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{{Short description|Neurodevelopmental disorder involving social communication difficulties and repetitive behavior}}
{{About|the classic autistic disorder|the modern diagnosis|Autism spectrum|the journal|Autism (journal)}}
{{Pp-semi-indef}}
{{Pp-move-indef}}
{{Being merged|autism spectrum|discuss=Talk:Autism spectrum#Merger proposal; Outdated terminology/taxonomy|date=February 2022}}
{{Update|reason=some parts of the article do not accurately reflect either the new DSM5 or ICD10 or ICD11 criteria|date=February 2021}}
{{Use dmy dates|date=June 2020}}
{{Use American English|date=August 2016}}
{{Infobox medical condition (new)
| name = Autism
| image = Autism-stacking-cans 2nd edit.jpg
| alt = Boy stacking cans
| caption = Repetitively stacking or lining up objects is commonly associated with autism.
| field = ], ], ]
| symptoms = Trouble with ], ] and ], and presence of restricted interests and repetitive behavior<ref name=Land2008/>
| complications = Social isolation, employment problems, stress
| onset = By age two or three<ref name=NIH2016>{{cite web |title= NIMH " Autism Spectrum Disorder |url= https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |website= nimh.nih.gov |access-date= 20 April 2017 |date= October 2016}}</ref><ref name=DSM5/>
| duration = Lifelong<ref name=NIH2016/>
| causes = ] and environmental factors<ref name=Ch2012/>
| diagnosis = Based on behavior and developmental history<ref name=NIH2016/>
| differential = ], ], ]<ref>{{cite book |vauthors=Corcoran J, Walsh J |title=Clinical Assessment and Diagnosis in Social Work Practice |url={{Google books|y28kokLoe78C|page=72|plainurl=yes}} |publisher=Oxford University Press, New York |date=9 February 2006 |isbn=978-0-19-516830-3 |oclc=466433183 |lccn=2005027740 |page=72 }}</ref>
| treatment = ], ], ]<ref name=CCD2007/><ref name=San2016/><ref>{{cite journal | vauthors = Sukhodolsky DG, Bloch MH, Panza KE, Reichow B | title = Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis | journal = Pediatrics | volume = 132 | issue = 5 | pages = e1341–e1350 | date = November 2013 | pmid = 24167175 | pmc = 3813396 | doi = 10.1542/peds.2013-1193 }}</ref>
| medication = ], ], ] (associated symptoms)<ref name=Ji2015/><ref name="Oswald DP 2006"/><ref name="ReferenceA"/>
| frequency = 24.8 million (2015)<ref name=GBD2015Pre/>
}}

<!-- Definition and symptoms -->
'''Kanner autism,''' or '''classic autism''', is a ] characterized by challenges with social communication, and by restricted and repetitive behaviors.<ref name=DSM5/> It is now considered part of the wider autism spectrum.<ref name=":3" /> The term 'autism' was historically used to refer specifically to Kanner autism,<ref>{{cite journal | vauthors = Rosen NE, Lord C, Volkmar FR | title = The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond | journal = Journal of Autism and Developmental Disorders | volume = 51 | issue = 12 | pages = 4253–4270 | date = December 2021 | pmid = 33624215 | doi = 10.1007/s10803-021-04904-1 | pmc = 8531066 }}</ref> which is the convention used in much of this entry, but it is now more commonly used for the spectrum at large.<ref>{{Cite web |title=Autism {{!}} Topic {{!}} NICE |url=https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/autism |access-date=2022-03-17 |website=www.nice.org.uk}}</ref><ref>{{Cite book | vauthors = Fletcher-Watson S |url=https://www.worldcat.org/oclc/1073035060 |title=Autism : a new introduction to psychological theory and current debates |date=2019 |others=Francesca Happé |isbn=978-1-315-10169-9 |edition= |location=Abingdon, Oxon |oclc=1073035060}}</ref>

Parents often notice signs of autism during the first three years of their child's life.<ref name="Land2008">{{cite journal | vauthors = Landa RJ | title = Diagnosis of autism spectrum disorders in the first 3 years of life | journal = Nature Clinical Practice. Neurology | volume = 4 | issue = 3 | pages = 138–147 | date = March 2008 | pmid = 18253102 | doi = 10.1038/ncpneuro0731 | doi-access = free }}</ref><ref name="DSM5">{{cite book | title = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) | chapter = Autism Spectrum Disorder, 299.00 (F84.0) | author = American Psychiatric Association | year = 2013 | publisher = American Psychiatric Publishing | pages = 50–59}}</ref> These signs often develop gradually, though some autistic children experience ] in their communication and social skills after reaching ] at a normal pace.<ref name="Stef2008">{{cite journal | vauthors = Stefanatos GA | title = Regression in autistic spectrum disorders | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 305–319 | date = December 2008 | pmid = 18956241 | doi = 10.1007/s11065-008-9073-y | s2cid = 34658024 }}</ref>

<!-- Associations and diagnosis -->
Autism has been hypothesized to be associated with a combination of ] and ],<ref name="Ch2012">{{cite journal | vauthors = Chaste P, Leboyer M | title = Autism risk factors: genes, environment, and gene-environment interactions | journal = Dialogues in Clinical Neuroscience | volume = 14 | issue = 3 | pages = 281–292 | date = September 2012 | pmid = 23226953 | pmc = 3513682 | doi = 10.31887/DCNS.2012.14.3/pchaste }}</ref> with genetic factors thought to heavily predominate.<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 = 585–595 | date = May 2016 | pmid = 26709141 | pmc = 4996332 | doi = 10.1111/jcpp.12499 }}</ref> Factors which may influence likelihood of autism during pregnancy include certain infections, such as ], toxins including ], alcohol, ], ], lead, and air pollution, ],<!-- <ref name="VohrPoggiDavis2017"/> --> and ]s, but significant uncertainties remain about these.<ref>{{cite journal | vauthors = Ornoy A, Weinstein-Fudim L, Ergaz Z | title = Prenatal factors associated with autism spectrum disorder (ASD) | journal = Reproductive Toxicology | volume = 56 | pages = 155–169 | date = August 2015 | pmid = 26021712 | doi = 10.1016/j.reprotox.2015.05.007 }}</ref><ref name="VohrPoggiDavis2017"/><ref name=SamsamAhangari2014/> ] surround other proposed environmental ]; for example, the ], which although disproven, continues to hold sway in certain communities.<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 = 3623–3629 | date = June 2014 | pmid = 24814559 | doi = 10.1016/j.vaccine.2014.04.085 }}</ref><ref name=Rut2005>{{cite journal | vauthors = Rutter M | title = Incidence of autism spectrum disorders: changes over time and their meaning | journal = Acta Paediatrica | volume = 94 | issue = 1 | pages = 2–15 | date = January 2005 | pmid = 15858952 | doi = 10.1111/j.1651-2227.2005.tb01779.x | s2cid = 79259285 }}</ref> Autism affects information processing in the brain and how ]s and their ]s connect and organize; how this occurs is not well understood.<ref name="Lev2009">{{cite journal | vauthors = Levy SE, Mandell DS, Schultz RT | title = Autism | journal = Lancet | volume = 374 | issue = 9701 | pages = 1627–1638 | date = November 2009 | pmid = 19819542 | pmc = 2863325 | doi = 10.1016/S0140-6736(09)61376-3 }}</ref> Contemporary diagnostic manuals include only one diagnostic category for ] (ASD), including classic autism along with ] and ] (PDD-NOS).<ref name=DSM5/><ref name="John2007">{{cite journal | vauthors = Johnson CP, Myers SM | title = Identification and evaluation of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1183–1215 | date = November 2007 | pmid = 17967920 | doi = 10.1542/peds.2007-2361 | url = http://pediatrics.aappublications.org/cgi/content/full/120/5/1183 | doi-access = free | archive-url = https://web.archive.org/web/20090208013449/http://pediatrics.aappublications.org/cgi/content/full/120/5/1183 | archive-date = 8 February 2009 }}</ref>

<!-- Treatment -->
There is no 'treatment' for autism as such,<ref>{{Cite web |date=2019-05-02 |title=Fake and harmful autism 'treatments' |url=https://www.nhs.uk/conditions/autism/autism-and-everyday-life/fake-and-harmful-treatments/ |access-date=2022-04-29 |website=nhs.uk |language=en}}</ref> and many sources advise that this is not an appropriate goal,<ref>{{Cite web |title=Making information and the words we use accessible |url=https://www.england.nhs.uk/learning-disabilities/about/get-involved/involving-people/making-information-and-the-words-we-use-accessible/ |access-date=2022-04-29 |website=NHS England}}</ref><ref>{{Cite web |title=How to talk about autism |url=https://www.autism.org.uk/what-we-do/help-and-support/how-to-talk-about-autism |access-date=2022-04-29 |website=www.autism.org.uk |language=en}}</ref> although treatment of co-occurring conditions remains an important goal.<ref>{{Cite web |title=The psychiatric management of autism in adults (CR228) |url=https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2020-college-reports/cr228 |access-date=2022-04-29 |website=Royal College of Psychiatrists (UK) |language=en}}</ref> Behavioral, psychological, education, and/or skill-building interventions may be used to assist autistic people to learn life skills necessary for living independently, as well as other social, communication, and language skills. Therapy also aims to reduce challenging behaviors and build upon strengths.<ref>{{Cite web|title=NIMH » Autism Spectrum Disorder|url=https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder/index.shtml|access-date=8 April 2021|website=National Institute of Mental Health (US) |publisher=National Institutes of Health (US)}}</ref> Some autistic adults are unable to live independently.<ref name=Ste106>{{cite journal | vauthors = Steinhausen HC, Mohr Jensen C, Lauritsen MB | title = A systematic review and meta-analysis of the long-term overall outcome of autism spectrum disorders in adolescence and adulthood | journal = Acta Psychiatrica Scandinavica | volume = 133 | issue = 6 | pages = 445–452 | date = June 2016 | pmid = 26763353 | doi = 10.1111/acps.12559 | s2cid = 12341774 }}</ref> An ] has developed, with a minority of individuals seeking a cure<ref>{{Cite web |date=2022-03-23 |title=Results and Analysis of the Autistic Not Weird 2022 Autism Survey - Autistic Not Weird |url=https://autisticnotweird.com/autismsurvey/ |access-date=2022-04-29 |language=en-GB}}</ref> and others believing autism should be ] to be accommodated instead of cured.<ref name=Sil2008>{{cite journal |journal=BioSocieties |year=2008 |volume=3 |issue=3 |pages=325–341 |title=Fieldwork on another planet: social science perspectives on the autism spectrum | vauthors = Silverman C |s2cid=145379758 |doi=10.1017/S1745855208006236}}</ref>

<!-- Epidemiology -->
Globally, classic autism is estimated to affect 24.8 million people {{as of|2015|lc=y}}.<ref name=GBD2015Pre>{{cite journal | 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 | collaboration = GBD 2015 Disease and Injury Incidence and Prevalence Collaborators | last1 = Vos | first1 = Theo | last2 = Allen | first2 = Christine | last3 = Arora | first3 = Megha | last4 = Barber | first4 = Ryan M. | last5 = Bhutta | first5 = Zulfiqar A. | last6 = Brown | first6 = Alexandria | last7 = Carter | first7 = Austin | last8 = Casey | first8 = Daniel C. | last9 = Charlson | first9 = Fiona J. | last10 = Chen | first10 = Alan Z. | last11 = Coggeshall | first11 = Megan | last12 = Cornaby | first12 = Leslie | last13 = Dandona | first13 = Lalit | last14 = Dicker | first14 = Daniel J. | last15 = Dilegge | first15 = Tina | last16 = Erskine | first16 = Holly E. | last17 = Ferrari | first17 = Alize J. | last18 = Fitzmaurice | first18 = Christina | last19 = Fleming | first19 = Tom | last20 = Forouzanfar | first20 = Mohammad H. | last21 = Fullman | first21 = Nancy | last22 = Gething | first22 = Peter W. | last23 = Goldberg | first23 = Ellen M. | last24 = Graetz | first24 = Nicholas | last25 = Haagsma | first25 = Juanita A. | last26 = Hay | first26 = Simon I. | last27 = Johnson | first27 = Catherine O. | last28 = Kassebaum | first28 = Nicholas J. | last29 = Kawashima | first29 = Toana | last30 = Kemmer | first30 = Laura | display-authors = 1 }}</ref> ASD is diagnosed four to five times more often in males than females.<ref name=ASD2016>{{cite web |url = https://www.cdc.gov/ncbddd/autism/data.html |title = ASD data and statistics |publisher = CDC.gov |access-date= 11 July 2016 |archive-url = https://web.archive.org/web/20140418153648/http://www.cdc.gov/ncbddd/autism/data.html |archive-date = 18 April 2014}}</ref> The number of people diagnosed has increased considerably since the 1990s, which may be partly due to increased recognition of the condition.<ref name="Russell">{{cite journal | vauthors = Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T | display-authors = 6 | title = Time trends in autism diagnosis over 20 years: a UK population-based cohort study | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | date = August 2021 | pmid = 34414570 | doi = 10.1111/jcpp.13505 | quote = The figure starkly illustrates an overall 787% increase in recorded incidence of autism diagnosis over 20 years. | s2cid = 237242123 }}</ref>

{{TOC limit}}

==Characteristics==
Autism is a highly variable ]<ref name=Geschwind/> whose symptoms first appear during infancy or childhood, and generally follows a steady course without ].<ref name=ICD-10-F84.0/> Autistic people may be severely impaired in some respects but average, or even superior, in others.<ref>{{cite book |vauthors=Pinel JP |title=Biopsychology |year=2011 |publisher=Pearson |location=Boston, Massachusetts |edition=8th |isbn=978-0-205-03099-6 |oclc=1085798897 |page=235}}</ref> Overt symptoms gradually begin after the age of six months, become established by age two or three years<ref>{{cite journal | vauthors = Rogers SJ | title = What are infant siblings teaching us about autism in infancy? | journal = Autism Research | volume = 2 | issue = 3 | pages = 125–137 | date = June 2009 | pmid = 19582867 | pmc = 2791538 | doi = 10.1002/aur.81 }}</ref> and tend to continue through adulthood, although often in more muted form.<ref name=Rapin/> It was said to be distinguished by a characteristic triad of symptoms: impairments in social interaction, impairments in communication, and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.<ref name=Filipek/> Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.<ref name=London/>

===Social development===
Social deficits distinguish ]s from other developmental disorders.<ref name=Rapin/> Autistic people have social impairments and often lack the intuition about others that many people take for granted. Noted autistic woman ] described her inability to understand the ] of ]s, or people with typical ], as leaving her feeling "like an anthropologist on Mars".<ref>{{cite book |vauthors=Sacks O |author-link=Oliver Sacks |title=An Anthropologist on Mars: Seven Paradoxical Tales |year=1995 |publisher=] |location=New York |isbn=978-0-679-43785-7 |oclc=34359253 |lccn=94026733 |title-link=An Anthropologist on Mars}}</ref>

Unusual social development becomes apparent early in childhood.<!-- ref name=Volkmar/ --> Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic ]s differ more strikingly from ]; for example, they have less ] and ], and do not have the ability to use simple movements to express themselves, such as pointing at things.<ref name=Volkmar/> Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate ]ly, and take turns with others. However, they do form ] to their primary caregivers.<ref>{{cite journal | vauthors = Sigman M, Dijamco A, Gratier M, Rozga A | title = Early detection of core deficits in autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 10 | issue = 4 | pages = 221–233 | year = 2004 | pmid = 15666338 | doi = 10.1002/mrdd.20046 | citeseerx = 10.1.1.492.9930 }}</ref> Most autistic children display moderately less ] than neurotypical children, although this difference disappears in children with higher mental development or less pronounced autistic traits.<ref>{{cite journal | vauthors = Rutgers AH, Bakermans-Kranenburg MJ, van Ijzendoorn MH, van Berckelaer-Onnes IA | title = Autism and attachment: a meta-analytic review | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 45 | issue = 6 | pages = 1123–1134 | date = September 2004 | pmid = 15257669 | doi = 10.1111/j.1469-7610.2004.t01-1-00305.x }}</ref> Older children and adults with ASD ]<ref name="Sigman">{{cite journal | vauthors = Sigman M, Spence SJ, Wang AT | title = Autism from developmental and neuropsychological perspectives | journal = Annual Review of Clinical Psychology | volume = 2 | pages = 327–355 | year = 2006 | pmid = 17716073 | doi = 10.1146/annurev.clinpsy.2.022305.095210 }}</ref> although this may be partly due to a ].<ref>{{cite journal | vauthors = Bird G, Cook R | title = Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism | journal = Translational Psychiatry | volume = 3 | issue = 7 | pages = e285 | date = July 2013 | pmid = 23880881 | pmc = 3731793 | doi = 10.1038/tp.2013.61 }}</ref>

Children with high-functioning autism have more intense and frequent loneliness compared to non-autistic peers, despite the common belief that autistic children prefer to be alone. Making and maintaining friendships often proves to be difficult for autistic people. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.<ref name=Burgess/>

{{anchor|Aggression and violence}}
There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD. The limited data suggest that, in children with intellectual disability, autism is associated with aggression, destruction of property, and meltdowns.<ref>{{cite journal | vauthors = Matson JL, Nebel-Schwalm M | title = Assessing challenging behaviors in children with autism spectrum disorders: a review | journal = Research in Developmental Disabilities | volume = 28 | issue = 6 | pages = 567–579 | date = November 2007 | pmid = 16973329 | doi = 10.1016/j.ridd.2006.08.001 }}</ref>

===Communication===
About one third to half of autistic people do not develop enough natural speech to meet their daily communication needs.<ref>{{cite journal | vauthors = Noens I, van Berckelaer-Onnes I, Verpoorten R, van Duijn G | title = The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability | journal = Journal of Intellectual Disability Research | volume = 50 | issue = Pt 9 | pages = 621–632 | date = September 2006 | pmid = 16901289 | doi = 10.1111/j.1365-2788.2006.00807.x | url = https://lirias.kuleuven.be/handle/123456789/216355 }}</ref> Differences in communication may be present from the first year of life, and may include delayed onset of ], unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (])<ref name=Landa/><ref name=Tager-Flusberg/> or ].<ref name=Kanner1943/> ] seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD.<ref name=John2007/> For example, they may look at a pointing hand instead of the object to which the hand is pointing,<ref name=Volkmar/><ref name=Tager-Flusberg/> and they consistently fail to point at objects in order to comment on or share an experience.<ref name=John2007/> Autistic children may have difficulty with imaginative play and with developing symbols into language.<ref name="Landa">{{cite journal | vauthors = Landa R | title = Early communication development and intervention for children with autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 13 | issue = 1 | pages = 16–25 | year = 2007 | pmid = 17326115 | doi = 10.1002/mrdd.20134 }}</ref><ref name="Tager-Flusberg">{{cite journal | vauthors = Tager-Flusberg H, Caronna E | title = Language disorders: autism and other pervasive developmental disorders | journal = Pediatric Clinics of North America | volume = 54 | issue = 3 | pages = 469–81, vi | date = June 2007 | pmid = 17543905 | doi = 10.1016/j.pcl.2007.02.011 }}</ref>

In a pair of studies, high-functioning autistic children aged 8–15 performed equally well as, and as adults better than, individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension, and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.{{better source needed|date=February 2021}}<ref name="Williams">{{cite journal | vauthors = Williams DL, Goldstein G, Minshew NJ | title = Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing | journal = Child Neuropsychology | volume = 12 | issue = 4–5 | pages = 279–298 | date = August 2006 | pmid = 16911973 | pmc = 1803025 | doi = 10.1080/09297040600681190 }}</ref>

===Repetitive behavior===
]
Autistic individuals can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.<ref name=Lam-Aman/>

* ]: Repetitive movements, such as hand flapping, head rolling, or body rocking.
* ]s: Time-consuming behaviors intended to reduce the anxiety that an individual feels compelled to perform repeatedly or according to rigid rules, such as placing objects in a specific order, checking things, or handwashing.
* Sameness: Resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
* ]: Unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.<ref name="Lam-Aman">{{cite journal | vauthors = Lam KS, Aman MG | title = The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 37 | issue = 5 | pages = 855–866 | date = May 2007 | pmid = 17048092 | doi = 10.1007/s10803-006-0213-z | s2cid = 41034513 }}</ref>
* Restricted interests: Interests or fixations that are abnormal in theme or intensity of focus, such as preoccupation with a single television program, toy, or game.
* ]: Behaviors such as eye-poking, ], hand-biting and head-banging.<ref name=John2007/>

No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors.<ref>{{cite journal | vauthors = Bodfish JW, Symons FJ, Parker DE, Lewis MH | title = Varieties of repetitive behavior in autism: comparisons to mental retardation | journal = Journal of Autism and Developmental Disorders | volume = 30 | issue = 3 | pages = 237–243 | date = June 2000 | pmid = 11055459 | doi = 10.1023/A:1005596502855 | s2cid = 16706630 }}</ref>

===Other symptoms===
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.<ref name="Filipek">{{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 = 439–484 | date = December 1999 | pmid = 10638459 | doi = 10.1023/A:1021943802493 | s2cid = 145113684 }} This paper represents a consensus of representatives from nine professional and four parent organizations in the US.</ref>
An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from ]s such as the memorization of trivia to the extraordinarily rare talents of prodigious ].<ref>{{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 = 1351–1357 | date = May 2009 | pmid = 19528017 | pmc = 2677584 | doi = 10.1098/rstb.2008.0326 }}</ref> Many individuals with ASD show superior skills in perception and attention, relative to the general population.<ref>{{cite journal | vauthors = Plaisted Grant K, Davis G | title = Perception and apperception in autism: rejecting the inverse assumption | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 364 | issue = 1522 | pages = 1393–1398 | date = May 2009 | pmid = 19528022 | pmc = 2677593 | doi = 10.1098/rstb.2009.0001 }}</ref> ] abnormalities are found in over 90% of autistic people, and are considered core features by some,<ref name="Geschwind-2009">{{cite journal | vauthors = Geschwind DH | title = Advances in autism | journal = Annual Review of Medicine | volume = 60 | pages = 367–380 | year = 2009 | pmid = 19630577 | pmc = 3645857 | doi = 10.1146/annurev.med.60.053107.121225 | author-link = Daniel Geschwind }}</ref> although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.<ref>{{cite journal | vauthors = Rogers SJ, Ozonoff S | title = Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 46 | issue = 12 | pages = 1255–1268 | date = December 2005 | pmid = 16313426 | doi = 10.1111/j.1469-7610.2005.01431.x }}</ref> Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).<ref>{{cite journal | vauthors = Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E | title = A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders | journal = Journal of Autism and Developmental Disorders | volume = 39 | issue = 1 | pages = 1–11 | date = January 2009 | pmid = 18512135 | doi = 10.1007/s10803-008-0593-3 | s2cid = 5208889 }}</ref> An estimated 60–80% of autistic people have motor signs that include ], ], and ];<ref name=Geschwind-2009/><ref name="doi.org">{{Cite journal| doi = 10.1007/s12559-021-09940-8| issn = 1866-9964| vauthors = Gargot T, Archambault D, Chetouani M, Cohen D, Johal W, Anzalone SM | title = Automatic Assessment of Motor Impairments in Autism Spectrum Disorders: A Systematic Review| journal = Cognitive Computation| access-date = 2022-01-22| date = 2022-01-10| volume = 14| issue = 2| pages = 624–659| s2cid = 248326222| url = https://doi.org/10.1007/s12559-021-09940-8}}</ref> deficits in motor coordination are pervasive across ASD and are greater in autism proper.<ref>{{cite journal | vauthors = Fournier KA, Hass CJ, Naik SK, Lodha N, Cauraugh JH | title = Motor coordination in autism spectrum disorders: a synthesis and meta-analysis | journal = Journal of Autism and Developmental Disorders | volume = 40 | issue = 10 | pages = 1227–1240 | date = October 2010 | pmid = 20195737 | doi = 10.1007/s10803-010-0981-3 | s2cid = 3469612 }}</ref> Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur.<ref name="Dominick">{{cite journal | vauthors = Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S | title = Atypical behaviors in children with autism and children with a history of language impairment | journal = Research in Developmental Disabilities | volume = 28 | issue = 2 | pages = 145–162 | year = 2007 | pmid = 16581226 | doi = 10.1016/j.ridd.2006.02.003 }}</ref>

There is tentative evidence that ] occurs more frequently in autistic people (see ]).<ref>{{cite journal | vauthors = Van Der Miesen AI, Hurley H, De Vries AL | title = Gender dysphoria and autism spectrum disorder: A narrative review | journal = International Review of Psychiatry | volume = 28 | issue = 1 | pages = 70–80 | year = 2016 | pmid = 26753812 | doi = 10.3109/09540261.2015.1111199 | s2cid = 20918937 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Glidden D, Bouman WP, Jones BA, Arcelus J | title = Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature | journal = Sexual Medicine Reviews | volume = 4 | issue = 1 | pages = 3–14 | date = January 2016 | pmid = 27872002 | doi = 10.1016/j.sxmr.2015.10.003 | url = https://figshare.com/articles/journal_contribution/Gender_dysphoria_and_autism_spectrum_disorder_a_systematic_review_of_the_literature/9620366 }}</ref> As well as that, a 2021 anonymized online survey of 16-90 year-olds revealed that autistic males are more likely to be bisexual, while autistic females are more likely to be homosexual.<ref>{{cite journal | vauthors = Weir E, Allison C, Baron-Cohen S | title = The sexual health, orientation, and activity of autistic adolescents and adults | journal = Autism Research | volume = 14 | issue = 11 | pages = 2342–2354 | date = November 2021 | pmid = 34536071 | doi = 10.17863/CAM.74771 }}</ref>

] are one of the most commonly ] in autistic people.<ref name="IsraelyanMargolis2018"/> These are linked to greater social impairment, irritability, behavior and sleep problems, language impairments and mood changes.<ref name="IsraelyanMargolis2018">{{cite journal | vauthors = Israelyan N, Margolis KG | title = Serotonin as a link between the gut-brain-microbiome axis in autism spectrum disorders | journal = Pharmacological Research | volume = 132 | pages = 1–6 | date = June 2018 | pmid = 29614380 | pmc = 6368356 | doi = 10.1016/j.phrs.2018.03.020 | type = Review }}</ref><ref name="WasilewskaKlukowski2015">{{cite journal | vauthors = Wasilewska J, Klukowski M | title = Gastrointestinal symptoms and autism spectrum disorder: links and risks - a possible new overlap syndrome | journal = Pediatric Health, Medicine and Therapeutics | volume = 6 | pages = 153–166 | year = 2015 | pmid = 29388597 | pmc = 5683266 | doi = 10.2147/PHMT.S85717 | type = Review }}</ref>

Parents of children with ASD have higher levels of ].<ref name="Volkmar">{{cite book |veditors=Volkmar FR, Paul R, Pelphrey KA, Rogers SJ |title=Handbook of Autism and Pervasive Developmental Disorders: Volume Two: Assessment, Interventions, and Policy |volume=2 |edition=4th |year=2014 |publisher=] |location=Hoboken, New Jersey |url={{Google books|4yzqAgAAQBAJ|page=301|plainurl=yes}} |isbn=978-1-118-28220-5 |oclc=946133861 |lccn=2013034363 |page=301 |access-date=1 March 2019 }}</ref> Siblings of children with ASD report greater admiration of and less conflict with the affected sibling than siblings of unaffected children and were similar to siblings of children with ] in these aspects of the sibling relationship. However, they reported lower levels of closeness and intimacy than siblings of children with Down syndrome; siblings of individuals with ASD have greater likelihood of negative well-being and poorer sibling relationships as adults.<ref>{{cite journal | vauthors = Orsmond GI, Seltzer MM | title = Siblings of individuals with autism spectrum disorders across the life course | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 13 | issue = 4 | pages = 313–320 | year = 2007 | pmid = 17979200 | doi = 10.1002/mrdd.20171 | url = http://www.waisman.wisc.edu/family/pubs/Autism/2007%20siblings_autism_life-course.pdf | citeseerx = 10.1.1.359.7273 | archive-url = https://web.archive.org/web/20130530100939/http://www.waisman.wisc.edu/family/pubs/Autism/2007%20siblings_autism_life-course.pdf | archive-date = 30 May 2013 }}</ref>

==Causes==
{{Main|Causes of autism}}

It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism's characteristic triad of symptoms.<ref name="Fractionable"/> However, there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur.<ref name="Fractionable">{{cite journal | vauthors = Happé F, Ronald A | title = The 'fractionable autism triad': a review of evidence from behavioural, genetic, cognitive and neural research | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 287–304 | date = December 2008 | pmid = 18956240 | doi = 10.1007/s11065-008-9076-8 | s2cid = 13928876 }}</ref><ref name="HappeTime">{{cite journal | vauthors = Happé F, Ronald A, Plomin R | title = Time to give up on a single explanation for autism | journal = Nature Neuroscience | volume = 9 | issue = 10 | pages = 1218–1220 | date = October 2006 | pmid = 17001340 | doi = 10.1038/nn1770 | doi-access = free }}</ref>

] that have been implicated in autism.<ref name="Beaudet"/>]]
Autism has a strong genetic basis, although the ] are complex and it is unclear whether ASD is explained more by rare ]s with major effects, or by rare multigene interactions of common genetic variants.<ref name="Abrahams">{{cite journal | vauthors = Abrahams BS, Geschwind DH | title = Advances in autism genetics: on the threshold of a new neurobiology | journal = Nature Reviews. Genetics | volume = 9 | issue = 5 | pages = 341–355 | date = May 2008 | pmid = 18414403 | pmc = 2756414 | doi = 10.1038/nrg2346 }}</ref><ref>{{cite journal | vauthors = Buxbaum JD | title = Multiple rare variants in the etiology of autism spectrum disorders | journal = Dialogues in Clinical Neuroscience | volume = 11 | issue = 1 | pages = 35–43 | year = 2009 | pmid = 19432386 | pmc = 3181906 | doi = 10.31887/DCNS.2009.11.1/jdbuxbaum }}</ref> Complexity arises due to interactions among multiple genes, the environment, and ] factors which do not change ] sequencing but are heritable and influence ].<ref name="Rapin">{{cite journal | vauthors = Rapin I, Tuchman RF | title = Autism: definition, neurobiology, screening, diagnosis | journal = Pediatric Clinics of North America | volume = 55 | issue = 5 | pages = 1129–46, viii | date = October 2008 | pmid = 18929056 | doi = 10.1016/j.pcl.2008.07.005 }}</ref> Many genes have been associated with autism through sequencing the genomes of affected individuals and their parents.<ref name="SandersHe2015">{{cite journal | vauthors = Sanders SJ, He X, Willsey AJ, Ercan-Sencicek AG, Samocha KE, Cicek AE, Murtha MT, Bal VH, Bishop SL, Dong S, Goldberg AP, Jinlu C, Keaney JF, Klei L, Mandell JD, Moreno-De-Luca D, Poultney CS, Robinson EB, Smith L, Solli-Nowlan T, Su MY, Teran NA, Walker MF, Werling DM, Beaudet AL, Cantor RM, Fombonne E, Geschwind DH, Grice DE, Lord C, Lowe JK, Mane SM, Martin DM, Morrow EM, Talkowski ME, Sutcliffe JS, Walsh CA, Yu TW, Ledbetter DH, Martin CL, Cook EH, Buxbaum JD, Daly MJ, Devlin B, Roeder K, State MW | display-authors = 6 | title = Insights into Autism Spectrum Disorder Genomic Architecture and Biology from 71 Risk Loci | journal = Neuron | volume = 87 | issue = 6 | pages = 1215–1233 | date = September 2015 | pmid = 26402605 | pmc = 4624267 | doi = 10.1016/j.neuron.2015.09.016 | author45-link = Kathryn Roeder }}</ref> Studies of twins suggest that ] is 0.7 for autism and as high as 0.9 for ASD, and siblings of those with autism are about 25 times more likely to be autistic than the general population.<ref name="Geschwind-2009"/> However, most of the mutations that increase the likelihood of a diagnosis of autism have not been identified. Typically, autism cannot be traced to a ] (single-gene) mutation or to a single ], and none of the genetic syndromes associated with ASDs have been shown to selectively cause ASD.<ref name="Abrahams"/> Numerous candidate genes have been located, with only small effects attributable to any particular gene.<ref name=Abrahams/> Most loci individually explain less than 1% of cases of autism.<ref>{{cite journal | vauthors = Persico AM, Napolioni V | title = Autism genetics | journal = Behavioural Brain Research | volume = 251 | pages = 95–112 | date = August 2013 | pmid = 23769996 | doi = 10.1016/j.bbr.2013.06.012 | s2cid = 15721666 }}</ref> The large number of autistic individuals with unaffected family members may result from spontaneous ]—such as ], ] or ] in genetic material during ].<ref>{{cite journal | vauthors = Cook EH, Scherer SW | title = Copy-number variations associated with neuropsychiatric conditions | journal = Nature | volume = 455 | issue = 7215 | pages = 919–923 | date = October 2008 | pmid = 18923514 | doi = 10.1038/nature07458 | s2cid = 4377899 | bibcode = 2008Natur.455..919C }}</ref><ref>{{cite journal | vauthors = Brandler WM, Antaki D, Gujral M, Noor A, Rosanio G, Chapman TR, Barrera DJ, Lin GN, Malhotra D, Watts AC, Wong LC, Estabillo JA, Gadomski TE, Hong O, Fajardo KV, Bhandari A, Owen R, Baughn M, Yuan J, Solomon T, Moyzis AG, Maile MS, Sanders SJ, Reiner GE, Vaux KK, Strom CM, Zhang K, Muotri AR, Akshoomoff N, Leal SM, Pierce K, Courchesne E, Iakoucheva LM, Corsello C, Sebat J | display-authors = 6 | title = Frequency and Complexity of De Novo Structural Mutation in Autism | journal = American Journal of Human Genetics | volume = 98 | issue = 4 | pages = 667–679 | date = April 2016 | pmid = 27018473 | pmc = 4833290 | doi = 10.1016/j.ajhg.2016.02.018 }}</ref> Hence, a substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome.<ref name="Beaudet">{{cite journal | vauthors = Beaudet AL | title = Autism: highly heritable but not inherited | journal = Nature Medicine | volume = 13 | issue = 5 | pages = 534–536 | date = May 2007 | pmid = 17479094 | doi = 10.1038/nm0507-534 | s2cid = 11673879 }}</ref> Autism may be underdiagnosed in women and girls due to an assumption that it is primarily a male condition,<ref>{{cite web | vauthors = Devlin H | date = 14 September 2018 | url = https://www.theguardian.com/society/2018/sep/14/thousands-of-autistic-girls-and-women-going-undiagnosed-due-to-gender-bias | title = Thousands of autistic girls and women 'going undiagnosed' due to gender bias | work = ] }}</ref> but genetic phenomena such as ] and ] have the ability to raise the frequency and severity of conditions in males, and theories have been put forward for a genetic reason why males are diagnosed more often, such as the ] and the ].<ref name=":02">{{cite journal | vauthors = Crespi B, Badcock C | title = Psychosis and autism as diametrical disorders of the social brain | journal = The Behavioral and Brain Sciences | volume = 31 | issue = 3 | pages = 241–61; discussion 261–320 | date = June 2008 | pmid = 18578904 | doi = 10.1017/S0140525X08004214 }}</ref><ref name=":2">{{cite journal | vauthors = Crespi B, Stead P, Elliot M | title = Evolution in health and medicine Sackler colloquium: Comparative genomics of autism and schizophrenia | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 107 | issue = Suppl 1 | pages = 1736–1741 | date = January 2010 | pmid = 19955444 | pmc = 2868282 | doi = 10.1073/pnas.0906080106 | doi-access = free | bibcode = 2010PNAS..107.1736C }}</ref><ref>{{cite journal | vauthors = Baron-Cohen S, Knickmeyer RC, Belmonte MK | title = Sex differences in the brain: implications for explaining autism | journal = Science | volume = 310 | issue = 5749 | pages = 819–823 | date = November 2005 | pmid = 16272115 | doi = 10.1126/science.1115455 | s2cid = 44330420 | bibcode = 2005Sci...310..819B | url = http://irep.ntu.ac.uk/id/eprint/2710/1/219535_PubSub1971_Belmonte.pdf }}</ref>

Maternal nutrition and inflammation during preconception and pregnancy influences fetal neurodevelopment. ] is associated with ASD, in both term and preterm infants.<ref name="VohrPoggiDavis2017">{{cite journal | vauthors = Vohr BR, Poggi Davis E, Wanke CA, Krebs NF | title = Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings | journal = Pediatrics | volume = 139 | issue = Suppl 1 | pages = S38–S49 | date = April 2017 | pmid = 28562247 | doi = 10.1542/peds.2016-2828F | type = Review | s2cid = 28637473 | doi-access = free }}</ref> Maternal inflammatory and ]s may damage fetal tissues, aggravating a genetic problem or damaging the nervous system.<ref name="SamsamAhangari2014">{{cite journal | vauthors = Samsam M, Ahangari R, Naser SA | title = Pathophysiology of autism spectrum disorders: revisiting gastrointestinal involvement and immune imbalance | journal = World Journal of Gastroenterology | volume = 20 | issue = 29 | pages = 9942–9951 | date = August 2014 | pmid = 25110424 | pmc = 4123375 | doi = 10.3748/wjg.v20.i29.9942 | type = Review }}</ref>

Exposure to air pollution during pregnancy, especially ] and particulates, may increase the likelihood of an autism diagnosis.<ref>{{cite journal | vauthors = Lyall K, Schmidt RJ, Hertz-Picciotto I | title = Maternal lifestyle and environmental risk factors for autism spectrum disorders | journal = International Journal of Epidemiology | volume = 43 | issue = 2 | pages = 443–464 | date = April 2014 | pmid = 24518932 | pmc = 3997376 | doi = 10.1093/ije/dyt282 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Lam J, Sutton P, Kalkbrenner A, Windham G, Halladay A, Koustas E, Lawler C, Davidson L, Daniels N, Newschaffer C, Woodruff T | display-authors = 6 | title = A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder | journal = PLOS ONE | volume = 11 | issue = 9 | pages = e0161851 | year = 2016 | pmid = 27653281 | pmc = 5031428 | doi = 10.1371/journal.pone.0161851 | doi-access = free | bibcode = 2016PLoSO..1161851L }}</ref> ]s that have been claimed without evidence to contribute to or exacerbate autism include certain foods, ]s, ]s, ], ]s and ] used in plastic products, ]s, ]s, ], smoking, ]s, ]s,<ref name=News2007>{{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 = 235–258 | year = 2007 | pmid = 17367287 | doi = 10.1146/annurev.publhealth.28.021406.144007 | doi-access = free }}</ref> and ]. Some, such as the MMR vaccine, have been completely disproven.<ref>{{cite journal | vauthors = Kinney DK, Munir KM, Crowley DJ, Miller AM | title = Prenatal stress and risk for autism | journal = Neuroscience and Biobehavioral Reviews | volume = 32 | issue = 8 | pages = 1519–1532 | date = October 2008 | pmid = 18598714 | pmc = 2632594 | doi = 10.1016/j.neubiorev.2008.06.004 }}</ref><ref>{{cite journal | vauthors = Hussain A, Ali S, Ahmed M, Hussain S | title = The Anti-vaccination Movement: A Regression in Modern Medicine | journal = Cureus | volume = 10 | issue = 7 | pages = e2919 | date = July 2018 | pmid = 30186724 | pmc = 6122668 | doi = 10.7759/cureus.2919 }}</ref><ref name=AFP2017>{{cite journal | vauthors = Spencer JP, Trondsen Pawlowski RH, Thomas S | title = Vaccine Adverse Events: Separating Myth from Reality | journal = American Family Physician | volume = 95 | issue = 12 | pages = 786–794 | date = June 2017 | pmid = 28671426 }}</ref><ref>{{cite journal | vauthors = Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V | title = Vaccines for measles, mumps, rubella, and varicella in children | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | pages = CD004407 | date = November 2021 | issue = 11 | pmid = 34806766 | pmc = 8607336 | doi = 10.1002/14651858.CD004407.pub5 | pmc-embargo-date = November 22, 2022 }}</ref>

Parents may first become aware of autistic symptoms in their child around the time of a routine vaccination. This has led to unsupported theories blaming ], a ], or the ] for causing autism.<ref name="GerberOffit2009">{{cite journal | vauthors = Gerber JS, Offit PA | title = Vaccines and autism: a tale of shifting hypotheses | journal = Clinical Infectious Diseases | volume = 48 | issue = 4 | pages = 456–461 | date = February 2009 | pmid = 19128068 | pmc = 2908388 | doi = 10.1086/596476 }}</ref> The latter theory was supported by a litigation-funded study that has since been shown to have been "an elaborate fraud".<ref name="WakefieldarticleBMJ">{{cite journal | vauthors = Godlee F, Smith J, Marcovitch H | 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 | s2cid = 43640126 | archive-url = https://web.archive.org/web/20131111093448/http://www.bmj.com/content/342/bmj.c7452.full | archive-date = 11 November 2013 }}</ref> Although these theories lack convincing scientific evidence and are biologically implausible,<ref name="GerberOffit2009"/> parental concern about a potential vaccine link with autism has led to lower rates of ], ] in some countries, and the preventable deaths of several children.<ref name="vaccines">Vaccines and autism:

* {{cite journal | vauthors = Doja A, Roberts W | title = Immunizations and autism: a review of the literature | journal = The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques | volume = 33 | issue = 4 | pages = 341–346 | date = November 2006 | pmid = 17168158 | doi = 10.1017/s031716710000528x | doi-access = free }}
* {{cite journal | vauthors = Gerber JS, Offit PA | title = Vaccines and autism: a tale of shifting hypotheses | journal = Clinical Infectious Diseases | volume = 48 | issue = 4 | pages = 456–461 | date = February 2009 | pmid = 19128068 | pmc = 2908388 | doi = 10.1086/596476 }}
* {{cite journal | vauthors = Gross L | title = A broken trust: lessons from the vaccine--autism wars | journal = PLOS Biology | volume = 7 | issue = 5 | pages = e1000114 | date = May 2009 | pmid = 19478850 | pmc = 2682483 | doi = 10.1371/journal.pbio.1000114 }}
* {{cite journal | vauthors = Paul R | title = Parents ask: Am I risking autism if I vaccinate my children? | journal = Journal of Autism and Developmental Disorders | volume = 39 | issue = 6 | pages = 962–963 | date = June 2009 | pmid = 19363650 | doi = 10.1007/s10803-009-0739-y | s2cid = 34467853 }}
* {{cite journal | vauthors = Poland GA, Jacobson RM | title = The age-old struggle against the antivaccinationists | journal = The New England Journal of Medicine | volume = 364 | issue = 2 | pages = 97–99 | date = January 2011 | pmid = 21226573 | doi = 10.1056/NEJMp1010594 | doi-access = free }}</ref><ref name="dublin">{{cite journal | vauthors = McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey MT | title = Measles outbreak in Dublin, 2000 | journal = The Pediatric Infectious Disease Journal | volume = 22 | issue = 7 | pages = 580–584 | date = July 2003 | pmid = 12867830 | doi = 10.1097/00006454-200307000-00002 }}</ref>

==Mechanism==
{{Main|Mechanism of autism}}
Autism's symptoms result from maturation-related changes in various systems of the brain.<!-- ref name=Penn/ --> How autism occurs is not well understood. Its mechanism can be divided into two areas: the ] of brain structures and processes associated with autism, and the ] linkages between brain structures and behaviors.<ref name="Penn">{{cite journal | vauthors = Penn HE | title = Neurobiological correlates of autism: a review of recent research | journal = Child Neuropsychology | volume = 12 | issue = 1 | pages = 57–79 | date = February 2006 | pmid = 16484102 | doi = 10.1080/09297040500253546 | s2cid = 46119993 }}</ref> The behaviors appear to have multiple pathophysiologies.<ref name=London/>

There is evidence that ] abnormalities may be involved.<ref name=IsraelyanMargolis2018/><ref name="WasilewskaKlukowski2015"/><ref name=RaoGershon2016/> A 2015 review proposed that immune dysregulation, ] inflammation, malfunction of the ], ] alterations, and food ]s may cause brain neuroinflammation and dysfunction.<ref name="WasilewskaKlukowski2015"/><!-- Quote = immune dysregulation, GI inflammation, malfunction of the ANS, genetic and metabolic activity of the microbiome, and dietary metabolites may contribute to brain dysfunction and neuroinflammation depending upon individual genetic vulnerability --> A 2016 review concludes that ] abnormalities might play a role in neurological disorders such as autism. Neural connections and the immune system are a pathway that may allow diseases originated in the intestine to spread to the brain.<ref name=RaoGershon2016>{{cite journal | vauthors = Rao M, Gershon MD | title = The bowel and beyond: the enteric nervous system in neurological disorders | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 13 | issue = 9 | pages = 517–528 | date = September 2016 | pmid = 27435372 | pmc = 5005185 | doi = 10.1038/nrgastro.2016.107 | type = Review }}</ref>

Several lines of evidence point to ] dysfunction as a cause of autism.<ref name=Lev2009/> Some rare mutations may lead to autism by disrupting some synaptic pathways, such as those involved with ].<ref name="Betancur">{{cite journal | vauthors = Betancur C, Sakurai T, Buxbaum JD | title = The emerging role of synaptic cell-adhesion pathways in the pathogenesis of autism spectrum disorders | journal = Trends in Neurosciences | volume = 32 | issue = 7 | pages = 402–412 | date = July 2009 | pmid = 19541375 | doi = 10.1016/j.tins.2009.04.003 | s2cid = 8644511 | url = https://www.hal.inserm.fr/inserm-00401195/file/Betancur_ASD_review_TINS_2009.pdf }}</ref> Gene replacement studies in mice suggest that autistic symptoms are closely related to later developmental steps that depend on activity in synapses and on activity-dependent changes.<ref name="Walsh">{{cite journal | vauthors = Walsh CA, Morrow EM, Rubenstein JL | title = Autism and brain development | journal = Cell | volume = 135 | issue = 3 | pages = 396–400 | date = October 2008 | pmid = 18984148 | pmc = 2701104 | doi = 10.1016/j.cell.2008.10.015 }}</ref> All known ]s (agents that cause ]s) related to autism appear to act during the first eight weeks from ], and though this does not exclude the possibility that autism can be initiated or affected later, there is strong evidence that autism arises very early in development.<ref name="Arndt">{{cite journal | vauthors = Arndt TL, Stodgell CJ, Rodier PM | title = The teratology of autism | journal = International Journal of Developmental Neuroscience | volume = 23 | issue = 2–3 | pages = 189–199 | year = 2005 | pmid = 15749245 | doi = 10.1016/j.ijdevneu.2004.11.001 | s2cid = 17797266 }}</ref>

==Diagnosis==
] is based on behavior, not cause or mechanism.<ref name="London">{{cite journal | vauthors = London E | title = The role of the neurobiologist in redefining the diagnosis of autism | journal = Brain Pathology | volume = 17 | issue = 4 | pages = 408–411 | date = October 2007 | pmid = 17919126 | pmc = 8095627 | doi = 10.1111/j.1750-3639.2007.00103.x | s2cid = 24860348 }}</ref><ref>{{cite journal | vauthors = Baird G, Cass H, Slonims V | title = Diagnosis of autism | journal = BMJ | volume = 327 | issue = 7413 | pages = 488–493 | date = August 2003 | pmid = 12946972 | pmc = 188387 | doi = 10.1136/bmj.327.7413.488 }}</ref> Under the ], autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, typically before age three, and lead to clinically significant functional impairment.<ref name=DSM5/> Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or ], and persistent preoccupation with unusual objects. The disturbance must not be better accounted for by ], ] or global developmental delay.<ref name=DSM5/> ] uses essentially the same definition.<ref name="ICD-10-F84.0">{{cite web|url=http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm+f84 |year=2007 |access-date=10 October 2009 |website=ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision |publisher=World Health Organization |title=F84. Pervasive developmental disorders |archive-url=https://web.archive.org/web/20130421042448/http://apps.who.int/classifications/apps/icd/icd10online/?gf80.htm%20f84 |archive-date=21 April 2013 |url-status=dead }}</ref>

Several diagnostic instruments are available. Two are commonly used in autism research: the ] (ADI-R) is a semistructured parent interview, and the ] (ADOS)<ref>{{cite journal | vauthors = Gotham K, Risi S, Dawson G, Tager-Flusberg H, Joseph R, Carter A, Hepburn S, McMAHON W, Rodier P, Hyman SL, Sigman M, Rogers S, Landa R, Spence MA, Osann K, Flodman P, Volkmar F, Hollander E, Buxbaum J, Pickles A, Lord C | display-authors = 6 | title = A replication of the Autism Diagnostic Observation Schedule (ADOS) revised algorithms | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 47 | issue = 6 | pages = 642–651 | date = June 2008 | pmid = 18434924 | pmc = 3057666 | doi = 10.1097/CHI.0b013e31816bffb7 }}</ref> uses observation and interaction with the child. The ] (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.<ref name=Volkmar/> The Diagnostic interview for social and communication disorders (DISCO) may also be used.<ref>{{cite journal | vauthors = Kan CC, Buitelaar JK, van der Gaag RJ | title=Autismespectrumstoornissen bij volwassenen | trans-title = Autism spectrum disorders in adults | lang=nl | journal = Nederlands Tijdschrift voor Geneeskunde | volume = 152 | issue = 24 | pages = 1365–1369 | date = June 2008 | pmid = 18664213 }}</ref>

A ] commonly performs a preliminary investigation by taking developmental history and physically examining the child. If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated ].<ref name=Dover/> A pediatric ] is often asked to assess behavior and cognitive skills, both to aid diagnosis and to help recommend educational interventions.<ref name="Kanne">{{cite journal | vauthors = Kanne SM, Randolph JK, Farmer JE | title = Diagnostic and assessment findings: a bridge to academic planning for children with autism spectrum disorders | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 367–384 | date = December 2008 | pmid = 18855144 | doi = 10.1007/s11065-008-9072-z | s2cid = 21108225 }}</ref> A ] for ASD at this stage might also consider ], ], and a ]<ref name=Dover/> such as ].<ref>{{cite journal | vauthors = Mantovani JF | title = Autistic regression and Landau-Kleffner syndrome: progress or confusion? | journal = Developmental Medicine and Child Neurology | volume = 42 | issue = 5 | pages = 349–353 | date = May 2000 | pmid = 10855658 | doi = 10.1017/S0012162200210621 }}</ref> The presence of autism can make it harder to diagnose coexisting psychiatric disorders such as ].<ref>{{cite journal | vauthors = Matson JL, Neal D | title = Cormorbidity: diagnosing comorbid psychiatric conditions | journal = Psychiatr Times | volume = 26 |issue=4 |year=2009|url=http://www.psychiatrictimes.com/display/article/10168/1403043 | archive-url = https://web.archive.org/web/20130403062215/http://www.psychiatrictimes.com/display/article/10168/1403043 | archive-date = 3 April 2013}}</ref>

] evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause.<ref name="Caronna">{{cite journal | vauthors = Caronna EB, Milunsky JM, Tager-Flusberg H | title = Autism spectrum disorders: clinical and research frontiers | journal = Archives of Disease in Childhood | volume = 93 | issue = 6 | pages = 518–523 | date = June 2008 | pmid = 18305076 | doi = 10.1136/adc.2006.115337 | s2cid = 18761374 }}</ref> Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes,<ref>{{cite journal | vauthors = Schaefer GB, Mendelsohn NJ | title = Genetics evaluation for the etiologic diagnosis of autism spectrum disorders | journal = Genetics in Medicine | volume = 10 | issue = 1 | pages = 4–12 | date = January 2008 | pmid = 18197051 | doi = 10.1097/GIM.0b013e31815efdd7 | s2cid = 4468548 | doi-access = free }}</ref> consensus guidelines in the US and UK are limited to high-resolution chromosome and ] testing.<ref name=Caronna/> A ] model of diagnosis has been proposed, which would routinely assess the genome's copy number variations.<ref>{{cite journal | vauthors = Ledbetter DH | title = Cytogenetic technology--genotype and phenotype | journal = The New England Journal of Medicine | volume = 359 | issue = 16 | pages = 1728–1730 | date = October 2008 | pmid = 18784093 | doi = 10.1056/NEJMe0806570 }}</ref> As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism's genetics.<ref>{{cite journal | vauthors = McMahon WM, Baty BJ, Botkin J | title = Genetic counseling and ethical issues for autism | journal = American Journal of Medical Genetics. Part C, Seminars in Medical Genetics | volume = 142C | issue = 1 | pages = 52–57 | date = February 2006 | pmid = 16419100 | doi = 10.1002/ajmg.c.30082 | s2cid = 24093961 | citeseerx = 10.1.1.590.4821 }}</ref> ] and ] tests are sometimes helpful, but are not routine.<ref name=Caronna/>

ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later.<ref name=Land2008/> In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice.<ref name="Dover">{{cite journal | vauthors = Dover CJ, Le Couteur A | title = How to diagnose autism | journal = Archives of Disease in Childhood | volume = 92 | issue = 6 | pages = 540–545 | date = June 2007 | pmid = 17515625 | pmc = 2066173 | doi = 10.1136/adc.2005.086280 }}</ref> Although the symptoms of autism and ASD begin early in childhood, they are sometimes missed; years later, adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits.

Signs of autism may be more challenging for clinicians to detect in females.{{better source needed|date=February 2021}}<ref name="pmid30945091">{{cite journal | vauthors = Schuck RK, Flores RE, Fung LK | title = Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder | journal = Journal of Autism and Developmental Disorders | volume = 49 | issue = 6 | pages = 2597–2604 | date = June 2019 | pmid = 30945091 | pmc = 6753236 | doi = 10.1007/s10803-019-03998-y }}</ref> Autistic females have been shown to engage in masking more frequently than autistic males.<ref name="pmid30945091"/> Masking may include making oneself perform normative facial expressions and eye contact.{{better source needed|date=February 2021}}<ref name="pmid28527095">{{cite journal | vauthors = Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W | title = "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions | journal = Journal of Autism and Developmental Disorders | volume = 47 | issue = 8 | pages = 2519–2534 | date = August 2017 | pmid = 28527095 | pmc = 5509825 | doi = 10.1007/s10803-017-3166-5 }}</ref> A notable percentage of autistic females may be misdiagnosed, diagnosed after a considerable delay, or not diagnosed at all.<ref name="pmid30945091"/>

Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis.<ref>{{cite journal | vauthors = Shattuck PT, Grosse SD | title = Issues related to the diagnosis and treatment of autism spectrum disorders | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 13 | issue = 2 | pages = 129–135 | year = 2007 | pmid = 17563895 | doi = 10.1002/mrdd.20143 }}</ref> It is particularly hard to diagnose autism among the ], partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes or ]s.<ref>{{cite journal | title = Visual impairment and autism: current questions and future research | vauthors = Cass H | author-link = Hilary Cass | s2cid = 146237979 |journal=Autism |year=1998 |volume=2 |issue=2 |pages=117–138|doi=10.1177/1362361398022002}}</ref>

===Classification===
The fourth edition of the ]'s diagnostic manual, DSM-IV, listed 'autistic disorder' as one of the five ]s (PDD), but these were collapsed into the single diagnosis of ] in 2013,<ref name=":3">{{cite journal | vauthors = Rosen NE, Lord C, Volkmar FR | title = The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond | journal = Journal of Autism and Developmental Disorders | volume = 51 | issue = 12 | pages = 4253–4270 | date = December 2021 | pmid = 33624215 | pmc = 8531066 | doi = 10.1007/s10803-021-04904-1 }}</ref> and the ]'s diagnostic manual ] (which had listed it as 'childhood autism' in its previous edition<ref>{{Cite web |title=ICD-10 Version:2016 |url=https://icd.who.int/browse10/2016/en#/F84.0 |access-date=2022-04-28 |website=icd.who.int}}</ref>) followed suit a few years later.<ref>{{Cite web |title=World Health Organisation updates classification of autism in the ICD-11 – Autism Europe |url=https://www.autismeurope.org/blog/2018/06/21/world-health-organisation-updates-classification-of-autism-in-the-icd-11/ |access-date=2022-04-28 |language=en-US}}</ref> It was said to be characterized by widespread abnormalities of social interactions and communication, severely restricted interests, and highly repetitive behavior.<ref name=ICD-10-F84.0/> These symptoms do not imply sickness, fragility, or emotional disturbance.<ref name=Rapin/>

Of the five PDD forms, ] was closest to classic autism in signs and likely causes; ] and ] share several signs with it, but may have unrelated causes; ] (PDD-NOS; also called ''atypical autism'') was diagnosed when the criteria are not met for a more specific disorder.<ref>{{cite journal | vauthors = Volkmar FR, State M, Klin A | title = Autism and autism spectrum disorders: diagnostic issues for the coming decade | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 50 | issue = 1–2 | pages = 108–115 | date = January 2009 | pmid = 19220594 | doi = 10.1111/j.1469-7610.2008.02010.x }}</ref> People would usually attract a diagnosis of Asperger syndrome rather than classic autism if they showed no substantial delay in ],<ref name="DSM-IV-TR-299.00">{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-IV |chapter=Diagnostic criteria for 299.00 Autistic Disorder |publisher=American Psychiatric Association |year=2000 |edition=4th |location=Washington, D.C. |isbn=978-0-89042-025-6 |oclc=768475353 |lccn=00024852 |chapter-url=http://cdc.gov/ncbddd/autism/hcp-dsm.html |archive-url= https://web.archive.org/web/20131029080544/http://www.cdc.gov/ncbddd/autism/hcp-dsm.html |archive-date=29 October 2013 |via=Centers for Disease Control}}</ref> but studies found that early language ability was a poor predictor of outcomes in adulthood.<ref>{{Cite journal | vauthors = Howlin P |date=2003-02-01 |title=Outcome in High-Functioning Adults with Autism with and Without Early Language Delays: Implications for the Differentiation Between Autism and Asperger Syndrome |journal=Journal of Autism and Developmental Disorders |language=en |volume=33 |issue=1 |pages=3–13 |doi=10.1023/A:1022270118899 |pmid=12708575 |s2cid=35817450 |issn=1573-3432}}</ref>

Research into causes has been hampered by the inability to identify biologically meaningful subgroups within the autistic population<ref>{{cite journal | vauthors = Altevogt BM, Hanson SL, Leshner AI | title = Autism and the environment: challenges and opportunities for research | journal = Pediatrics | volume = 121 | issue = 6 | pages = 1225–1229 | date = June 2008 | pmid = 18519493 | doi = 10.1542/peds.2007-3000 | url = http://pediatrics.aappublications.org/cgi/content/full/121/6/1225 | s2cid = 24595814 | archive-url = https://web.archive.org/web/20100115140620/http://pediatrics.aappublications.org/cgi/content/full/121/6/1225 | archive-date = 15 January 2010 }}</ref> and by the traditional boundaries between the disciplines of ], ], ] and ].<ref>{{cite journal | vauthors = Reiss AL | title = Childhood developmental disorders: an academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 50 | issue = 1–2 | pages = 87–98 | date = January 2009 | pmid = 19220592 | pmc = 5756732 | doi = 10.1111/j.1469-7610.2008.02046.x }}</ref> Newer technologies such as ] and ] can help identify biologically relevant ]s (observable traits) that can be viewed on ]s, to help further ] studies of autism;<ref>{{cite journal | vauthors = Piggot J, Shirinyan D, Shemmassian S, Vazirian S, Alarcón M | title = Neural systems approaches to the neurogenetics of autism spectrum disorders | journal = Neuroscience | volume = 164 | issue = 1 | pages = 247–256 | date = November 2009 | pmid = 19482063 | doi = 10.1016/j.neuroscience.2009.05.054 | s2cid = 207246176 }}</ref> one example is lowered activity in the ] of the brain, which is associated with impaired perception of people versus objects.<ref name=Lev2009/> It has been proposed to classify autism using genetics as well as behavior.<ref>{{cite journal | vauthors = Stephan DA | title = Unraveling autism | journal = American Journal of Human Genetics | volume = 82 | issue = 1 | pages = 7–9 | date = January 2008 | pmid = 18179879 | pmc = 2253980 | doi = 10.1016/j.ajhg.2007.12.003 }}</ref> (For more, see ], geneticist and neuroscientist)

==== Spectrum ====
Autism has long been thought to cover a wide ], ranging from individuals with severe impairments—who may be silent, ], and prone to frequent repetitive behavior such as hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, ] communication.<ref>{{cite journal | vauthors = Happé F | title = Understanding assets and deficits in autism: why success is more interesting than failure | journal = Psychologist | volume = 12 | issue = 11 | pages = 540–547 | year = 1999 | url = http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_12-editionID_46-ArticleID_133-getfile_getPDF/thepsychologist/psy_11_99_p540-547_happe.pdf | archive-url = https://web.archive.org/web/20120517162434/http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_12-editionID_46-ArticleID_133-getfile_getPDF/thepsychologist/psy_11_99_p540-547_happe.pdf |archive-date=17 May 2012}}</ref> Because the behavior spectrum is continuous, boundaries between diagnostic categories were necessarily somewhat arbitrary.<ref name=Geschwind-2009/> The autism spectrum, in turn, is sometimes said to be a subset of the broader autism ], which describes individuals who may not have ASD but do have autistic-like ], such as avoiding eye contact.<ref>{{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 = 185–190 | date = February 1997 | pmid = 9016266 | doi = 10.1176/ajp.154.2.185 | doi-access = free }}</ref>

==Screening==
About half of parents of children with ASD notice their child's unusual behaviors by age 18 months, and about four-fifths notice by age 24 months.<ref name=Land2008/> According to an article, failure to meet any of the following milestones "is an absolute indication to proceed with further evaluations. Delay in referral for such testing may delay early diagnosis and treatment and affect the long-term outcome".<ref name=Filipek/>
* No response to name (or ]) by 6 months.<ref name=CDCearlywarningsigns>{{cite web |url = https://www.cdc.gov/ncbddd/actearly/autism/case-modules/early-warning-signs/03-closer-look.html#tabs-1-1 |title = Autism case training part 1: A closer look – key developmental milestones |publisher = CDC.gov |access-date= 5 August 2019|date = 18 August 2016 }}</ref>
* No ] by 12 months.
* No ] (pointing, waving, etc.) by 12 months.
* No single words by 16 months.
* No two-word (spontaneous, not just ]) phrases by 24 months.
* Loss of any language or social skills, at any age.

The ] in 2016 found it was unclear if screening was beneficial or harmful among children in whom there is no concern.{{unbalanced inline|date=February 2021}}<ref>{{cite journal | vauthors = Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP | display-authors = 6 | 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 | date = February 2016 | pmid = 26881372 | doi = 10.1001/jama.2016.0018 | doi-access = free }}</ref> The Japanese practice is to ] all children for ASD at 18 and 24 months, using autism-specific formal screening tests. In contrast, in the UK, children whose families or doctors recognize possible signs of autism are screened. It is not known which approach is more effective.<ref name=Lev2009/> Screening tools include the ] (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the First Year Inventory; initial data on M-CHAT and its predecessor, the ] (CHAT), on children aged 18–30 months suggests that it is best used in a clinical setting and that it has low ] (many false-negatives) but good ] (few false-positives).<ref name=Land2008/> It may be more accurate to precede these tests with a broadband screener that does not distinguish ASD from other developmental disorders.<ref>{{cite journal | vauthors = Wetherby AM, Brosnan-Maddox S, Peace V, Newton L | title = Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age | journal = Autism | volume = 12 | issue = 5 | pages = 487–511 | date = September 2008 | pmid = 18805944 | pmc = 2663025 | doi = 10.1177/1362361308094501 }}</ref> Screening tools designed for one culture's norms for behaviors like eye contact may be inappropriate for a different culture.<ref>{{cite journal | vauthors = Wallis KE, Pinto-Martin J | title = The challenge of screening for autism spectrum disorder in a culturally diverse society | journal = Acta Paediatrica | volume = 97 | issue = 5 | pages = 539–540 | date = May 2008 | pmid = 18373717 | doi = 10.1111/j.1651-2227.2008.00720.x | s2cid = 39744269 }}</ref> Although ] for autism is generally still impractical, it can be considered in some cases, such as children with neurological symptoms and ]s.<ref>{{cite journal | vauthors = Lintas C, Persico AM | title = Autistic phenotypes and genetic testing: state-of-the-art for the clinical geneticist | journal = Journal of Medical Genetics | volume = 46 | issue = 1 | pages = 1–8 | date = January 2009 | pmid = 18728070 | pmc = 2603481 | doi = 10.1136/jmg.2008.060871 }}</ref>

Some authors suggest that automatic motor assessment could be useful to screen the children with ASD<ref name="doi.org"/> for instance with behavioural motor and emotionals reactions during smartphone watching.<ref>{{cite journal | vauthors = Egger HL, Dawson G, Hashemi J, Carpenter KL, Espinosa S, Campbell K, Brotkin S, Schaich-Borg J, Qiu Q, Tepper M, Baker JP, Bloomfield RA, Sapiro G | display-authors = 6 | title = Automatic emotion and attention analysis of young children at home: a ResearchKit autism feasibility study | journal = NPJ Digital Medicine | volume = 1 | issue = 1 | pages = 20 | date = 2018-06-01 | pmid = 31304303 | doi = 10.1038/s41746-018-0024-6 | pmc = 6550157 }}</ref>

==Prevention==
While infection with ] during pregnancy causes fewer than 1% of cases of autism,<ref name=Duchan >{{cite journal | vauthors = Duchan E, Patel DR | title = Epidemiology of autism spectrum disorders | journal = Pediatric Clinics of North America | volume = 59 | issue = 1 | pages = 27–43, ix–x | date = February 2012 | pmid = 22284791 | doi = 10.1016/j.pcl.2011.10.003 }}</ref> ] can prevent many of those cases.<ref name="Lancet2015">{{cite journal | vauthors = Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA | title = Rubella | journal = Lancet | volume = 385 | issue = 9984 | pages = 2297–2307 | date = June 2015 | pmid = 25576992 | pmc = 4514442 | doi = 10.1016/S0140-6736(14)60539-0 }}</ref>

==Management==
{{Main|Autism therapies}}
]
The main goals when treating autistic children are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes.<ref name=":0"/><ref>{{cite journal | vauthors = Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S | 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 = 439–450 | date = May 2009 | pmid = 19437303 | doi = 10.1080/15374410902851739 | s2cid = 205873629 | citeseerx = 10.1.1.607.9620 }}</ref> No single treatment is best and treatment is typically tailored to the child's needs.<ref name="CCD2007">{{cite journal | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–1182 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free }}</ref> Families and the educational system are the main resources for treatment.<ref name=Lev2009/> Services should be carried out by ], ] teachers, ], and licensed ]. Studies of interventions have methodological problems that prevent definitive conclusions about ].<ref>{{cite journal | vauthors = Ospina MB, Krebs Seida J, Clark B, Karkhaneh M, Hartling L, Tjosvold L, Vandermeer B, Smith V | display-authors = 6 | title = Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review | journal = PLOS ONE | volume = 3 | issue = 11 | pages = e3755 | year = 2008 | pmid = 19015734 | pmc = 2582449 | doi = 10.1371/journal.pone.0003755 | doi-access = free | bibcode = 2008PLoSO...3.3755O }}</ref> However, the development of evidence-based interventions has advanced in recent years.<ref name=":0">{{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 = 2 November 2015 | pmid = 26430947 | doi = 10.1080/15374416.2015.1077448 | doi-access = free }}</ref> Although many ] interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of ]s of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.<ref>{{cite journal | vauthors = Seida JK, Ospina MB, Karkhaneh M, Hartling L, Smith V, Clark B | title = Systematic reviews of psychosocial interventions for autism: an umbrella review | journal = Developmental Medicine and Child Neurology | volume = 51 | issue = 2 | pages = 95–104 | date = February 2009 | pmid = 19191842 | doi = 10.1111/j.1469-8749.2008.03211.x | doi-access = free }}</ref> Intensive, sustained ] programs and behavior therapy early in life can help children acquire self-care, communication, and job skills,<ref name=CCD2007/> and often improve functioning and decrease symptom severity and maladaptive behaviors;<ref name="Rogers">{{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> claims that intervention by around age three years is crucial are not substantiated.<ref name="HowlinCharman">{{cite journal | vauthors = Howlin P, Magiati I, Charman T | title = Systematic review of early intensive behavioral interventions for children with autism | journal = American Journal on Intellectual and Developmental Disabilities | volume = 114 | issue = 1 | pages = 23–41 | date = January 2009 | pmid = 19143460 | doi = 10.1352/2009.114:23-41 }}</ref> While medications have not been found to help with core symptoms, they may be used for associated symptoms, such as irritability, inattention, or repetitive behavior patterns.<ref name=Ji2015>{{cite journal | vauthors = Ji N, Findling RL | title = An update on pharmacotherapy for autism spectrum disorder in children and adolescents | journal = Current Opinion in Psychiatry | volume = 28 | issue = 2 | pages = 91–101 | date = March 2015 | pmid = 25602248 | doi = 10.1097/YCO.0000000000000132 | s2cid = 206141453 }}</ref>

===Education===
Educational interventions often used include ] (ABA), developmental models, structured teaching, ], ] therapy, and ] and cognitive behavioral interventions in adults without intellectual disability to reduce depression, anxiety, and obsessive-compulsive disorder.<ref name=CCD2007/><ref name=":1">{{cite journal | vauthors = Benevides TW, Shore SM, Andresen ML, Caplan R, Cook B, Gassner DL, Erves JM, Hazlewood TM, King MC, Morgan L, Murphy LE, Purkis Y, Rankowski B, Rutledge SM, Welch SP, Wittig K | display-authors = 6 | title = Interventions to address health outcomes among autistic adults: A systematic review | journal = Autism | volume = 24 | issue = 6 | pages = 1345–1359 | date = August 2020 | pmid = 32390461 | pmc = 7787674 | doi = 10.1177/1362361320913664 | s2cid = 218586379 | doi-access = free }}</ref> Among these approaches, interventions either treat autistic features comprehensively, or focalize treatment on a specific area of deficit.<ref name=":0"/> The quality of research for early intensive behavioral intervention (EIBI)—a treatment procedure incorporating over thirty hours per week of the ] that is carried out with very young children—is currently low, and more vigorous research designs with larger sample sizes are needed.<ref>{{cite journal | vauthors = Reichow B, Hume K, Barton EE, Boyd BA | title = Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD) | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 10 | pages = CD009260 | date = May 2018 | pmid = 29742275 | pmc = 6494600 | doi = 10.1002/14651858.CD009260.pub3 }}</ref> Two theoretical frameworks outlined for early childhood intervention include ] and ] ABA interventions, and developmental social pragmatic models (DSP).<ref name=":0"/> One interventional strategy utilizes a parent training model, which teaches parents how to implement various ABA and DSP techniques, allowing for parents to disseminate interventions themselves.<ref name=":0"/> Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation. Despite the recent development of parent training models, these interventions have demonstrated effectiveness in numerous studies, being evaluated as a probable efficacious mode of treatment.<ref name=":0"/>
]'s code of practice on provision of autism services.]]

] has demonstrated effectiveness in enhancing communication and adaptive functioning in preschool children;<ref name=CCD2007/><ref name="Eikeseth">{{cite journal | vauthors = Eikeseth S | title = Outcome of comprehensive psycho-educational interventions for young children with autism | journal = Research in Developmental Disabilities | volume = 30 | issue = 1 | pages = 158–178 | year = 2009 | pmid = 18385012 | doi = 10.1016/j.ridd.2008.02.003 | citeseerx = 10.1.1.615.3336 }}</ref> it is also well-established for improving the intellectual performance of that age group.<ref name=CCD2007/><ref name=Rogers/><ref name="Eikeseth"/> Similarly, a teacher-implemented intervention that utilizes a more ] combined with a developmental social pragmatic approach has been found to be beneficial in improving social-communication skills in young children, although there is less evidence in its treatment of global symptoms.<ref name=":0"/> Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided.<ref name=Kanne/> It is not known whether treatment programs for children lead to significant improvements after the children grow up,<ref name=Rogers/> and the limited research on the effectiveness of adult residential programs shows mixed results.<ref>{{cite journal | vauthors = Van Bourgondien ME, Reichle NC, Schopler E | title = Effects of a model treatment approach on adults with autism | journal = Journal of Autism and Developmental Disorders | volume = 33 | issue = 2 | pages = 131–140 | date = April 2003 | pmid = 12757352 | doi = 10.1023/A:1022931224934 | s2cid = 30125359 }}</ref> The appropriateness of including children with varying severity of autism spectrum disorders in the general education population is a subject of current debate among educators and researchers.<ref>{{cite journal |journal=Topics in Language Disorders |year=2003 |volume=23 |issue=2 |pages=116–133 |title=Inclusion of Learners with Autism Spectrum Disorders in General Education Settings | vauthors = Simpson RL, de Boer-Ott SR, Smith-Myles B|s2cid=143733343 |url=http://www.nursingcenter.com/pdf.asp?AID=520301 |archive-url=https://web.archive.org/web/20110714215923/http://www.nursingcenter.com/pdf.asp?AID=520301 |archive-date=14 July 2011 |doi=10.1097/00011363-200304000-00005}}</ref>

===Medication===
Medications may be used to treat ASD symptoms that interfere with integrating a child into home or school when behavioral treatment fails.<ref name="San2016">{{cite journal | vauthors = Sanchack KE, Thomas CA | title = Autism Spectrum Disorder: Primary Care Principles | journal = American Family Physician | volume = 94 | issue = 12 | pages = 972–979 | date = December 2016 | pmid = 28075089 }}</ref> They may also be used for associated health problems, such as ] or ].<ref name=San2016/> More than half of US children diagnosed with ASD are prescribed ]s or ]s, with the most common drug classes being ]s, ]s, and ]s.<ref name="Oswald DP 2006">{{cite journal | vauthors = Oswald DP, Sonenklar NA | title = Medication use among children with autism spectrum disorders | journal = Journal of Child and Adolescent Psychopharmacology | volume = 17 | issue = 3 | pages = 348–355 | date = June 2007 | pmid = 17630868 | doi = 10.1089/cap.2006.17303 }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Doyle CA, McDougle CJ | title = Pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders across the lifespan | journal = Dialogues in Clinical Neuroscience | volume = 14 | issue = 3 | pages = 263–279 | date = September 2012 | pmid = 23226952 | pmc = 3513681 | doi = 10.31887/DCNS.2012.14.3/cdoyle }}</ref> The ] drugs ] and ] are ]-approved for treating associated aggressive and self-injurious behaviors.<ref name=Ji2015/><ref name=Rapin/><ref>{{cite journal | vauthors = Leskovec TJ, Rowles BM, Findling RL | title = Pharmacological treatment options for autism spectrum disorders in children and adolescents | journal = Harvard Review of Psychiatry | volume = 16 | issue = 2 | pages = 97–112 | year = 2008 | pmid = 18415882 | doi = 10.1080/10673220802075852 | s2cid = 26112061 }}</ref> However, their side effects must be weighed against their potential benefits, and autistic people may respond atypically.<ref name=Ji2015/> Side effects, for example, may include weight gain, tiredness, drooling, and aggression.<ref name=Ji2015/> ] antidepressants, such as ] and ], have been shown to be effective in reducing repetitive and ritualistic behaviors, while the stimulant medication ] is beneficial for some children with co-morbid inattentiveness or hyperactivity.<ref name=CCD2007/> There is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.{{medcn|date=February 2021}} No known medication relieves autism's core symptoms of social and communication impairments.{{medcn|date=February 2021}} Experiments in mice have reversed or reduced some symptoms related to autism by replacing or modulating gene function, suggesting the possibility of targeting therapies to specific rare mutations known to cause autism.<ref>{{cite journal | vauthors = Naviaux JC, Schuchbauer MA, Li K, Wang L, Risbrough VB, Powell SB, Naviaux RK | title = Reversal of autism-like behaviors and metabolism in adult mice with single-dose antipurinergic therapy | journal = Translational Psychiatry | volume = 4 | issue = 6 | pages = e400 | date = June 2014 | pmid = 24937094 | pmc = 4080315 | doi = 10.1038/tp.2014.33 }}</ref>

===Alternative medicine===
Although many ] are available, few are supported by scientific studies.<ref name=Sigman/> Treatment approaches have little empirical support in ] contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.<ref name=Burgess/> Some alternative treatments may place the child at risk. The preference that autistic children have for unconventional foods can lead to reduction in bone cortical thickness with this being greater in those on ]s, as a consequence of the low intake of ] and ]; however, suboptimal bone development in ASD has also been associated with lack of exercise and ].<ref name="TyeRunicles2018">{{cite journal | vauthors = Tye C, Runicles AK, Whitehouse AJ, Alvares GA | title = Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review | journal = Frontiers in Psychiatry | volume = 9 | pages = 751 | year = 2019 | pmid = 30733689 | pmc = 6354568 | doi = 10.3389/fpsyt.2018.00751 | doi-access = free | type = Review }}</ref> In 2005, botched ] killed a five-year-old child with autism.<ref name="pmid18775371">{{cite journal | vauthors = Levy SE, Hyman SL | title = Complementary and alternative medicine treatments for children with autism spectrum disorders | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 17 | issue = 4 | pages = 803–20, ix | date = October 2008 | pmid = 18775371 | pmc = 2597185 | doi = 10.1016/j.chc.2008.06.004 | type = Review }}</ref><ref>{{cite journal | vauthors = Brown MJ, Willis T, Omalu B, Leiker R | title = Deaths resulting from hypocalcemia after administration of edetate disodium: 2003-2005 | journal = Pediatrics | volume = 118 | issue = 2 | pages = e534–e536 | date = August 2006 | pmid = 16882789 | doi = 10.1542/peds.2006-0858 | url = http://pediatrics.aappublications.org/cgi/content/full/118/2/e534 | s2cid = 28656831 | archive-url = https://web.archive.org/web/20090727080307/http://pediatrics.aappublications.org/cgi/content/full/118/2/e534 | archive-date = 27 July 2009 }}</ref> Chelation is not recommended for autistic people since the associated risks outweigh any potential benefits.<ref name="JamesStevenson2015">{{cite journal | vauthors = James S, Stevenson SW, Silove N, Williams K | title = Chelation for autism spectrum disorder (ASD) | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD010766 | date = May 2015 | pmid = 26106752 | doi = 10.1002/14651858.CD010766 | veditors = James S | type = Review }}</ref> Another alternative medicine practice with no evidence is ], a mixture of ], supplements, and 'vaccine detoxing'.{{medcn|date=February 2021}}

Although popularly used as an ] for autistic people, {{as of|2018|lc=y}} there is no good evidence to recommend a ] as a standard treatment.<ref name="GogouKolios2018">{{cite journal | vauthors = Gogou M, Kolios G | title = Are therapeutic diets an emerging additional choice in autism spectrum disorder management? | journal = World Journal of Pediatrics | volume = 14 | issue = 3 | pages = 215–223 | date = June 2018 | pmid = 29846886 | doi = 10.1007/s12519-018-0164-4 | type = Review | s2cid = 44155118 | quote = Current literature knowledge provides evidence that ketogenic and casein/gluten-free diet may have their own place in our reserve for the therapeutic management of specific subsets of children with autism. ... More clinical studies about the effect of gluten/caseinfree diet in these patients are available. However, available data arise from studies with small sample size and are still controversial. In general, despite encouraging data, no definite proof still exists. Under this view, the use of therapeutic diets in children with autism should be restricted to specific subgroups, such as children with autism and epilepsy or specific inborn errors of metabolism ''(ketogenic diet)'', children with known food intolerance/allergy or even children with food intolerance markers (''gluten- and casein-free diet''). Their implementation should always be guided by health care practitioners. }}</ref><ref name="MariBausetZazpe">{{cite journal | vauthors = Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M | title = Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review | journal = Journal of Child Neurology | volume = 29 | issue = 12 | pages = 1718–1727 | date = December 2014 | pmid = 24789114 | doi = 10.1177/0883073814531330 | hdl-access = free | s2cid = 19874518 | hdl = 10171/37087 }}</ref><ref name="Millward2008">{{cite journal | vauthors = Millward C, Ferriter M, Calver S, Connell-Jones G | title = Gluten- and casein-free diets for autistic spectrum disorder | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003498 | date = April 2008 | pmid = 18425890 | pmc = 4164915 | doi = 10.1002/14651858.CD003498.pub3 | veditors = Ferriter M | quote = Knivsberg 2002 "monitoring of the compliance with diet was not carried out" (...) "several reports of children 'sneaking food' from siblings or classmates" }}</ref> A 2018 review concluded that it may be a therapeutic option for specific groups of children with autism, such as those with known ]s or ], or with food intolerance markers. The authors analyzed the prospective trials conducted to date that studied the efficacy of the gluten- and casein-free diet in children with ASD (4 in total). All of them compared gluten- and casein-free diet versus normal diet with a control group (2 double-blind randomized controlled trials, 1 double-blind crossover trial, 1 single-blind trial). In two of the studies, whose duration was 12 and 24 months, a significant improvement in ASD symptoms (efficacy rate 50%) was identified. In the other two studies, whose duration was 3 months, no significant effect was observed.<ref name="GogouKolios2018"/> The authors concluded that a longer duration of the diet may be necessary to achieve the improvement of the ASD symptoms.<ref name="GogouKolios2018"/> Other problems documented in the trials carried out include transgressions of the diet, small sample size, the heterogeneity of the participants and the possibility of a ] effect.<ref name = "Millward2008"/><ref name="HymanStewart2016">{{cite journal | vauthors = Hyman SL, Stewart PA, Foley J, Cain U, Peck R, Morris DD, Wang H, Smith T | display-authors = 6 | title = The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with Autism | journal = Journal of Autism and Developmental Disorders | volume = 46 | issue = 1 | pages = 205–220 | date = January 2016 | pmid = 26343026 | doi = 10.1007/s10803-015-2564-9 | quote = 20 natural challenges when parents reported that children by mistake consumed foods containing gluten or casein. | s2cid = 12884691 }}</ref> In the subset of people who have ] there is limited evidence that suggests that a ] may improve some autistic behaviors.<ref name="Buie">{{cite journal | vauthors = Buie T | title = The relationship of autism and gluten | journal = Clinical Therapeutics | volume = 35 | issue = 5 | pages = 578–583 | date = May 2013 | pmid = 23688532 | doi = 10.1016/j.clinthera.2013.04.011 | type = Review | quote = At this time, the studies attempting to treat symptoms of autism with diet have not been sufficient to support the general institution of a gluten-free or other diet for all children with autism. There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear. }}</ref><ref name="VoltaCaio">{{cite journal | vauthors = Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE | title = Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders | journal = Best Practice & Research. Clinical Gastroenterology | volume = 29 | issue = 3 | pages = 477–491 | date = June 2015 | pmid = 26060112 | doi = 10.1016/j.bpg.2015.04.006 | quote = autism spectrum disorders (ASD) have been hypothesized to be associated with NCGS . Notably, a gluten- and casein-free diet might have a positive effect in improving hyperactivity and mental confusion in some patients with ASD. This very exciting association between NCGS and ASD deserves further study before conclusions can be firmly drawn }}</ref><ref name="SanMauroGaricano">{{cite journal | vauthors = San Mauro Martín I, Garicano Vilar E, Collado Yurrutia L, Ciudad Cabañas MJ | title = | language = es | journal = Nutricion Hospitalaria | volume = 30 | issue = 6 | pages = 1203–1210 | date = December 2014 | pmid = 25433099 | doi = 10.3305/nh.2014.30.6.7866 | trans-title = Is gluten the great etiopathogenic agent of disease in the XXI century? }}</ref>

Results of a systematic review on interventions to address health outcomes among autistic adults found emerging evidence to support ]-based interventions for improving mental health. This includes decreasing stress, anxiety, ruminating thoughts, anger, and aggression.<ref name=":1" /> There is tentative evidence that ] may improve social interactions, verbal communication, and non-verbal communication skills.<ref name="Geretsegger2014">{{cite journal | vauthors = Geretsegger M, Elefant C, Mössler KA, Gold C | title = Music therapy for people with autism spectrum disorder | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD004381 | date = June 2014 | volume = 2016 | pmid = 24936966 | pmc = 6956617 | doi = 10.1002/14651858.CD004381.pub3 }}</ref> There has been early research looking at ]s in children with autism.<ref>{{cite report | title = Therapies for Children With Autism Spectrum Disorders | page = 8 | date = April 2011 | pmid = 21834171 | quote = Hyperbaric therapy, in which oxygen is administered in special chambers that maintain a higher air pressure, has shown possible effects in other chronic neurologic conditions and has also undergone preliminary exploration in ASDs. | publisher=Agency for Healthcare Research and Quality (US) |type=Report No. 11-EHC029-EF | url=https://www.ncbi.nlm.nih.gov/books/NBK56343/ | vauthors=Warren Z, Veenstra-VanderWeele J, Stone W, etal }}{{Update inline|date=May 2022|reason=There is a 2014 update to the report: https://www.ncbi.nlm.nih.gov/books/NBK241444/ (free to access)}}</ref> Studies on pet therapy have shown positive effects.<ref>{{cite journal | vauthors = Rumayor CB, Thrasher AM | title = Reflections on Recent Research Into Animal-Assisted Interventions in the Military and Beyond | journal = Current Psychiatry Reports | volume = 19 | issue = 12 | pages = 110 | date = November 2017 | pmid = 29177710 | doi = 10.1007/s11920-017-0861-z | s2cid = 207338873 }}</ref>

==Prognosis==
There is no known cure for autism.<ref name=CCD2007/><ref name=Lev2009/> The degree of symptoms can decrease, occasionally to the extent that people lose their diagnosis of ASD;<ref name="Helt2008">{{cite journal | vauthors = Helt M, Kelley E, Kinsbourne M, Pandey J, Boorstein H, Herbert M, Fein D | title = Can children with autism recover? If so, how? | journal = Neuropsychology Review | volume = 18 | issue = 4 | pages = 339–366 | date = December 2008 | pmid = 19009353 | doi = 10.1007/s11065-008-9075-9 | s2cid = 4317267 | citeseerx = 10.1.1.695.2995 }}</ref> this occurs sometimes after intensive treatment and sometimes not. It is not known how often this outcome happens;<ref name=Rogers/> reported rates in unselected samples have ranged from 3% to 25%.<ref name=Helt2008/> Most autistic children acquire language by age five or younger, though a few have developed communication skills in later years.<ref>{{cite journal | vauthors = Pickett E, Pullara O, O'Grady J, Gordon B | title = Speech acquisition in older nonverbal individuals with autism: a review of features, methods, and prognosis | journal = Cognitive and Behavioral Neurology | volume = 22 | issue = 1 | pages = 1–21 | date = March 2009 | pmid = 19372766 | doi = 10.1097/WNN.0b013e318190d185 | s2cid = 20196166 }}</ref> Many autistic children lack ], future employment opportunities or ].<ref name="Burgess">{{cite journal | vauthors = Burgess AF, Gutstein SE | title = Quality of Life for People with Autism: Raising the Standard for Evaluating Successful Outcomes | journal = Child and Adolescent Mental Health | volume = 12 | issue = 2 | pages = 80–86 | date = May 2007 | pmid = 32811109 | doi = 10.1111/j.1475-3588.2006.00432.x | url = http://kingwoodpsychology.com/recent_publications/camh_432.pdf | url-status = dead | access-date = 24 November 2013 | archive-url = https://web.archive.org/web/20131203011037/http://kingwoodpsychology.com/recent_publications/camh_432.pdf | archive-date = 3 December 2013 }}</ref> Although core difficulties tend to persist, symptoms often become less severe with age.<ref name=Rapin/>

Few high-quality studies address long-term ]. Some adults show modest improvement in communication skills, but a few decline; no study has focused on autism after midlife.<ref>{{cite journal | vauthors = Seltzer MM, Shattuck P, Abbeduto L, Greenberg JS | title = Trajectory of development in adolescents and adults with autism | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 10 | issue = 4 | pages = 234–247 | year = 2004 | pmid = 15666341 | doi = 10.1002/mrdd.20038 }}</ref> Acquiring language before age six, having an ] above 50, and having a marketable skill all predict better outcomes; ] is unlikely with severe autism.<ref>{{cite journal | vauthors = Tidmarsh L, Volkmar FR | title = Diagnosis and epidemiology of autism spectrum disorders | journal = Canadian Journal of Psychiatry | volume = 48 | issue = 8 | pages = 517–525 | date = September 2003 | pmid = 14574827 | doi = 10.1177/070674370304800803 | s2cid = 38070709 | doi-access = free }}</ref>

Many autistic people face significant obstacles in transitioning to adulthood.<ref>{{cite journal | vauthors = Hendricks DR, Wehman P | s2cid = 14636906 | title = Transition From School to Adulthood for Youth With Autism Spectrum Disorders: Review and Recommendations | journal = Focus on Autism and Other Developmental Disabilities | date = 24 March 2009 | volume = 24 | issue = 2 | pages = 77–88 | doi = 10.1177/1088357608329827}}</ref> Compared to the general population autistic people are more likely to be unemployed and to have never had a job. About half of people in their 20s with autism are not employed.<ref>{{cite web | vauthors = Roux AM, Rast JE, Rava JA, Anderson KA, Shattuck PT | date = 31 August 2015 | location = Philadelphia, PA | work = Life Course Outcomes Research Program, A.J. Drexel Autism Institute | publisher = Drexel University | title = Employment Outcomes of Young Adults on the Autism Spectrum | url = https://drexel.edu/autismoutcomes/publications-and-reports/publications/Employment-Outcomes-of-Young-Adults-on-the-Autism-Spectrum/ }}</ref>

Autistic people tend to face increased stress levels related to psychosocial factors, such as stigma, which may increase the rates of mental health issues in the autistic population.<ref>{{Cite journal| vauthors = Botha M, Frost DM |date=1 March 2020|title=Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population |journal=Society and Mental Health|language=en|volume=10|issue=1|pages=20–34 |doi=10.1177/2156869318804297 |s2cid=149984518 |url=http://dspace.stir.ac.uk/bitstream/1893/32030/1/Frost_Botha%20and%20Frost%202018.pdf}}</ref>

==Epidemiology==
{{Main|Epidemiology of autism}}
]

As of 2007, ]s estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per 1,000 for ASD.<ref name=News2007/> A 2016 survey in the United States reported a rate of 25 per 1,000 children for ASD.<ref>{{cite web | vauthors = Mozes A | date = 26 November 2018 |title=Report: Autism Rate Rises to 1 in 40 Children |url=https://www.webmd.com/brain/autism/news/20181126/report-autism-rate-rises-to-1-in-40-children |website=WebMD |access-date=26 September 2019 }}</ref> Globally, autism affects an estimated 24.8 million people {{as of|2015|lc=y}}, while Asperger syndrome affects a further 37.2 million.<ref name=GBD2015Pre/> In 2012, the ] estimated that the overall prevalence of autism among adults aged 18 years and over in the UK was 1.1%.<ref name=NHSEstimating>{{cite web |website= The Information Centre for Health and Social Care |publisher= National Health Service, UK |url= http://www.hscic.gov.uk/catalogue/PUB05061/esti-prev-auti-ext-07-psyc-morb-surv-rep.pdf |vauthors= Brugha T, Cooper SA, McManus S, Purdon S, Smith J, Scott FJ, Spiers N, Tyrer F | display-authors = 6 |title= Estimating the prevalence of autism spectrum conditions in adults: extending the 2007 Adult Psychiatric Morbidity Survey |date= 31 January 2012 |access-date= 29 December 2014 |url-status=dead |archive-url= https://web.archive.org/web/20141230033423/http://www.hscic.gov.uk/catalogue/PUB05061/esti-prev-auti-ext-07-psyc-morb-surv-rep.pdf |archive-date= 30 December 2014 |df= dmy-all }}</ref> Rates of ]'s has been estimated at 3.7 per 1,000, Asperger syndrome at roughly 0.6 per 1,000, and childhood disintegrative disorder at 0.02 per 1,000.<ref name="Fombonne-2009">{{cite journal | vauthors = Fombonne E | title = Epidemiology of pervasive developmental disorders | journal = Pediatric Research | volume = 65 | issue = 6 | pages = 591–598 | date = June 2009 | pmid = 19218885 | doi = 10.1203/PDR.0b013e31819e7203 | doi-access = free }}</ref> CDC estimates about 1 out of 59 (1.7%) for 2014, an increase from 1 out of every 68 children (1.5%) for 2010.<ref>{{cite web |title=Data and Statistics on Autism Spectrum Disorder |url=https://www.cdc.gov/ncbddd/autism/data.html |website=Centers for Disease Control and Prevention |access-date=7 March 2019 |date=15 November 2018}}</ref>

In the UK, from 1998 to 2018, the autism diagnoses increased by 787%.<ref name="Russell" /> This increase is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness<ref name=Fombonne-2009/><ref>{{cite journal | vauthors = Wing L, Potter D | title = The epidemiology of autistic spectrum disorders: is the prevalence rising? | journal = Mental Retardation and Developmental Disabilities Research Reviews | volume = 8 | issue = 3 | pages = 151–161 | year = 2002 | pmid = 12216059 | doi = 10.1002/mrdd.10029 }}</ref><ref>{{cite journal | vauthors = Gernsbacher MA, Dawson M, Goldsmith HH | title = Three Reasons Not to Believe in an Autism Epidemic | journal = Current Directions in Psychological Science | volume = 14 | issue = 2 | pages = 55–58 | date = April 2005 | pmid = 25404790 | pmc = 4232964 | doi = 10.1111/j.0963-7214.2005.00334.x }}</ref> (particularly among women),<ref name="Russell" /> though unidentified environmental factors cannot be ruled out.<ref name=Rut2005/> The available evidence does not rule out the possibility that autism's true prevalence has increased;<ref name=Fombonne-2009/> a real increase would suggest directing more attention and funding toward psychosocial factors and changing environmental factors instead of continuing to focus on genetics.<ref name="Szpir">{{cite journal | vauthors = Szpir M | title = Tracing the origins of autism: a spectrum of new studies | journal = Environmental Health Perspectives | volume = 114 | issue = 7 | pages = A412–A418 | date = July 2006 | pmid = 16835042 | pmc = 1513312 | doi = 10.1289/ehp.114-a412 }}</ref> Vaccination does not cause autism and is not behind any increase in autism prevalence rates, if any change in the rate of autism exists at all.<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 = 3623–3629 | date = June 2014 | pmid = 24814559 | doi = 10.1016/j.vaccine.2014.04.085 }}</ref>

Males have higher likelihood of being diagnosed with ASD than females. The sex ratio averages 4.3:1 and is greatly modified by cognitive impairment: it may be close to 2:1 with intellectual disability and more than 5.5:1 without.<ref name="News2007"/>{{obsolete source|date=September 2021}} ] about the higher prevalence in males have been investigated, but the cause of the difference is unconfirmed;<ref name="Chaste">{{cite journal | vauthors = Chaste P, Leboyer M | title = Autism risk factors: genes, environment, and gene-environment interactions | journal = Dialogues in Clinical Neuroscience | volume = 14 | issue = 3 | pages = 281–292 | date = September 2012 | pmid = 23226953 | pmc = 3513682 | doi = 10.31887/DCNS.2012.14.3/pchaste }}</ref> one theory is that females are underdiagnosed.<ref>{{cite journal | vauthors = Schaafsma SM, Pfaff DW | title = Etiologies underlying sex differences in Autism Spectrum Disorders | journal = Frontiers in Neuroendocrinology | volume = 35 | issue = 3 | pages = 255–71 | date = August 2014 | pmid = 24705124 | doi = 10.1016/j.yfrne.2014.03.006 | s2cid = 7636860 }}</ref>
Although the evidence does not implicate any single pregnancy-related factor as a cause of autism, the likelihood of an autism diagnosis is associated with advanced age in either parent, and with diabetes, bleeding, and use of psychiatric drugs in the mother during pregnancy.<ref name=Chaste/><ref>{{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> The likelihood is greater with older fathers than with older mothers; two potential explanations are the known increase in mutation burden in older sperm, and the hypothesis that men marry later if they carry genetic liability and show some signs of autism.<ref name="Geschwind">{{cite journal | vauthors = Geschwind DH | title = Autism: many genes, common pathways? | journal = Cell | volume = 135 | issue = 3 | pages = 391–395 | date = October 2008 | pmid = 18984147 | pmc = 2756410 | doi = 10.1016/j.cell.2008.10.016 }}</ref> Most professionals believe that race, ethnicity, and socioeconomic background do not affect the occurrence of autism.<ref>{{cite journal | vauthors = Bertoglio K, Hendren RL | title = New developments in autism | journal = The Psychiatric Clinics of North America | volume = 32 | issue = 1 | pages = 1–14 | date = March 2009 | pmid = 19248913 | doi = 10.1016/j.psc.2008.10.004 }}</ref>

Several other conditions are common in children with autism.<ref name=Lev2009/> They include:
* ''']s'''. About 10–15% of autism cases have an identifiable ] (single-gene) condition, ], or other genetic syndrome,<ref>{{cite journal | vauthors = Folstein SE, Rosen-Sheidley B | title = Genetics of autism: complex aetiology for a heterogeneous disorder | journal = Nature Reviews. Genetics | volume = 2 | issue = 12 | pages = 943–955 | date = December 2001 | pmid = 11733747 | doi = 10.1038/35103559 | s2cid = 9331084 }}</ref> and ASD is associated with several genetic disorders.<ref>{{cite journal | vauthors = Zafeiriou DI, Ververi A, Vargiami E | title = Childhood autism and associated comorbidities | journal = Brain & Development | volume = 29 | issue = 5 | pages = 257–272 | date = June 2007 | pmid = 17084999 | doi = 10.1016/j.braindev.2006.09.003 | s2cid = 16386209 }}</ref>
* ''']'''. The percentage of autistic individuals who also meet criteria for intellectual disability has been reported as anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing ].<ref>{{cite book |chapter=Learning in autism |vauthors=Dawson M, Mottron L, Gernsbacher MA |title=Learning and Memory: A Comprehensive Reference |volume=2 |pages=759–772 |veditors=Byrne JH, Roediger HL |publisher=] |year=2008 |doi=10.1016/B978-012370509-9.00152-2 |isbn=978-0-12-370504-4 |oclc=775005136 |chapter-url=http://psych.wisc.edu/lang/pdf/Dawson_AutisticLearning.pdf |access-date=26 July 2008 |archive-url=https://web.archive.org/web/20120303191513/http://psych.wisc.edu/lang/pdf/Dawson_AutisticLearning.pdf |archive-date=3 March 2012}}</ref> In comparison, for PDD-NOS the association with intellectual disability is much weaker,<ref>{{cite journal | vauthors = Chakrabarti S, Fombonne E | title = Pervasive developmental disorders in preschool children | journal = JAMA | volume = 285 | issue = 24 | pages = 3093–3099 | date = June 2001 | pmid = 11427137 | doi = 10.1001/jama.285.24.3093 | doi-access = free }}</ref> and by definition, the diagnosis of Asperger's excludes intellectual disability.<ref>{{cite book | title=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) | publisher=American Psychiatric Association |place=Washington, D.C. | year=2000 | page=80}}</ref>
* ''']s''' are common among children with ASD; there are no firm data, but studies have reported prevalences ranging from 11% to 84%. Many anxiety disorders have symptoms that are better explained by ASD itself, or are hard to distinguish from ASD's symptoms.<ref>{{cite journal | vauthors = White SW, Oswald D, Ollendick T, Scahill L | title = Anxiety in children and adolescents with autism spectrum disorders | journal = Clinical Psychology Review | volume = 29 | issue = 3 | pages = 216–229 | date = April 2009 | pmid = 19223098 | pmc = 2692135 | doi = 10.1016/j.cpr.2009.01.003 }}</ref>
* ''']''', with variations in likelihood of epilepsy due to age, cognitive level, and type of ].<ref>{{cite journal | vauthors = Spence SJ, Schneider MT | title = The role of epilepsy and epileptiform EEGs in autism spectrum disorders | journal = Pediatric Research | volume = 65 | issue = 6 | pages = 599–606 | date = June 2009 | pmid = 19454962 | pmc = 2692092 | doi = 10.1203/PDR.0b013e31819e7168 }}</ref>
* Several ''']s''', such as ], are associated with autistic symptoms.<ref name="Manzi">{{cite journal | vauthors = Manzi B, Loizzo AL, Giana G, Curatolo P | title = Autism and metabolic diseases | journal = Journal of Child Neurology | volume = 23 | issue = 3 | pages = 307–314 | date = March 2008 | pmid = 18079313 | doi = 10.1177/0883073807308698 | s2cid = 30809774 }}</ref>
* ''']''' are significantly increased in the autistic population.<ref>{{cite journal | vauthors = Ozgen HM, Hop JW, Hox JJ, Beemer FA, van Engeland H | title = Minor physical anomalies in autism: a meta-analysis | journal = Molecular Psychiatry | volume = 15 | issue = 3 | pages = 300–307 | date = March 2010 | pmid = 18626481 | doi = 10.1038/mp.2008.75 | doi-access = free }}</ref>
* '''Preempted diagnoses'''. Although the DSM-IV rules out the concurrent diagnosis of many other conditions along with autism, the full criteria for ] (ADHD), ], and other of these conditions are often present and these ] are increasingly accepted.{{medcn|date=February 2021}}
* '''Sleep problems''' affect about two-thirds of individuals with ASD at some point in childhood. These most commonly include symptoms of ] such as difficulty in falling asleep, frequent ], and early morning awakenings. Sleep problems are associated with difficult behaviors and family stress, and are often a focus of clinical attention over and above the primary ASD diagnosis.<ref>{{cite journal | vauthors = Richdale AL, Schreck KA | title = Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies | journal = Sleep Medicine Reviews | volume = 13 | issue = 6 | pages = 403–411 | date = December 2009 | pmid = 19398354 | doi = 10.1016/j.smrv.2009.02.003 }}</ref>

==History==
{{Further|History of Asperger syndrome}}
], a ] caught in 1798 who displayed possible symptoms of autism<ref name="Wolff"/>]]

A few examples of autistic symptoms and treatments were described long before autism was named. The '']'' of ], compiled by his notetaker, Mathesius, contains the story of a 12-year-old boy who may have been severely autistic.<ref>{{cite journal |journal=Autism |volume=1 |issue=1 |pages=13–23 |year=1997 |doi=10.1177/1362361397011004 |title=The history of ideas on autism: legends, myths and reality | vauthors = Wing L |s2cid=145210370 | author-link1 = Lorna Wing}}</ref> The earliest well-documented case of autism is that of ], as detailed in a 1747 court case in which his brother successfully petitioned to annul Blair's marriage to gain Blair's inheritance.<ref>{{cite book |vauthors=Houston RA, Frith U |title=Autism in History: The Case of Hugh Blair of Borgue |year=2000 |publisher=] |location=Oxford |isbn=978-0-631-22089-3 |oclc=231866075 |lccn=00036033}}</ref> The ], a ] caught in 1798, showed several signs of autism; the medical student ] treated him with a behavioral program designed to help him form social attachments and to induce speech via imitation.<ref name="Wolff">{{cite journal | vauthors = Wolff S | title = The history of autism | journal = European Child & Adolescent Psychiatry | volume = 13 | issue = 4 | pages = 201–208 | date = August 2004 | pmid = 15365889 | doi = 10.1007/s00787-004-0363-5 | s2cid = 6106042 }}</ref>

The ] word ''autismus'' (English translation ''autism'') was coined by the ] psychiatrist ] in 1910 as he was defining symptoms of ]. He derived it from the Greek word ''autós'' (αὐτός, meaning "self"), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".<ref>{{cite journal | vauthors = Kuhn R | title = Eugen Bleuler's concepts of psychopathology | journal = History of Psychiatry | volume = 15 | issue = 59 Pt 3 | pages = 361–366 | date = September 2004 | pmid = 15386868 | doi = 10.1177/0957154X04044603 | s2cid = 5317716 }} The quote is a translation of Bleuler's 1910 original.</ref> A Soviet child psychiatrist, ], described a similar syndrome that was published in Russian in 1925, and in German in 1926.<ref>{{cite journal | vauthors = Manouilenko I, Bejerot S | title = Sukhareva--Prior to Asperger and Kanner | journal = Nordic Journal of Psychiatry | volume = 69 | issue = 6 | pages = 479–482 | date = August 2015 | pmid = 25826582 | doi = 10.3109/08039488.2015.1005022 | s2cid = 207473133 | url = http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-47358 | publication-date = 31 March 2015 | type = Report }}</ref>

=== Clinical development and diagnoses ===
] introduced the label ''early infantile autism'' in 1943.]]

The word ''autism'' first took its modern sense in 1938 when ] of the ] adopted Bleuler's terminology ''autistic psychopaths'' in a lecture in German about ].<ref>{{cite journal | journal=Wien Klin Wochenschr |year=1938 |volume=51 |pages=1314–1317 | title = Das psychisch abnormale Kind |trans-title=The psychically abnormal child | vauthors = Asperger H | author-link1 = Hans Asperger | language=de}}</ref> Asperger was investigating an ASD now known as ], though for various reasons it was not widely recognized as a separate diagnosis until 1981.<ref name="Wolff"/> ] of the ] first used ''autism'' in its modern sense in English when he introduced the label ''early infantile autism'' in a 1943 report of 11 children with striking behavioral similarities.<ref name="Kanner1943">{{cite journal | vauthors = Kanner L | title = Autistic disturbances of affective contact | journal = Acta Paedopsychiatrica | volume = 35 | issue = 4 | pages = 100–136 | year = 1943 | pmid = 4880460 | author-link1 = Leo Kanner }} Reprinted in {{cite journal | vauthors = Kanner L | title = Autistic disturbances of affective contact | journal = Acta Paedopsychiatrica | volume = 35 | issue = 4 | pages = 100–136 | year = 1968 | pmid = 4880460 }}</ref> Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders.<ref name="HappeTime"/> It is not known whether Kanner derived the term independently of Asperger.<ref name="Lyons">{{cite journal | vauthors = Lyons V, Fitzgerald M | title = Asperger (1906-1980) and Kanner (1894-1981), the two pioneers of autism | journal = Journal of Autism and Developmental Disorders | volume = 37 | issue = 10 | pages = 2022–2023 | date = November 2007 | pmid = 17922179 | doi = 10.1007/s10803-007-0383-3 | s2cid = 38130758 }}</ref>

Kanner's reuse of ''autism'' led to decades of confused terminology like ''infantile schizophrenia'', and child psychiatry's focus on maternal deprivation led to misconceptions of autism as an infant's response to "]s". Starting in the late 1960s autism was established as a separate syndrome.<ref>{{cite journal | vauthors = Fombonne E | title = Modern views of autism | journal = Canadian Journal of Psychiatry | volume = 48 | issue = 8 | pages = 503–505 | date = September 2003 | pmid = 14574825 | doi = 10.1177/070674370304800801 | s2cid = 8868418 | doi-access = free }}</ref>

=== Terminology and distinction from schizophrenia ===
As late as the mid-1970s there was little evidence of a genetic role in autism, while in 2007 it was believed to be one of the most heritable psychiatric conditions.<ref>{{cite book |chapter=Genetic epidemiology of autism spectrum disorders | vauthors = Szatmari P, Jones MB | author-link1 = Peter Szatmari | pages=157–178 |title=Autism and Pervasive Developmental Disorders |edition=2nd | veditors = Volkmar FR |publisher=Cambridge University Press |year=2007 |isbn=978-0-521-54957-8}}</ref> Although the rise of parent organizations and the destigmatization of childhood ASD have affected how ASD is viewed,<ref name="Wolff"/> parents continue to feel ] in situations where their child's autistic behavior is perceived negatively,<ref>{{cite journal | vauthors = Chambres P, Auxiette C, Vansingle C, Gil S | title = Adult attitudes toward behaviors of a six-year-old boy with autism | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 7 | pages = 1320–1327 | date = August 2008 | pmid = 18297387 | doi = 10.1007/s10803-007-0519-5 | s2cid = 19769173 }}</ref> and many ]s and ]s express some beliefs consistent with outdated autism research.<ref>{{cite journal | vauthors = Heidgerken AD, Geffken G, Modi A, Frakey L | title = A survey of autism knowledge in a health care setting | journal = Journal of Autism and Developmental Disorders | volume = 35 | issue = 3 | pages = 323–330 | date = June 2005 | pmid = 16119473 | doi = 10.1007/s10803-005-3298-x | s2cid = 2015723 }}</ref>

It took until 1980 for the ] to differentiate autism from childhood schizophrenia. In 1987, the ] provided a checklist for diagnosing autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, autism, Asperger syndrome, Rett syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorders. The two categories that exist are impaired social communication and/or interaction, and restricted and/or repetitive behaviors.<ref>{{cite journal | vauthors = Baker JP | title = Autism at 70--redrawing the boundaries | journal = The New England Journal of Medicine | volume = 369 | issue = 12 | pages = 1089–1091 | date = September 2013 | pmid = 24047057 | doi = 10.1056/NEJMp1306380 | url = http://pdfs.semanticscholar.org/daf7/ff077eb74aa9a1afdc70c101581e1b128ca3.pdf | url-status = dead | s2cid = 44613078 | archive-url = https://web.archive.org/web/20190307045533/http://pdfs.semanticscholar.org/daf7/ff077eb74aa9a1afdc70c101581e1b128ca3.pdf | archive-date = 3 March 2019 }}</ref>

The Internet has helped autistic individuals bypass nonverbal cues and emotional sharing that they find difficult to deal with, and has given them a way to form online communities and work remotely.<ref>{{cite journal | vauthors = Biever C | title = Web removes social barriers for those with autism |journal=New Scientist |issue=2610 |pages=26–27 |year=2007 |url=https://www.newscientist.com/article/mg19426106.100 |archive-url=https://web.archive.org/web/20121020165135/http://www.newscientist.com/article/mg19426106.100 |archive-date=20 October 2012}}</ref> ] have developed: some in the community seek a cure, while others believe that ]<ref name=Sil2008/><ref>{{cite news |vauthors=Harmon A |title=How about not 'curing' us, some autistics are pleading |date=20 December 2004 |work=The New York Times |url=https://www.nytimes.com/2004/12/20/health/20autism.html |archive-url=https://web.archive.org/web/20130511002649/http://www.nytimes.com/2004/12/20/health/20autism.html |archive-date=11 May 2013}}</ref>

==Society and culture==
{{Main|Societal and cultural aspects of autism}}
{{multiple image
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An autistic culture has emerged, accompanied by the ] and ] movements.<ref>{{cite web| vauthors = Shapiro J | title = Autism Movement Seeks Acceptance, Not Cures| publisher = NPR| access-date = 10 November 2015 | date = 26 June 2006 | url = https://www.npr.org/templates/story/story.php?storyId=5488463}}</ref><ref>{{cite web| vauthors = Trivedi B | title = Autistic and proud of it| website = New Scientist| access-date = 10 November 2015 | url = https://www.newscientist.com/article/mg18625041-500-autistic-and-proud-of-it/}}</ref><ref name="Solomon">{{cite news |work=New York |title=The autism rights movement | vauthors = Solomon A |date=25 May 2008 |access-date=27 May 2008 |url=https://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><ref>{{Cite book |title=The Economic World |publisher=Chronicle Publishing Company |year=1917 |location=New York city |pages=366}}</ref> Events include ], ], ], ], and others.<ref>{{cite web| title = World Autism Awareness Day, 2 April| publisher = United Nations| access-date = 17 November 2015 | url = https://www.un.org/en/events/autismday/}}</ref><ref>{{cite web| vauthors = Bascom J | title = Autistic Pride Day 2015: A Message to the Autistic Community| access-date = 18 November 2015 | date = 18 June 2015 | url = http://autisticadvocacy.org/2015/06/autistic-pride-day-2015-a-message-to-the-autistic-community/}}</ref><ref>{{cite web| title = Autism Sunday – Home| website = Autism Sunday| access-date = 17 November 2015| year = 2010| url = http://www.autismsunday.co.uk/| archive-url = https://web.archive.org/web/20100303043146/http://www.autismsunday.co.uk/| url-status=dead| archive-date = 3 March 2010}}</ref><ref>{{cite web| title = About Autreat| publisher = Autreat.com| access-date = 17 November 2015 |year = 2013| url = http://www.autreat.com/autreat.html}}</ref> Social-science scholars study those with autism in hopes to learn more about "autism as a culture, transcultural comparisons&nbsp;... and research on social movements."<ref>{{cite journal| vauthors = Silverman C |s2cid=145379758 |title=Fieldwork on Another Planet: Social Science Perspectives on the Autism Spectrum|journal=BioSocieties|volume=3|issue=3|year=2008|pages=325–341|issn=1745-8552|doi=10.1017/S1745855208006236}}</ref> Many autistic individuals have been successful in their fields.<ref>{{cite web| title = Famous People With Autism Spectrum Disorder: Autistic Celebrities (List)| website = Mental Health Daily| access-date = 18 November 2015 | url = http://mentalhealthdaily.com/2015/09/19/famous-people-with-autism-spectrum-disorder-autistic-celebrities-list/| date = 19 September 2015}}</ref>{{Better source needed|date=May 2022}}

=== Autism rights movement ===
The ] is a ] within the context of ]s that emphasizes the concept of ], viewing the autism spectrum as a result of natural variations in the ] 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 on imitating the behaviors of those without autism, and the recognition of the autistic community as a ].<ref name= Jaarsma2012>{{cite journal | vauthors = Jaarsma P, Welin S | 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 | s2cid = 18618887 | 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 ]. This perspective is distinct from ] that autism is caused by environmental factors such as ]s.<ref name="Solomon"/> A common criticism against autistic activists is that the majority of them are "]" or have Asperger syndrome and do not represent the views of "]" autistic people.<ref name= Jaarsma2012/>

===Employment===
About half of autistic people 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 | year = 2017 | pmid = 28211841 | doi = 10.3233/WOR-172492 | url = http://pdfs.semanticscholar.org/f4e8/c8416f505308e26600c26eb88cea0b264e48.pdf | url-status = dead | s2cid = 3749575 | archive-url = https://web.archive.org/web/20201120114006/http://pdfs.semanticscholar.org/f4e8/c8416f505308e26600c26eb88cea0b264e48.pdf | archive-date = 20 November 2020 }}</ref> Among those who find work in the United States, most are employed in sheltered settings working for wages below the national minimum.<ref>{{cite news | vauthors = DePillis L |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 |newspaper=The Washington Post|date=12 February 2016}}</ref> While employers state hiring concerns about productivity and supervision, experienced employers of autistic people 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 decreased earnings 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 = 343–349 | date = April 2007 | pmid = 17404130 | doi = 10.1001/archpedi.161.4.343 | 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 | title = Association of childhood autism spectrum disorders and loss of family income | journal = Pediatrics | volume = 121 | issue = 4 | pages = e821–e826 | date = April 2008 | pmid = 18381511 | doi = 10.1542/peds.2007-1594 | url = http://pediatrics.aappublications.org/cgi/content/full/121/4/e821 | s2cid = 55179 | 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–e208 | date = July 2008 | pmid = 18595965 | doi = 10.1542/peds.2007-3037 | url = http://pediatrics.aappublications.org/cgi/content/full/122/1/e202 | s2cid = 22686553 | archive-url = https://web.archive.org/web/20091206190622/http://pediatrics.aappublications.org/cgi/content/full/122/1/e202 | archive-date = 6 December 2009 }}</ref>

== References ==
{{Reflist}}

== External links ==
{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Autism}}


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| ICD9 = {{ICD9|299.00}}
{{R from move}}
| OMIM = 209850
| MedlinePlus = 001526
| eMedicineSubj = med
| eMedicineTopic = 3202
| eMedicine_mult = {{eMedicine2|ped|180}}
| MeshID = D001321
| GeneReviewsNBK = NBK1442
| GeneReviewsName = Autism overview
| ICD11={{ICD11|6A02}}
| Curlie=Health/Mental_Health/Disorders/Neurodevelopmental/Autism_Spectrum
}} }}
{{Subject bar|c=y|b=y|q=y|d=Q38404|n=Category:Autism|wikt=autism}}
{{Pervasive developmental disorders}}
{{Mental and behavioral disorders|selected = childhood}}
{{Autism resources}}
{{Nonverbal communication}}
{{Authority control}}


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Latest revision as of 16:13, 26 May 2024

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