be non-communicative. Aside from the societal implications of labelling someone “low functioning” and the possible connotations stemming from such a label, such functioning categorisation do not seemingly offer as accurate a representation as many people might think. The high-functioning autistic child who for example, has been excluded from school on the basis of their behaviour, cannot be readily labelled “high-functioning” if the presentation of their autistic behaviours has led to such a serious outcome. This on the basis that part of the diagnostic decision to diagnose autism is taken by appreciation of whether or not presented behaviours significantly interfere with day-to-day living ( 3 ). What might replace functioning labels is still a matter for debate. The use of “levels of support requirement” utilised in current diagnostic criteria offer a template for further discussions. Such discussions may also need to recognise that the traits of autism are not static over a lifetime ( 51 ) and support levels may vary as a result.

Whatever terminology is put forward to replace functioning labels, there is a need to address some very apparent differences in the way that parts of the autism spectrum are viewed, represented and included in research. Described as the “understudied populations” by some authors ( 66 ) those with limited verbal communicative language and learning disability have long been disadvantaged in research terms and also in more general depictions of autism. In more recent times, there has been a subtle shift to acknowledge the bias that exists against those with a more profound presentation of autism ( 67 ). Further developments are however required to ensure that such groups are not excluded; not least also to guarantee the generalisability of autism research to the entire spectrum and not just one portion of it.

On the topic of generalisability to the entire autism spectrum, the moves to further involve those diagnosed with autism in research, clinical and sociological discussions presents opportunities and obstacles in equal measure. The application of the International Classification of Functioning, Disability and Health (ICF) to autism ( 68 ) to measure “health-related functioning” represented a key moment in autism participatory research. Taking on board various views and opinions about autism, the development of the ICF core autism sets has allowed those with autism and their significant others to voice their opinions about autism ( 69 ).

Such joint initiatives are to be welcomed on the basis of the multiple perspectives they offer including lived experience of autism. But with such participation, so questions are also raised about how representative such opinions are to the entire autism spectrum ( 70 ). Questions on whether those who are able to participate in such initiatives “can ever truly speak for the entire autism spectrum?” are bound to follow. Questions also about whether such first-hand reports are more important than parental or caregiver input when it comes to individuals on the autism spectrum are likewise important to ask. This bearing in mind that those with autism participating in such initiatives bring with them the same potential biases as researchers and clinicians carry with them about the nature of autism, albeit not necessarily in total agreement.

The translation of research findings into clinical practice represents another important issue that has yet to be suitably addressed. Although covering a sizeable area, several important stumbling blocks have prohibited the move from “bench to bedside” when it comes to autism research. The focus for example, on the overt behavioural presentation of autism, has in some senses continued to hinder the translational progress of more biological-based findings into autism practice. Nowhere is this seemingly more evident than when it comes to the over-representation of gastrointestinal (GI) issues in relation to autism and their management or treatment. Despite multiple findings of such issues being present ( 16 ), very little is seemingly offered despite autism-specific screening and management guidance being in place for nearly a decade at the time of writing ( 71 ). Other quite consistently reported research findings in relation to low functional levels of vitamin D ( 72 ) for example, have similarly not sparked massive shifts in clinical practices. Ignoring such potentially important clinical features contributes to a state of relative health inequality that is experienced by many on the autism spectrum.

Without trying to prioritise some areas over others, there are some important topics in relation to autism that are becoming important to autism research and clinical practice. Many of these topics are more “real life” focused; taking into account the impact of autism or autistic traits on daily living skills and functioning. These include issues such as the truly shocking early mortality statistics around autism ( 73 ) and the need for more detailed inquiry into the factors around such risks such as suicide ( 74 ) and self-injury ( 75 ) and wandering/elopement ( 76 ) alongside the considerable influence of conditions such as epilepsy.

Although already previously hinted at in this paper, the nature of the relationship between autism and various “comorbid” conditions observed to be over-represented alongside is starting to become more widely discussed in scientific circles. Whether for example, moves to intervene to mitigate issues such as depression in relation to autism might also have knock-on effects on the presentation of core autistic features is something being considered. Interest in other topics such as employment, ageing, parenting and the worrying issue of contact with law enforcement or criminal justice systems ( 77 ) are also in the ascendancy.

Conclusions

Autism as a diagnostic label continues to evolve in research, clinical practice and sociological terms. Although the core features described by Kanner and others have weathered such evolution, important shifts in knowledge, views and opinions have influenced many important issues around those core behaviours. As well as increasing understanding of autism, many of the changes, past and present, have brought about challenges too.

Author Contributions

All authors contributed equally to the writing and review of this manuscript.

This paper was fully funded by ESPA Research using part of a donation from the Robert Luff Foundation (charity number: 273810). The Foundation played no role in the content, formulation or conclusions reached in this manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: autism, research, clinical, sociological, knowledge, future

Citation: Whiteley P, Carr K and Shattock P (2021) Research, Clinical, and Sociological Aspects of Autism. Front. Psychiatry 12:481546. doi: 10.3389/fpsyt.2021.481546

Received: 28 June 2019; Accepted: 30 March 2021; Published: 29 April 2021.

Reviewed by:

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*Correspondence: Paul Whiteley, paul.whiteley@espa-research.org.uk

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Autism spectrum disorder research: knowledge mapping of progress and focus between 2011 and 2022

Miaomiao jiang.

1 National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China

Xianjing Li

Liyang zhao.

2 Translational Medicine Center of Chinese Institute for Brain Research, Beijing, China

3 Guangdong Key Laboratory of Mental Health and Cognitive Science, Institute for Brain Research and Rehabilitation (IBRR), South China Normal University, Guangzhou, China

Lifang Wang

Associated data.

The original contributions presented in the study are included in the article/ Supplementary material , further inquiries can be directed to the corresponding authors.

In recent years, a large number of studies have focused on autism spectrum disorder (ASD). The present study used bibliometric analysis to describe the state of ASD research over the past decade and identify its trends and research fronts.

Studies on ASD published from 2011 to 2022 were obtained from the Web of Science Core Collection (WoSCC). Bibliometrix, CiteSpace, and VOSviewer were used for bibliometric analysis.

A total of 57,108 studies were included in the systematic search, and articles were published in more than 6,000 journals. The number of publications increased by 181.7% (2,623 in 2011 and 7,390 in 2021). The articles in the field of genetics are widely cited in immunology, clinical research, and psychological research. Keywords co-occurrence analysis revealed that “causative mechanisms,” “clinical features,” and “intervention features” were the three main clusters of ASD research. Over the past decade, genetic variants associated with ASD have gained increasing attention, and immune dysbiosis and gut microbiota are the new development frontiers after 2015.

This study uses a bibliometric approach to visualize and quantitatively describe autism research over the last decade. Neuroscience, genetics, brain imaging studies, and gut microbiome studies improve our understanding of autism. In addition, the microbe-gut-brain axis may be an exciting research direction for ASD in the future. Therefore, through visual analysis of autism literature, this paper shows the development process, research hotspots, and cutting-edge trends in this field to provide theoretical reference for the development of autism in the future.

Introduction

Autism spectrum disorder (ASD) refers to a group of early-onset, lifelong, heterogeneous neurodevelopmental conditions with complex mechanisms of emergence ( 1 ). The prevalence of ASD has increased from 1 in 69 by 2012 to 1 in 44 by 2018, as reported by the Centers for Disease Control and Prevention for 2012–2018 ( 2 , 3 ). Recent research estimates the male-to-female ratio is closer to 2:1 or 3:1, indicating a higher diagnostic prevalence of autism in males compared to females ( 4 – 6 ). Some studies have shown a high heritability of 80–93% in ASD and reported hundreds of risk gene loci ( 7 ).

Specific autistic characteristics usually appear before the age of 3 years, and some children on the spectrum may have limited nonverbal and verbal communication by the age of 18–24 months ( 8 , 9 ). The diagnosis of ASD is based on the core features of social communication impairment and unusual and repetitive sensory-motor behavior ( 10 ). Some autistic individuals can be definitively diagnosed with autism as early as 2–3 years of age and the mean age of diagnosis for autistic children is still 4–5 years ( 1 , 11 ). It is important to stress that more adults are getting assessed for possible autism ( 5 ). As autism is increasingly diagnosed, multidisciplinary involvement can help have a positive impact on the well-being and quality of life for both children and adults on the spectrum ( 12 ). Several mental diseases also affect autistic individuals, increasing the diagnosis complexity ( 13 ).

Over the past decade, researchers have struggled to explain the neurological etiology, and great progress has been made in the genetics, epigenetics, neuropathology, and neuroimaging of ASD ( 9 ). However, there is a lack of systematic review of field research and discussion of future research hotspots. Bibliometrics ( 14 ) belongs to interdisciplinary research, which has been widely used in science by analyzing highly cited papers, field keyword clustering, and the internal cooperation links of countries, thus providing a comprehensive interpretation of the development process of autism research field ( 15 ).

In some of the previous bibliometrics studies on ASD, a single software was used to focus on a specific field or research aspect of the autism ( 16 – 18 ), and the trend in the past decade has not yet been displayed. The present study comprehensively combines Bibliometrix package, CiteSpace, and VOSviewer to (1) dynamically assess quantitative indicators of ASD research publications and use different index indicators to measure the quality of research; (2) further identify the most contributing countries, institutions, journals, and authors; (3) analyze the citation network architecture; (4) determine the top 100 most cited papers; (5) conduct keyword analysis. Subsequently, bibliometrics was used to understand the current hotspots and trends in the field of ASD research for further in-depth investigation.

Materials and methods

Data collection and search strategies.

We comprehensively searched the Web of Science Core Collection (WoSCC) database from 2011 to 2022. WoSCC is a daily updated database covering an abstract index of multidisciplinary literature that exports complete citation data, maintained by Thomson Reuters (New York, NY, USA) ( 19 ). The articles’ data were independently searched by two researchers on May 29, 2022, to avoid bias caused by database updates. The scientometric retrieval process is illustrated in Figure 1 . A total of 68,769 original articles in English language were retrieved, excluding 11,661 irrelevant articles, such as meeting abstracts, editorial materials, corrections, and letters. A total of 57,108 documents were exported, and the retrieved documents would be exported in the form of all records and references.

Flowchart of the screening process.

Grey prediction model

Grey models (GM) are used to construct differential prediction models with limited and incomplete data ( 20 ). The GM (1,1) model, with high accuracy and convenient calculations, is extensively utilized in the energy and medical industries ( 21 ). We used the standard GM (1,1) model to forecast the annual publication volume over the next 5 years. The operation of GM (1,1) model was done by using Python software.

Bibliometric analysis and visualization

The records of the retrieved publications were exported to Bibliometrix, CiteSpace, and VOSviewer for further bibliometric analysis.

Bibliometrix package (running on R4.0.3) was utilized to capture and extract the bibliographic information on selected publications, including topic, author, keywords, and country distribution ( 22 ). The productivity of authors/journals in the field was measured by the number of publications (Np) and assessing metrics, such as the number of citations, publication h-index value, and m-index value. The h-index is used to quantify the scientific output and measure the citation impact, and two people with similar h-index may have a similar impact in the scientific field, even if the total number of papers or total citations are different ( 23 ). The m-index can be used to compare the influence of scholars with different academic career years. The number of citations of a document is a measure of its scientific impact to a certain extent ( 24 ). Bibliometrix package was also used to screen the top 100 articles and explore research trends and hotspots.

VOSviewer is a free computer program to visualize bibliometric maps ( 25 ). The keyword co-occurrence network was constructed using VOSviewer. CiteSpace is based on the Java environment and uses methods, such as co-occurrence analysis and cluster analysis, for the visualization of scientific literature research data in specific disciplines. The visual knowledge maps were constructed using the procedural steps of CiteSpace ( 26 ), including time slicing, threshold, pruning, merging, and mapping; then, the contribution of countries and institutions of ASD over the past decade was assessed based on centrality scores. The co-citation network and dual-map of references were constructed by CiteSpace. A dual-map ( 27 ) overlay is a bipartite overlay analysis method by CiteSspace, which uses the distribution map cited journals in the WoS database as the base map, and the map generated by the cited literature data as the overlay map.

Annual publications

A total of 57,108 articles were included in this study, consisting of 46,574 articles, 2,643 conference papers, and 7,891 reviews. From 2011 to 2022, the number of publications maintained a steady growth rate ( Figure 2A ), and the grey prediction model predicted the trend of increasing publication volume in the next 5 years ( Figure 2B ). The main information for all publications is shown in Supplementary Table S1 .

Global trends in publications of ASD research. (A) Single-year publication output over the past decade. (B) Model forecast curves for publication growth trends.

Distribution of countries and institutions

Autism-related research has been conducted by researchers from a variety of countries and institutions, and articles in this field have been cited 1,231,588 times ( Tables 1 , ​ ,2). 2 ). CiteSpace visualizes collaborative networks between institutions and countries ( Figures 3A , ​ ,B). B ). As shown in the international collaborations network of autism research ( Figure 3C ), the USA and UK are the leading countries working closely with other countries.

Publications in top 10 most productive countries.

Publications in top 10 most productive Institutions.

The distribution of countries and institutions. Map of countries (A) and institutions (B) contributed to publications related to ASD research. (C) Network diagram showing international collaborations involved in ASD research. The nodes represent the countries and institutions; the color depth and size of the circle are positively correlated to the number of posts. The thickness of the curved connecting lines represents the strength of collaboration in the countries and institutions.

Analysis of journals

The h-index combines productivity and impact; typically, a high h-index means a high recognition. As presented in Table 3 , the Journal of Autism and Developmental Disorders, PLOS One, and Molecular Psychiatry were among the top three of the 20 journals with the highest h-index. The Journal of Autism and Developmental Disorders has the highest number of articles (3478) and cited number of publications (90308). Among the top 20, four journals with impact factors >10 include Molecular Psychiatry (IF: 13.437), Biological Psychiatry (IF: 12.810), Proceedings of the National Academy of Sciences of the United States of America (IF: 12.779), Journal of the American Academy of Child and Adolescent Psychiatry (IF: 13.113), which have been cited more than 10,000 times. In addition, 75% of journals belong to Q1 ( Table 3 ). The cited journals provided the knowledge base of the citing journals. The yellow paths illustrate that studies published in “molecular, biology, immunology” journals tended to cite journals primarily in the domains of “molecular, biology, genetics,” and “psychology, education, social.” The paths colored with grass-green paths illustrate that studies published in “medicine, medical, clinical” journals tended to cite journals primarily in the domains of “molecular, biology, and genetics.” The pale blue paths showcase that research published in “psychology, education, health” journals preferred to quote journals mostly in the domains of “molecular, biology, genetics,” “health, nursing, medicine,” and “psychology, education, social ( Figure 4 ).”

Top 20 journals ranked by h_index.

TC: total citation; IF: impact factor.

A dual-map overlay of journals that published work related to ASD. A presentation of citation paths at a disciplinary level on a dual-map overlay. The width of the paths is proportional to the z-score-scale citation frequency. The labels on the map represent the research subjects covered by the journals, and the wavy curve connects the citing articles on the left side of the map and the cited articles on the right side of the map.

Analysis of authors

The top 10 most effective authors who have contributed to autism research are listed in Table 4 . The g-index and m-index are derivatives of the h-index, and if scientists publish at least 10 articles, of which 7 papers have been cited cumulatively 51 (>49), the g-index is 7; the m-index is related to the academic age of the scientists. The large g-index, h-index, and m-index indicate a great influence on the scholar’s academic influence and high academic achievement. Professor Catherine Lord from the USA is ranked first and has made outstanding contributions to autism research over the past 10 years. In terms of the number of publications, Simon Baron-Cohen was the most productive author ( n  = 278), followed by Tony Charman ( n  = 212) and Christopher Gillberg ( n  = 206). In terms of citations in this field, Daniel H. Geschwind was ranked first (18,127 citations), followed by Catherine Lord (14,830 citations) and Joseph D. Buxbaum (14,528 citations).

Top 10 most effective authors contributing to autism research.

TC: total citation; NP: number of papers.

Analysis of reference

The co-citation analysis network of 1,056,125 references ( Figure 5A ) showed that two articles appear simultaneously in the bibliography of the third cited document. The top 20 co-cited references (over the past decade) summarized in ASD studies are listed in Supplementary Table S2 . Most of this highly cited literature focuses on the genetic field, discovering genetic risk loci and associated mutations, constructing mutation networks highly associated with autism, and identifying genes associated with autism synaptic destruction. Some studies indicated that de novo mutations in ASD might partially explain the etiology. Multiple studies have revealed genetic variants associated with ASD, such as rare copy number variants (CNVs), de novo likely gene-disrupting (LGD) mutations, missense or nonsense de novo variants, and de novo duplications. In the cluster network graph, different colors represent varied clusters, and each node represents a cited paper, displaying the distribution of topics in the field ( Figure 5B ). The network is divided into 25 co-citation clusters ( Figure 5B ), primarily related to the diagnosis, etiology, and intervention of autism. The etiological studies include five clusters, de novo mutation, inflammation, gut microbiota, mitochondrial dysfunction, and mouse model. Intervention literature focuses on early intensive behavioral intervention, intranasal oxytocin, video modeling, and multisensory integration. The diagnostic aspects of ASD include neuroimaging functional connectivity and Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In addition, some of the references focus on gender/sex differences and sleep problems. Coronavirus disease 2019 (COVID-19) is a new cluster for autism research.

Mapping on co-cited references. (A) A network map showing the co-cited references. (B) Co-cited clusters with cluster labels.

Co-occurrence analysis of keywords

The co-occurrence analysis of keywords in ASD research articles was performed using VOSviewer software; the keywords that occurred ≥200 times were analyzed after being grouped into four clusters of different colors ( Figure 6A ); the temporal distribution of keywords is summarized in Figure 6B . This map identifies various categories of research: Etiological mechanisms (red), Clinical features (green), Intervention features (blue), and the Asperger cluster (yellow). In the “Etiological mechanisms” cluster, the research includes brain structure and function, genetics, and neuropathology. In the “Clinical features” cluster, the common keywords were “symptoms,” “diagnosis,” “prevalence,” and its comorbidities, including “anxiety” and “sleep.” In the “Intervention features” cluster, the research population of ASD is concentrated in “young children,” “intervention,” and “communication.” These interventions improve the learning and social skills through the involvement of parents and schools.

Keywords co-occurrence network. (A) Cluster analysis of keywords. There are four clusters of keywords: red indicates Cluster 1 ( n  = 145), green indicates Cluster 2 ( n  = 104), blue indicates Cluster 3 ( n  = 78), yellow indicates Cluster 4 ( n  = 80). (B) Evolution of keyword frequency. A minimum number of occurrences of a keyword = 200. Overall, 407 keywords met the threshold criteria. The yellow keywords appear later than purple keywords.

The 100 top-cited publications

The screening of the 100 most cited publications on ASD between 2011 and 2022 by Bibliometrix software package, each with >500 citations. The detailed evaluation index information for countries, institutions, journals, and authors ( Supplementary Tables S3 – S6 ).

Taken together, the results indicated that the United States is the country that publishes the most highly cited articles ( n  = 64), including single-country publications ( n  = 37) and multiple-country publications ( n  = 27); most articles are from academic institutions within the USA ( Figures 7A , ​ ,B B ).

Analysis of the 100 top-cited publications Characteristics of 100 top-cited publications. The most relevant countries (A) , affiliations (B) , journals (C) and authors (D) . Trend topics (E) and thematic evolution (F) of 100 top-cited publication. Coupling Map (G) : the coupled analysis of the article, references and keywords is carried out, the centrality of the x -axis is displayed, the y -axis is the impact, and the confidence (conf%) is calculated.

The 100 top-cited ASD publications were published in 48 journals; 17 articles were published in Nature ( n  = 17), making it the highest h-index journal in this list ( Supplementary Table S5 ). In addition, 10 articles were published in Cell, and 7 articles were published in Nature Genetics ( Figure 7C ). When considering the individual authors’ academic contributions, Bernie Devlin provided 13 publications, followed by Kathryn Roeder and Stephan J Sanders, with 11 publications each ( Figure 7D ). The details of the top 10 top-cited papers are summarized in Table 5 . An article titled “A general framework for estimating the relative pathogenicity of human genetic variants” published by Martin Kircher in Nature Genetics, received the highest number of citations ( n  = 3,353).

Detail of top 10 citation paper.

The 100 top-cited ASD articles encompassed a range of keywords ( Figure 7E ) and displayed the main cluster of themes through specific periods (2011–2022) by analyzing those in the selected literature. The Sankey diagrams of thematic evolution explain the topics that evolved throughout the years ( Figure 7F ). In summary, the core topics of the ASD field in 2011–2014 consisted of the risk of childhood ASD and further developed into the field of human genetic variants, such as CNV and de novo mutations. In the subperiod 2015–2020, the further expansion of studies in this field leads to new clusters, such as “immune system,” “brain development,” and “fecal microbiota.” Genome research in the upper right quadrant, including mutations and risk, is a major and evolving theme. The coupled map showing the brain-gut axis field, including intestinal microbiota and chain fatty acids, located in the lower right corner is crucial for autism research but is not yet well-developed ( Figure 7G ). The research on autism, including animal models, schizophrenia, is a well-developed field, but that on high-functioning autism and diagnosis is a marginal field.

This study used various bibliometric tools and software to analyze the published articles on ASD based on the WoSCC database from 2011 to 2022. By 2022, the annual number of publications and citations of ASD-related research showed an overall upward trend, reflecting the sustained interest and the diversity of areas.

General information

In terms of regional distribution, researchers from different countries and regions have participated in autism research, and international cooperation has been relatively close over the past decade. The scientific research is supported by several countries and institutions, as well as by large-scale international cooperation ( 28 , 29 ). The USA has the highest collaboration performance, especially with UK, Canada, Australia and China. In addition to the limitations of financial aid, ethical, cultural, and racial issues are complex constraints that should be overcome for more diversity in autism research ( 30 , 31 ). We speculated that further collaboration between institutions and countries could promote autism research.

Among the top 20 academic journals, most of the papers were in the Journal of Autism and Developmental Disorders. The frequent publishing of ASD-related papers indicates the interest of readers and journal editors in Autism. Also, substantial studies have been carried out on ASDs, autism, and molecular autism. These journals are ascribed to the field of ASD, focusing on autism research and communication ASD science. However, the analysis of the 10 most cited publications revealed that they were published in such as Nature, Cell, Lancet; these ASD studies were all from high-impact journals.

From the perspective of authors, some of them have made outstanding contributions to global ASD research. Professor Catherine Lord, the top rank for h-index, m-index analysis conducted by the author, and who developed the two gold standards for autism diagnosis ( 32 , 33 ), are the most influencing factors in the field. ASD is a disease with complex genetic roots. Dr. Catherine Lord has conducted multiple studies using genome-wide association study (GWAS) and gene set analysis to identify variant signatures in autism ( 34 ). A recent meta-analysis showed that 74–93% of ASD risk is heritable, with an analysis of CNVs that highlights the key role of rare and de novo mutations in the etiology of ASD ( 35 ). Variation-affected gene clusters on networks associated with synaptic transmission, neuronal development, and chromatin regulation ( 36 , 37 ). The identification of the cross-disorder genetic risk factors found by assessing SNP heritability in five psychiatric disorders ( 38 ). Five of the top 10 cited papers in Table 5 focus on genetic variation, suggesting that over the past decade, research has shifted from a general concept of genetic risk to the different types of genetic variations associated with autism.

Simon Baron-Cohen of the Autism Research Center at the University of Cambridge was the most published author between 2011 and 2021. He contributed to the mind-blindness hypothesis of autism, developed the autism spectrum quotient (AQ) screening tool for autism, and focused on gender differences in autism ( 39 – 41 ). There are gender/sex differences in the volume and tissue density of brain regions, including the amygdala, hippocampus, and insula, and the heart-blind hypothesis links emotional recognition in individuals with autism to deficits in the amygdala ( 41 – 43 ). Then, Simon et al. backed up the “extreme male brain” theory of autism in a study of 36,000 autistic individuals aged 16–89 ( 44 ). Recently, an increasing number of studies from different perspectives have focused on how sex/gender differences are related to autism ( 4 , 5 , 45 ). In the future, studies of neural dimorphism in brain development in autism need to be conducted across the lifespan to reduce age-induced biases ( 41 ).

Hotspots and Frontiers

Keyword analysis was a major indicator for research trends and hotspot analysis. This study shows that keywords for autism research include etiological mechanism, clinical characteristics, and intervention characteristics. Genetic, environmental, epigenetic, brain structure, neuropathological, and immunological factors have contributed to studying its etiological mechanism ( 46 , 47 ). The studies on the abnormal cortical development in ASD have reported early brain overgrowth ( 48 ), reduced resting cerebral blood flow in the medial PFC and anterior cingulate ( 49 ), focal disruption of neuronal migration ( 50 ), and transcriptomic alterations in the cerebral cortex of autism ( 51 ). Genomics studies have identified several variants and genes that increase susceptibility to autism, affecting biological pathways related to chromatin remodeling, regulation of neuronal function, and synaptic development ( 51 – 54 ). In addition, many autism-related genes are enriched in cortical glutamatergic neurons, and mutations in the genes encoding these proteins result in neuronal excitation-inhibitory balance ( 51 , 55 ). A recent study using single-cell sequencing of the developing human cerebral cortex found strong cell-type-specific enrichment of noncoding mutations in ASD ( 56 ). Interestingly, genes interact with the environment; some studies have shown that environmental exposure during pregnancy is a risk factor for brain development ( 57 ), and there are changes in DNA methylation in the brains of ASD patients, reflecting an underlying epigenetic dysregulation.

Presently, the diagnosis of ASD is mainly based on symptoms and behaviors, but the disease has a high clinical heterogeneity, and the individual differences between patients are obvious ( 58 ). In this study, the keywords of the intervention cluster show the importance of early individualized intervention. Patient data are multidimensional, and individualized diagnoses could be made at multiple levels, such as age, gender, clinical characteristics, and genetic characteristics ( 59 ). Early individual genetic diagnosis aids clinical evaluation, ranging from chromosomal microarray (CMA) to fragile X genetic testing ( 60 ). However, the results of genetic research cannot guide the treatment. Notably, the treatment of autism is dominated by educational practices and behavioral interventions ( 61 ). Medication may address other co-occurring conditions, such as sleep disturbances, epilepsy, and gastrointestinal dysfunction ( 9 ). Professor Catherine Lord pointed out that the future of autism requires coordinated, large-scale research to develop affordable, individualized, staged assessments and interventions for people with ASD ( 62 ). Professor Baron-Cohen noted that increasing the sample size and collecting data from the same individual multiple times could reduce heterogeneity ( 58 ). In addition, screening for objective and valid biomarkers in the future would help to stratify diagnosis and reduce heterogeneity.

According to the keyword trend analysis of 100 highly cited documents, the genetic risk of autism was determined as the hot focus of research, and immune dysregulation and gut microbiome are the new development frontiers after 2015. Patients with ASD have altered immune function, microglia activation was observed in postmortem brain samples, and increased production of inflammatory cytokines and chemokines was observed in cerebrospinal fluid. The microglia are involved in synaptic pruning, and cytokines also affect neuronal migration and axonal projections ( 63 – 65 ). In addition, abnormal peripheral immune responses during pregnancy might affect the developing brain, increasing likelihood of autism ( 66 ). Several studies have pointed to abnormalities in immune-related genes in the brain and peripheral blood of autistic patients ( 51 , 67 , 68 ). Immune dysfunction is involved in the etiology of ASD and mediates the accompanying symptoms of autism. The patients have multiple immune-related diseases, asthma, allergic rhinitis, Crohn’s disease, and gastrointestinal dysfunction ( 69 – 71 ). Children with frequent gastrointestinal symptoms, such as abdominal pain, gas, constipation, or diarrhea, had pronounced social withdrawal and stereotyped behavior ( 70 – 72 ). Several studies suggested that these autism-related gastrointestinal problems might be related to intestinal microbiota composition ( 72 – 74 ). Accumulating evidence suggested that the microbiota-gut-brain axis influences human neurodevelopment, a complex system involving immune, metabolic, and vagal pathways in which bacterial metabolites directly affect the brain by disrupting the gut and blood–brain barrier ( 75 – 78 ). Fecal samples from children with autism contained high Clostridium species and low Bifidobacterium species ( 79 , 80 ). Probiotics can modulate gut microbiota structure and increase the relative abundance of Bifidobacteria , and clinical studies have shown that supplementation with probiotic strains improves attention problems in children with autism ( 81 , 82 ). Recent clinical trials have shown that microbiota transfer therapy improves gastrointestinal symptoms and autism-like behaviors in children with ASD ( 83 , 84 ).

This scientometric study comprehensively analyzes about a decade of global autism research. Research in the field of autism is increasing, with the United States making outstanding contributions, while neuroscience, genetics, brain imaging studies, or studies of the gut microbiome deepen our understanding of the disorder. The study of the brain-gut axis elucidates the mechanism of immunology in autism, and immunological research may be in the renaissance. The current data serve as a valuable resource for studying ASD. However, the future of autism needs further development. In the future, relevant research should be included for a complete representation of the entire autism population, and further collaboration between individuals, institutions, and countries is expected to accelerate the development of autism research.

Data availability statement

Author contributions.

MJ, DZ, JL, and LW conceived and designed the study. MJ, TL, XL, KY, and LZ contributed to data collection and data analysis. MJ wrote the original manuscript. DZ, JL, and LW revised the article and contributed to the final version of the manuscript. All authors contributed to the article and approved the submitted version.

This work was supported by grants from the Key-Area Research and Development Program of Guangdong Province (2019B030335001) and the National Natural Science Foundation of China (grant numbers 82171537, 81971283, 82071541, and 81730037).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1096769/full#supplementary-material

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