Autism: Seeing the World Through a Different Lens

In India, with a population of 1.4 billion, around 2 million individuals are affected by autism spectrum disorder. Despite its prevalence, most lack a clear understanding of the condition, which manifests differently in each person. Autism spectrum disorder is a complex condition, much like a unique puzzle where each piece fits together differently for every individual. Some people with autism may struggle with social interactions as if they are missing a crucial piece of a social puzzle. Others might experience sensory sensitivities, becoming overwhelmed by sounds or textures, similar to navigating a noisy, crowded room without earplugs. Despite these challenges, individuals with autism often have unique strengths and talents, frequently excelling in specific areas such as art, music, or mathematics.

It is a neurological and developmental condition that impacts communication, behaviour, and social interaction. Symptoms usually appear in the first two years of childhood, but diagnosis can occur at any age.

Until 2013, there was no standalone diagnosis of autism. Instead, the Diagnostic and Statistical Manual of Mental Disorders — a handbook published by the American Psychiatric Association for mental health professionals across the globe to diagnose and classify mental disorders — included four distinct diagnoses. These were:

• Autistic disorder
• Asperger's syndrome
• Childhood disintegrative disorder
• Pervasive developmental disorder (PDD-NOS).
  

Autism was grouped under the broader category of PDD, which encompassed a range of social communication challenges. Within this category, there were four subtypes: infantile autism, childhood-onset PDD, residual autism, and atypical PDD.

In 2013, the APA made significant changes by consolidating these diagnoses into a single term: Autism Spectrum Disorder (ASD). This update reflected research showing that the previous categories were inconsistently applied across clinics and treatment centres. It also introduced new diagnostic criteria and severity levels to better understand autism. 

To be diagnosed with ASD, an individual should exhibit symptoms in:

•  all three parameters identified under the social-communication sub-category, and
•  at least two of the four restricted and repetitive behaviours

Additionally, the symptoms:

• Must be evident from early developmental stages.
• Cause significant disruptions in an individual’s ability to function socially or in their school/college/ job. 
• Cannot be explained by another developmental or intellectual condition.
  

Hallmark symptoms can look like:

Social communication

• Inconsistent eye contact 
• Difficulty adjusting behaviour to social situations
• Struggles with imaginative play and making friends
  
  
  Repetitive behaviours
• Intense interest in specific topics 
• Upset by minor routine changes

The causes of autism are not yet completely understood. Current research shows that it could likely be due to a combination of genetic and environmental factors. In fact, over 100 genes are currently known to increase the risk of autism, and it’s estimated that there could be more than 1,000 in total. 

Autism research is still in its early stages and continues to evolve. More investigation is necessary to fully understand why certain factors increase the likelihood of an individual being born on the autism spectrum.

Here is an updated list of key risk factors based on extensive studies:

• Children born to older parents: Studies have shown that children born to older mothers are at a higher risk. A 2009 study indicates that advanced maternal age poses a greater risk than paternal age.
• Exposure to environmental toxins: Fetal exposure to heavy metals, air pollutants, and environmental toxins during pregnancy can significantly increase the risk of developmental issues.
• Diabetes during pregnancy: Maternal diabetes (gestational diabetes or pre-existing diabetes) during pregnancy can contribute to a higher risk for offspring, including developmental and health complications.
• Maternal obesity during pregnancy: Obesity in the mother during pregnancy is linked to a higher risk of developmental disorders and complications.
• Extremely low birth weight: Babies born with extremely low birth weight (less than 1,000 grams) have an elevated risk of various health problems, both in infancy and later in life.
• Complications during birth: A combination of complications during birth, such as prolonged labour, low oxygen levels, or birth injuries, can increase the likelihood of developmental issues.
• Fetal exposure to certain drugs: Drugs like valproate, used to treat epilepsy and other conditions, have been linked to an increased risk of developmental disorders when taken during pregnancy.

Diet doesn’t cause autism. “As per current research, there is no concrete evidence to support this”, says Dr Nidhi Singhal, Director of Research and Training at Action For Autism. 

However, kids or adults with autism may have selective eating habits, and it can be a particularly challenging experience for parents of young children with autism. Difficulty in trying out different food items or food aversion can be attributed to sensory challenges with the texture or smell of food items or a preference for 'sameness'.  

According to a 2019 analysis, the evidence supporting the efficacy of dietary interventions, including restrictive diets, as treatments for young people with autism remains controversial. 

A 2024 study identified a link between maternal diet during pregnancy and autism risk. The researchers discovered that pregnant women who followed a healthy diet — rich in vegetables, fruits, nuts, fish, and whole grains, while avoiding high-fat foods, processed meats, soft drinks, and refined carbohydrates — had a 22% lower likelihood of giving birth to a child with autism compared to those who consumed a less nutritious diet.

While the exact manifestation varies, here are some everyday struggles of kids with autism:

• Verbal communication can be a struggle; kids may find it challenging to develop language skills and understand what is said to them. 
• May repeat words or use words or phrases they may have heard on TV/movies
• May avoid eye contact
• May not respond when called by their name
• Have extremely narrow interests

Autism spectrum disorder has been largely understood and researched from the perspective of males. Not only has this stereotyped the autism symptoms, but the use of the ‘male lens’ has also hampered autism diagnosis in females, leading to misdiagnosis or underdiagnosis.  

Recent research indicates that there are notable differences between the brains of boys and girls with autism. Naturally, girls with autism spectrum disorder do not present the same behavioural patterns as boys do. “Girls with autism may appear more social, talkative, and prone to imitating others, often as a result of extensive masking”, notes Dr Singhal.

Additionally, even girls who exhibit classic autistic traits may not get diagnosed unless they also present ‘significant behavioural or learning difficulties’. This is often attributed to a "gender bias" in diagnosis. Dr Singhal adds, “Someone might view a girl who struggles with socialising as merely shy, rather than recognising it as a potential sign of autism spectrum disorder, because society often accepts "delicacy" as a typical trait for young girls.”

Autism is a lifelong neurodevelopmental condition that does not go away with age. Even as adults, one may experience the symptoms throughout their lives.

While the symptoms may be present early on, some individuals may not receive a diagnosis until they are adults. This is especially true in the case of women; many receive a late diagnosis as they ‘mask’ their symptoms through childhood and adolescence. Masking refers to deliberately or inadvertently concealing parts of oneself as a coping mechanism. Autistic individuals often mask to fit in as per societal expectations and gain acceptance from peers.

In particular, adults on the autism spectrum may experience challenges:

• Navigating job responsibilities and understanding workplace dynamics
• Building social connections 
• Maintaining friendships
• Planning for long-term stability

It is important to remember that the way autism manifests in adults can change significantly as they continue to grow. Many autistic adults also develop a range of strategies to navigate the challenges. That’s why autism often looks different for everyone. 

Increased awareness about autism leads to early recognition and improved support. This can, in turn, improve the quality of life for kids and adults with autism.

Awareness also helps others recognise the unique challenges faced by autistic individuals, thereby improving the chances of creating a more inclusive and accommodating society. 

Attention Deficit Hyperactivity Disorder or ADHD is also a neurodevelopmental condition, just like autism spectrum disorder, and primarily affects attention span and movement/self-control.

The hallmark symptoms of ADHD include:

• Difficulty paying attention or staying on task, but not due to lack of comprehension or defiance of authority. 
• Difficulty with self-control
• Being extremely restless or being constantly on the move. 
  

Both ADHD and ASD arise due to ‘atypical allocation of attentional resources’.While the core symptoms present differently, there is overlap. For instance, both ADHD and ASD result in difficulties with socialising. In the case of autism, it is because of the poor understanding of social cues, whereas for ADHD, it's because of inattention or impulsivity.

The Maori word for autism, takiwatanga, which means ‘in their own space and time’, sums it up beautifully. Brains with autism have their unique operating systems, and it is important to recognise and celebrate their differences.  

Experts do not attribute autism to a single cause. Both genetics and environmental factors during prenatal and perinatal stages play a role.

A mix of genetics and environmental factors may result in autism spectrum disorder. 

Autism starts on account of atypical brain development leading to differences in communication, behaviour, social interaction, and thinking.

It is a combination of genetic changes and environmental factors.

First signs may be visible as early as 12 months to 18 months of age.

Autism is not a disease. It is a neurodevelopmental condition which results in a uniquely wired brain. As such, there is no way to prevent it.