Facts to Know:
- Autism is a disorder of brain development that affects social communication skills as well as regulation of emotion and behavior.
- Autism spectrum disorder affects approximately 1-2% of the population. Boys are four times more likely to be diagnosed with autism than girls.
- Autism is thought to be caused by the interaction of multiple genetic and environmental factors that impact how the brain develops and learns from a very early age.
- With behavioral and skills-based treatment, people with autism spectrum disorder can live functional and fulfilling lives.
What is autism spectrum disorder?
Autism spectrum disorder is a neurodevelopmental disorder that affects verbal communication, social interaction, sensory processing, and behavioral flexibility. These challenges often persist over the lifespan, impacting a person’s ability to manage self-care activities, build relationships, pursue academic goals and engage in work.
Autism characteristics usually first appear between 12-24 months of age, although it varies by individual. Research shows that changes in brain development actually occur much earlier, likely starting during pregnancy. For some children, signs and symptoms of ASD may be present early on but do not become impairing until much later in childhood
Many different genes and environmental risk factors contribute to the development of autism. The genes involved often affect how cells in the brain grow and communicate with one another. Sometimes parents also carry these genes, and other times the genes are the result of new mutations that occurred during development. Generally, many risk genes are required for autism symptoms to develop.
Environmental risk factors also affect the chances of developing autism. These risk factors may work by causing changes to genes prior to or shortly after conception or they may directly affect brain development during pregnancy and early infancy. Known risk factors include prematurity, parental age, and certain medications when taken during pregnancy. Research evidence continues to demonstrate that there is no link between vaccinations and autism.
Because many different things contribute to autism, it can also present in many different ways. The term autism spectrum disorder (ASD) describes the wide range of symptoms and abilities of individuals with autism. Autism spectrum disorder has replaced older diagnositc terms such as Asperger syndrome and pervasive development disorders (PDD). Other related disorders include social communication disorder (SCD) and non-verbal learning disability (NVLD). Regardless of the diagnostic term used, treatment should be tailored to the individual goals and needs of patients and their families.
Autism spectrum disorder varies substantially from person to person. The frequency and intensity of the associated characteristics often predict the types of treatment that will be most helpful.
- Challenges in social communication and interaction, such as:
- initiating and sustaining back-and-forth conversation
- utilizing appropriate eye contact and body language
- developing and maintaining relationships
- identifying and understanding social cues
- adjusting behavior to social context
- Engagement in restricted or repetitive behaviors, interests or activities, such as:
- engaging in repetitive behaviors or speech (recurring gestures or movement with no clear purpose, repeatedly saying the same word over and over)
- exhibiting inflexibility to change in environment or new experiences (rigid thinking patterns, small changes in schedule or plans may elicit acute distress, difficulty switching to and from tasks or activities)
- demonstrating fixed interests with intense focus (excessive time and energy focused on specific objects or activities at the expense of others)
- endorsing unusual sensory experiences (increased or decreased sensitivity to sounds, smells, temperature, or textures, and deep pressure, reduced pain sensitivity)
- Challenges with regulating emotion (may engage in aggressive behaviors when in distress, self-harm behavior, excessive irritability or outbursts).
Individuals with autism spectrum disorder are also more like to experience co-occurring mental health conditions, such as attention-deficit hyperactivity disorder, depression, anxiety, and schizophrenia. People with autism often have difficulty with executive functioning, which includes domains such as attention, working memory, problem-solving, flexibility and completing tasks quickly.
A diagnosis of autism-spectrum disorder is typically made during childhood in the context of language delays, rigid or repetitive behaviors, and social challenges. Some autistic individuals are not diagnosed until much later, often when work or social demands outweigh compensatory strategies. Diagnostic assessments should be conducted by a licensed medical professional such as a child psychologist, neuropsychologist, developmental pediatrician, or psychiatrist. Psychological and neuropsychological testing are frequently used to clarify diagnoses, rule out other conditions, and guide treatment planning. There are currently no known medical tests to diagnose autism spectrum disorder, although genetic testing is usually recommended once a diagnosis is established.
At ColumbiaDoctors, diagnostic evaluations and second opinions are available for patients of all ages, from early childhood through adulthood. We also offer Expert Comprehensive Evaluations (ECE) for people seeking to clarify their diagnosis and obtain treatment recommendations.
Early Interventions Services
For young children with autism, early behavioral therapies help to strengthen and are the mainstay of early intervention. Many children may benefit from Applied Behavior Analysis (ABA), occupational therapy and speech/language therapies.
Recovery oriented and skills-based behavioral therapies are considered evidence-based treatment for autism spectrum disorder. It has been found that a combination of skills-based treatments, such as social skills training, cognitive remediation and supported employment/education, as well as CBT for autism can improve life satisfaction and overall functioning. Targeted executive functioning skills training can address some of the challenges related to attention, working memory, flexibility, motivation, sustained attention/focus, and other cognitive domains.
To address some of the social challenges, individualized skills coaching provides participants with necessary skills and practice in social situations, especially navigating contexts that may result in emotional distress. Skills coaches also work to promote self-care behaviors, daily routines and accountability by leveraging the skills learned in groups. These sessions often take place in the community to generalize learning.
Family and Caregiver Support
- Supportive therapy
- Parent-Child Interaction Therapy (PCIT)
- Research Units in Behavioral Intervention (RUBI)
In some cases, medication management may be used to address co-occurring mental health concerns or target specific symptoms. In consultation with a psychiatrist, medication, or combination of medications, can support treatment goals. Our psychiatrists work with each individual to determine which medications, and at what dose, work best. Other physicians may be part of the treatment team that address co-occurring medical needs, such as seizures, gastrointestinal problems, sleep difficulties, and nutrition.
How Can I Receive Treatment for autism spectrum disorder at Columbia?
At ColumbiaDoctors, we work closely with patients and their families to developed individualized treatments for children and adults with autism spectrum disorder. Our clinicians combine a thorough evaluation of each individual’s problems with the latest research to design a customized treatment plan.
The Lieber Recovery Clinic is a specialized service that offers comprehensive outpatient treatment for adults (age 18+ years old) with high functioning autism spectrum disorder, emphasizing skills conducive for work, school, and independent living.