All about autism

Posted on 1 April 2023

There’s a reason autism is also referred to as autism spectrum condition (ASC), autism spectrum disorder (ASD) or even “being on the spectrum”. That’s because one case of autism has little in common with the next. Here’s everything you need to know ahead of World Autism Day. 

How common is autism? 

The global prevalence of autism stands at one in every 54 births, says Dr Michele van Niekerk, a pediatrician at Mediclinic Hermanus with a special interest in neurodiversity.  

Dr van Niekerk explains that diagnostic criteria for autism were adjusted in the American Psychiatric Association’s 5th Diagnostic and Statistical Manual, which classifies mental health conditions. “As a result, conditions like Asperger’s and pervasive developmental disorder (PDD), which were previously considered to be different types of autism, are no longer classified separately or even used as diagnostic terms. They are all, simply, autism.” 

That said, the severity of autism cases may vary considerably, according to level of function. “Level 3 is the most severe, requiring substantial support,” Dr van Niekerk notes. 

Could my child be autistic? 

As a neurobiological condition, autism is present at birth. However, as children grow and develop, they may encounter new challenges.  

“Autism typically manifests as a social and communication disorder, because individuals have difficulty with language as well as non-verbal communication in social situations,” Dr van Niekerk says. While language development may be delayed, in some cases it’s very advanced. But at the same time, autistic individuals struggle to understand what other people mean when they’re talking. “This can lead to frustration, as they don’t know what other people expect of them and misunderstandings are common,” she says.  

It’s not unusual for autistic individuals to misread social cues, and they may respond inappropriately in social situations; disregarding personal space, for instance, or making inappropriate eye contact. They may also be very literal in their interpretation of situations and fail to understand the context or “bigger picture” of a situation. 

 

Dr Van Niekerk says additional diagnostic criteria include an insistence on rigid routines, inflexibility, and a dislike of change, especially unexpected change. “There’s a distinct preference for sameness, which helps to comfort and ground individuals – change can make them feel anxious and distressed,” she notes. In fact, unexpected change can lead to severe emotional dysregulation, including meltdowns, shutdowns or extreme behavioural disturbance. “These reactions are due to the hypersensitivity of an autistic brain. Individuals on the spectrum tend to be overanxious and are often in a constant state of fight or flight.”  

Other indicators include fixations, and a tendency to repeat activities, thoughts or phrases, possibly because they have a soothing effect. 

Challenges you may encounter 

Autistic individuals feel as if they never know what to expect – and, as anyone who has experienced a prolonged state of uncertainty will attest, this is extremely stressful. “It can be potentially detrimental to physical and emotional wellbeing, which is why correct diagnosis by a qualified professional is critical,” Dr van Niekerk says. 

Linked to this, exhaustive anxiety is common amongst autistic people. This is fuelled by the discomfort they experience in social situations as well as their misunderstanding of situations, intentions, inference and instructions. It can place a strain on relationships at home, school or any other environment, and make it difficult for the individual to regulate their emotions.  

“When an individual has a negative experience of a social situation, they may revert to repetitive thought patterns or rumination, which exacerbates their anxiety by causing self-doubt and emotional distress,” Dr van Niekerk says. “On the other hand, their tendency to repetition can work in their favour: repetitive interests and hobbies, for example, may lead to original ideas.” 

Heightened sensory awareness is another challenge, making people living with autism particularly sensitive to light, sound, textures, smell, or movement. Exposure to these inputs can overload the nervous system and be very overwhelming. In response, many individuals display sensory seeking behaviour – like a repetitive type of activity – to soothe themselves by calming the system, or to activate it. 

Part of a bigger problem 

 Autism often co-occurs with other neurodevelopmental conditions, such as ADHD, obsessive compulsive disorder (OCD), Tourette’s syndrome and specific learning disorders (previously known as dyslexia). 

 Dr van Niekerk is firm about the need for early diagnosis. She warns that girls who are on the spectrum may try to mask their challenges or use compensation strategies, which means their anxiety often goes unnoticed. “Consequently, they experience constant stress and live in a state of persistent pretence, which predisposes them to potential psychiatric problems later in life.” 

Multidisciplinary approach 

The complex nature of an autism diagnosis requires a multimodal approach to support, involving parents, teachers, employers and healthcare or allied healthcare professionals. These might include a paediatrician, occupational therapist and psychologist. 

Dr van Niekerk says that despite the challenges associated with a diagnosis, autistic individuals have a different way of perceiving and interacting with the world and because of this may have specific fascinations, strengths and talents. “They can’t be expected to ‘change’ or have their brains rewired, even through intensive therapy, and it’s unfair to expect them to conform,” she says. “It’s vital that their diversity is recognised and understood, and that they’re allowed to feel comfortable with the way they are – even if this means modifying some rules or making accommodation for them, because this is the best way to protect their self-esteem.”