Can A Person Develop Autism After Early Childhood
Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
There is no official diagnosis called “late-onset autism.” In fact, the DSM-5, which lists and describes all developmental and mental disorders states that the onset of symptoms is in the early developmental period.
Still, there are plenty of articles out there about children who appear to regress after developing normally throughout their earliest years. And there are plenty of people who seem to develop autistic symptoms as teens or even adults.
So does regressive or late-onset autism actually exist? What do we know about it so far?
Rates Are On The Rise
An estimated 1 in 40 children in this country have autism to some degree, according to a recent study from Pediatrics based on 2016 data. That’s about 1.5 million children between the ages 3 to 17. Nationwide, autism strikes three to four times more boys than girls the rates are about the same for kids of all races.
Although there seems to be an autism epidemic, the Pediatrics study attributes the increasing prevalence to more inclusive reporting. The definition of autism has been expanded in the past decade to include a wider spectrum of problems with communication and social interaction. “Ten years ago, many children with mild autism were simply not diagnosed,” says Adrian Sandler, M.D., a developmental-behavioral pediatrician at Mission Children’s Hospital, in Asheville, North Carolina, and chair of the American Academy of Pediatrics’ committee on children with disabilities. Plus, there are more state and federal programs for autistic kids, giving doctors an incentive to diagnose and refer them. However, there may be additional, unknown reasons for the spike in autism rates, and researchers are investigating everything from environmental toxins to viruses to food allergies.
Autism Is A Genetic Disorder
Although autism was once believed to be the result of improper parenting, researchers now believe that genesnot psychological factorsare to blame. In fact, a 2019 study published in JAMA Psychiatry found that 80% of autism risk comes from inherited genetic factors. The study was widespread, looking at 2 million people from five countries .
If a couple has one child with autism, there is a 5 to 10 percent chance that siblings will have some sort of autistic disorder. With identical twins, the likelihood is 60 percent. Even though profoundly autistic people rarely have children, researchers often find that a relative has mild autistic symptoms or a high-functioning autism-spectrum disorder.
Experts believe that autism is the result of multiple genes anywhere from three to 20 interacting with each other. This may explain why the symptoms and severity of the disorder vary greatly. These genes may cause a baby’s brain to develop abnormally in utero or make him more susceptible to unknown triggers. “There is probably a combination of genetic and environmental influences,” says Catherine Lord, Ph.D., director of the Center for Autism and Communication Disorders at the University of Michigan, in Ann Arbor. Although the genes linked to autism have not yet been pinpointed, intense research is under way.
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Why Is Autism Increasing Dramatically
Let us start by reiterating some facts about autism.
- Multiple large-scale studies have established, with adequate proof, that vaccines do not cause autism.
- Autism does not develop due to bad parenting choices.
- Autistic spectrum disorders are not contagious.
Although the number of children diagnosed with autism has steadily increased over the last few years, this is not because more children develop autism now than before.
Experts cite the following reasons to explain the rise in autism cases in recent years.
ASD includes a broad spectrum of disorders with following symptoms, thus accommodating more kids under the title of autism.
How Is Asd Diagnosed
ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps.
Autism spectrum disorder is diagnosed by clinicians based on symptoms, signs, and testing according to the Diagnostic and Statistical Manual of Mental Disorders-V, a guide created by the American Psychiatric Association used to diagnose mental disorders. Children should be screened for developmental delays during periodic checkups and specifically for autism at 18- and 24-month well-child visits.
Very early indicators that require evaluation by an expert include:
- no babbling or pointing by age 1
- no single words by age 16 months or two-word phrases by age 2
- no response to name
- excessive lining up of toys or objects
- no smiling or social responsiveness
Later indicators include:
- impaired ability to make friends with peers
- impaired ability to initiate or sustain a conversation with others
- absence or impairment of imaginative and social play
- repetitive or unusual use of language
- abnormally intense or focused interest
- preoccupation with certain objects or subjects
- inflexible adherence to specific routines or rituals
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Risk Of Asd In Second Child
The risk of autism spectrum disorder is about to 1.5%. However, the risk of a second child will be 20% when a family already have an autistic child. If the child going to be born is a boy has a risk of ASD 2 3 times greater than a girl.
If there are two or more children with ASD in a family, the risk of ASD in the next child also increases by about 30%. Again, the risk for boys is about 2-3 times higher than the girls.
The risk of ASD also depends on the Timing, order of birth and age of parents. The timing gap between the two siblings should be more so that there is less risk of ASD. The order of birth also plays a vital role. The 2nd child will have a high risk of ASD as compared to the elder one. Aging of parents has a high risk with a genetic disability such as Down Syndrome.
Age Limit For Autism Development
Older children, teens, and adults do not develop autism. In fact, to qualify for an autism spectrum diagnosis, you must have symptoms that appear during early childhood .
Thus, if you know an adult or older child who has suddenly, out of the blue, developed behavioral or social communication issues, you are not seeing someone who has acquired autism after a period of normal development.
People who appear to suddenly behave in an “autistic” manner may have developed any one of a number of other mental health issues, some of which do most commonly appear in early adulthood.
Autism-like behaviors may result from a wide range of disorders from social phobia to generalized anxiety to obsessive-compulsive disorder. These are serious disorders that have a significant impact on an individuals’ ability to function effectively, make or keep friends, or hold a job, and they should be treated. But they are not autism.
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Signs Of Nonverbal Communication Difficulties
- Avoids eye contact.
- Uses facial expressions that dont match what they are saying
- Doesnt pick up on other peoples facial expressions, tone of voice, and gestures.
- Makes very few gestures . May come across as cold or robot-like.
- Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises. Can also be unresponsive to people entering/leaving, as well as efforts by others to attract the childs attention.
- Atypical posture, clumsiness, or eccentric ways of moving .
Children with autism spectrum disorder have trouble picking up on subtle nonverbal cues and using body language. This makes the give-and-take of social interaction very difficult.
Whats The Outlook For Autistic Children
Autism is a spectrum of neurological differences that develop during childhood.
Although there is not a cure for autism, many in the autism community believe these neurological differences dont need to be cured. Theyre just a different way of communicating and interacting with the world.
Decades of research have shown that early intervention can have a powerful effect on health outcomes for autistic children. When therapies begin in early childhood, autistic children benefit from the incredible adaptability of their growing brain and nervous system.
Some signs of autism can appear during infancy, such as:
- limited eye contact
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How Parents Can Spot The Warning Signs
As a parent, youre in the best position to spot the earliest warning signs of autism. You know your child better than anyone and observe behaviors and quirks that a pediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your childs pediatrician can be a valuable partner, but dont discount the importance of your own observations and experience. The key is to educate yourself so you know whats typical and whats not.
Monitor your childs development. Autism involves a variety of developmental delays, so keeping a close eye on whenor ifyour child is hitting the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays dont automatically point to autism, they may indicate a heightened risk.
Take action if youre concerned. Every child develops at a different pace, so you dont need to panic if your child is a little late to talk or walk. When it comes to healthy development, theres a wide range of typical. But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your childs doctor immediately. Dont wait.
Regression of any kind is a serious autism warning sign
How Is Autism Treated
There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.
Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.
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Brain Development And Autism
The brain develops differently in autistic children compared with typically developing children.
In young children, the brain is developing all the time. Every time a child does something or responds to something, connections in the brain are reinforced and become stronger.
Over time, the connections that arent reinforced disappear theyre pruned away as theyre not needed. This pruning is how the brain makes room for important connections those needed for everyday actions and responses, like walking, talking or understanding emotions.
In autistic children, the brain tends to grow faster than average during early childhood, especially during the first three years of life. The brains of autistic babies appear to have more cells than they need, as well as poor connections between the cells.
Also, pruning doesnt seem to happen as much in autistic children. This means that information might be lost or sent through the wrong connections. The lack of pruning might also explain why the brain seems to be growing faster in autistic children than in typically developing children.
Its not yet clear what causes this difference in brain development.
Regression Can Be Real Or Apparent
Over the past few years, there have been some debates as to whether regression, in which there is a loss of acquired communication or social skills, is a real phenomenon or an apparent one. Some have wondered whether parent reports were exaggerated.
Video records, however, combined with studies, make it clear that at least some children do in fact regress into autism while others either show signs of autism in infancy or “plateau” in their development.
A relatively new set of studies looking at the younger siblings of children with autism in their earliest months are discovering that subtle regression is quite common. While parents may notice issues such as loss of language or eye contact, researchers are noticing small losses in the areas of motor skills and response to social cues.
Such regression typically occurs before age 3. According to researcher Lonnie Zwaigenbaum, “upwards of 20% to 30% recall a period when their children lost social and communication skills in the second year of life.”
At present, no one knows exactly what causes regression, but according to developmental-behavioral pediatrician Paul Wang, We understand now that regression is common. It starts early, and it can affect many different developmental skills.”
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Signs Of Speech And Language Difficulties
- Speaks in an atypical tone of voice, or with an odd rhythm or pitch .
- Repeats the same words or phrases over and over, often without communicative intent.
- Responds to a question by repeating it, rather than answering it.
- Uses language incorrectly or refers to him or herself in the third person.
- Has difficulty communicating needs or desires.
- Doesnt understand simple directions, statements, or questions.
- Takes what is said too literally .
Children with autism spectrum disorder have difficulty with speech and language. Often, they start talking late.
Limited Or No Response To Their Name
At 6 months , most infants show an awareness of their own names, especially when its spoken by their mother.
Autistic infants show a developmental difference: By 9 months, many babies who later develop ASD dont orient to their own names. say this usually appears as a pattern of nonresponse, rather than a single instance.
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What Is Joint Attention
Problems with joint attention are one of the most early and common signs of ASD. Joint attention is when your child looks back and forth between an object and a person. When a child does this to share interest and interact with another person, he develops skills that help him connect with other people. Most children with ASD have delays in joint attention skills, or they dont have any joint attention skills.
These are examples of how children with ASD may show different joint attention skills:
Autism ‘begins Long Before Birth’
Scientists say they have new evidence that autism begins in the womb.
Patchy changes in the developing brain long before birth may cause symptoms of autism spectrum disorder , research suggests.
The study, in the New England Journal of Medicine, raises hopes that better understanding of the brain may improve the lives of children with autism.
It reinforces the need for early identification and treatment, says a University of California team.
US scientists analysed post-mortem brain tissue of 22 children with and without autism, all between two and 15 years of age.
They used genetic markers to look at how the outermost part of the brain, the cortex, wired up and formed layers.
Abnormalities were found in 90% of the children with autism compared with only about 10% of children without.
The changes were dotted about in brain regions involved in social and emotional communication, and language, long before birth, they say.
The researchers, from the University of California, San Diego and the Allen Institute for Brain Science in Seattle, say their patchy nature may explain why some toddlers with autism show signs of improvement if treated early enough.
They think the plastic infant brain may have a chance of rewiring itself to compensate.
“The finding that these defects occur in patches rather than across the entirety of cortex gives hope as well as insight about the nature of autism,” said Prof Eric Courchesne, a neuroscientist at the University of California San Diego.
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How Can You Prevent Autism In Babies
While you cant prevent having a child with an autistic disorder, you can increase your odds of having a healthy baby by doing these lifestyle changes: Live healthy. Have regular check-ups, eat well-balanced meals, and exercise. Make sure you have good prenatal care, and take all recommended vitamins and supplements.
Signs And Symptoms Of Autism In Babies And Toddlers
If autism is caught in infancy, treatment can take full advantage of the young brains remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.
The earliest signs of autism involve the absence of typical behaviorsnot the presence of atypical onesso they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a good baby, since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.
Some autistic infants dont respond to cuddling, reach out to be picked up, or look at their mothers when being fed.
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Autism May Be Linked To Being Firstborn Breech Births Or Moms 35 Or Older
- University of Utah Health Sciences
- Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, according to a new study with Utah children.
Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, University of Utah School of Medicine researchers have reported in a new study with Utah children.
In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder , compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found.
Although they didn’t identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first.
“The results of this study give us an opportunity to look more closely at these risk factors for children across the autism spectrum, and not only those diagnosed with autism,” said first author Deborah A. Bilder, M.D., assistant professor of psychiatry. “This shows that further investigation of the influence of prenatal factors is warranted.”
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