×
Create a new article
Write your page title here:
We currently have 7,593 articles on LGBTQIA+ Wiki. Type your article name above or create one of the articles listed here!



    LGBTQIA+ Wiki
    LGBTQIA+ Wiki
    7,593Articles
    in:
    Ace-spec identity, Umbrella Terms

    Asexual Spectrum: Difference between revisions

    Content added Content deleted
    VisualWikitext
    (h)
    mNo edit summary
     
    (104 intermediate revisions by 53 users not shown)
    Line 1: Line 1:
    [[File:Acespec.png|alt=A flag with four even horizontal stripes. From top to bottom they are dark blue, purple, light grey, and dusty pink.|thumb|Alternate asexual spectrum flag.|The asexual spectrum flag by @theflagarchive]]
    {{short description|Range of neurodevelopmental disorders}}{{Use dmy dates|date=July 2020}}{{Infobox medical condition (new)|name=Autism spectrum|synonyms=Autism spectrum disorder, autistic spectrum disorder|image=Autism-stacking-cans 2nd edit.jpg|alt=Boy stacking cans|caption=Repetitively stacking or lining up objects is associated with the autism spectrum|field=[[Clinical psychology]], [[psychiatry]], [[pediatrics]], [[occupational medicine]]|symptoms=Problems with [[communication]], [[social interaction]], restricted interests, repetitive behavior<ref name=DSM5/>|complications=[[Social isolation]], employment problems, family stress, [[bullying]], [[self-harm]],{{citation needed|date=July 2020}} [[suicide]]<ref>{{cite journal |vauthors= Ruggieri V |title=Autism, depression and risk of suicide |journal=Medicina |date=2020 |volume=80 |issue=Suppl 2 |pages=12–16 |pmid=32150706}}</ref>|onset=By the age of 3 years<ref name="ICD10Blue">{{Cite book |chapter-url=https://www.who.int/classifications/icd/en/bluebook.pdf |title=The ICD-10 Classification of Mental and Behavioural Disorders – Clinical descriptions and diagnostic guidelines |publisher=[[World Health Organization]] |location=Geneva |pages=198 |chapter=F84.0 Childhood autism}}</ref>|duration=Lifelong or long-term<ref name=NIH2016/>|causes=Uncertain<ref name=NIH2016/>|risks=Advanced parental age, exposure to [[valproate]] during pregnancy, [[low birth weight]]<ref name=DSM5/>|diagnosis=Based on symptoms<ref name=NIH2016>{{cite web |title=Autism Spectrum Disorder |url=https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml#part_145441 |publisher=NIMH |access-date=22 January 2018 |date=October 2016}}</ref>|differential=[[Intellectual disability]], [[Rett syndrome]], [[ADHD]], [[selective mutism]], [[Childhood schizophrenia|childhood-onset schizophrenia]]<ref name=DSM5/>|prevention=|treatment=[[Behavioral therapy]],<ref name=Occu2008>{{cite journal | vauthors = Case-Smith J, Arbesman M | title = Evidence-based review of interventions for autism used in or of relevance to occupational therapy | journal = The American Journal of Occupational Therapy | volume = 62 | issue = 4 | pages = 416–29 | date = 2008 | pmid = 18712004 | doi = 10.5014/ajot.62.4.416 | doi-access = free }}</ref> [[psychotropic medication]]<ref name=Acc2016>{{cite journal | vauthors = Accordino RE, Kidd C, Politte LC, Henry CA, McDougle CJ | s2cid = 6255194 | title = Psychopharmacological interventions in autism spectrum disorder | journal = Expert Opinion on Pharmacotherapy | volume = 17 | issue = 7 | pages = 937–52 | date = 2016 | pmid = 26891879 | doi = 10.1517/14656566.2016.1154536 }}</ref>|medication=|prognosis=|frequency=1% of people<ref name=DSM5/> (62.2 million 2015)<ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 }}</ref>|deaths=}}<!--Definition and symptoms-->The '''autism spectrum''' encompasses a range of [./https://en.wikipedia.org/wiki/Neurodevelopmental_disorder neurodevelopmental] conditions, including [./https://en.wikipedia.org/wiki/Autism autism] and [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome], generally known as '''autism spectrum disorders''' ('''ASD'''). Individuals on the autistic spectrum experience difficulties with social communication and interaction and also exhibit restricted, repetitive patterns of behavior, interests, or activities. Symptoms are typically recognized between one and two years of age.<ref name="DSM5">{{cite book|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)|chapter=Autism Spectrum Disorder. 299.00 (F84.0)|year=2013|pages=50–59|location=Arlington, VA|publisher=American Psychiatric Publishing|isbn=978-0-89042-559-6|doi=10.1176/appi.books.9780890425596|hdl=2027.42/138395}}</ref> However, a lot of children are not finally diagnosed until they are older. Final diagnosis could still be given as an adolescent or even as an adult.<ref>{{Cite web|last=CDC|date=2020-03-13|title=Screening and Diagnosis {{!}} Autism Spectrum Disorder (ASD) {{!}} NCBDDD|url=https://www.cdc.gov/ncbddd/autism/screening.html|access-date=2020-09-21|website=Centers for Disease Control and Prevention|language=en-us}}</ref> The term "spectrum" refers to the variation in the type and severity of symptoms.<ref name=":9">{{cite journal|vauthors=Lai MC, Lombardo MV, Chakrabarti B, Baron-Cohen S|title=Subgrouping the autism "spectrum": reflections on DSM-5|journal=PLOS Biology|volume=11|issue=4|pages=e1001544|date=23 April 2013|pmid=23630456|pmc=3635864|doi=10.1371/journal.pbio.1001544}}</ref> Those in the mild range may function independently, while those with moderate to severe symptoms may require more substantial support in their daily lives.<ref name="DSM5" /><ref>{{cite journal|vauthors=Weitlauf AS, Gotham KO, Vehorn AC, Warren ZE|title=Brief report: DSM-5 "levels of support:" a comment on discrepant conceptualizations of severity in ASD|journal=Journal of Autism and Developmental Disorders|volume=44|issue=2|pages=471–6|date=February 2014|pmid=23812664|pmc=3989992|doi=10.1007/s10803-013-1882-z}}</ref> Long-term problems may include difficulties in performing daily tasks, creating and keeping relationships, and maintaining a job.<ref name=":3">{{Cite book|title=Fundamentals of Abnormal Psychology|last=Comer|first=Ronald J.|name-list-style=vanc|publisher=Worth /Macmillan Learning|year=2016|location=New York|pages=457}}</ref><!--Cause and diagnosis-->The cause of autism spectrum conditions is uncertain. Risk factors include having an older parent, a family history of autism, and certain genetic conditions. It is estimated that between 64% and 91% of risk is due to family history.<ref>{{cite journal|vauthors=Tick B, Bolton P, Happé F, Rutter M, Rijsdijk F|title=Heritability of autism spectrum disorders: a meta-analysis of twin studies|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=57|issue=5|pages=585–95|date=May 2016|pmid=26709141|pmc=4996332|doi=10.1111/jcpp.12499}}</ref> Diagnosis is based on symptoms. In 2013, the ''Diagnostic and Statistical Manual of Mental Disorders'' version 5 ([./https://en.wikipedia.org/wiki/DSM-5 DSM-5]) replaced the previous subgroups of autistic disorder, [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome], [./https://en.wikipedia.org/wiki/Pervasive_developmental_disorder_not_otherwise_specified pervasive developmental disorder not otherwise specified] (PDD-NOS), and [./https://en.wikipedia.org/wiki/Childhood_disintegrative_disorder childhood disintegrative disorder] with the single term "autism spectrum disorder".<ref name="DSM5Autism">{{cite web|url=http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf|title=Autism spectrum disorder fact sheet|publisher=American Psychiatric Publishing|work=DSM5.org|year=2013|access-date=13 October 2013|url-status=dead|archive-url=https://web.archive.org/web/20131006210933/http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf|archive-date=6 October 2013}}</ref><ref name=":9" /><!--Treatment and epidemiology-->Treatment efforts are generally individualized and can include behavioural therapy and the teaching of coping skills. Medications may be used to try to help improve symptoms. Evidence to support the use of medications, however, is not very strong.<!--Epidemiology and culture-->An estimated 1% of the population (62.2 million globally) are on the autism spectrum {{as of|2015|lc=y}}.<ref name="DSM5" /> In the United States it is estimated to affect more than 2% of children (about 1.5 million) as of 2016.<ref>{{cite web|title=HRSA-led study estimates 1 in 40 U.S. children has diagnosed autism|url=https://www.hrsa.gov/about/news/press-releases/hrsa-led-study-estimates-children-diagnosed-autism|website=hrsa.gov|access-date=17 October 2019|date=19 November 2018}}</ref> Males are diagnosed four times more often than females.<ref name=":3" /><ref name="HHS2017">{{Cite web|url=https://www.acf.hhs.gov/ecd/10-facts-about-asd|title=10 Facts about Autism Spectrum Disorder (ASD)|website=Early Childhood Development {{!}} ACF|language=en|access-date=6 November 2019}}</ref> The [./https://en.wikipedia.org/wiki/Autism_rights_movement autism rights movement] promotes the concept of [./https://en.wikipedia.org/wiki/Neurodiversity neurodiversity], which views autism as a natural variation of the brain rather than a disorder to be cured.<ref name="Solomon">{{cite news|work=New York|title=The autism rights movement|last=Solomon|first=Andrew|name-list-style=vanc|date=25 May 2008|access-date=27 May 2008|url=http://nymag.com/news/features/47225/|archive-url=https://web.archive.org/web/20080527025140/http://nymag.com/news/features/47225/|archive-date=27 May 2008|url-status=live}}</ref>
    [[File:AceSpec flag by @sude.the.acespec on instagram.jpg|thumb|Alternate asexual spectrum flag by SudeTheAcespec]]
    [[File:Acespec flag.png|thumb|Alternate ace spectrum flag by DistinctiveSoy.]]
    [[File:Ace spec identities.png|thumb|Some of the asexual spectrum sexual orientations explained with pie.]]


    == Classification ==
    {{Further|Autism#Classification}}
    [[File:Autism_Spectrum_Disorders_subcategories.png|link=https://en.wikipedia.org/wiki/File:Autism_Spectrum_Disorders_subcategories.png|alt=|thumb|DSM-IV diagnoses that fall under the umbrella of autism spectrum disorder in DSM-V]]


    The '''asexual spectrum''' or '''asexual umbrella''' is a group of [[sexual orientations]] that all fall under the [[Umbrella Term|umbrella term]] of [[asexual]]. Individuals on the asexual spectrum may completely lack [[sexual attraction]] or feel it so little that they relate more to the asexual experience than to the [[allosexual]] experience. The common link between individuals on the asexual spectrum is that they do not feel the "standard" amount of sexual attraction or feel it in the "standard" way.
    === DSM IV (2000) ===
    Autism forms the core of the autism spectrum disorders. Asperger syndrome is closest to autism in signs and likely causes;<ref name="Lord 2000">{{cite journal|vauthors=Lord C, Cook EH, Leventhal BL, Amaral DG|title=Autism spectrum disorders|journal=Neuron|volume=28|issue=2|pages=355–63|date=November 2000|pmid=11144346|doi=10.1016/S0896-6273(00)00115-X|s2cid=7100507}}</ref> unlike autism, people with Asperger syndrome have no significant delay in [./https://en.wikipedia.org/wiki/Language_development language development] or [./https://en.wikipedia.org/wiki/Cognitive_development cognitive development], according to the older [./https://en.wikipedia.org/wiki/DSM-IV_codes DSM-IV] criteria.<ref>{{vcite book|title=Diagnostic and Statistical Manual of Mental Disorders|editionphrase=4th ed., text revision ([[DSM-IV-TR]])|author=[[American Psychiatric Association]]|date=2000|isbn=0890420254|chapter=Diagnostic criteria for 299.80 Asperger's Disorder (AD)|chapterurl=http://www.behavenet.com/capsules/disorders/asperger.htm|publisher=<!-- citation bot fodder -->|location=<!-- citation bot fodder -->|access-date=10 August 2007|url=http://www.behavenet.com/capsules/disorders/asperger.htm|archive-url=https://web.archive.org/web/20070607192022/http://www.behavenet.com/capsules/disorders/asperger.htm|archive-date=7 June 2007|url-status=dead}}</ref> PDD-NOS is diagnosed when the criteria are not met for a more specific disorder. Some sources also include [./https://en.wikipedia.org/wiki/Rett_syndrome Rett syndrome] and [./https://en.wikipedia.org/wiki/Childhood_disintegrative_disorder childhood disintegrative disorder], which share several signs with autism but may have unrelated causes; other sources differentiate them from ASD, but group all of the above conditions into the [./https://en.wikipedia.org/wiki/Pervasive_developmental_disorder pervasive developmental disorders].<ref name="Lord 2000" /><ref name="NIMH-ASD-PDD">{{vcite web|year=2009|title=Autism spectrum disorders (pervasive developmental disorders)|publisher=National Institute of Mental Health|url=http://nimh.nih.gov/health/publications/autism/complete-index.shtml|access-date=23 April 2009|url-status=dead|archive-url=https://web.archive.org/web/20090429222922/http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml|archive-date=29 April 2009}}</ref>


    Individuals on the asexual spectrum are often referred to as "ace-spec" for short. Ace-spec individuals can have any [[Romantic Orientation|romantic orientation]], including [[aromantic]].
    Autism, Asperger syndrome, and PDD-NOS are sometimes called the ''autistic disorders'' instead of ASD,<ref>{{cite journal|vauthors=Freitag CM|s2cid=205678822|title=The genetics of autistic disorders and its clinical relevance: a review of the literature|journal=Molecular Psychiatry|volume=12|issue=1|pages=2–22|date=January 2007|pmid=17033636|doi=10.1038/sj.mp.4001896|doi-access=free}}</ref> whereas autism itself is often called ''autistic disorder'', ''childhood autism'', or ''infantile autism''.<ref name="Piven">{{cite journal|vauthors=Piven J, Palmer P, Jacobi D, Childress D, Arndt S|title=Broader autism phenotype: evidence from a family history study of multiple-incidence autism families|journal=The American Journal of Psychiatry|volume=154|issue=2|pages=185–90|date=February 1997|pmid=9016266|doi=10.1176/ajp.154.2.185|doi-access=free}}</ref> Although the older term ''pervasive developmental disorder'' and the newer term ''autism spectrum disorder'' largely or entirely overlap,<ref name="NIMH-ASD-PDD" /> the earlier was intended to describe a specific set of diagnostic labels, whereas the latter refers to a postulated [./https://en.wikipedia.org/wiki/Spectrum_disorder spectrum disorder] linking various conditions.<ref>{{cite journal|vauthors=Klin A|title=[Autism and Asperger syndrome: an overview]|journal=Revista Brasileira de Psiquiatria|volume=28|issue=suppl 1|pages=S3-11|date=May 2006|pmid=16791390|doi=10.1590/S1516-44462006000500002|doi-access=free}}</ref> ASD is a subset of the broader autism [./https://en.wikipedia.org/wiki/Phenotype phenotype] (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as [./https://en.wikipedia.org/wiki/Eye_contact#Difficulty avoiding eye contact].<ref name="Piven" />
    == Ace-Spec Identities ==
    While there are numerous ace-spec identities, some are more common, like asexual, [[demisexual]], and [[greysexual]], and can stand on their own as identities. Other common ace-spec identities include:
    *[[Aceflux]]
    *[[Acespike]]
    *[[Fictosexual]]
    *[[Fraysexual]]
    *[[Lithosexual|Lithosexual]], formerly known as akoisexual
    *[[Reciprosexual]]


    === DSM V (2013) ===
    === Microlabels ===
    Some identities in the asexual spectrum are [[Microlabel|microlabels]] or identities that fall under the umbrella but cannot stand on their own and must be used in addition to another ace-spec label. Some common ace-spec microlabels include:
    A revision to autism spectrum disorder (ASD) was presented in the ''Diagnostic and Statistical Manual of Mental Disorders'' version 5 ([./https://en.wikipedia.org/wiki/DSM-5 DSM-5]), released May 2013.<ref>{{cite web|url=http://www.dsm5.org|title=Home &#124; APA DSM-5|publisher=Dsm5.org|access-date=21 February 2012|url-status=dead|archive-url=https://web.archive.org/web/20081119150242/http://www.dsm5.org/|archive-date=19 November 2008}}</ref> The new diagnosis encompasses previous diagnoses of autistic disorder, [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome], childhood disintegrative disorder, and [./https://en.wikipedia.org/wiki/PDD-NOS PDD-NOS]. Slightly different diagnostic definitions are used in other countries. Rather than categorizing these diagnoses, the DSM-5 has adopted a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella. Some have proposed that individuals on the autism spectrum may be better represented as a single diagnostic category. Within this category, the DSM-5 has proposed a framework of differentiating each individual by dimensions of severity, as well as associated features (i.e., known genetic disorders, and intellectual disability).
    *[[Aegosexual|Aegosexual]], also known as autochorisexual
    *[[Apothisexual]]
    *[[Bellussexual]]
    *[[Caedsexual]]
    *[[Cupiosexual]]
    *[[Iamvanosexual]]
    *[[Myrsexual]]
    *[[Placiosexual]]
    *[[Requiessexual|Requissexual]]
    *[[Adexsexual]]


    == Terminology ==
    Another change to the DSM includes collapsing social and communication deficits into one domain.<ref>{{cite journal|vauthors=Kulage KM, Smaldone AM, Cohn EG|title=How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis|journal=Journal of Autism and Developmental Disorders|volume=44|issue=8|pages=1918–32|date=August 2014|pmid=24531932|doi=10.1007/s10803-014-2065-2|s2cid=18865395}}</ref> Thus, an individual with an ASD diagnosis will be described in terms of severity of social communication symptoms, severity of fixated or restricted behaviors or interests, hyper- or [./https://en.wikipedia.org/wiki/Hyposensitivity hyposensitivity] to sensory stimuli, and associated features.
    Terms like [[Sex-Ambivalent]], [[Sex-Favorable]], [[Sex-Indifferent]], and [[Sex-Repulsed]] help ace-spec individuals explain their relationship with sex. Ace-spec individuals may also have a non-standard understanding of [[attraction]], particularly [[sexual attraction]].


    Other terms help ace-spec individuals discuss their orientation beyond sex, such as [[Romantic Attraction|romantic orientation]], [[Split Attraction Model (SAM)|the Split Attraction Model]], [[Repulsion Descriptors|repulsion descriptors]], and [[Tertiary Attraction|tertiary attraction]]. Terms like [[Angled Aroace|angled]], [[Electio Aroace|electio]], and [[Oriented Aroace|oriented]] are useful for ace-spec individuals who are also part of the [[Aromantic Spectrum|aromantic spectrum]], also known as "aroace."
    The restricting of onset age has also been loosened from 3 years of age to "early developmental period", with a note that symptoms may manifest later when social demands exceed capabilities.<ref name="IACC">{{cite web|title=DSM-5 Diagnostic Criteria|url=https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml#autism-spectrum-disorder|publisher=U.S. Department of Health & Human Services [[Interagency Autism Coordinating Committee]]|access-date=17 May 2017}}</ref>


    == Signs and symptoms ==
    == Flag ==
    The first flag to gain widespread usage as an acespec flag was the asexual flag, created in August of 2010 to represent the entire asexual spectrum, and it was selected after a thorough three-stage poll by the community, originating on AVEN, the largest acespec community at the time, but extending towards other acespec communities to ensure as many individuals as possible could be included in this decision. <ref>{{Archive|Site=web|URL=https://asexualagenda.wordpress.com/2018/02/21/the-ace-flag-a-history-and-celebration/}}</ref>
    Autism spectrum disorder (ASD) is characterized by persistent challenges with social communication and social interaction, and by the presence of restricted, repetitive patterns of behavior, interests, or activities.<ref name="Lancet2018">{{cite journal|vauthors=Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J|s2cid=51922565|title=Autism spectrum disorder|journal=Lancet|volume=392|issue=10146|pages=508–520|date=August 2018|pmid=30078460|doi=10.1016/S0140-6736(18)31129-2|pmc=7398158}}</ref> These symptoms begin in early childhood, and can impact function.<ref name="DSM 5">{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition|chapter=Autism Spectrum Disorder, 299.00 (F84.0)|editor=American Psychiatric Association|year=2013|publisher=American Psychiatric Publishing|pages=50–59}}</ref> There is also a unique disorder called [./https://en.wikipedia.org/wiki/Savant_syndrome savant syndrome] that can co-occur with autism.<ref name=":8">{{cite journal|vauthors=Treffert DA|title=The savant syndrome: an extraordinary condition. A synopsis: past, present, future|journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences|volume=364|issue=1522|pages=1351–7|date=May 2009|pmid=19528017|pmc=2677584|doi=10.1098/rstb.2008.0326}}</ref> As many as one in 10 children with autism and savant syndrome can have outstanding skills in music, art, and mathematics.<ref name=":8" /> Self-injurious behavior (SIB) is more common and has been found to correlate with intellectual disability.<ref>{{cite journal|vauthors=Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ|title=The association between self-injurious behaviors and autism spectrum disorders|journal=Psychology Research and Behavior Management|volume=7|pages=125–36|date=2014|pmid=24748827|pmc=3990505|doi=10.2147/PRBM.S44635}}</ref><ref name="Oliver2015">{{cite journal|vauthors=Oliver C, Richards C|title=Practitioner Review: Self-injurious behaviour in children with developmental delay|journal=J Child Psychol Psychiatry|volume=56|issue=10|pages=1042–54|date=October 2015|pmid=25916173|doi=10.1111/jcpp.12425|url=http://pure-oai.bham.ac.uk/ws/files/26880648/Oliver_Richards_2015_Self_injurious_behaviour_children_dev._delay_JCPP.pdf|type=Review}}</ref> Approximately 50% of those with ASD take part in some type of SIB (head-banging, self-biting).<ref name="Mins2014">{{cite journal|vauthors=Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ|title=The association between self-injurious behaviors and autism spectrum disorders|journal=Psychology Research and Behavior Management|volume=7|pages=125–36|date=April 2014|pmid=24748827|pmc=3990505|doi=10.2147/PRBM.S44635}}</ref>


    The black stripe represents asexuals and lack of attraction, the grey stripe represents demisexuals, gray-asexuals and everyone else that's on the ace-spec, the white stripe represents allosexual allies and the purple stripe represents the community as a whole, and it was likely chosen because AVEN had purple as part of its colour scheme. It has been adopted as a symbol for asexuals, but has never stopped being used as a symbol of the entire spectrum and to this day it's the most commonly used flag for asexual spectrum communities.
    Other characteristics of ASD include restricted and repetitive behaviors (RRBs). These include a range of gestures and behaviors as defined in the Diagnostic and Statistic Manual for Mental Disorders.<ref name="RRB">{{cite journal|vauthors=Richler J, Huerta M, Bishop SL, Lord C|title=Developmental trajectories of restricted and repetitive behaviors and interests in children with autism spectrum disorders|journal=Development and Psychopathology|volume=22|issue=1|pages=55–69|date=1 January 2010|pmid=20102647|pmc=2893549|doi=10.1017/S0954579409990265}}</ref>


    Recently, some individuals have expressed interest in developing a different flag to differentiate the spectrum with all its identities from the asexual identity, regardless of the original intent of the flag, since it has been widely adopted by asexuals. To that end, some different flags have been adopted by these members of the spectrum, these flags were created by Tumblr user ''theflagarchive'' on July 25, 2020<ref>[{{Archive|Site=web|URL=https://theflagarchive.tumblr.com/post/624655680467599360/asexual-spectrum-flag-while-i-like-the-asexual Tumblr post creating the asexual spectrum flag.}}]</ref> and Instagram user ''sude.the.acespec'' on June 16, 2{{Archive|Site=web|URL=021.<ref>[https://www.instagram.com/p/CQMfS9mDH5J/?utm_source=ig_web_button_share_sheet Instagram post creating the second alternative to the asexual spectrum flag.}}]</ref>
    [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome] was distinguished from autism in the DSM-IV by the lack of delay or deviance in early language development.<ref name="DSM-IV-TR">{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.)|year=2000|publisher=American Psychiatric Association|location=Washington, D.C.}}</ref> Additionally, individuals diagnosed with Asperger syndrome did not have significant cognitive delays.<ref>{{cite web|title=NINDS Asperger Syndrome Information Page|url=https://www.ninds.nih.gov/disorders/all-disorders/asperger-syndrome-information-page|publisher=National Institute of Neurological Disorders and Stroke}}</ref> [./https://en.wikipedia.org/wiki/PDD-NOS PDD-NOS] was considered "subthreshold autism" and "atypical autism" because it was often characterized by milder symptoms of autism or symptoms in only one domain (such as social difficulties).<ref>{{cite journal|author=Mesibov GB|title=Ask the Editor: What is PDD-NOS and how is it diagnosed?|journal=Journal of Autism and Developmental Disorders|year=1997|volume=27|issue=4}}</ref> The DSM-5 eliminated four separate diagnoses—Asperger syndrome; pervasive developmental disorder, not otherwise specified (PDD-NOS); childhood disintegrative disorder; and autistic disorder—and combined them under the diagnosis of autism spectrum disorder.<ref name="DSM 5" />


    For the first flag, the dark blue or black stripe represents the asexual community, its history and solidarity. The purple stripe comes from the asexual flag and represents all asexual identities. The pink stripe represents self-determination, pride in one's identity, and acceptance of one's own and others' asexuality. The cream stripe represents diversity in experiences and types of attractions.
    === Developmental course ===
    Most parents report that the onset of autism symptoms occur within the first year of life.<ref name="Zwaigenbaum 2009">{{cite journal|vauthors=Zwaigenbaum L, Bryson S, Lord C, Rogers S, Carter A, Carver L, Chawarska K, Constantino J, Dawson G, Dobkins K, Fein D, Iverson J, Klin A, Landa R, Messinger D, Ozonoff S, Sigman M, Stone W, Tager-Flusberg H, Yirmiya N|display-authors=6|title=Clinical assessment and management of toddlers with suspected autism spectrum disorder: insights from studies of high-risk infants|journal=Pediatrics|volume=123|issue=5|pages=1383–91|date=May 2009|pmid=19403506|pmc=2833286|doi=10.1542/peds.2008-1606}}</ref><ref name="Lord 1995">{{cite journal|vauthors=Lord C|title=Follow-up of two-year-olds referred for possible autism|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=36|issue=8|pages=1365–82|date=November 1995|pmid=8988272|doi=10.1111/j.1469-7610.1995.tb01669.x}}</ref> There are two possible developmental courses of autism spectrum disorder. One course of development is more gradual in nature, in which parents report concerns in development over the first two years of life and diagnosis is made around 3–4 years of age. Some of the early signs of ASDs in this course include decreased looking at faces, failure to turn when name is called, failure to show interests by showing or pointing, and delayed imaginative play.<ref name="Zwaigenbaum 2001">{{cite journal|vauthors=Zwaigenbaum L|title=Autistic spectrum disorders in preschool children|journal=Canadian Family Physician|volume=47|issue=10|pages=2037–42|date=October 2001|pmid=11723598|pmc=2018435|url=http://www.cfp.ca/content/47/10/2037.abstract}}</ref>


    For the second flag, the black stripe represents the spectrum, sexualities that is under the asexual spectrum. The purple stripe also comes from the asexual flag and represents the community, individuals of different regions, religions, genders, sexual or romantic attractions that is in the asexual spectrum. The white stripe represents the acceptance of being in the asexual spectrum, being proud of it. The gray stripe is for the allies, and supporters that accepts the asexual spectrum community no matter what.
    A second course of development is characterized by normal or near-normal development in the first 15 months to 3 years before onset of regression or loss of skills. Regression may occur in a variety of domains, including communication, social, cognitive, and self-help skills; however, the most common regression is loss of language.<ref name="Martínez-Pedraza 2009">{{cite journal|vauthors=Martínez-Pedraza F, Carter AS|title=Autism spectrum disorders in young children|journal=Child and Adolescent Psychiatric Clinics of North America|volume=18|issue=3|pages=645–63|date=July 2009|pmid=19486843|pmc=3166636|doi=10.1016/j.chc.2009.02.002}}</ref><ref name="Werner et al.">{{cite journal|vauthors=Werner E, Dawson G, Munson J, Osterling J|s2cid=22485657|title=Variation in early developmental course in autism and its relation with behavioral outcome at 3-4 years of age|journal=Journal of Autism and Developmental Disorders|volume=35|issue=3|pages=337–50|date=June 2005|pmid=16119475|doi=10.1007/s10803-005-3301-6}}</ref> Childhood disintegrative disorder, a DSM-IV diagnosis now included under ASD in DSM-V, is characterized by regression after normal development in the first 3 to 4 years of life.<ref>{{Cite web|title=Autism spectrum disorder – childhood disintegrative disorder: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/001535.htm|website=medlineplus.gov|language=en|access-date=8 May 2020}}</ref>


    A third alternate ace-spec flag was created by FANDOMS user ''DistinctiveSoy'', 20th July 2021. The purple represents all the variation of asexual identities, the white represents inclusivity, the grey represents acceptance of oneself and others, the black represents aro-ace individuals and the spiral represents how different ace-spec sexualities are from allo-spec sexualities.
    There continues to be a debate over the differential outcomes based on these two developmental courses. Some studies suggest that regression is associated with poorer outcomes and others report no differences between those with early gradual onset and those who experience a regression period.<ref name="Mash & Barkley">{{cite book|first1=Eric J.|last1=Mash|first2=Russell A.|last2=Barkley|name-list-style=vanc|title=Child Psychopathology|url=https://archive.org/details/childpsychopatho00mash_735|url-access=limited|year=2003|publisher=The Guilford Press|location=New York|pages=[https://archive.org/details/childpsychopatho00mash_735/page/n421 409]–454}}</ref> While there is conflicting evidence surrounding language outcomes in ASD, some studies have shown that cognitive and language abilities at age {{frac|2|1|2}} may help predict language proficiency and production after age 5.<ref>{{cite journal|vauthors=Ellis Weismer S, Kover ST|title=Preschool language variation, growth, and predictors in children on the autism spectrum|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=56|issue=12|pages=1327–37|date=December 2015|pmid=25753577|pmc=4565784|doi=10.1111/jcpp.12406}}</ref> Overall, the literature stresses the importance of early intervention in achieving positive longitudinal outcomes.<ref name="Dawson & Osterling">{{cite book|vauthors=Dawson G, Osterling J|chapter=Early Intervention in Autism|veditors=Guralnick MJ|title=The effectiveness of early intervention|year=1997|publisher=Brookes|location=Baltimore|pages=307–326}}</ref>

    === Social skills ===
    Impairments in social skills present many challenges for individuals with ASD. Deficits in social skills may lead to problems with friendships, romantic relationships, daily living, and vocational success.<ref name="Barnhill G. P. 2007 116–126">{{cite journal|vauthors=Barnhill GP|year=2007|title=Outcomes in adults with Asperger syndrome|journal=Focus on Autism and Other Developmental Disabilities|volume=22|issue=2|pages=116–126|doi=10.1177/10883576070220020301|s2cid=1355689}}</ref> One study that examined the outcomes of adults with ASD found that, compared to the general population, those with ASD were less likely to be married, but it is unclear whether this outcome was due to deficits in social skills or intellectual impairment.<ref>{{cite journal|vauthors=Howlin P, Moss P|s2cid=44544407|title=Adults with autism spectrum disorders|journal=Canadian Journal of Psychiatry|volume=57|issue=5|pages=275–83|date=May 2012|pmid=22546059|doi=10.1177/070674371205700502|doi-access=free}}</ref>

    Prior to 2013, deficits in social function and communication were considered two separate symptoms of autism.<ref>{{cite journal|vauthors=Frye RE|title=Social Skills Deficits in Autism Spectrum Disorder: Potential Biological Origins and Progress in Developing Therapeutic Agents|journal=CNS Drugs|volume=32|issue=8|pages=713–734|date=August 2018|pmid=30105528|doi=10.1007/s40263-018-0556-y|pmc=6105175}}</ref> The current criteria for autism diagnosis require individuals to have deficits in three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships.<ref name="DSM5" />

    Some of the symptoms related to social reciprocity include:

    * Lack of mutual sharing of interests: many children with autism prefer not to play or interact with others.
    * Lack of awareness or understanding of other people's thoughts or feelings: a child may get too close to peers without noticing that this makes them uncomfortable.
    * Atypical behaviors for attention: a child may push a peer to gain attention before starting a conversation.<ref name=":6">{{cite web|url=https://www.uptodate.com/contents/autism-spectrum-disorder-clinical-features?search=autism&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H4|title=Autism spectrum disorder: Clinical features|last1=Augustyn|first1=Marilyn|name-list-style=vanc|website=UpToDate|access-date=22 March 2020}}</ref>

    People with autism spectrum usually display atypical nonverbal behaviors:

    * Poor eye contact: a child with autism may fail to make eye contact when called by name, or they may avoid making eye contact with an observer. Aversion of gaze can also be seen in anxiety disorders, however poor eye contact in autistic children is not due to shyness or anxiety; rather, it is overall diminished in quantity.
    * Facial expressions: they often do not know how to recognize emotions from others' facial expressions, or they may not respond with the appropriate facial expressions.
    * Unusual speech: at least half of children with autism speak in a flat, monotone voice or they may not recognize the need to control the volume of their voice in different social settings. For example, they may speak loudly in libraries or movie theaters.<ref>{{cite journal|vauthors=Fusaroli R, Lambrechts A, Bang D, Bowler DM, Gaigg SB|title=Is voice a marker for Autism spectrum disorder? A systematic review and meta-analysis|journal=Autism Research|volume=10|issue=3|pages=384–407|date=March 2017|pmid=27501063|doi=10.1002/aur.1678|s2cid=13772771|url=https://pure.au.dk/ws/files/101709535/046565.full.pdf}}</ref>

    === Communication skills ===
    Communication deficits are due to problems with social-emotional skills like [./https://en.wikipedia.org/wiki/Joint_attention joint attention] and [./https://en.wikipedia.org/wiki/Social_reciprocity social reciprocity]. Difficulties with nonverbal communication skills such as poor eye contact, and impaired use of proper facial expressions and gestures are common.<ref>{{cite web|title=Autism: Overview|url=https://www.asha.org/Practice-Portal/Clinical-Topics/Autism/|publisher=American Speech-Language-Hearing Association|access-date=17 December 2017}}</ref><ref name="NIH2017Com">{{cite web|title=Autism Spectrum Disorder: Communication Problems in Children|url=https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children|website=NIDCD|access-date=17 December 2017|date=18 August 2015}}</ref> Some of the linguistic behaviors in individuals with autism include repetitive or rigid language, and restricted interests in conversation. For example, a child might repeat words or insist on always talking about the same subject.<ref name=":6" /> ASD can present with impairments in pragmatic communication skills, such as difficulty initiating a conversation or failure to consider the interests of the listener to sustain a conversation.<ref name=":6" /> Language impairment is also common in children with autism, but it is not necessary for the diagnosis.<ref name=":6" /> Many children with ASD develop language skills at an uneven pace where they easily acquire some aspects of communication, while never fully developing others.<ref name="NIH2017Com" /> In some cases, individuals remain [./https://en.wikipedia.org/wiki/Nonverbal_autism completely nonverbal] throughout their lives, although the accompanying levels of literacy and nonverbal communication skills vary.

    They may not pick up on body language or social cues such as eye contact and facial expressions if they provide more information than the person can process at that time. Similarly, they have trouble recognizing subtle expressions of emotion and identifying what various emotions mean for the conversation. They struggle with understanding the context and subtext of conversational or printed situations, and have trouble forming resulting conclusions about the content. This also results in a lack of social awareness and atypical language expression.<ref name="iidc.indiana.edu">{{cite web|last1=Vicker|first1=Beverly|name-list-style=vanc|title=Social communication and language characteristics associated with high-functioning, verbal children and adults with autism spectrum disorder|url=https://www.iidc.indiana.edu/pages/Social-Communication-and-Language-Characteristics-Associated-with-High-Functioning-Verbal-Children-and-Adults-with-ASD|publisher=Indiana Resource Center for Autism|access-date=17 December 2017}}</ref> How emotional processing and facial expressions differ between those on the autism spectrum and others is not clear, but emotions are processed differently between different partners.<ref>{{cite journal|vauthors=Keating CT, Cook JL|title=Facial expression production and recognition in autism spectrum disorders: a shifting landscape|journal=Child Adolesc Psychiatr Clin N Am|volume=29|issue=3|pages=557–571|date=July 2020|pmid=32471602|doi=10.1016/j.chc.2020.02.006|type=Review|doi-access=free}}</ref>

    It is also common for individuals with ASD to communicate strong interest in a specific topic, speaking in lesson-like monologues about their passion instead of enabling reciprocal communication with whomever they are speaking to.<ref name="NIH2017Com" /> What looks like self-involvement or indifference toward others stems from a struggle to recognize or remember that other people have their own personalities, perspectives, and interests.<ref name="iidc.indiana.edu" /> The ability to be focused in on one topic in communication is known as [./https://en.wikipedia.org/wiki/Monotropism monotropism], and can be compared to "tunnel vision" in the mind for those individuals with ASD.<ref name=":2">{{Cite book|title=Understanding and Working With the Spectrum of Autism An Insider's View|url=https://archive.org/details/understandingwor00laws_352|url-access=limited|last=Lawson|first=Wendy|name-list-style=vanc|publisher=Jessica Kingsley Publishers London and Philadelphia|year=2001|isbn=978-1853029714|location=Philadelphia, PA|pages=[https://archive.org/details/understandingwor00laws_352/page/n33 33]}}</ref> Language expression by those on the autism spectrum is often characterized by repetitive and rigid language. Often children with ASD repeat certain words, numbers, or phrases during an interaction, words unrelated to the topic of conversation. They can also exhibit a condition called [./https://en.wikipedia.org/wiki/Echolalia echolalia] in which they respond to a question by repeating the inquiry instead of answering.<ref name="NIH2017Com" />

    === Behavioral characteristics ===
    Autism spectrum disorders include a wide variety of characteristics. Some of these include behavioral characteristics which widely range from slow development of social and learning skills to difficulties creating connections with other people. They may develop these difficulties of creating connections due to anxiety or depression, which people with autism are more likely to experience, and as a result isolate themselves.<ref>{{cite web|title=Engaging people on the autism spectrum|date=7 October 2013|publisher=Autism Spectrum Australia|url=https://www.autismspectrum.org.au/about-aspect/diversity-inclusion/engaging-people-on-the-autism-spectrum}}</ref> Other behavioral characteristics include abnormal responses to sensations including sights, sounds, touch, and smell, and problems keeping a consistent speech rhythm. The latter problem influences an individual's social skills, leading to potential problems in how they are understood by communication partners. Behavioral characteristics displayed by those with autism spectrum disorder typically influence development, language, and social competence. Behavioral characteristics of those with autism spectrum disorder can be observed as perceptual disturbances, disturbances of development rate, relating, speech and language, and motility.<ref>{{cite book|last1=Shaughnessy Hinerman|first1=Paige|name-list-style=vanc|title=Teaching Autistic Children to Communicate|date=1983|publisher=Aspens System Corporation|location=Rockville, Maryland|isbn=978-0-89443-884-4|page=180}}</ref>

    The second core symptom of Autism spectrum is a pattern of restricted and repetitive behaviors, activities, and interests. In order to be diagnosed with ASD, a child must have at least two of the following behaviors:<ref name="DSM5" /><ref name="Lancet2018" />

    * Stereotyped behaviors – Most children with autism perform repetitive behaviors such as rocking, hand flapping, finger flicking, head banging, or repeating phrases or sounds.<ref name=":6" /> These behaviors may occur constantly or only when the child gets stressed, anxious or upset.
    * Resistance to change – Children with autism spectrum also tend to have routines and rituals that they must follow, like eating certain foods in a specific order, or taking the same path to school every day.<ref name=":6" /> The child may have a meltdown if there is any change or disruption to his routine.
    * Restricted interests – Children may become excessively interested in a particular thing or topic, and devote all their attention to it. For example, young children might completely focus on things that spin and ignore everything else. Older children might try to learn everything about a single topic, such as the weather or sports, and talk about it constantly.<ref name=":6" />
    * Sensory Processing Disorder – Many people with Autism have difficulty processing complex combinations of emotional and sensory stimuli. Their inability to process this information in a timely manner produces an information pile up which will trigger a stress reaction. They must be able to escape the environment causing this information pile up or their stress reaction may escalate to a severe anxiety reaction or panic attack. This will ultimately result in an autistic meltdown.
    * Oversensitivity – Many people with autism are overly sensitive to loud sounds, bright lights, strong smells, or being touched.

    ==== Self-injury ====
    Self-injurious behaviors (SIB) are common in ASD and include head-banging, self-cutting, self-biting, and hair-pulling.<ref name="Mins2014" /> These behaviors can result in serious injury or death.<ref name="Mins2014" /> Following are theories about the cause of self-injurious behavior in autistic individuals:<ref name="Oliver2015" />

    * Frequency and/or continuation of self-injurious behavior can be influenced by environmental factors e.g. reward in return for halting self-injurious behavior. However this theory is not applicable to younger children with autism. There is some evidence that frequency of self-injurious behavior can be reduced by removing or modifying environmental factors that reinforce this behavior.
    * Higher rates of self-injury are also noted in socially isolated individuals with autism
    * Self-injury could be a response to modulate pain perception when chronic pain or other health problems that cause pain are present
    * An abnormal basal ganglia connectivity may predispose to self-injurious behavior

    == Causes ==
    {{Main|Causes of autism}}While specific causes of autism spectrum disorders have yet to be found, many risk factors identified in the research literature may contribute to their development. These risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify general risk factors, but much more difficult to pinpoint specific factors. Given the current state of knowledge, prediction can only be of a global nature and therefore requires the use of general markers.<ref name="Tager-Flusberg 2010">{{cite journal|vauthors=Tager-Flusberg H|title=The origins of social impairments in autism spectrum disorder: studies of infants at risk|journal=Neural Networks|volume=23|issue=8–9|pages=1072–6|year=2010|pmid=20800990|pmc=2956843|doi=10.1016/j.neunet.2010.07.008}}</ref>

    === Genetics ===
    [[File:Autism_susceptibility_genes_effect_on_brain_structure.png|link=https://en.wikipedia.org/wiki/File:Autism_susceptibility_genes_effect_on_brain_structure.png|alt=|thumb|Hundreds of different genes are implicated in susceptibility to developing autism, most of which alter the brain structure in a similar way]]
    As of 2018, it appeared that somewhere between 74% and 93% of ASD risk is heritable.<ref name="Lancet2018" /> After an older child is diagnosed with ASD, 7–20% of subsequent children are likely to be as well.<ref name="Lancet2018" /> If parents have a child with ASD they have a 2% to 8% chance of having a second child with ASD. If the child with ASD is an identical twin the other will be affected 36 to 95 percent of the time. If they are fraternal twins the other will only be affected up to 31 percent of the time.<ref>{{cite web|url=https://www.cdc.gov/ncbddd/autism/signs.html|title=Signs & Symptoms – Autism Spectrum Disorder (ASD) – NCBDDD – CDC|date=26 February 2015|publisher=Centers for Disease Control and Prevention}}</ref>

    As of 2018, understanding of genetic risk factors had shifted from a focus on a few alleles to an understanding that genetic involvement in ASD is probably diffuse, depending on a large number of variants, some of which are common and have a small effect, and some of which are rare and have a large effect. The most common gene disrupted with large effect rare variants appeared to be ''[./https://en.wikipedia.org/wiki/CHD8 CHD8]'', but less than 0.5% of people with ASD have such a mutation. Some ASD is associated with clearly genetic conditions, like [./https://en.wikipedia.org/wiki/Fragile_X_syndrome fragile X syndrome]; however only around 2% of people with ASD have fragile X.<ref name="Lancet2018" />

    Current research suggests that genes that increase susceptibility to ASD are ones that control protein synthesis in neuronal cells in response to cell needs, activity and adhesion of neuronal cells, synapse formation and remodeling, and excitatory to inhibitory neurotransmitter balance. Therefore despite up to 1000 different genes thought to contribute to increased risk of ASD, all of them eventually affect normal neural development and connectivity between different functional areas of the brain in a similar manner that is characteristic of an ASD brain. Some of these genes are known to modulate production of the GABA neurotransmitter which is the main inhibitory neurotransmitter in the nervous system. These GABA-related genes are underexpressed in an ASD brain. On the other hand, genes controlling expression of glial and immune cells in the brain e.g. astrocytes and microglia, respectively, are overexpressed which correlates with increased number of glial and immune cells found in postmortem ASD brains. Some genes under investigation in ASD pathophysiology are those that affect the [./https://en.wikipedia.org/wiki/MTOR mTOR] signaling pathway which supports cell growth and survival.<ref name="Chen2015">{{cite journal|vauthors=Chen JA, Peñagarikano O, Belgard TG, Swarup V, Geschwind DH|title=The emerging picture of autism spectrum disorder: genetics and pathology|journal=Annu Rev Pathol|volume=10|pages=111–44|date=2015|pmid=25621659|doi=10.1146/annurev-pathol-012414-040405|type=Review}}</ref>

    All these genetic variants contribute to the development of the autistic spectrum, however, it can not be guaranteed that they are determinants for the development.<ref>{{cite journal|vauthors=Werling DM, Brand H, An JY, Stone MR, Zhu L, Glessner JT, Collins RL, Dong S, Layer RM, Markenscoff-Papadimitriou E, Farrell A, Schwartz GB, Wang HZ, Currall BB, Zhao X, Dea J, Duhn C, Erdman CA, Gilson MC, Yadav R, Handsaker RE, Kashin S, Klei L, Mandell JD, Nowakowski TJ, Liu Y, Pochareddy S, Smith L, Walker MF, Waterman MJ, He X, Kriegstein AR, Rubenstein JL, Sestan N, McCarroll SA, Neale BM, Coon H, Willsey AJ, Buxbaum JD, Daly MJ, State MW, Quinlan AR, Marth GT, Roeder K, Devlin B, Talkowski ME, Sanders SJ|display-authors=6|title=An analytical framework for whole-genome sequence association studies and its implications for autism spectrum disorder|journal=Nature Genetics|volume=50|issue=5|pages=727–736|date=April 2018|pmid=29700473|pmc=5961723|doi=10.1038/s41588-018-0107-y}}</ref>

    === Early life ===
    Several prenatal and perinatal complications have been reported as possible risk factors for autism. These risk factors include maternal [./https://en.wikipedia.org/wiki/Gestational_diabetes gestational diabetes], maternal and paternal age over 30, bleeding after first trimester, use of prescription medication (e.g. [./https://en.wikipedia.org/wiki/Valproate valproate]) during pregnancy, and [./https://en.wikipedia.org/wiki/Meconium meconium] in the [./https://en.wikipedia.org/wiki/Amniotic_fluid amniotic fluid]. While research is not conclusive on the relation of these factors to autism, each of these factors has been identified more frequently in children with autism, compared to their siblings who do not have autism, and other typically developing youth.<ref name="Garder, Spiegelman, Buka">{{cite journal|vauthors=Gardener H, Spiegelman D, Buka SL|title=Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis|journal=Pediatrics|volume=128|issue=2|pages=344–55|date=August 2011|pmid=21746727|pmc=3387855|doi=10.1542/peds.2010-1036}}</ref> While it is unclear if any single factors during the prenatal phase affect the risk of autism,<ref name=":1">{{cite journal|vauthors=Gardener H, Spiegelman D, Buka SL|title=Prenatal risk factors for autism: comprehensive meta-analysis|journal=The British Journal of Psychiatry|volume=195|issue=1|pages=7–14|date=July 2009|pmid=19567888|pmc=3712619|doi=10.1192/bjp.bp.108.051672}}</ref> complications during pregnancy may be a risk.<ref name=":1" />

    Low [./https://en.wikipedia.org/wiki/Vitamin_D vitamin D] levels in early development has been hypothesized as a risk factor for autism.<ref>{{cite journal|vauthors=Mazahery H, Camargo CA, Conlon C, Beck KL, Kruger MC, von Hurst PR|title=Vitamin D and Autism Spectrum Disorder: A Literature Review|journal=Nutrients|volume=8|issue=4|pages=236|date=April 2016|pmid=27110819|pmc=4848704|doi=10.3390/nu8040236}}</ref>

    === Disproven vaccine hypothesis ===
    {{Main|MMR vaccine and autism}}In 1998 [./https://en.wikipedia.org/wiki/Andrew_Wakefield Andrew Wakefield] led a [./https://en.wikipedia.org/wiki/MMR_vaccine_controversy fraudulent study] that suggested that the [./https://en.wikipedia.org/wiki/MMR_vaccine MMR vaccine] may cause autism.<ref>{{cite news|url=https://www.thetimes.co.uk/article/mmr-doctor-andrew-wakefield-fixed-data-on-autism-mgj82qsk50g|title=MMR doctor Andrew Wakefield fixed data on autism|first=Brian|last=Deer|name-list-style=vanc|date=8 February 2009|newspaper=The Sunday Times}}</ref><ref>{{cite news|url=https://www.theguardian.com/society/2010/feb/02/lancet-retracts-mmr-paper|title=Lancet retracts 'utterly false' MMR paper|first1=Sarah|last1=Boseley|name-list-style=vanc|date=2 February 2010|via=theguardian.com|newspaper=The Guardian}}</ref><ref>{{cite book|chapter=Chapter: 6 Influenza Vaccine|url=https://www.nap.edu/read/13164/|title=Adverse Effects of Vaccines: Evidence and Causality|doi=10.17226/13164|pmid=24624471|isbn=978-0-309-21435-3|collaboration=Committee to Review Adverse Effects of Vaccines; Board on Population Health and Public Health Practice; Institute of Medicine|veditors=Stratton K, Ford A, Rusch E, Clayton EW|location=Washington (DC)|publisher=National Academies Press (US)|date=August 2011|author1=Committee to Review Adverse Effects of Vaccines|last2=Institute Of|first2=Medicine|last3=Stratton|first3=K.|last4=Ford|first4=A.|last5=Rusch|first5=E.|last6=Clayton|first6=E. W.}}</ref><ref>{{cite journal|vauthors=Flaherty DK|title=The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science|journal=The Annals of Pharmacotherapy|volume=45|issue=10|pages=1302–4|date=October 2011|pmid=21917556|doi=10.1345/aph.1Q318|s2cid=39479569}}</ref><ref name="Godlee2011">{{cite journal|vauthors=Godlee F, Smith J, Marcovitch H|s2cid=43640126|title=Wakefield's article linking MMR vaccine and autism was fraudulent|journal=BMJ|volume=342|pages=c7452|date=January 2011|pmid=21209060|doi=10.1136/bmj.c7452|url=http://www.bmj.com/content/342/bmj.c7452.full}}</ref> This conjecture suggested that autism results from brain damage caused either by the MMR vaccine itself, or by [./https://en.wikipedia.org/wiki/Thimerosal thimerosal], a vaccine preservative.<ref name="Tan and Parkin 2008">{{cite journal|vauthors=Tan M, Parkin JE|title=Route of decomposition of thiomersal (thimerosal)|journal=International Journal of Pharmaceutics|volume=208|issue=1–2|pages=23–34|date=November 2000|pmid=11064208|doi=10.1016/S0378-5173(00)00514-7}}</ref> No convincing scientific evidence supports these claims, and further evidence continues to refute them, including the observation that the rate of autism continues to climb despite elimination of thimerosal from routine childhood vaccines.<ref name="Waterhouse 2008">{{cite journal|vauthors=Waterhouse L|s2cid=8863638|title=Autism overflows: increasing prevalence and proliferating theories|journal=Neuropsychology Review|volume=18|issue=4|pages=273–86|date=December 2008|pmid=19015994|doi=10.1007/s11065-008-9074-x}}</ref> A 2014 meta-analysis examined ten major studies on autism and vaccines involving 1.25 million children worldwide; it concluded that neither the MMR vaccine, which has never contained thimerosal,<ref>{{cite web|title=Frequently Asked Questions about Thimerosal|url=https://www.cdc.gov/vaccinesafety/concerns/thimerosal/faqs.html|publisher=Centers for Disease Control and Prevention|access-date=21 February 2017}}</ref> nor the vaccine components thimerosal or mercury, lead to the development of ASDs.<ref>{{cite journal|vauthors=Taylor LE, Swerdfeger AL, Eslick GD|title=Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies|journal=Vaccine|volume=32|issue=29|pages=3623–9|date=June 2014|pmid=24814559|doi=10.1016/j.vaccine.2014.04.085|lay-url=http://www.news.com.au/lifestyle/health/vaccination-versus-autism-study-professor-guy-eslick-tells-why-hes-taking-on-the-scaremongers/story-fneuzlbd-1226929208418|lay-source=news.com.au}}</ref>

    == Pathophysiology ==
    {{Main|Autism#Mechanism}}In general, neuroanatomical studies support the concept that autism may involve a combination of brain enlargement in some areas and reduction in others.<ref name="Koenig 2001">{{cite book|title=The development of autism: perspectives from theory and research|vauthors=Koenig K, Tsatsanis KD, Volkmar FR|publisher=L. Erlbaum|year=2001|isbn=9780805832457|veditors=Burack JA, Charman T, Yirmiya N, Zelazo PR|location=Mahwah, N.J.|pages=73–92|chapter=Neurobiology and Genetics of Autism : A Developmental Perspective|oclc=806185029}}<!--| access-date = 9 July 2013 --></ref> These studies suggest that autism may be caused by abnormal neuronal growth and pruning during the early stages of prenatal and postnatal brain development, leaving some areas of the brain with too many neurons and other areas with too few neurons.<ref name="Minshew 1996">{{cite journal|vauthors=Minshew NJ|s2cid=8134205|title=Brief report: brain mechanisms in autism: functional and structural abnormalities|journal=Journal of Autism and Developmental Disorders|volume=26|issue=2|pages=205–9|date=April 1996|pmid=8744486|doi=10.1007/BF02172013}}</ref> Some research has reported an overall brain enlargement in autism, while others suggest abnormalities in several areas of the brain, including the frontal lobe, the mirror neuron system, the limbic system, the temporal lobe, and the [./https://en.wikipedia.org/wiki/Corpus_callosum corpus callosum].<ref>{{cite journal|vauthors=Stanfield AC, McIntosh AM, Spencer MD, Philip R, Gaur S, Lawrie SM|title=Towards a neuroanatomy of autism: a systematic review and meta-analysis of structural magnetic resonance imaging studies|journal=European Psychiatry|volume=23|issue=4|pages=289–99|date=June 2008|pmid=17765485|doi=10.1016/j.eurpsy.2007.05.006}}</ref><ref>{{cite journal|vauthors=Lefebvre A, Beggiato A, Bourgeron T, Toro R|s2cid=8794474|title=Neuroanatomical Diversity of Corpus Callosum and Brain Volume in Autism: Meta-analysis, Analysis of the Autism Brain Imaging Data Exchange Project, and Simulation|journal=Biological Psychiatry|volume=78|issue=2|pages=126–34|date=July 2015|pmid=25850620|doi=10.1016/j.biopsych.2015.02.010|doi-access=free}}</ref>

    In [./https://en.wikipedia.org/wiki/Functional_neuroimaging functional neuroimaging] studies, when performing [./https://en.wikipedia.org/wiki/Theory_of_mind theory of mind] and facial emotion response tasks, the [./https://en.wikipedia.org/wiki/Median median] person on the autism spectrum exhibits less activation in the primary and secondary somatosensory [./https://en.wikipedia.org/wiki/Cerebral_cortex cortices] of the brain than the median member of a properly sampled [./https://en.wikipedia.org/wiki/Control_group control population]. This finding coincides with reports demonstrating abnormal patterns of cortical thickness and [./https://en.wikipedia.org/wiki/Grey_matter grey matter] volume in those regions of autistic persons' brains.<ref name="Sugranyes 2011">{{cite journal|vauthors=Sugranyes G, Kyriakopoulos M, Corrigall R, Taylor E, Frangou S|title=Autism spectrum disorders and schizophrenia: meta-analysis of the neural correlates of social cognition|journal=PLOS ONE|volume=6|issue=10|pages=e25322|year=2011|pmid=21998649|pmc=3187762|doi=10.1371/journal.pone.0025322|bibcode=2011PLoSO...625322S}}</ref>

    === Brain connectivity ===
    Brains of autistic individuals have been observed to have abnormal connectivity and the degree of these abnormalities directly correlates with the severity of autism. Following are some observed abnormal connectivity patterns in autistic individuals:<ref name="OReilly2017">{{cite journal|vauthors=O'Reilly C, Lewis JD, Elsabbagh M|title=Is functional brain connectivity atypical in autism? A systematic review of EEG and MEG studies|journal=PLOS ONE|volume=12|issue=5|pages=e0175870|date=2017|pmid=28467487|pmc=5414938|doi=10.1371/journal.pone.0175870|bibcode=2017PLoSO..1275870O|type=Review}}</ref><ref name="Chen2015" />

    * Decreased connectivity ''between'' different specialized regions of the brain (e.g. lower neuron density in [./https://en.wikipedia.org/wiki/Corpus_callosum corpus callosum]) and relative overconnectivity ''within'' specialized regions of the brain by adulthood. Connectivity between different regions of the brain ('long-range' connectivity) is important for integration and global processing of information and comparing incoming sensory information with the existing model of the world within the brain. Connections within each specialized regions ('short-range' connections) are important for processing individual details and modifying the existing model of the world within the brain to more closely reflect incoming sensory information. In infancy, children at high risk for autism that were later diagnosed with autism were observed to have abnormally high long-range connectivity which then decreased through childhood to eventual long-range ''under''connectivity by adulthood.<ref name="OReilly2017" />
    * Abnormal preferential processing of information by the left hemisphere of the brain vs. preferential processing of information by right hemisphere in neurotypical individuals. The left hemisphere is associated with processing information related to details whereas the right hemisphere is associated with processing information in a more global and integrated sense that is essential for pattern recognition. For example, visual information like face recognition is normally processed by the right hemisphere which tends to integrate all information from an incoming sensory signal, whereas an ASD brain preferentially processes visual information in the left hemisphere where information tends to be processed for local details of the face rather than the overall configuration of the face. This left [./https://en.wikipedia.org/wiki/Lateralization_of_brain_function lateralization] negatively impacts both facial recognition and [./https://en.wikipedia.org/wiki/Spatial_visualization_ability spatial skills].<ref name="OReilly2017" />
    * Increased functional connectivity within the left hemisphere which directly correlates with severity of autism. This observation also supports preferential processing of details of individual components of sensory information over global processing of sensory information in an ASD brain.<ref name="OReilly2017" />
    * Prominent abnormal connectivity in the [./https://en.wikipedia.org/wiki/Frontal_lobe frontal] and [./https://en.wikipedia.org/wiki/Occipital_lobe occipital] regions. In autistic individuals low connectivity in the frontal cortex was observed from infancy through adulthood. This is in contrast to long-range connectivity which is high in infancy and low in adulthood in ASD.<ref name="OReilly2017" /> Abnormal neural organization is also observed in the [./https://en.wikipedia.org/wiki/Broca's_area Broca's area] which is important for speech production.<ref name="Chen2015" />

    === Neuropathology ===
    Listed below are some characteristic findings in ASD brains on molecular and cellular levels regardless of the specific genetic variation or mutation contributing to autism in a particular individual:

    * [./https://en.wikipedia.org/wiki/Limbic_system Limbic system] with smaller neurons that are more densely packed together. Given that the limbic system is the main center of emotions and memory in the human brain, this observation may explain social impairment in ASD.<ref name="Chen2015" />
    * Fewer and smaller [./https://en.wikipedia.org/wiki/Purkinje_cell Purkinje neurons] in the cerebellum. New research suggest a role of the cerebellum in emotional processing and language.<ref name="Chen2015" />
    * Increased number of [./https://en.wikipedia.org/wiki/Astrocyte astrocytes] and [./https://en.wikipedia.org/wiki/Microglia microglia] in the cerebral cortex. These cells provide metabolic and functional support to neurons and act as immune cells in the nervous system, respectively.<ref name="Chen2015" />
    * Increased brain size in early childhood causing macrocephaly in 15–20% of ASD individuals. The brain size however normalizes by mid-childhood. This variation in brain size in not uniform in the ASD brain with some parts like the frontal and temporal lobes being larger, some like the parietal and occipital lobes being normal sized, and some like cerebellar vermis, corpus callosum, and basal ganglia being smaller than [./https://en.wikipedia.org/wiki/Neurotypical neurotypical] individuals.<ref name="Chen2015" />
    * [./https://en.wikipedia.org/wiki/Cell_adhesion_molecule Cell-adhesion molecules] (CAMs) that are essential to formation and maintenance of connections between neurons, [./https://en.wikipedia.org/wiki/Neuroligin neuroligins] found on [./https://en.wikipedia.org/wiki/Postsynaptic postsynaptic] neurons that bind [./https://en.wikipedia.org/wiki/Presynaptic presynaptic] CAMs, and proteins that anchor CAMs to neurons are all found to be mutated in ASD.<ref name="Chen2015" />

    === Gut-immune-brain axis ===
    [[File:Autism_gut_immune_brain_axis.png|link=https://en.wikipedia.org/wiki/File:Autism_gut_immune_brain_axis.png|thumb|Role of gut-immune-brain axis in autism; BBB – blood brain barrier]]
    Up to 70% of autistic individuals have GI related problems like reflux, diarrhea, constipation, [./https://en.wikipedia.org/wiki/Inflammatory_bowel_disease inflammatory bowel disease], and food allergies. The severity of GI symptoms is directly proportional to the severity of autism. It has also been shown that the makeup of gut bacteria in ASD patients is different than that of neurotypical individuals. This has raised the question of influence of gut bacteria on ASD development via inducing an inflammatory state.<ref name=":14">{{Cite journal|last1=Azhari|first1=Atiqah|last2=Azizan|first2=Farouq|last3=Esposito|first3=Gianluca|date=July 2019|title=A systematic review of gut-immune-brain mechanisms in Autism Spectrum Disorder|journal=Developmental Psychobiology|volume=61|issue=5|pages=752–771|doi=10.1002/dev.21803|issn=1098-2302|pmid=30523646}}</ref>

    Listed below are some research findings on the influence of gut bacteria and abnormal immune responses on brain development:<ref name=":14" />

    * Some studies on rodents have shown gut bacteria influencing emotional functions and neurotransmitter balance in the brain, both of which are impacted in ASD.<ref name="Chen2015" />
    * The immune system is thought to be the intermediary that modulates the influence of gut bacteria on the brain. Some ASD individuals have a dysfunctional immune system with higher numbers of some types of immune cells, [./https://en.wikipedia.org/wiki/Cytokine biochemical messengers and modulators], and [./https://en.wikipedia.org/wiki/Autoantibody autoimmune antibodies]. Increased inflammatory [./https://en.wikipedia.org/wiki/Biomarker biomarkers] correlate with increased severity of ASD symptoms and there is evidence to support a state of chronic brain inflammation in ASD.<ref name=":14" />
    * More pronounced inflammatory responses to bacteria were found in ASD individuals with an abnormal gut microbiota. Additionally [./https://en.wikipedia.org/wiki/Immunoglobulin_A IgA] antibodies that are central to gut immunity were also found in elevated levels in ASD populations. Some of these antibodies may also attack [./https://en.wikipedia.org/wiki/Myelin_basic_protein proteins that support myelination] of the brain, a process that is important for robust transmission of neural signal in [./https://en.wikipedia.org/wiki/Myelinated_nerve_fibers many nerves].<ref name=":14" />
    * Activation of the [./https://en.wikipedia.org/wiki/Immune_tolerance_in_pregnancy maternal] [./https://en.wikipedia.org/wiki/Immune_system immune system] during pregnancy (by gut bacteria, [./https://en.wikipedia.org/wiki/Lipopolysaccharide bacterial toxins], an infection, or non-infectious causes) and gut bacteria in the mother that induce increased levels of [./https://en.wikipedia.org/wiki/T_helper_17_cell Th17], a proinflammatory immune cell, have been associated with an increased risk of autism. Some maternal [./https://en.wikipedia.org/wiki/Immunoglobulin_G IgG] antibodies that cross the placenta to provide passive immunity to the fetus can also attack the fetal brain. One study found that 12% of mothers of autistic children have IgG that are active against the fetal brain.<ref name=":14" />
    * Inflammation within the gut itself does not directly affect brain development. Rather it is the inflammation within the brain promoted by inflammatory responses to harmful gut microbiome that impact brain development.<ref name=":14" />
    * [./https://en.wikipedia.org/wiki/Proinflammatory_cytokines Proinflammatory biomessengers] IFN-γ, IFN-α, TNF-α, IL-6 and IL-17 have been shown to promote autistic behaviors in animal models. Giving [./https://en.wikipedia.org/wiki/Anti-IL-6 anti-IL-6] and anti-IL-17 along with [./https://en.wikipedia.org/wiki/Interleukin_6 IL-6] and [./https://en.wikipedia.org/wiki/Interleukin_17 IL-17], respectively, have been shown to negate this effect in the same animal models.<ref name=":14" />
    * Some gut proteins and microbial products can cross the [./https://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrier blood–brain barrier] (BBB) and activate [./https://en.wikipedia.org/wiki/Mast_cell mast cells] in the brain. Mast cells release proinflammatory factors and histamine which further increase BBB permeability and help set up a cycle of chronic inflammation.<ref name=":14" />

    === Mirror neuron system ===
    {{Further|Mirror neuron#Autism}}The [./https://en.wikipedia.org/wiki/Mirror_neuron mirror neuron] system (MNS) consists of a network of brain areas that have been associated with empathy processes in humans.<ref name="Fadiga et al">{{cite journal|vauthors=Fadiga L, Craighero L, Olivier E|title=Human motor cortex excitability during the perception of others' action|journal=Current Opinion in Neurobiology|volume=15|issue=2|pages=213–8|date=April 2005|pmid=15831405|doi=10.1016/j.conb.2005.03.013|s2cid=10511430}}</ref> In humans, the MNS has been identified in the [./https://en.wikipedia.org/wiki/Inferior_frontal_gyrus inferior frontal gyrus (IFG)] and the [./https://en.wikipedia.org/wiki/Inferior_parietal_lobule inferior parietal lobule (IPL)] and is thought to be activated during imitation or observation of behaviors.<ref name="Shamy-Tsoory">{{cite journal|vauthors=Shamay-Tsoory SG|title=The neural bases for empathy|journal=The Neuroscientist|volume=17|issue=1|pages=18–24|date=February 2011|pmid=21071616|doi=10.1177/1073858410379268|s2cid=2646438}}</ref> The connection between mirror neuron dysfunction and autism is tentative, and it remains to be seen how mirror neurons may be related to many of the important characteristics of autism.<ref name="Dinstein">{{cite journal|vauthors=Dinstein I, Thomas C, Behrmann M, Heeger DJ|title=A mirror up to nature|journal=Current Biology|volume=18|issue=1|pages=R13-8|date=January 2008|pmid=18177704|pmc=2517574|doi=10.1016/j.cub.2007.11.004}}</ref><ref name="Biological Psychology">{{cite book|vauthors=Kalat J|title=Biological Psychology|date=2009|isbn=978-0-495-60300-9|pages=237–8|edition=Tenth}}</ref>

    === "Social brain" interconnectivity ===
    A number of discrete brain regions and networks among regions that are involved in dealing with other people have been discussed together under the rubric of the "social brain". {{As of|2012}}, there is a consensus that autism spectrum is likely related to problems with interconnectivity among these regions and networks, rather than problems with any specific region or network.<ref name="Kennedy et al">{{cite journal|vauthors=Kennedy DP, Adolphs R|title=The social brain in psychiatric and neurological disorders|journal=Trends in Cognitive Sciences|volume=16|issue=11|pages=559–72|date=November 2012|pmid=23047070|pmc=3606817|doi=10.1016/j.tics.2012.09.006}}</ref>

    === Temporal lobe ===
    Functions of the [./https://en.wikipedia.org/wiki/Temporal_lobe temporal lobe] are related to many of the deficits observed in individuals with ASDs, such as receptive language, social cognition, [./https://en.wikipedia.org/wiki/Joint_attention joint attention], action observation, and empathy. The temporal lobe also contains the [./https://en.wikipedia.org/wiki/Superior_temporal_sulcus superior temporal sulcus] (STS) and the [./https://en.wikipedia.org/wiki/Fusiform_face_area fusiform face area] (FFA), which may mediate facial processing. It has been argued that dysfunction in the STS underlies the social deficits that characterize autism. Compared to typically developing individuals, one fMRI study found that individuals with [./https://en.wikipedia.org/wiki/High-functioning_autism high-functioning autism] had reduced activity in the FFA when viewing pictures of faces.<ref>{{cite journal|vauthors=Schultz RT|title=Developmental deficits in social perception in autism: the role of the amygdala and fusiform face area|journal=International Journal of Developmental Neuroscience|volume=23|issue=2–3|pages=125–41|year=2005|pmid=15749240|doi=10.1016/j.ijdevneu.2004.12.012|s2cid=17078137}}</ref>

    === Mitochondria ===
    {{update|date=July 2020}}ASD could be linked to [./https://en.wikipedia.org/wiki/Mitochondrial_disease mitochondrial disease] (MD), a basic cellular abnormality with the potential to cause disturbances in a wide range of body systems.<ref name="Haas">{{cite journal|vauthors=Haas RH, Parikh S, Falk MJ, ''et al''|s2cid=4939996|title=Mitochondrial disease: a practical approach for primary care physicians|journal=Pediatrics|volume=120|issue=6|pages=1326–33|date=December 2007|pmid=18055683|doi=10.1542/peds.2007-0391}}</ref> A 2012 [./https://en.wikipedia.org/wiki/Meta-analysis meta-analysis] study, as well as other population studies have shown that approximately 5% of children with ASD meet the criteria for classical MD.<ref name="Rossignol">{{cite journal|vauthors=Rossignol DA, Frye RE|title=Mitochondrial dysfunction in autism spectrum disorders: a systematic review and meta-analysis|journal=Molecular Psychiatry|volume=17|issue=3|pages=290–314|date=March 2012|pmid=21263444|pmc=3285768|doi=10.1038/mp.2010.136}}</ref> It is unclear why the MD occurs considering that only 23% of children with both ASD and MD present with mitochondrial DNA ([./https://en.wikipedia.org/wiki/MtDNA mtDNA]) abnormalities.<ref name="Rossignol" />

    === Serotonin ===
    Serotonin is a major neurotransmitter in the nervous system and contributes to formation of new neurons (neurogenesis), formation of new connections between neurons (synaptogenesis), remodeling of synapses, and survival and migration of neurons, processes that are necessary for a developing brain and some also necessary for learning in the adult brain. 45% of ASD individuals have been found to have increased blood serotonin levels.<ref name="Chen2015" /> It has been hypothesized that increased activity of [./https://en.wikipedia.org/wiki/Serotonin serotonin] in the developing brain may facilitate the onset of autism spectrum disorder, with an association found in six out of eight studies between the use of [./https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor selective serotonin reuptake inhibitors] (SSRIs) by the pregnant mother and the development of ASD in the child exposed to SSRI in the antenatal environment. The study could not definitively conclude SSRIs caused the increased risk for ASDs due to the biases found in those studies, and the authors called for more definitive, better conducted studies.<ref>{{cite journal|vauthors=Gentile S|title=Prenatal antidepressant exposure and the risk of autism spectrum disorders in children. Are we looking at the fall of Gods?|journal=Journal of Affective Disorders|volume=182|pages=132–7|date=August 2015|pmid=25985383|doi=10.1016/j.jad.2015.04.048}}</ref> Confounding by indication has since then been shown to be likely.<ref>{{cite journal|vauthors=Dragioti E, Solmi M, Favaro A, Fusar-Poli P, Dazzan P, Thompson T, Stubbs B, Firth J, Fornaro M, Tsartsalis D, Carvalho AF, Vieta E, McGuire P, Young AH, Shin JI, Correll CU, Evangelou E|display-authors=6|title=Association of Antidepressant Use With Adverse Health Outcomes: A Systematic Umbrella Review|journal=JAMA Psychiatry|volume=76|issue=12|pages=1241–1255|date=October 2019|pmid=31577342|pmc=6777224|doi=10.1001/jamapsychiatry.2019.2859}}</ref> However, it is also hypothesized that SSRIs may help reduce symptoms of ASD and even positively affect brain development in some ASD patients.<ref name="Chen2015" />

    == Diagnosis ==
    [[File:Autism_diagnostic_process.png|link=https://en.wikipedia.org/wiki/File:Autism_diagnostic_process.png|thumb|Process for screening and diagnosing Autism Spectrum Disorder; ASD – Autism Spectrum Disorder; M-CHAT – Modified Checklist for Autism in Toddlers; (+) – positive test result; (-) – negative test result]]
    ASD can be detected as early as 18 months or even younger in some cases.<ref>{{cite web|title=Autism Spectrum Disorder (ASD): Screening and Diagnosis|url=https://www.cdc.gov/ncbddd/autism/screening.html|publisher=Centers for Disease Control and Prevention|date=26 February 2015}}</ref> A reliable diagnosis can usually be made by the age of two years, however, because of delays in seeking and administering assessments, diagnoses often occur much later.<ref name="Lord 2006">{{cite journal|vauthors=Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A|title=Autism from 2 to 9 years of age|journal=Archives of General Psychiatry|volume=63|issue=6|pages=694–701|date=June 2006|pmid=16754843|doi=10.1001/archpsyc.63.6.694|doi-access=free}}</ref> The diverse expressions of ASD behavioral and observational symptoms and absence of one specific genetic or molecular marker for the disease pose diagnostic challenges to clinicians who use assessment methods based on symptoms alone. Individuals with an ASD may present at various times of development (e.g., toddler, child, or adolescent), and symptom expression may vary over the course of development.<ref name="Volkmar 1999">{{cite journal|vauthors=Volkmar F, Cook EH, Pomeroy J, Realmuto G, Tanguay P|title=Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues|journal=Journal of the American Academy of Child and Adolescent Psychiatry|volume=38|issue=12 Suppl|pages=32S–54S|date=December 1999|pmid=10624084|doi=10.1016/s0890-8567(99)80003-3}}</ref> Furthermore, clinicians who use those methods must differentiate among pervasive developmental disorders, and may also consider similar conditions, including [./https://en.wikipedia.org/wiki/Intellectual_disability intellectual disability] not associated with a pervasive developmental disorder, specific language disorders, ADHD, anxiety, and psychotic disorders.<ref>{{cite journal|vauthors=Constantino JN, Charman T|title=Diagnosis of autism spectrum disorder: reconciling the syndrome, its diverse origins, and variation in expression|journal=The Lancet. Neurology|volume=15|issue=3|pages=279–91|date=March 2016|pmid=26497771|doi=10.1016/s1474-4422(15)00151-9|s2cid=206162618|url=https://kclpure.kcl.ac.uk/ws/files/49746512/Constantino_Charman_post_print_Lancet_Neurology.pdf}}</ref> Ideally the diagnosis of ASD should be given by a team of professionals from different disciplines (e.g. child psychiatrists, child neurologists, psychologists) and only after the child has been observed in many different settings.<ref name=":18">{{Cite journal|last=Simms|first=Mark D.|date=February 2017|title=When Autistic Behavior Suggests a Disease Other than Classic Autism|journal=Pediatric Clinics of North America|volume=64|issue=1|pages=127–138|doi=10.1016/j.pcl.2016.08.009|issn=1557-8240|pmid=27894440}}</ref>

    Considering the unique challenges in diagnosing ASD using behavioral and observational assessment, specific practice parameters for its [./https://en.wikipedia.org/wiki/Evidence_based_assessment assessment] were published by the American Academy of Neurology in the year 2000,<ref name="Filipek (2000)">{{cite journal|vauthors=Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW, Tuchman RF, Volkmar FR|display-authors=6|title=Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society|journal=Neurology|volume=55|issue=4|pages=468–79|date=August 2000|pmid=10953176|doi=10.1212/wnl.55.4.468|doi-access=free}}</ref> the American Academy of Child and Adolescent Psychiatry in 1999,<ref name="Volkmar 1999" /> and a consensus panel with representation from various professional societies in 1999.<ref name="Filipek 1999">{{cite journal|vauthors=Filipek PA, Accardo PJ, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin S, Tuchman RF, Volkmar FR|display-authors=6|title=The screening and diagnosis of autistic spectrum disorders|journal=Journal of Autism and Developmental Disorders|volume=29|issue=6|pages=439–84|date=December 1999|pmid=10638459|doi=10.1023/A:1021943802493|s2cid=145113684}}</ref> The practice parameters outlined by these societies include an initial screening of children by general practitioners (i.e., "Level 1 screening") and for children who fail the initial screening, a comprehensive diagnostic assessment by experienced clinicians (i.e. "Level 2 evaluation"). Furthermore, it has been suggested that assessments of children with suspected ASD be evaluated within a developmental framework, include multiple informants (e.g., parents and teachers) from diverse contexts (e.g., home and school), and employ a multidisciplinary team of professionals (e.g., clinical psychologists, neuropsychologists, and psychiatrists).<ref name="Ozonoff 2005">{{cite journal|vauthors=Ozonoff S, Goodlin-Jones BL, Solomon M|s2cid=14322690|title=Evidence-based assessment of autism spectrum disorders in children and adolescents|journal=Journal of Clinical Child and Adolescent Psychology|volume=34|issue=3|pages=523–40|date=September 2005|pmid=16083393|doi=10.1207/s15374424jccp3403_8|url=http://webmedia.unmc.edu/mmi/mathews/4_Autism-%20evidence-based%20assessment.pdf}}</ref>

    {{Asof|2019}}, psychologists would wait until a child showed initial evidence of ASD tendencies, then administer various psychological assessment tools to assess for ASD.<ref name="Ozonoff 2005" /> Among these measurements, the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) are considered the "gold standards" for assessing autistic children.<ref name="Corsello 2007">{{cite journal|vauthors=Corsello C, Hus V, Pickles A, Risi S, Cook EH, Leventhal BL, Lord C|title=Between a ROC and a hard place: decision making and making decisions about using the SCQ|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=48|issue=9|pages=932–40|date=September 2007|pmid=17714378|doi=10.1111/j.1469-7610.2007.01762.x|hdl=2027.42/74877|hdl-access=free}}</ref><ref name="Huerta 2010">{{cite journal|vauthors=Huerta M, Lord C|title=Diagnostic evaluation of autism spectrum disorders|journal=Pediatric Clinics of North America|volume=59|issue=1|pages=103–11, xi|date=February 2012|pmid=22284796|pmc=3269006|doi=10.1016/j.pcl.2011.10.018}}</ref> The ADI-R is a semi-structured parent interview that probes for symptoms of autism by evaluating a child's current behavior and developmental history. The ADOS is a semistructured interactive evaluation of ASD symptoms that is used to measure social and communication abilities by eliciting several opportunities (or "presses") for spontaneous behaviors (e.g., eye contact) in standardized context. Various other questionnaires (e.g., The [./https://en.wikipedia.org/wiki/Childhood_Autism_Rating_Scale Childhood Autism Rating Scale], [./https://en.wikipedia.org/wiki/Autism_Treatment_Evaluation_Checklist Autism Treatment Evaluation Checklist]) and tests of cognitive functioning (e.g., The Peabody Picture Vocabulary Test) are typically included in an ASD assessment battery.

    === Screening ===
    Screening recommendations for autism in children younger than 3 years are:<ref name=":13">{{Cite journal|last1=Siu|first1=Albert L.|last2=US Preventive Services Task Force (USPSTF)|last3=Bibbins-Domingo|first3=Kirsten|last4=Grossman|first4=David C.|last5=Baumann|first5=Linda Ciofu|last6=Davidson|first6=Karina W.|last7=Ebell|first7=Mark|last8=García|first8=Francisco A. R.|last9=Gillman|first9=Matthew|last10=Herzstein|first10=Jessica|last11=Kemper|first11=Alex R.|date=16 February 2016|title=Screening for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement|journal=JAMA|volume=315|issue=7|pages=691–696|doi=10.1001/jama.2016.0018|issn=1538-3598|pmid=26881372|doi-access=free}}</ref>

    * US Preventive Services Task Force (USPSTF) does not recommend universal screen of young children for autism due to poor evidence of benefits of this screening when parents and clinicians have no concerns about ASD. The major concern is a false-positive diagnosis that would burden a family with very time consuming and financially demanding treatment interventions when it is not truly required. USPSTF also did not find any robust studies showing effectiveness of behavioral therapies in reducing ASD symptom severity<ref name=":13" />
    * American Academy of Pediatrics recommends ASD screening of all children between the ages if 18 and 24 months.<ref name=":13" /> The AAP also recommends that children who screen positive for ASD be referred to ASD treatment services without waiting for a comprehensive diagnostic workup.<ref name=":15">{{Cite journal|last1=Blumberg|first1=Stephen J.|last2=Zablotsky|first2=Benjamin|last3=Avila|first3=Rosa M.|last4=Colpe|first4=Lisa J.|last5=Pringle|first5=Beverly A.|last6=Kogan|first6=Michael D.|date=October 2016|title=Diagnosis lost: Differences between children who had and who currently have an autism spectrum disorder diagnosis|journal=Autism: The International Journal of Research and Practice|volume=20|issue=7|pages=783–795|doi=10.1177/1362361315607724|issn=1461-7005|pmc=4838550|pmid=26489772}}</ref>
    * The American Academy of Family Physicians did not find sufficient evidence of benefit of universal early screening for ASD<ref name=":13" />
    * The American Academy of Neurology and Child Neurology Society recommends general routine screening for delayed or abnormal development in children followed by screening for ASD only if indicated by the general developmental screening<ref name=":13" />
    * Thee American Academy of Child and Adolescent Psychiatry recommend routinely screening autism symptoms in young children<ref name=":13" />
    * The UK National Screening Committee does not recommend universal ASD screening in young children. Their main concerns includes higher chances of misdiagnosis at younger ages and lack of evidence of effectiveness of early interventions<ref name=":13" />

    === Misdiagnosis ===
    There is a concern about significant levels of misdiagnosis of autism in neurodevelopmentally normal children. This is because 18–37% of children diagnosed with ASD eventually lose their diagnosis and this high rate of lost diagnosis cannot be accounted for by successful ASD treatment alone. The common reasons parents understood as the cause of lost ASD diagnosis were new information about child (73.5%), diagnosis given so child could receive ASD treatment services (24.2%) to treat another developmental disorder, ASD treatment success (21%), and incorrect diagnosis (1.9%).<ref name=":15" />

    Many of the children who were later found not to meet ASD diagnosis criteria then received diagnosis for another developmental disorder like ADHD (most common), sensory disorders, anxiety, personality disorder, or learning disability.<ref name=":15" /> Neurodevelopment and psychiatric disorders that are commonly misdiagnosed as ASD include [./https://en.wikipedia.org/wiki/Specific_language_impairment specific language impairment], [./https://en.wikipedia.org/wiki/Social_Communication_Disorder social communication disorder], anxiety disorder, [./https://en.wikipedia.org/wiki/Reactive_attachment_disorder reactive attachment disorder], cognitive impairment, visual impairment, hearing impairment and normal behavioral variations.<ref>{{cite web|title=Conditions That May Look Like Autism, but Aren't|publisher=WebMD|url=https://www.webmd.com/brain/autism/autism-similar-conditions|access-date=10 May 2020}}</ref> Some normal behavioral variations that resemble autistic traits are repetitive behaviors, sensitivity to change in daily routines, focused interests, and toe-walking. These are considered normal behavioral variations when they do not cause impaired function. Boys are more likely to exhibit repetitive behaviors especially when excited, tired, bored, or stressed. Some ways of distinguishing normal behavioral variations from abnormal behaviors are the ability of the child to suppress these behaviors and the absence of these behaviors during sleep.<ref name=":18" />

    Listed below are some risk factors for ASD misdiagnosis:

    * Children diagnosed with PDD-NOS or a mild form of ASD which may be harder to distinguish from other developmental delays<ref name=":15" />
    * Children diagnosed with ASD whose parents had no concerns about abnormal development in their child<ref name=":15" />
    * Initial ASD diagnosis given by generalists (e.g. pediatricians, family physicians etc.), mental health providers, and schools rather than specialists in child neurodevelopmental disorders e.g. child psychiatrists or child neurologists<ref name=":15" />

    === Prognosis ===
    Few children who are correctly diagnosed with ASD are thought to lose this diagnosis due to treatment or outgrowing their symptoms. Children with poor treatment outcomes also tend to be ones that had moderate to severe forms of ASD, whereas children who appear to have responded to treatment are the ones with milder forms of ASD.<ref name=":15" />

    === Comorbidity ===
    {{Main|Conditions comorbid to autism spectrum disorders}}Autism spectrum disorders tend to be highly comorbid with other disorders. [./https://en.wikipedia.org/wiki/Comorbidity Comorbidity] may increase with age and may worsen the course of youth with ASDs and make intervention/treatment more difficult. Distinguishing between ASDs and other diagnoses can be challenging, because the traits of ASDs often overlap with symptoms of other disorders, and the characteristics of ASDs make traditional diagnostic procedures difficult.<ref name="Helverschou 2011">{{cite book|title=Psychiatric Disorders in People with Autism Spectrum Disorders: Phenomenology and Recognition|vauthors=Helverschou SB, Bakken TL, Martinsen H|work=International handbook of autism and pervasive developmental disorders|publisher=Springer|year=2011|isbn=9781441980649|veditors=Matson JL, Sturmey P|location=New York|pages=53–74|oclc=746203105}}<!--| access-date = 12 June 2013 --></ref><ref name="Underwood 2010">{{cite journal|vauthors=Underwood L, McCarthy J, Tsakanikos E|s2cid=13735841|title=Mental health of adults with autism spectrum disorders and intellectual disability|journal=Current Opinion in Psychiatry|volume=23|issue=5|pages=421–6|date=September 2010|pmid=20613532|doi=10.1097/YCO.0b013e32833cfc18}}</ref>

    * The most common medical condition occurring in individuals with autism spectrum disorders is seizure disorder or [./https://en.wikipedia.org/wiki/Epilepsy epilepsy], which occurs in 11–39% of individuals with ASD.<ref name="Ballaban-Gill & Tuchman">{{cite journal|vauthors=Ballaban-Gil K, Tuchman R|title=Epilepsy and epileptiform EEG: association with autism and language disorders|journal=Mental Retardation and Developmental Disabilities Research Reviews|volume=6|issue=4|pages=300–8|year=2000|pmid=11107195|doi=10.1002/1098-2779(2000)6:4<300::AID-MRDD9>3.0.CO;2-R}}</ref>
    * [./https://en.wikipedia.org/wiki/Tuberous_sclerosis Tuberous sclerosis], an [./https://en.wikipedia.org/wiki/Autosomal_dominant autosomal dominant] genetic condition in which non-malignant tumors grow in the brain and on other vital organs, is present in 1–4% of individuals with ASDs.<ref name="Wiznitzer">{{cite journal|vauthors=Wiznitzer M|s2cid=38157900|title=Autism and tuberous sclerosis|journal=Journal of Child Neurology|volume=19|issue=9|pages=675–9|date=September 2004|pmid=15563013|doi=10.1177/08830738040190090701}}</ref>
    * Intellectual disabilities are some of the most common comorbid disorders with ASDs. Recent estimates suggest that 40–69% of individuals with ASD have some degree of an [./https://en.wikipedia.org/wiki/Intellectual_disability intellectual disability],<ref name="Mash & Barkley" /> more likely to be severe for females. A number of genetic syndromes causing intellectual disability may also be comorbid with ASD, including [./https://en.wikipedia.org/wiki/Fragile_X_syndrome fragile X], [./https://en.wikipedia.org/wiki/Down_syndrome Down], [./https://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome Prader-Willi], [./https://en.wikipedia.org/wiki/Angelman_syndrome Angelman], [./https://en.wikipedia.org/wiki/Williams_syndrome Williams syndrome]<ref>{{cite journal|vauthors=Zafeiriou DI, Ververi A, Vargiami E|s2cid=16386209|title=Childhood autism and associated comorbidities|journal=Brain & Development|volume=29|issue=5|pages=257–72|date=June 2007|pmid=17084999|doi=10.1016/j.braindev.2006.09.003}}</ref> and [./https://en.wikipedia.org/wiki/SYNGAP1-related_intellectual_disability SYNGAP1-related intellectual disability].{{medcn|date=July 2020}}<ref>{{medcn|date=July 2020}}{{cite journal|vauthors=Satterstrom FK, Kosmicki JA, Wang J, et al|title=Large-Scale Exome Sequencing Study Implicates Both Developmental and Functional Changes in the Neurobiology of Autism|journal=Cell|volume=180|issue=3|pages=568–584.e23|date=February 2020|pmid=31981491|doi=10.1016/j.cell.2019.12.036|pmc=7250485}}</ref><ref>{{cite journal|vauthors=Adam MP, Ardinger HH, Pagon RA, ''et al''|title=SYNGAP1-Related Intellectual Disability|journal=Gene Reviews|date=2019|pmid=30789692|url=https://www.ncbi.nlm.nih.gov/books/NBK537721/|type=Review}}</ref>
    * [./https://en.wikipedia.org/wiki/Learning_disabilities Learning disabilities] are also highly comorbid in individuals with an ASD. Approximately 25–75% of individuals with an ASD also have some degree of a learning disability.<ref name="Obrien & Pearson">{{cite journal|vauthors=O'Brien G, Pearson J|title=Autism and learning disability|journal=Autism|volume=8|issue=2|pages=125–40|date=June 2004|pmid=15165430|doi=10.1177/1362361304042718|s2cid=17372893}}</ref>
    * Various [./https://en.wikipedia.org/wiki/Anxiety_disorders anxiety disorders] tend to co-occur with autism spectrum disorders, with overall comorbidity rates of 7–84%.<ref name="Mash & Barkley" /> Rates of comorbid [./https://en.wikipedia.org/wiki/Depression_(mood) depression] in individuals with an ASD range from 4–58%.<ref name="Lainhart">{{cite journal|author=Lainhart J|title=Psychiatric problems in individuals with autism, their parents and siblings|journal=[[International Review of Psychiatry]]|year=1999|volume=11|pages=278–298|doi=10.1080/09540269974177|issue=4}}</ref> The relationship between ASD and [./https://en.wikipedia.org/wiki/Schizophrenia schizophrenia] remains a controversial subject under continued investigation, and recent meta-analyses have examined genetic, environmental, infectious, and immune risk factors that may be shared between the two conditions.<ref>{{cite journal|vauthors=Chisholm K, Lin A, Abu-Akel A, Wood SJ|s2cid=21450062|title=The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence|journal=Neuroscience and Biobehavioral Reviews|volume=55|pages=173–83|date=August 2015|pmid=25956249|doi=10.1016/j.neubiorev.2015.04.012|url=http://pure-oai.bham.ac.uk/ws/files/22611324/Chisholm_et_al_Association_between_autism_and_schizophrenia_2015_Post_Print.pdf}}</ref><ref>{{cite journal|vauthors=Hamlyn J, Duhig M, McGrath J, Scott J|title=Modifiable risk factors for schizophrenia and autism—shared risk factors impacting on brain development|journal=Neurobiology of Disease|volume=53|pages=3–9|date=May 2013|pmid=23123588|doi=10.1016/j.nbd.2012.10.023|s2cid=207067275}}</ref><ref>{{cite journal|vauthors=Crespi BJ, Thiselton DL|title=Comparative immunogenetics of autism and schizophrenia|journal=Genes, Brain, and Behavior|volume=10|issue=7|pages=689–701|date=October 2011|pmid=21649858|doi=10.1111/j.1601-183X.2011.00710.x|s2cid=851655}}</ref>
    * Deficits in ASD are often linked to behavior problems, such as difficulties following directions, being cooperative, and doing things on other people's terms.<ref name="Tsakanikos 2007">{{cite journal|vauthors=Tsakanikos E, Costello H, Holt G, Sturmey P, Bouras N|title=Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism|journal=Journal of Autism and Developmental Disorders|volume=37|issue=6|pages=1080–5|date=July 2007|pmid=17053989|doi=10.1007/s10803-006-0248-1|s2cid=14272598|url=http://cogprints.org/6268/2/JADD_2007.pdf}}</ref> Symptoms similar to those of [./https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder attention deficit hyperactivity disorder] (ADHD) can be part of an ASD diagnosis.<ref name="Rommelse et al.">{{cite journal|vauthors=Rommelse NN, Franke B, Geurts HM, Hartman CA, Buitelaar JK|title=Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder|journal=European Child & Adolescent Psychiatry|volume=19|issue=3|pages=281–95|date=March 2010|pmid=20148275|pmc=2839489|doi=10.1007/s00787-010-0092-x}}</ref>
    * [./https://en.wikipedia.org/wiki/Sensory_processing_disorder Sensory processing disorder] is also comorbid with ASD, with comorbidity rates of 42–88%.<ref name="Baranek 2002">{{cite journal|vauthors=Baranek GT|title=Efficacy of sensory and motor interventions for children with autism|journal=Journal of Autism and Developmental Disorders|volume=32|issue=5|pages=397–422|date=October 2002|pmid=12463517|doi=10.1023/A:1020541906063|s2cid=16449130}}</ref>
    * Starting in adolescence, some people with Asperger syndrome (26% in one sample)<ref name=":17">{{cite journal|vauthors=Lugnegård T, Hallerbäck MU, Gillberg C|title=Personality disorders and autism spectrum disorders: what are the connections?|journal=Comprehensive Psychiatry|volume=53|issue=4|pages=333–40|date=May 2012|pmid=21821235|doi=10.1016/j.comppsych.2011.05.014}}</ref> fall under the criteria for the similar condition [./https://en.wikipedia.org/wiki/Schizoid_personality_disorder schizoid personality disorder], which is characterised by a [./https://en.wikipedia.org/wiki/Asociality lack of interest in social relationships], a tendency towards a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and [./https://en.wikipedia.org/wiki/Apathy apathy].<ref name=":17" /><ref name=":16">{{cite journal|vauthors=Tantam D|title=Lifelong eccentricity and social isolation. II: Asperger's syndrome or schizoid personality disorder?|journal=The British Journal of Psychiatry|volume=153|pages=783–91|date=December 1988|pmid=3256377|doi=10.1192/bjp.153.6.783}}</ref><ref name=":5">{{Cite book|title=Integrated Treatment for Co-Occurring Disorders: Personality Disorders and Addiction|author=Sharon C. Ekleberry|publisher=Routledge|year=2008|isbn=978-0789036933|pages=31–32|chapter=Cluster A - Schizoid Personality Disorder and Substance Use Disorders|chapter-url=https://books.google.com/books?id=O5HY1xcfjEcC&pg=PA31}}</ref> Asperger syndrome was traditionally called "[./https://en.wikipedia.org/wiki/Schizoid_disorder_of_childhood schizoid disorder of childhood]".

    == Management ==
    {{Main|Autism therapies}}There is no known cure for autism, although those with [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome] and those who have autism and require little-to-no support are more likely to experience a lessening of symptoms over time.<ref name="McPartland">{{cite journal|vauthors=McPartland J, Klin A|title=Asperger's syndrome|journal=Adolescent Medicine Clinics|volume=17|issue=3|pages=771–88; abstract xiii|date=October 2006|pmid=17030291|doi=10.1016/j.admecli.2006.06.010|doi-broken-date=10 November 2020}}</ref><ref name="Woodbury-Smith">{{cite journal|vauthors=Woodbury-Smith MR, Volkmar FR|s2cid=12808995|title=Asperger syndrome|journal=European Child & Adolescent Psychiatry|volume=18|issue=1|pages=2–11|date=January 2009|pmid=18563474|doi=10.1007/s00787-008-0701-0|url=http://www.ssoar.info/ssoar/handle/document/12424|type=Submitted manuscript}}</ref><ref name="Coplan">{{cite journal|vauthors=Coplan J, Jawad AF|s2cid=8440775|title=Modeling clinical outcome of children with autistic spectrum disorders|journal=Pediatrics|volume=116|issue=1|pages=117–22|date=July 2005|pmid=15995041|doi=10.1542/peds.2004-1118|lay-url=http://stokes.chop.edu/publications/press/?ID=181|lay-date=5 July 2005|lay-source=press release}}</ref> Several interventions can help children with autism.<ref name="HHS2017" /> The main goals of treatment are to lessen associated deficits and family distress, and to increase [./https://en.wikipedia.org/wiki/Quality_of_life quality of life] and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes.<ref>{{cite journal|vauthors=Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S|s2cid=205873629|title=Meta-analysis of Early Intensive Behavioral Intervention for children with autism|journal=Journal of Clinical Child and Adolescent Psychology|volume=38|issue=3|pages=439–50|date=May 2009|pmid=19437303|doi=10.1080/15374410902851739|citeseerx=10.1.1.607.9620}}</ref><ref name="Smith">{{cite journal|vauthors=Smith T, Iadarola S|title=Evidence Base Update for Autism Spectrum Disorder|journal=Journal of Clinical Child and Adolescent Psychology|volume=44|issue=6|pages=897–922|date=2015|pmid=26430947|doi=10.1080/15374416.2015.1077448|doi-access=free}}</ref> Although evidence-based interventions for autistic children vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing problem behaviors. It has been argued that no single treatment is best and treatment is typically tailored to the child's needs.<ref name="Myers">{{cite journal|vauthors=Myers SM, Johnson CP|s2cid=1656920|title=Management of children with autism spectrum disorders|journal=Pediatrics|volume=120|issue=5|pages=1162–82|date=November 2007|pmid=17967921|doi=10.1542/peds.2007-2362|url=http://pediatrics.aappublications.org/cgi/content/full/120/5/1162|lay-url=http://aap.org/advocacy/releases/oct07autism.htm|lay-date=29 October 2007|lay-source=AAP|doi-access=free}}</ref>

    === Non-pharmacological interventions ===
    Intensive, sustained [./https://en.wikipedia.org/wiki/Special_education special education] or [./https://en.wikipedia.org/wiki/Remedial_education remedial education] programs and [./https://en.wikipedia.org/wiki/Behavior_therapy behavior therapy] early in life can help children acquire self-care, social, and job skills. Available approaches include [./https://en.wikipedia.org/wiki/Applied_behavior_analysis applied behavior analysis], developmental models, [./https://en.wikipedia.org/wiki/TEACCH structured teaching], [./https://en.wikipedia.org/wiki/Speech_and_language_therapy speech and language therapy], [./https://en.wikipedia.org/wiki/Social_skills social skills] therapy, and [./https://en.wikipedia.org/wiki/Occupational_therapy occupational therapy].<ref name="Myers" /> Among these approaches, interventions either treat autistic features comprehensively, or focus treatment on a specific area of deficit.<ref name="Smith" /> Generally, when educating those with autism, specific tactics may be used to effectively relay information to these individuals. Using as much social interaction as possible is key in targeting the inhibition autistic individuals experience concerning person-to-person contact. Additionally, research has shown that employing semantic groupings, which involves assigning words to typical conceptual categories, can be beneficial in fostering learning.<ref>{{cite book|last1=Sigman|first1=Marian|first2=Lisa|last2=Capps|name-list-style=vanc|title=Children with Autism: A Developmental Perspective|location=Cambridge|publisher=Harvard University Press|date=2002|pages=178–179|isbn=978-0-674-05313-7}}</ref>

    There has been increasing attention to the development of evidence-based interventions for young children with ASD. Two theoretical frameworks outlined for early childhood intervention include [./https://en.wikipedia.org/wiki/Applied_behavioral_analysis applied behavioral analysis] (ABA) and [./https://en.wikipedia.org/wiki/Developmental_social-pragmatic_model the developmental social-pragmatic model] (DSP).<ref name="Smith" /> Although ABA therapy has a strong evidence base, particularly in regard to early intensive home-based therapy, ABA's effectiveness may be limited by diagnostic severity and [./https://en.wikipedia.org/wiki/IQ IQ] of the person affected by ASD.<ref>{{cite journal|vauthors=Rogers SJ, Vismara LA|title=Evidence-based comprehensive treatments for early autism|journal=Journal of Clinical Child and Adolescent Psychology|volume=37|issue=1|pages=8–38|date=January 2008|pmid=18444052|pmc=2943764|doi=10.1080/15374410701817808}}</ref> The ''Journal of Clinical Child and Adolescent Psychology'' has deemed two early childhood interventions as "well-established": individual comprehensive ABA, and focused teacher-implemented ABA combined with DSP.<ref name="Smith" />

    Another [./https://en.wikipedia.org/wiki/Evidence-based_practice evidence-based] intervention that has demonstrated efficacy is a parent training model, which teaches parents how to implement various ABA and DSP techniques themselves.<ref name="Smith" /> Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation.

    A multitude of unresearched alternative therapies have also been implemented. Many have resulted in harm to autistic people and should not be employed unless proven to be safe.<ref name="Myers" /> However, a recent systematic review on adults with autism has provided emerging evidence for decreasing stress, anxiety, ruminating thoughts, anger, and aggression through [./https://en.wikipedia.org/wiki/Mindfulness mindfulness]-based interventions for improving mental health.<ref>{{Cite journal|last1=Benevides|first1=Teal W|last2=Shore|first2=Stephen M|last3=Andresen|first3=May-Lynn|last4=Caplan|first4=Reid|last5=Cook|first5=Barb|last6=Gassner|first6=Dena L|last7=Erves|first7=Jasmine M|last8=Hazlewood|first8=Taylor M|last9=King|first9=M Caroline|last10=Morgan|first10=Lisa|last11=Murphy|first11=Lauren E|date=11 May 2020|title=Interventions to address health outcomes among autistic adults: A systematic review|journal=Autism|volume=24|issue=6|language=en|pages=1345–1359|doi=10.1177/1362361320913664|pmid=32390461|issn=1362-3613|doi-access=free}}</ref>

    In October 2015, the American Academy of Pediatrics (AAP) proposed new evidence-based recommendations for early interventions in ASD for children under 3.<ref name="APP2015">{{cite journal|vauthors=Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins D, Wetherby A, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR|display-authors=6|title=Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research|journal=Pediatrics|volume=136|issue=Supplement 1|pages=S60-81|date=October 2015|pmid=26430170|doi=10.1542/peds.2014-3667E|url=http://pediatrics.aappublications.org/content/136/Supplement_1/S60|doi-access=free}}</ref> These recommendations emphasize early involvement with both developmental and behavioral methods, support by and for parents and caregivers, and a focus on both the core and associated symptoms of ASD.<ref name="APP2015" /> However, a Cochrane review found no evidence that early intensive behavioral intervention (EIBI) is effective in reducing behavioral problems associated with autism in most children with ASD but did help improve IQ and language skills. The Cochrane review did acknowledge that this may be due to the low quality of studies currently available on EIBI and therefore providers should recommend EIBI based on their clinical judgement and the family's preferences. No adverse effects of EIBI treatment were found.<ref>{{Cite journal|last1=Reichow|first1=Brian|last2=Hume|first2=Kara|last3=Barton|first3=Erin E.|last4=Boyd|first4=Brian A.|date=9 May 2018|title=Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)|journal=The Cochrane Database of Systematic Reviews|volume=5|pages=CD009260|doi=10.1002/14651858.CD009260.pub3|issn=1469-493X|pmc=6494600|pmid=29742275}}</ref> Studies on pet therapy have shown positive effects.<ref>{{cite journal|vauthors=Siewertsen CM, French ED, Teramoto M|title=Autism spectrum disorder and pet therapy|journal=Advances in Mind-Body Medicine|volume=29|issue=2|pages=22–5|date=2015|pmid=25831431}}</ref>

    Generally speaking, treatment of ASD focuses on behavioral and educational interventions to target its two core symptoms: social communication deficits and restricted, repetitive behaviors.<ref name=":7">{{Cite web|url=https://www.uptodate.com/contents/autism-spectrum-disorder-in-children-and-adolescents-pharmacologic-interventions?topicRef=627&source=see_link#H9|title=Autism spectrum disorder in children and adolescents: Pharmacologic interventions|last=Weissman|first=Laura|name-list-style=vanc|date=March 2020|access-date=17 March 2020}}</ref> If symptoms continue after behavioral strategies have been implemented, some medications can be recommended to target specific symptoms or co-existing problems such as restricted and repetitive behaviors (RRBs), anxiety, depression, hyperactivity/inattention and sleep disturbance.<ref name=":7" /> [./https://en.wikipedia.org/wiki/Melatonin Melatonin] for example can be used for sleep problems.<ref>{{cite journal|vauthors=Williams Buckley A, Hirtz D, Oskoui M, ''et al''|title=Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology|journal=Neurology|volume=94|issue=9|pages=392–404|date=March 2020|pmid=32051244|pmc=7238942|doi=10.1212/WNL.0000000000009033}}</ref>

    While there are a number of parent-mediated behavioral therapies to target social communication deficits in children with autism, there is uncertainty regarding the efficacy of interventions to treat RRBs.<ref>{{cite journal|vauthors=Harrop C|title=Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors|language=en-US|journal=Autism|volume=19|issue=6|pages=662–72|date=August 2015|pmid=25186943|doi=10.1177/1362361314545685|s2cid=32326472}}</ref><ref>{{cite journal|vauthors=Harrop C|title=Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors|journal=Autism|volume=19|issue=6|pages=662–72|date=August 2015|pmid=25186943|doi=10.1177/1362361314545685|s2cid=32326472}}</ref>

    === Pharmacological interventions ===
    There is some emerging data that show positive effects of [./https://en.wikipedia.org/wiki/Risperidone risperidone] on restricted and repetitive behaviors (i.e., [./https://en.wikipedia.org/wiki/Stimming stimming]; e.g., flapping, twisting, complex whole-body movements), but due to the small sample size of these studies and the concerns about its side effects, antipsychotics are not recommended as primary treatment of RRBs.<ref>{{cite journal|vauthors=Ameis SH, Kassee C, Corbett-Dick P, Et al|s2cid=49209337|title=Systematic review and guide to management of core and psychiatric symptoms in youth with autism|journal=Acta Psychiatrica Scandinavica|volume=138|issue=5|pages=379–400|date=November 2018|pmid=29904907|doi=10.1111/acps.12918}}</ref>

    == Epidemiology ==
    {{Main|Epidemiology of autism}}While rates of autism spectrum disorders are consistent across cultures, they vary greatly by gender, with boys diagnosed far more frequently than girls. The average male-to-female diagnosis ratio for ASDs is 4.2:1,<ref>{{cite journal|vauthors=Fombonne E|title=Epidemiology of pervasive developmental disorders|journal=Pediatric Research|volume=65|issue=6|pages=591–8|date=June 2009|pmid=19218885|doi=10.1203/PDR.0b013e31819e7203|doi-access=free}}</ref> with 1 in 70 boys, but only 1 in 315 girls.<ref>{{cite journal|author=(ADDM) Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Principal Investigators|title=Prevalence of autism spectrum disorders-Autism and Developmental Disabilities Monitoring Network|journal=MMWR Surveillance Summaries|year=2009|volume=58|pages=1–20}}</ref> Girls, however, are more likely to have associated cognitive impairment. Among those with an ASD and intellectual disability, the sex ratio may be closer to 2:1.<ref>{{cite journal|vauthors=Volkmar FR, Lord C, Bailey A, Schultz RT, Klin A|title=Autism and pervasive developmental disorders|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=45|issue=1|pages=135–70|date=January 2004|pmid=14959806|doi=10.1046/j.0021-9630.2003.00317.x}}</ref> Prevalence differences may be a result of gender differences in expression of clinical symptoms, with [./https://en.wikipedia.org/wiki/Sex_differences_in_autism women and girls with autism] showing less atypical behaviors and, therefore, less likely to receive an ASD diagnosis.<ref name="Tsakanikos Underwood 2011">{{cite journal|vauthors=Tsakanikos E, Underwood L, Kravariti E, Bouras N, McCarthy J|title=Gender differences in co-morbid psychopathology and clinical management in adults with autism spectrum disorders|journal=Research in Autism Spectrum Disorders|volume=5|issue=2|year=2011|pages=803–808|issn=1750-9467|doi=10.1016/j.rasd.2010.09.009}}</ref>

    Autism prevalence has been estimated at 1–2 per 1,000, Asperger syndrome at roughly 0.6 per 1,000, childhood disintegrative disorder at 0.02 per 1,000, and PDD-NOS at 3.7 per 1,000.<ref name="Newschaffer 2007">{{cite journal|vauthors=Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J, Reaven J, Reynolds AM, Rice CE, Schendel D, Windham GC|display-authors=6|title=The epidemiology of autism spectrum disorders|journal=Annual Review of Public Health|volume=28|pages=235–58|year=2007|pmid=17367287|doi=10.1146/annurev.publhealth.28.021406.144007|doi-access=free}}</ref> These rates are consistent across cultures and ethnic groups, as autism is considered a universal disorder.<ref name="Mash & Barkley" />

    Using DSM-V criteria 92% of the children diagnosed with a autism spectrum disorder per DSM-IV still meet the diagnostic criteria of an autism spectrum disorder. However if both Autism Spectrum Disorder and Social Communication Disorder categories of DSM-V are combined, the [./https://en.wikipedia.org/wiki/Prevalence prevalence] of autism is mostly unchanged from the prevalence per the DSM-IV criteria. The best estimate for prevalence of ASD is 0.7% or 1 child in 143 children.<ref>{{Cite book|title=Autism spectrum disorders|last1=Hollander|first1=Eric|last2=Hagerman|first2=Randi Jenssen|last3=Fein|first3=Deborah|publisher=American Psychiatric Association Publishing|date=30 April 2018|isbn=978-1-61537-192-1|edition=First|location=Washington, DC|oclc=1022084798}}</ref> Relatively mild forms of autism, such as Aspergers as well as other developmental disorders were included in the recent DSM-5 diagnostic criteria.<ref name="Baio2018">{{cite journal|vauthors=Baio J, Wiggins L, Christensen DL, ''et al''|title=Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014|journal=Morbidity and Mortality Weekly Report. Surveillance Summaries|volume=67|issue=6|pages=1–23|date=April 2018|pmid=29701730|pmc=5919599|doi=10.15585/mmwr.ss6706a1}}</ref> ASD rates were constant between 2014 and 2016 but twice the rate compared to the time period between 2011 and 2014 (1.25 vs 2.47%). A Canadian meta-analysis from 2019 confirmed these effects as the profiles of people diagnosed with autism became less and less different from the profiles of the general population.<ref>{{cite journal|vauthors=Rødgaard EM, Jensen K, Vergnes JN, Soulières I, Mottron L|title=Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism: A Meta-analysis|journal=JAMA Psychiatry|volume=76|issue=11|pages=1124–1132|date=August 2019|pmid=31433441|pmc=6704749|doi=10.1001/jamapsychiatry.2019.1956}}</ref> In the US, the rates for diagnosed ASD have been steadily increasing since 2000 when records began being kept.<ref>{{cite web|title=CDC Press Releases|url=https://www.cdc.gov/media/releases/2016/p0331-children-autism.html|publisher=CDC|access-date=31 December 2019|language=en-us|date=1 January 2016}}</ref> While it remains unclear whether this trend represents a true rise in incidence, it likely reflects changes in ASD diagnostic criteria, improved detection, and increased public awareness of autism.<ref>{{cite book|vauthors=Hill AP|date=2014|veditors=Volkmar FR|title=Epidemiology of autism spectrum disorders|journal=Handbook of Autism and Pervasive Developmental Disorders. Diagnosis, Development, and Brain Mechanisms|publisher=Wiley|location=New York|volume=1|pages=57–96|doi=10.1002/9781118911389|isbn=9781118911389}}</ref>

    === United States ===
    In the United States it is estimated to affect more than 2% of children (about 1.5 million) as of 2016.<ref>{{cite web|title=HRSA-led study estimates 1 in 40 U.S. children has diagnosed autism|url=https://www.hrsa.gov/about/news/press-releases/hrsa-led-study-estimates-children-diagnosed-autism|publisher=U.S. Department of Health & Human Services, Health Resources and Services Administration|work=HRSA News Room|access-date=17 October 2019|date=19 November 2018}}</ref> According to the latest CDC prevalence reports, 1 in 59 children (1.7%) in the United States had a diagnosis of ASD in 2014, reflecting a 2.5-fold increase from the prevalence rate in 2000.<ref name="Baio2018" /> [./https://en.wikipedia.org/wiki/Prevalence Prevalence] is estimated at 6 per 1,000 for autism spectrum disorders as a whole,<ref name="Newschaffer 2007" /> although prevalence rates vary for each of the developmental disorders in the spectrum.

    == History ==
    {{Further|Autism#History}}Controversies have surrounded various claims regarding the etiology of autism spectrum disorders. In the 1950s, the "[./https://en.wikipedia.org/wiki/Refrigerator_mother_theory refrigerator mother theory]" emerged as an explanation for autism. The hypothesis was based on the idea that autistic behaviors stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanor of a child's mother.<ref name="Kanner 1949">{{cite journal|vauthors=Kanner L|title=Problems of nosology and psychodynamics of early infantile autism|journal=The American Journal of Orthopsychiatry|volume=19|issue=3|pages=416–26|date=July 1949|pmid=18146742|doi=10.1111/j.1939-0025.1949.tb05441.x}}</ref> Naturally, parents of children with an autism spectrum disorder suffered from blame, guilt, and self-doubt, especially as the theory was embraced by the medical establishment and went largely unchallenged into the mid-1960s. The "refrigerator mother" theory has since continued to be refuted in scientific literature, including a 2015 systematic review which showed no association between caregiver interaction and language outcomes in ASD.<ref>{{cite journal|vauthors=Tager-Flusberg H|title=Risk Factors Associated With Language in Autism Spectrum Disorder: Clues to Underlying Mechanisms|journal=Journal of Speech, Language, and Hearing Research|volume=59|issue=1|pages=143–54|date=February 2016|pmid=26502110|pmc=4867927|doi=10.1044/2015_jslhr-l-15-0146}}</ref>

    [./https://en.wikipedia.org/wiki/Leo_Kanner Leo Kanner], a child psychiatrist, was the first person to describe ASD as a neurodevelopmental disorder in 1943 by calling it 'infantile autism' and therefore rejected the 'refrigerator mother' theory.<ref>{{Cite journal|last=Harris|first=James|s2cid=4978549|date=February 2018|title=Leo Kanner and autism: a 75-year perspective|journal=International Review of Psychiatry (Abingdon, England)|volume=30|issue=1|pages=3–17|doi=10.1080/09540261.2018.1455646|issn=1369-1627|pmid=29667863}}</ref>

    Another controversial claim suggests that watching extensive amounts of television may cause autism. This hypothesis was largely based on research suggesting that the increasing rates of autism in the 1970s and 1980s were linked to the growth of cable television at this time.<ref name="Waterhouse 2008" />

    == Society and culture ==
    {{Further|Societal and cultural aspects of autism}}

    === Caregivers ===
    Families who care for an autistic child face added stress from a number of different causes. Parents may struggle to understand the diagnosis and to find appropriate care options. Parents often take a negative view of the diagnosis, and may struggle emotionally. In the words of one parent whose two children were both diagnosed with autism, "In the moment of diagnosis, it feels like the death of your hopes and dreams."<ref>{{Cite news|url=https://www.wired.com/2015/04/alternative-medicine-believers-journey-back-science/|title=An Alternative-Medicine Believer's Journey Back to Science|last=Levinovitz|first=Alan|name-list-style=vanc|newspaper=WIRED|access-date=13 February 2017|quote=The entire diagnosis and explanation took no more than 45 minutes. 'In the moment of diagnosis, it feels like the death of your hopes and dreams,' Louise [Laidler] says. There's a quiet grief in her voice, even though two decades have passed. 'In a way, it's even harder than a death, because you can't mourn and go on,' she says. 'You have to figure out how to care for your new child.'}}</ref> More than half of parents over the age of 50 are still living with their child as about 85% of people with ASD have difficulties living independently.<ref name="Kar2012">{{cite journal|vauthors=Karst JS, Van Hecke AV|title=Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation|journal=Clinical Child and Family Psychology Review|volume=15|issue=3|pages=247–77|date=September 2012|pmid=22869324|doi=10.1007/s10567-012-0119-6|s2cid=19170894}}</ref>

    === Autism rights movement ===
    The [./https://en.wikipedia.org/wiki/Autism_rights_movement autism rights movement] is a [./https://en.wikipedia.org/wiki/Social_movement social movement] within the context of [./https://en.wikipedia.org/wiki/Disability_rights_movement disability rights] that emphasizes the concept of [./https://en.wikipedia.org/wiki/Neurodiversity neurodiversity], viewing the autism spectrum as a result of natural variations in the [./https://en.wikipedia.org/wiki/Human_brain human brain] rather than a disorder to be cured.<ref name="Solomon" /> The autism rights movement advocates for including greater acceptance of autistic behaviors; therapies that focus on coping skills rather than imitating the behaviors of those without autism;<ref name="Bigthink">{{cite web|last1=Ratner|first1=Paul|name-list-style=vanc|title=Should Autism Be Cured or Is "Curing" Offensive?|url=https://bigthink.com/paul-ratner/should-autism-be-cured-or-is-curing-offfensive|website=Big Think|access-date=16 June 2019|date=10 July 2016}}</ref> and the recognition of the autistic community as a [./https://en.wikipedia.org/wiki/Minority_group minority group].<ref name="Bigthink" /><ref name="Jaarsma2012">{{cite journal|vauthors=Jaarsma P, Welin S|s2cid=18618887|title=Autism as a natural human variation: reflections on the claims of the neurodiversity movement|journal=Health Care Analysis|volume=20|issue=1|pages=20–30|date=March 2012|pmid=21311979|doi=10.1007/s10728-011-0169-9|url=http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-72172}}</ref> Autism rights or neurodiversity advocates believe that the autism spectrum is genetic and should be accepted as a natural expression of the [./https://en.wikipedia.org/wiki/Human_genome human genome]. This perspective is distinct from two other likewise distinct views: the medical perspective, that autism is caused by a genetic defect and should be addressed by targeting the autism gene(s), and [./https://en.wikipedia.org/wiki/Fringe_theories fringe theories] that autism is caused by environmental factors such as [./https://en.wikipedia.org/wiki/Vaccine vaccines].<ref name="Solomon" /> A common criticism against autistic activists is that the majority of them are "[./https://en.wikipedia.org/wiki/High-functioning_autism high-functioning]" or have [./https://en.wikipedia.org/wiki/Asperger_syndrome Asperger syndrome] and do not represent the views of "[./https://en.wikipedia.org/wiki/Low-functioning_autism low-functioning]" autistic people.<ref name="Jaarsma2012" />

    === Academic performance ===
    The number of students identified and served as eligible for autism services in the United States has increased from 5,413 children in 1991–1992 to 370,011 children in the 2010–2011 academic school year.<ref name=":0">{{cite journal|vauthors=Stichter JP, Riley-Tillman TC, Jimerson SR|title=Assessing, understanding, and supporting students with autism at school: Contemporary science, practice, and policy|journal=School Psychology Quarterly|volume=31|issue=4|pages=443–449|date=December 2016|pmid=27929316|doi=10.1037/spq0000184}}</ref> The [./https://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services United States Department of Health and Human Services] reported approximately 1 in 68 children at age 8 are diagnosed with autism spectrum disorder (ASD) although onset is typically between ages 2 and 4.<ref name=":0" />

    The increasing number of students with ASD in the schools presents significant challenges to [./https://en.wikipedia.org/wiki/Teacher teachers], [./https://en.wikipedia.org/wiki/School_psychology school psychologists], and other school professionals.<ref name=":0" /> These challenges include developing a consistent practice that best support the social and cognitive development of the increasing number of students with ASD.<ref name=":0" /> Although there is considerable research addressing assessment, identification, and support services for children with ASD, there is a need for further research focused on these topics within the school context.<ref name=":0" /> Further research on appropriate support services for students with ASD will provide school psychologists and other education professionals with specific directions for advocacy and service delivery that aim to enhance school outcomes for students with ASD.<ref name=":0" />

    Attempts to identify and use best intervention practices for students with autism also pose a challenge due to overdependence on popular or well-known interventions and curricula.<ref name=":0" /> Some evidence suggests that although these interventions work for some students, there remains a lack of specificity for which type of student, under what environmental conditions (one-on-one, specialized instruction or general education) and for which targeted deficits they work best.<ref name=":0" /> More research is needed to identify what assessment methods are most effective for identifying the level of educational needs for students with ASD.

    A difficulty for academic performance in students with ASD, is the tendency to generalize learning.<ref name=":2" /> Learning is different for each student, which is the same for students with ASD. To assist in learning, accommodations are commonly put into place for students with differing abilities. The existing schema of these students works in different ways and can be adjusted to best support the educational development for each student.<ref>{{Cite web|url=https://www.simplypsychology.org/piaget.html#adaptation|title=Jean Piaget's Theory of Cognitive Development {{!}} Simply Psychology|website=simplypsychology.org|access-date=19 February 2019}}</ref>

    The cost of educating a student with ASD in the US is about $8,600 a year more than the cost of educating an average student, which is about $12,000.<ref>{{cite web|title=Facts and Statistics|url=https://www.autism-society.org/what-is/facts-and-statistics/|publisher=Autism Society|access-date=6 November 2019}}</ref>

    === Employment ===
    About half of people in their 20s with autism are unemployed, and one third of those with graduate degrees may be unemployed.<ref name="Ohl">{{cite journal|vauthors=Ohl A, Grice Sheff M, Small S, Nguyen J, Paskor K, Zanjirian A|title=Predictors of employment status among adults with Autism Spectrum Disorder|journal=Work|volume=56|issue=2|pages=345–355|date=2017|pmid=28211841|doi=10.3233/WOR-172492}}</ref> Among those on the autism spectrum who find work, most are employed in sheltered settings working for wages below the national minimum.<ref>{{cite news|last1=DePillis|first1=Lydia|name-list-style=vanc|title=Disabled people are allowed to work for pennies per hour – but maybe not for much longer|url=https://www.washingtonpost.com/news/wonk/wp/2016/02/12/disabled-people-are-allowed-to-work-for-pennies-per-hour-but-maybe-not-for-much-longer/?noredirect=on|access-date=31 December 2018|work=Washington Post|date=12 February 2016}}</ref> While employers state hiring concerns about productivity and supervision, experienced employers of autistics give positive reports of above average memory and detail orientation as well as a high regard for rules and procedure in autistic employees.<ref name="Ohl" /> A majority of the economic burden of autism is caused by lost productivity in the job market.<ref>{{cite journal|vauthors=Ganz ML|title=The lifetime distribution of the incremental societal costs of autism|journal=Archives of Pediatrics & Adolescent Medicine|volume=161|issue=4|pages=343–9|date=April 2007|pmid=17404130|doi=10.1001/archpedi.161.4.343|lay-url=http://www.hsph.harvard.edu/news/press-releases/2006-releases/press04252006.html|lay-source=Harvard School of Public Health|lay-date=25 April 2006|doi-access=free}}</ref> Some studies also find decreased earning among parents who care for autistic children.<ref>{{cite journal|vauthors=Montes G, Halterman JS|s2cid=55179|title=Association of childhood autism spectrum disorders and loss of family income|journal=Pediatrics|volume=121|issue=4|pages=e821-6|date=April 2008|pmid=18381511|doi=10.1542/peds.2007-1594|url=http://pediatrics.aappublications.org/cgi/content/full/121/4/e821|archive-url=https://web.archive.org/web/20100304071520/http://pediatrics.aappublications.org/cgi/content/full/121/4/e821|archive-date=4 March 2010}}</ref><ref>{{cite journal|vauthors=Montes G, Halterman JS|title=Child care problems and employment among families with preschool-aged children with autism in the United States|journal=Pediatrics|volume=122|issue=1|pages=e202-8|date=July 2008|pmid=18595965|doi=10.1542/peds.2007-3037|s2cid=22686553|url=http://pediatrics.aappublications.org/cgi/content/full/122/1/e202|archive-url=https://web.archive.org/web/20091206190622/http://pediatrics.aappublications.org/cgi/content/full/122/1/e202|archive-date=6 December 2009}}</ref> Adding content related to autism in existing diversity training can clarify misconceptions, support employees, and help provide new opportunities for autistics.{{Citation needed|date=June 2019}}

    == See also ==

    * [./https://en.wikipedia.org/wiki/Social_narrative Social narrative]
    * ''[./https://en.wikipedia.org/wiki/Love_on_the_Spectrum Love on the Spectrum]'', Australian Netflix TV series
    * ''[./https://en.wikipedia.org/wiki/Atypical Atypical]'', 2017 TV series


    == References ==
    == References ==
    <references group="" responsive="1"></references>
    <references />

    == External links ==

    * {{Curlie|Health/Mental_Health/Disorders/Neurodevelopmental/Autism_Spectrum}}
    {{Medical condition classification and resources|DiseasesDB=|ICD10=|ICD9={{ICD9|299.00}}|ICDO=|OMIM=|MedlinePlus=001526|MeSH=D000067877|GeneReviewsNBK=NBK1442|GeneReviewsName=Autism Spectrum Disorders}}{{Pervasive developmental disorders}}{{Autism resources}}{{Mental and behavioural disorders|selected=neurological}}
    [[Category:Ace-spec identity]]
    [[Category:Ace-spec identity]]
    [[Category:Terminology]]
    [[Category:Umbrella Terms]]
    <br />

    Latest revision as of 21:43, 15 January 2024

    A flag with four even horizontal stripes. From top to bottom they are dark blue, purple, light grey, and dusty pink.
    The asexual spectrum flag by @theflagarchive
    Alternate asexual spectrum flag by SudeTheAcespec
    Alternate ace spectrum flag by DistinctiveSoy.
    Some of the asexual spectrum sexual orientations explained with pie.


    The asexual spectrum or asexual umbrella is a group of sexual orientations that all fall under the umbrella term of asexual. Individuals on the asexual spectrum may completely lack sexual attraction or feel it so little that they relate more to the asexual experience than to the allosexual experience. The common link between individuals on the asexual spectrum is that they do not feel the "standard" amount of sexual attraction or feel it in the "standard" way.

    Individuals on the asexual spectrum are often referred to as "ace-spec" for short. Ace-spec individuals can have any romantic orientation, including aromantic.

    Ace-Spec Identities

    While there are numerous ace-spec identities, some are more common, like asexual, demisexual, and greysexual, and can stand on their own as identities. Other common ace-spec identities include:

    Microlabels

    Some identities in the asexual spectrum are microlabels or identities that fall under the umbrella but cannot stand on their own and must be used in addition to another ace-spec label. Some common ace-spec microlabels include:

    Terminology

    Terms like Sex-Ambivalent, Sex-Favorable, Sex-Indifferent, and Sex-Repulsed help ace-spec individuals explain their relationship with sex. Ace-spec individuals may also have a non-standard understanding of attraction, particularly sexual attraction.

    Other terms help ace-spec individuals discuss their orientation beyond sex, such as romantic orientation, the Split Attraction Model, repulsion descriptors, and tertiary attraction. Terms like angled, electio, and oriented are useful for ace-spec individuals who are also part of the aromantic spectrum, also known as "aroace."

    Flag

    The first flag to gain widespread usage as an acespec flag was the asexual flag, created in August of 2010 to represent the entire asexual spectrum, and it was selected after a thorough three-stage poll by the community, originating on AVEN, the largest acespec community at the time, but extending towards other acespec communities to ensure as many individuals as possible could be included in this decision. [1]

    The black stripe represents asexuals and lack of attraction, the grey stripe represents demisexuals, gray-asexuals and everyone else that's on the ace-spec, the white stripe represents allosexual allies and the purple stripe represents the community as a whole, and it was likely chosen because AVEN had purple as part of its colour scheme. It has been adopted as a symbol for asexuals, but has never stopped being used as a symbol of the entire spectrum and to this day it's the most commonly used flag for asexual spectrum communities.

    Recently, some individuals have expressed interest in developing a different flag to differentiate the spectrum with all its identities from the asexual identity, regardless of the original intent of the flag, since it has been widely adopted by asexuals. To that end, some different flags have been adopted by these members of the spectrum, these flags were created by Tumblr user theflagarchive on July 25, 2020[2] and Instagram user sude.the.acespec on June 16, 2{{Archive|Site=web|URL=021.[3]

    For the first flag, the dark blue or black stripe represents the asexual community, its history and solidarity. The purple stripe comes from the asexual flag and represents all asexual identities. The pink stripe represents self-determination, pride in one's identity, and acceptance of one's own and others' asexuality. The cream stripe represents diversity in experiences and types of attractions.

    For the second flag, the black stripe represents the spectrum, sexualities that is under the asexual spectrum. The purple stripe also comes from the asexual flag and represents the community, individuals of different regions, religions, genders, sexual or romantic attractions that is in the asexual spectrum. The white stripe represents the acceptance of being in the asexual spectrum, being proud of it. The gray stripe is for the allies, and supporters that accepts the asexual spectrum community no matter what.

    A third alternate ace-spec flag was created by FANDOMS user DistinctiveSoy, 20th July 2021. The purple represents all the variation of asexual identities, the white represents inclusivity, the grey represents acceptance of oneself and others, the black represents aro-ace individuals and the spiral represents how different ace-spec sexualities are from allo-spec sexualities.

    References

    1. ↑ https://web.archive.org/web/https://asexualagenda.wordpress.com/2018/02/21/the-ace-flag-a-history-and-celebration/
    2. ↑ [https://web.archive.org/web/https://theflagarchive.tumblr.com/post/624655680467599360/asexual-spectrum-flag-while-i-like-the-asexual Tumblr post creating the asexual spectrum flag. ]
    3. ↑ Instagram post creating the second alternative to the asexual spectrum flag.}}
    Retrieved from "https://lgbtqia.wiki/wiki/Asexual_Spectrum?oldid=201862"
    Cookies help us deliver our services. By using our services, you agree to our use of cookies.
    More information
    Cookies help us deliver our services. By using our services, you agree to our use of cookies.
    More information