How Does the Autism Spectrum Work? How to Diagnose | cannabisMD

How Does the Autism Spectrum Work? How to Diagnose

Autism Spectrum Disorder Diagnosis

Our understanding of autism has come a long way since the pioneering work of Asperger before World War 2. Before it was studied, what we would now call autism was treated variously as illness, madness, “retardation”, possession by spirits, or stupidity.

They were cruel times for people on the autism spectrum. Nobody understood the why people with autism were so different and not many people were tolerant of them. Jobs like lighthouse keepers or post carriers suited people who, for whatever reason, could not interact with others in the ways that were expected of them.

As jobs became more socially dependent and schooling improved, people started realizing that there were substantial numbers of people who had similar behavioural traits. The early psychologists called them “autists”. A common perception was that they made up for their strange social inabilities with savant like abilities. This is how Dr Asperger is thought to have saved some of the children in his care from the Nazi’s, who were determined to destroy “undesirables”. By convincing them that these children might be useful, he probably saved some from inevitable death.

Since then, the recognition and acceptance of autistic people has grown. Special autistic schools that are designed specifically for children who are diagnosed with autism , or autism spectrum disorders (ASD), have sprung up. There are laws mandating provision for childhood disintegrative disorder (as it is sometimes known), and social understanding has increased.

Until recently, however, the causes of autism were completely mysterious. Thankfully, recent advances in scanners and biological understanding have contributed to the autism spectrum theory.

Today Autism is categorized of one of five persuasive development disorders. These disorders include:

  1. Autism
  2. Asperger’s Syndrome (accounting for around 9% of autism diagnoses)
  3. Rett syndrome
  4. Childhood disintegrative disorder
  5. Pervasive developmental disorder not otherwise specified (PDD NOS)

Autism Spectrum Disorders

Autism is a spectrum, like a rainbow of different conditions. Each patient falls somewhere on that spectrum. Whereabouts they fall has a huge impact on their symptoms, treatments and quality of life. The range and severity of autism spectrum disorders is huge. The difference between a person on one end of the spectrum and a person on the other can be astronomical.

Asperger’s Syndrome

At one end, you have people who until recently would have been diagnosed with Asperger’s syndrome. However, this is now recognized as a part of ASD. These are generally high functioning people. They have serious difficulties when it comes to social communication with other people. Otherwise, they can manage themselves quite well with some help.

Around 1/3 of people with Asperger’s have unusual aptitude for certain tasks, like drawing or maths. The numbers of people in industries like IT with Asperger’s is disproportionate. Far from being a single identifiable condition, Asperger’s has been found to be an umbrella term for many different, higher functioning, forms of autism.

Because of the variety of symptoms of higher functioning ASDs, it is hard to write in general terms about them. Many people with higher functioning ASDs are perfectly capable people but can be included in the bracket as having a “communication disorder”.

Further along the spectrum are people with autistic disorders who are less capable of taking care of themselves. Some of the common symptoms of autism include:

  • Repetitive behaviours
  • Developmental delays
  • Much reduced or absent social communication ability
  • Intellectual disability
  • Unusually slow child development

Needless to say, life for people on the autism spectrum can be very challenging. In our connected world where social ability often trumps practical skill or capabilities, people with autism find it hard to get along and find a place for themselves in the world.

Read more about Asperger’s Syndrome in the statistical manual of mental disorders.

The Neurodiverse Brain

The current theory of ASDs is that they are communication disorders. For most people, the different parts of the brain all communicate with each other relatively harmoniously. None is dominant unless certain conditions arise, when one part of the brain is needed more than others. This is how a neurotypical brain works.

In neurodiverse people’s brains certain parts of the brain are more dominant than others. Instead of each part of the brain getting an equal or fair share, only certain parts get attention. This could be due to communication pathways for certain thought patterns being longer, slower, or less powerful. It could also be due to some parts being unusually powerful and overriding the signals from other parts.

This is what research suggests is the reason for the often intense focus that neurodiverse people can exhibit when they encounter an object or task that they like. This focus is often at the expense of what their brain classifies as less important stimuli, like social cues, bodily functions, or the cost to the person’s own body or mind.

Many neurodiverse people miss social cues and information. This could be due to the part of the brain that processes this being:

  • Underdeveloped
  • Badly integrated
  • Dominated by other parts of the brain
  • Not having developed in the first place

The vast majority of people with ASD do care about other people and are aware of their difficulties socializing. They are just unable to access that information when something their brain categorizes as more important is happening. Usually, when the person has what they did “wrong” explained to them, it emotionally affects them as it would anyone else, but they just had to take a different route to get to the understanding.

When different parts of the brain are not regulated as well as in neurotypical brains, stimuli can be overwhelming. Many children with Autism Spectrum Disorder (ASD) will find loud noises, bright lights, flavours or sensations intolerable because the stimuli is amplified. Neurotypical people can attenuate signals from the disparate parts of their brain more efficiently, so when they hear a loud noise their brain is able to recognize it and continue to think about what to do about it. Many neurodiverse people find that when certain stimuli occur, that is the only thing happening in their minds and it is impossible to escape from.

This can be very distressing. It partially explains the way that many children with autism are very picky about food, clothes, music, and other common stimuli. They find things that do not cause their brains to go into overdrive and stick to them.

The oversensitivity to stimuli is thought to be related to the higher incidence of epilepsy that is found in ASD populations. A dominant signal from, for example, the visual cortex can trigger the brain-wide firing of neurons in synchrony that is autism. It is thought that neurotypical people’s brains can attenuate these signals before they start the cascade and some neurodiverse brains cannot.

ASD Development

Exactly what causes a brain to grow into an autistic brain as opposed to a neurotypical brain is still not understood. The brain is unimaginably complex and even small changes to the way it grows can have massive effects on the eventual configuration of that brain.

The prevailing theory is that autism is mostly a genetic disorder that is exacerbated by environmental conditions. ASD appears to be largely heritable, as parents who have the condition are more likely to have children who also have it. If one twin has ASD, the other has a much higher chance of developing the condition too. Even though genes are known to play an important role in the development of ASD, exactly which genes are involved is unknown. There are some genetic syndromes like Fragile X and Williams syndromes that appear to be related to ASD. They seem to be significant risk factors.

Genes are the basis for a baby’s growth. They contain all the information for that person’s body. However, it has been found relatively recently that all genes have “epigenetic” switches, which tell the cell when to turn on a gene. If some environmental factor, for example premature birth, toxins, or alcohol, is present while that little brain is growing, it is thought that the epigenetic switches can be activated in different ways than normal. The brain then grows in a way that is not typical, producing what we call neurodiverse brains.

Factors like vaccines, most drugs, upbringing and diet, have all been ruled out as possible causes of ASD. Far more important seems to be the genetic predisposition and the conditions in the womb. Early intervention seems to be very important.

Diagnosis

Some parents will have a likely diagnosis of their child relatively early. Autism is often related to infantile epilepsy, conditions like neurofibromatosis, cerebral palsy, Down’s syndrome, and muscular dystrophy. These are quite rare diseases, so it is often only when developmental delays appear at around 18 months that parents begin to notice.

Children develop on remarkably predictable timetables, and even though there is a lot of variation in development, it is possible to diagnose a child as probably autistic after their first birthday. Some of the typical warning signs include:

  • Early social cues might be missed
  • Language acquisition could be delayed, or impaired
  • Repetitive behaviours exhibited
  • Intolerance to foods, lights, sounds and other stimuli

To get a proper diagnosis, you will need a doctor with special training to examine the neurodiverse person. Tests of interaction, intelligence, focus, and general abilities will allow that person to be compared against the average to see if they are developing or have developed in a typical manner.

Development is a complex topic, and some of the children who exhibit autistic traits early on go on to catch up on developmental milestones and become demonstrably neurotypical children or adults. Other children might exhibit normal behaviours until a certain point in their development, when they can very quickly develop autistic traits.

Why this happens is unknown. Somewhere and somehow the growth regulators started behaving differently and caused the brain to develop in a different way.

As many as 50% of the American population of people with ASD are thought to be undiagnosed. This is largely due to proper diagnosis only becoming mainstream in the 1990’s. Many people with a developmental disorder not otherwise diagnosed have very difficult lives; a diagnosis even in later life can be enormously helpful in understanding yourself and other people with your condition.

There is plenty of information on the internet from support groups, advocates, and other people with ASD about how to get the right help. The National Institute of Mental Health and the American Psychiatric Association are particularly helpful.

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