Introduction
Neurodevelopmental disorders that manifest early in life are devastating for affected children and their caregivers. For example, Autism Spectrum Disorders (ASD) impairs the normal ability to form social bonds (Barlow et al., 2018). Three defining characteristics must be present to establish an ASD diagnosis: poor nonverbal communication, restrictive and repetitive behavior, and inability to initiate social relationships (Barlow et al., 2018). Some authors state that abnormal brain development in these children is caused by the dysregulation of gene expression patterns in cell differentiation (Khundrakpam et al., 2017).
For instance, the neuroimaging study showed that 1100 subjects with ASD had an increased neocortex thickness (Khundrakpam et al., 2017). Other hypotheses suggest that it is caused by environmental toxins and paternal age (Taylor et al., 2020). Still, despite multiple theories, the exact etiology of ASD remains elusive. Moreover, this disease does not have any definitive treatment; thus, many patients have symptoms that require special attention and complex care later in life. Therefore, this paper aims to discuss the clinical presentation of ASD, ordinary skills disrupted by it, and treatment options at three stages of life: childhood, adolescence, and adulthood.
Childhood: Presentation, Normal Performance Disrupted, and Possible Treatment
Although ASD first presents in childhood, it is challenging to recognize it at the early stages of development. One of the defining characteristics of this neurodevelopmental disorder is a context-dependent repetitive behavior that increases after the age of four when it usually should disappear (Berry et al., 2018). The recent guidelines describe four types of restrictive and repetitive actions in ASD patients: stereotyped movements or speech, adherence to ritualized patterns, narrow interests, and abnormal focus on sensations (Berry et al., 2018). Still, the severity of these patterns present in children with ASD seems to decrease with age.
The normal functioning affected in these patients is social interaction skills. Children with autism have no interest in playing with peers and rarely express affection to their caregivers (Barlow et al., 2018). Furthermore, their nonverbal communication abilities are below expected at a specific age, negatively impacting a child’s performance in social circumstances because many of them have difficulty in language acquisition. Moreover, the intellectual development of ASD children can be affected, making those with lower IQ need more assistance in the future compared to their counterparts with higher IQ scores (Barlow et al., 2018). Indeed, less severe forms of ASD may function normally later in life, provided if they had proper training and support during childhood.
Although there is no standard treatment protocol for ASD patients, some interventions were effective at minimizing the disease manifestation. For example, the first person to start teaching toddlers with ASD how to speak was Ivar Lovaas, who began his work in the 1960s (Barlow et al., 2018). Furthermore, less severe forms of this disorder were found to have good academic performance if they had proper psychological support and training (Barlow et al., 2018). However, pharmacological treatment did not show any efficacy because of the complexity of involved biochemical pathways. Overall, the current approach that reduces social withdrawal in ASD children is an early psychosocial intervention that should be individually adjusted based on the severity of symptoms.
Adolescence: Presentation, Normal Performance Disrupted, and Possible Treatment
Considering the intricacy of ASD etiology, clinical presentation, and treatment, the transition from childhood to adolescence can be challenging for patients with autism. According to Harris et al. (2021), most ASD youth have comorbid conditions for which they are prescribed one or more medications. For example, they may have gastrointestinal issues, seizures, mood disorders, and metabolic or cardiovascular problems (Harris et al., 2021). Furthermore, adolescents with autism were reported to have a higher risk of substance use and suicidal behavior (Harris et al., 2021). Thus, teenagers with ASD need special assistance in helping them adjust to social circumstances.
This age group’s lack of proper communication skills can affect their socialization, resulting in bullying from peers, depression, and anxiety. A tendency to adhere to repetitive behavior makes them incapable of adapting to a new environment (Barlow et al., 2018). Therefore, these children require a personalized approach when being transferred from pediatric to adult care. Specifically, parents and healthcare practitioners should discuss various aspects of adolescent life with these children to help them understand social norms and behaviors. For example, Harris et al. (2021) developed a unique program to assist teenagers in moving from pediatric care to adulthood.
The primary suggestions of these guidelines include discussing hygiene and sexuality, social skills, further education, employment, and other plans for adult life (Harris et al., 2021). Furthermore, the transition process incorporates complete physical and mental examination, reviewing health insurance plans, and guardianship (Harris et al., 2021). Every ASD child is unique because patients may have distinct backgrounds and levels of development; thus, clinicians and social workers ought to treat every case differently.
Adulthood: Presentation, Normal Performance Disrupted, and Possible Treatment
ASD in adulthood can be devastating because of the loss of help and support. The prevalence of this disorder is increasing in the United States, leading to high nonmedical and healthcare costs that are expected to reach almost $500 billion in 2025 (Howlin & Magiati, 2017).
Although the clinical presentation of ASD in adults diverges from childhood symptoms, research shows that many patients with autism remain socially isolated and dependent on someone later in life (Howlin & Magiati, 2017). Still, the U.S. follow-up studies demonstrated a significant improvement in verbal and nonverbal communication skills, social reciprocity, and stereotypical behavior in ASD patients over time (Howlin & Magiati, 2017). Nevertheless, it appears that the outcome of this disorder is dependent on such factors as mental health, family environment, intellectual abilities, and symptoms severity.
Therapeutic intervention in adulthood is a complicated topic because aging is usually associated with reduced brain plasticity. Despite some cognitive skills such as attention, verbal memory, and planning decline in ASD, working and visual memory are less affected by age in people with autism (Howlin & Magiati, 2017). It seems that adults with ASD need, on average, less attention and support than youth. Still, healthcare workers should always consider the peculiarities of these patients.
Conclusion
In summary, Autism Spectrum disorder is a complex neurodevelopmental condition that manifests in early childhood and persists later in life. The exact etiology of this disease is unknown, but various studies suggest genetic and environmental components. The clinical presentation of ASD may vary, but the standard diagnostic criteria include stereotypical behavior, lack of interest and skills in social interaction, and poor nonverbal communication abilities. Unfortunately, there is no definitive treatment for these patients; thus, early psychosocial intervention remains the most effective method to teach children fundamental social skills and minimize their isolation. Finally, transitioning from pediatric to adult care is essential to help ASD patients adapt to a new environment in the future.
References
Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2018). Abnormal Psychology: An integrative approach (8th ed.). Cengage Learning.
Berry, K., Russell, K., & Frost, K. (2018). Restricted and repetitive behaviors in autism spectrum disorder: A review of associated features and presentation across clinical populations. Current Developmental Disorders Reports, 5(2), 108-115. Web.
Harris, J. F., Gorman, L. P., Doshi, A., Swope, S., & Page, S. D. (2021). Development and implementation of health care transition resources for youth with autism spectrum disorders within a primary care medical home. Autism, 25(3), 753-766. Web.
Howlin, P., & Magiati, I. (2017). Autism spectrum disorder: Outcomes in adulthood. Current Opinion in Psychiatry, 30(2), 69-76. Web.
Khundrakpam, B. S., Lewis, J. D., Kostopoulos, P., Carbonell, F., & Evans, A. C. (2017). Cortical thickness abnormalities in autism spectrum disorders through late childhood, adolescence, and adulthood: A large-scale MRI study. Cerebral Cortex, 27(3), 1721-1731. Web.
Taylor, M. J., Rosenqvist, M. A., Larsson, H., Gillberg, C., D’Onofrio, B. M., Lichtenstein, P., & Lundström, S. (2020). Etiology of autism spectrum disorders and autistic traits over time. JAMA Psychiatry, 77(9), 936-943.