Autism spectrum disorder (ASD) is often misunderstood, leading to persistent myths about its causes, symptoms, and treatment. While awareness has grown, misinformation continues to shape public perception. David Young, MD, a pediatric neurologist at Loma Linda University Children’s Hospital, breaks down some of the most common misconceptions about autism and explains what the latest research reveals.
What are some of the most common misconceptions about autism that you encounter?
Autism presents in many different ways, leading to widespread misconceptions about its nature and causes. Some common stereotypes suggest that all individuals with autism are either violent or exceptionally gifted when autism exists on a broad spectrum. Additionally, people often expect autism to appear the same in boys and girls, which can lead to missed diagnoses in girls due to subtler signs. Misconceptions about its causes have also persisted, with some blaming vaccines, poor parenting, or environmental factors. However, research indicates that autism has a strong genetic basis, though environmental influences may also play a role.
Many people believe autism is caused by vaccines. Can you clarify the science behind this and address this myth?
This belief originated from a controversial paper published in the late 1990s, which studied 12 children and suggested a possible link between the MMR vaccine and developmental regression. However, the paper was later retracted due to reported misconduct. Given the high number of children receiving vaccines and the prevalence of autism, some coincidences were inevitable. Since then, numerous studies with much larger sample sizes have found no connection between the MMR vaccine, or any other vaccines, and autism.
What are the early signs of autism that parents and pediatricians should look for?
While we may focus on particularly noticeable behaviors such as stimming or lining up toy trains, it can be helpful to go back to the core symptoms of autism, which are challenges with socialization as well as restricted or repetitive behaviors. Social challenges include reduced back-and-forth social interactions, communication, and relationship-building, all of which must be impaired for the diagnosis. The second domain with repetitive behaviors like flapping hands or spinning wheels may be more obvious, but only some of these signs may be present. Subtler signs, like a strong preference for routines or intense, narrow interests, can also be key indicators. Additionally, sensory differences in autism can involve both heightened and diminished sensitivity to stimuli like lights, textures, or sounds.
At what age can autism typically be diagnosed, and why is early diagnosis important?
The signs of autism often become more reliably detectable by 18 months or possibly even younger. In some cases, re-evaluation at 5 years old can help to clarify the diagnosis when kids can participate in neuropsychological testing more reliably. Early evaluation is crucial because early intervention with behavioral and developmental therapies can alter a child's trajectory during the most formative years.
What does the diagnostic pathway for autism look like, and what specialists are involved?
Individual providers can perform autism assessments, but a multidisciplinary team can comprehensively tease out a wide range of potential diagnoses. These teams typically include a psychologist who directly tests the child using an established battery of standardized assessments. Speech and Occupational Therapists assess language and motor function. Medical providers such as Pediatricians and Neurologists assess for genetic syndromes or other medical conditions that might mask, mimic, or co-occur with autism.
Are there any common conditions that are misdiagnosed as autism or that co-occur with it?
Since autism encompasses a range of symptoms and a spectrum of severities, its signs can overlap with many other conditions. For example, the repetitive behaviors and fixations can also be seen in ADHD. Social and communication impairments may also be primarily related to intellectual disabilities or learning disorders, or autism can co-exist with them.
Can autism be "cured," or is it more about management and support?
There is currently no cure for autism, and some view autism as a different way of living rather than something to be cured. A major goal has been to help those with autism to live the best lives they can. Finding robust, reliable treatments has proven challenging because the condition is so heterogeneous. We will likely see more targeted treatments once research identifies the underlying root cause or causes for autism.
What should parents know about raising a child with autism?
Parents should know that they are not alone. Many online resources, foundations, and family groups exist to provide support. And it's important to give oneself grace on the sometimes-convoluted journey and to join with others on similar paths.
How can parents best advocate for their child’s needs in medical and educational settings?
Parents can utilize their school district's IEP (Individualized Education Plan) evaluation process to obtain neuropsychological testing and educational services for their child. Genetic testing is also becoming a more affordable way to identify syndromes that may underlie a child's autism, which can help families learn the specific ways in which their child may show autism and connect them with families of other children with the same genetic condition.
What do we currently know about the genetic factors that contribute to autism?
Hundreds of genes have been identified as risk factors for autism, with likely hundreds more to be identified through ongoing research. Heritability estimates for autism are currently around 70-90%, meaning that most of the differences in autism can be explained by genetics. These genetic factors likely work in concert with environmental influences to explain the rest of the differences, though the heterogeneity of autism has made it difficult to identify what these environmental factors are. As we understand better how each of these genes work, we may find common patterns among them that might help us identify the underlying cause of autism and different subtypes of autism.
How likely is it for autism to run in families, and should parents with one child on the spectrum be concerned about future children?
Repeated studies have shown that 20% of children with an older sibling diagnosed with autism would themselves be diagnosed with autism, about seven times higher than in the general population. This means that close surveillance and a low threshold to evaluate for autism can be especially important to identify it as early as possible in these families.
Understanding autism requires looking beyond stereotypes and misinformation. While there is no cure, individuals with autism can thrive with the right support and interventions. Ongoing research continues to shed light on the genetic and environmental factors involved, paving the way for more personalized approaches to care.
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