What are Autistic Spectrum Disorders?
Autism Spectrum Disorder
Is your child struggling to reach developmental milestones? Do they avoid eye contact, find communication and social interaction hard, or have trouble handling sights, sounds and textures? These can be signs of autism spectrum disorder (ASD).
Autism spectrum disorder describes a broad range of differences in social communication, behavior, sensory processing, speech and nonverbal communication. Autism is being diagnosed more often than in the past. Every autistic person is different, and the challenges autism brings can range from mild to significant.
How Is Autism Classified?
In 2013, the American Psychiatric Association combined four separate diagnoses into one diagnosis called autism spectrum disorder. These were autistic disorder, childhood disintegrative disorder, pervasive developmental disorder–not otherwise specified (PDD-NOS) and Asperger syndrome. Today, rather than using subtypes, clinicians describe the level of support a person needs. Understanding your child’s specific strengths and challenges is important for planning care and support.
How Common Is Autism?
According to the Centers for Disease Control and Prevention, about 1 in 31 eight-year-olds in the United States (3.2%) were identified with autism in 2022. Autism is about 3.4 times more common in boys than in girls, and it occurs in all racial and ethnic groups (1).
What Are the Signs of Autism?
Autism involves two main areas: differences in social communication, and restricted or repetitive behaviors, interests and sensory responses.
Children with autism may have difficulty with back-and-forth social interaction, such as sharing interests and emotions or taking turns in conversation. They may have differences in nonverbal communication, including eye contact, body language and gestures, and they may find it hard to develop and maintain relationships.
They may show repetitive movements, repeat words or phrases, or use objects in repetitive ways. Many prefer sameness and strict routines, and they may have very intense, focused interests.
Many autistic children also respond to sensory input differently. They may be over- or under-sensitive to sounds, textures, pain or temperature, or show unusual interest in sensory experiences (2).
What Causes Autism?
There is no single cause of autism. It appears to result from a complex combination of genetic and environmental factors (3).
Research suggests the immune system may also be involved. Studies have found differences in several types of immune cells in people with autism, as well as changes in antibodies, including increased autoantibodies in some individuals (4). Studies have also found signs of activated microglia, the brain’s immune cells, in different brain regions in people with autism (5). Some research has also found signs of increased oxidative stress in children with autism (6).
Despite popular belief, research shows that vaccines, including those containing thimerosal, do not cause autism, and that maternal smoking and assisted reproductive technologies do not appear to raise the risk. Older parental age is associated with a higher risk. Birth complications involving trauma or a lack of oxygen have also been linked to autism, while maternal obesity, maternal diabetes and cesarean delivery show weaker associations (7).
Whatever the cause, early identification matters. A study by Clifford and colleagues followed babies through their first three years and asked mothers about their child’s temperament and social behavior. Babies later diagnosed with autism showed fewer positive emotional reactions in the first year, more sensory sensitivity from 6 months on, less smiling, laughing and cuddling during the second year, and more sadness, shyness and difficulty being soothed by age 2 (8).
These findings matter because early support leads to the best outcomes. Autism is lifelong. Therapies are not cures, but they can improve social skills, quality of life and independence in daily activities. The earlier support begins, the more likely a child is to gain independence as they grow.
What Happens in the Brain With Autism?
Researchers have found many differences in brain chemistry, structure and connectivity in autism.
Brain chemistry. Many behaviors in autism have been linked to differences in the brain’s dopamine system (9). Brain chemical signaling can also be influenced by the gut, since gut bacteria produce substances that affect it. Several differences in gut bacteria have been found in autism (10).
Brain connections. Brain imaging studies in autism have found weaker long-distance connections and weaker connections between the two sides of the brain, along with stronger connections in some other networks, including those involved in attention and focus (11).
The cerebellum. Research suggests the cerebellum plays an important role in autism. Studies have found differences in cerebellar structure, brain chemistry, oxidative stress, inflammation and the cerebellum’s role in movement and thinking (12).
The frontal lobes. Studies suggest the prefrontal cortex may develop differently in autism, including differences in how its networks are organized that may affect the balance between brain activation and inhibition (13). Some children with autism also show faster-than-typical growth of the frontal cortex early in life (14).
The orbitofrontal cortex helps judge the emotional meaning of events, guide learning, direct attention and support social understanding. Research in adults with autism has found changes in the balance of activation and inhibition in this area, which may affect its communication with the brain’s emotional centers and may help explain differences in social and emotional processing (15).
The anterior insula helps you sense what’s happening inside your own body and relate emotionally to others. It is part of a “salience network” that combines outside sensory information with your internal state. Studies have consistently found reduced activity in this area in autism (16).
The basal ganglia help control movement as well as thinking, social interaction, speech and repetitive behaviors. Studies have found differences in the size and cell density of parts of the basal ganglia in autism, which may affect the balance of activity between different brain regions (17).
Sensory Processing, Balance and Eye Movements in Autism
Studies show that most people with autism have some differences in processing sounds, sights, movement or touch. Central auditory processing problems have been found in many studies and may relate to difficulties with speech perception and expression (18).
The vestibular system, the inner ear’s balance system, helps the brain create a sense of direction that other senses build on. Some researchers have proposed that differences in vestibular processing may contribute to some features of autism (19). Studies have found differences in vestibular reflexes in autistic children, which may reflect differences in the cerebellum and brainstem (20).
Eye movements can also differ in autism, which may reflect differences in brain areas that control eye movements and attention (21). Research in autistic adults without intellectual disability has pointed to areas including the dorsolateral prefrontal cortex and frontal eye fields, and possibly the basal ganglia and parietal lobes (22). Children with autism may also have difficulty using visual feedback to adjust their eye movements, which has been linked to differences in the cerebellum (23).
People with autism often scan faces and social scenes differently. Research shows that even with simple, non-social targets, their fast eye movements can be less accurate and more variable, with lower peak speeds. These findings suggest that differences in the cerebellum and brainstem contribute to differences in movement control in autism (24).
Eye tracking may help with early identification of autism. In one study, children ages 4 to 6 watched a short video of a woman speaking. Autistic children spent less time looking at several key areas, and the time spent looking at the mouth and body distinguished autistic from non-autistic children with about 85% accuracy (25).
Many people with autism experience sensory input differently. For some, the feel of a shirt or a handshake can be uncomfortable or even painful, which can make social situations harder. A study by Blakemore and colleagues found that adults with Asperger syndrome rated touch sensations as more intense than people without autism (26). Some studies suggest that sensory integration and proprioceptive activities can help with these challenges (27).
How Is Autism Usually Treated?
The most common therapies for autism include applied behavior analysis (ABA), occupational therapy, speech therapy and physical therapy, and medications are sometimes used. These approaches aim to build skills, reduce challenges and support independence and quality of life (28). They tend to work best when started early.
Medications such as antidepressants and antipsychotics are sometimes used to manage specific symptoms. They can be helpful, but they can also have side effects, so they need careful management by your child’s prescriber (29).
How the NeuroRescue Program Can Help
Our care is designed to work alongside your child’s pediatrician, therapists and school team, never in place of them. Please don’t change any of your child’s medications without talking with their prescriber.
We focus on the neurological systems that support movement, balance, eye control and sensory processing. Depending on your child’s needs, their program may include the following.
Vestibular and balance exercises. Vestibular rehabilitation exercises have been studied for improving balance and posture control in children with autism (30).
Eye movement exercises. Many of the brain areas involved in autism, including the brainstem, vestibular system, cerebellum, basal ganglia, and parietal and frontal lobes, also help control eye movements. We use targeted eye movement exercises with the goal of supporting attention, focus and regulation.
Virtual reality. Exercises in a virtual reality environment have been studied for supporting social interaction and thinking skills (31).
Light therapy. One study found that low-level laser therapy reduced irritability in children and adolescents with autism (32).
Nutritional support. Research is exploring probiotics and other supplements for the gut and inflammation-related aspects of autism (33). When appropriate, we may recommend them as part of your child’s program.
Transcranial magnetic stimulation for adults. TMS has been studied for reducing irritability, hyperactivity and repetitive behaviors in autism (34). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner and is offered only to patients 18 and older. Because autism is lifelong, it may be an option for autistic adults.
Every NeuroRescue Program is different, with therapies chosen based on your child’s testing and needs. No two brains are alike, and no two programs are either.
How the NeuroRescue Program Works
Your child’s NeuroRescue Program begins with their Discovery Day. We start with a detailed history and neurological exam, done at a pace that works for your child. We measure how their visual, vestibular and balance systems are working through computerized analysis of eye movements, inner ear reflexes and balance under different conditions.
Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your child’s sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand your child’s strengths, which systems are struggling, and how quickly they tire. We use that information to design a personal NeuroRescue Program, aimed at improving function and endurance in the systems that need support. Our testing also helps us decide when to push and when to let your child rest.
Autism is lifelong, and we do not claim to cure it. Our goal is to help your child build skills in movement, balance, sensory processing and regulation, so they can feel more comfortable and confident and get more out of their other therapies, at home, at school and with friends.
Your Next Step
Raising a child with autism comes with real challenges, and real strengths. While we cannot cure autism, there is hope for improving function and quality of life. To find out if the NeuroRescue Program is right for your child, contact one of our patient care coordinators to schedule a Discovery Day.
It’s never too late to take the next step.
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