autism spectrum autism spectrum autism, formally called autism spectrum disorder (asd) and autism spectrum condition (asc), and sometimes called the autism spectrum, is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, and repetitive or restricted patterns of behaviors, interests, or activities, which can include hyper- and hyporeactivity to sensory input. "autism" redirects here. autism may also refer to classic autism. autism spectrumother namesautism, autism spectrum condition (asc), autism spectrum disorder (asd)repetitively stacking or lining up objects is a common trait associated with autism.specialtypsychiatry, clinical psychology, pediatrics, occupational medicinesymptomsdifficulties in social interaction, verbal and nonverbal communication, and the presence of repetitive behavior or restricted interestscomplicationssocial isolation, educational and employment problems, anxiety, stress, bullying, self-harm, depressiononsetearly childhooddurationlifelongcausesmultifactorial, with many uncertain factorsrisk factorsfamily history, certain genetic conditions, having older parents, certain prescribed drugs, perinatal and neonatal health issuesdiagnostic methodbased on combination of clinical observation of behavior and development and comprehensive diagnostic testing completed by a team of qualified professionals (including clinical psychologists, neuropsychologists, pediatricians, and speech-language pathologists)differential diagnosisintellectual disability, anxiety, bipolar disorder, depression, rett syndrome, attention deficit hyperactivity disorder, schizoid personality disorder, selective mutism, schizophrenia, obsessive–compulsive disorder, social anxiety disorder, einstein syndrome, ptsd, learning disorders (mainly speech disorders), social anxietymanagementapplied behavior analysis, cognitive behavioral therapy, occupational therapy, psychotropic medication, speech–language pathologyfrequency 1 in 100 children (1%) worldwide autism is a spectrum disorder, meaning that it can manifest very differently in each person. because of this, there is wide variation in the support needs of autistic people. for example, some are nonspeaking, while others have proficient spoken language. psychiatry has traditionally classified autism as a neurodevelopmental disorder, but the autism rights movement and some researchers see autism as part of neurodiversity, the natural diversity in human thinking and experience, with strengths, differences, and weaknesses. autistic people still have a disability, but need to be accommodated, rather than cured. this view of the condition has led to significant controversy among those who are autistic alongside advocates, practitioners, and charities. there are many theories about what causes autism; it is highly heritable and believed to be mainly genetic, but many genes are involved, and environmental factors may also be relevant. the syndrome frequently co-occurs with other conditions, including attention deficit hyperactivity disorder, epilepsy, and intellectual disability. disagreements continue about questions such as what should be included as part of the diagnosis, whether there are meaningful subtypes of autism, and the significance of autism-associated traits in the wider population. the combination of broader criteria and increased awareness has led to a trend of steadily increasing estimates of autism prevalence, causing a misconception that there is an autism epidemic and perpetuating the myth that it is caused by vaccines. although there is no cure for autism, early behavioral interventions can help children with speech delays gain self-care, social, and language skills. independent living is unlikely in those with higher support needs, so intervention for them requires finding and learning alternative modes of communication. it is well-established that the atypical antipsychotic drugs risperidone and aripiprazole alleviate the associated symptoms of irritability. classification spectrum model before the dsm-5 (2013) and icd-11 (2022) diagnostic manuals were adopted, what is now called asd was found under the diagnostic category pervasive developmental disorder. the previous system relied on a set of closely related and overlapping diagnoses such as asperger syndrome and kanner syndrome. this created unclear boundaries between the terms, so for the dsm-5 and icd-11, a spectrum approach was taken. the new system is also more restrictive, meaning fewer people now qualify for diagnosis. the dsm-5 and icd-11 use different categorisation tools to define this spectrum. dsm-5 uses a "level" system, which ranks how in need of support the patient is, while the icd-11 system has two axes: intellectual impairment and language impairment, as these are seen as the most crucial factors. it is now known that autism is a highly variable neurodevelopmental disorder that is generally thought to cover a broad and deep spectrum, manifesting very differently from one person to another. some have high support needs, may be non-speaking, and experience developmental delays; this is more likely with other co-existing diagnoses. others have relatively low support needs; they may have more typical speech-language and intellectual skills but atypical social/conversation skills, narrowly focused interests, and wordy, pedantic communication. they may still require significant support in some areas of their lives. the spectrum model should not be understood as a continuum running from mild to severe, but instead means that autism can present very differently in each individual. how a person presents can depend on context, and may vary over time. while the dsm and icd are greatly influenced by each other, there are also differences. for example, rett syndrome was included in asd in the dsm-5, but in the icd-11 it was excluded and placed in the chapter on developmental anomalies. the icd and the dsm change over time, and there has been collaborative work toward a convergence of the two since 1980 (when dsm-iii was published and icd-9 was current), including more rigorous biological assessment—in place of historical experience—and a simplification of the classification system. icd the world health organization's international classification of diseases (11th revision), icd-11, was released in june 2018 and came into full effect as of january 2022. it describes asd as follows: autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual's age and sociocultural context. the onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual's functioning observable in all settings, although they may vary according to social, educational, or other context. individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.— icd-11, chapter 6, section a02 icd-11 was produced by professionals from 55 countries out of the 90 involved and is the most widely used reference worldwide. dsm the american psychiatric association's diagnostic and statistical manual of mental disorders, fifth edition, text revision (dsm-5-tr), released in 2022, is the current version of the dsm. it is the predominant mental health diagnostic system used in the united states and canada, and is often used in anglophone countries. its fifth edition, dsm-5, released in may 2013, was the first to define asd as a single diagnosis, which is still the case in the dsm-5-tr. asd encompasses previous diagnoses, including asperger syndrome, childhood disintegrative disorder, pdd-nos, and the range of diagnoses that included the word autism. rather than distinguishing among these diagnoses, the dsm-5 and dsm-5-tr adopt a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella in one diagnostic category. within this category, the dsm-5 and the dsm include a framework that differentiates each individual by dimensions of symptom severity, as well as by associated features (i.e., the presence of other disorders or factors that likely contribute to the symptoms, other neurodevelopmental or mental disorders, intellectual disability, or language impairment). the symptom domains are social communication and restricted, repetitive behaviors, with the option of a separate severity—the negative impact of the symptoms on the individual—being specified for each domain, rather than an overall severity. before the dsm-5, the dsm separated social deficits and communication deficits into two domains. further, the dsm-5 changed to an onset age in the early developmental period, with a note that symptoms may manifest later when social demands exceed capabilities, rather than the previous, more restricted three years of age. these changes remain in the dsm-5-tr. common characteristics pre-diagnosis for many autistic people, characteristics first appear during infancy or childhood and follow a steady course without remission (different developmental timelines are described in more detail below). autistic people may be severely impaired in some respects but average, or even superior, in others. clinicians consider assessment for asd when a patient shows: regular difficulties in social interaction or communication restricted or repetitive behaviors (often called "stimming") resistance to changes or restricted interests these features are typically assessed with the following, when appropriate: problems in obtaining or sustaining employment or education difficulties in initiating or sustaining social relationships connections with mental health or learning disability services a history of neurodevelopmental conditions (including learning disabilities and adhd) or mental health conditions. there are many signs associated with autism; the presentation varies widely: common signs for autistic spectrum disorder avoidance of eye-contact little or no babbling as an infant not showing interest in indicated objects delayed language skills (e.g. having a smaller vocabulary than peers or difficulty expressing themselves in words) reduced interest in other children or caretakers, possibly with more interest in objects difficulty playing reciprocal games (e.g. peek-a-boo) hyper- or hypo-sensitivity to or unusual response to the smell, texture, sound, taste, or appearance of things resistance to changes in routine repetitive, limited, or otherwise unusual usage of toys (e.g. lining up toys) repetition of words or phrases (echolalia) repetitive motions or movements, including stimming self-harming broader autism phenotype the broader autism phenotype (bap) describes individuals who may not have asd but do have autistic traits, such as avoiding eye contact and stimming. social and communication skills in social contexts, autistic people may respond and behave differently than people without asd. impairments in social skills present many challenges for autistic people. deficits in social skills may lead to problems with friendships, romantic relationships, daily living, and vocational success. one study that examined the outcomes of autistic adults found that, compared to the general population, autistic people were less likely to be married, but it is unclear whether this outcome was due to deficits in social skills, intellectual impairment, or another reason. one factor is likely discrimination against autistic people, which is perpetuated by myths—for example, the myth that they have no empathy. until 2013, deficits in social function and communication were considered two separate symptom domains of autism. the current social communication domain criteria for autism diagnosis require individuals to have deficits across three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships. a range of social-emotional reciprocity difficulties (an individual's ability to naturally engage in social interactions) may be present. autistic individuals may lack mutual sharing of interests; many autistic children prefer not to play or interact with others. they may lack awareness or understanding of other people's thoughts or feelings: a child may get too close to peers (entering their personal space) without noticing that this makes them uncomfortable. they may also engage in atypical behaviors to gain attention: a child may push a peer to gain attention before starting a conversation. older autistic children and adults perform worse on tests of face and emotion recognition than non-autistic individuals, although this may be due to the prevalence of alexithymia in autistic people rather than autism itself. autistic people experience deficits in their ability to develop, maintain, and understand relationships, as well as difficulties adjusting behavior to fit social contexts. asd presents with impairments in pragmatic communication skills, such as difficulty initiating a conversation or failure to consider the listener's interests to sustain a conversation. the ability to be focused exclusively on one topic in communication is known as monotropism, and can be compared to "tunnel vision". it is common for autistic people to communicate strong interest in a specific topic, speaking in lesson-like monologues about their passion instead of enabling reciprocal communication. what may look like self-involvement or indifference to others stems from a struggle to recognize or remember that other people have their own personalities, perspectives, and interests. another difference in pragmatic communication skills is that autistic people may not recognize the need to control the volume of their voice in different social settings; for example, they may speak loudly in libraries or movie theaters. autistic people display atypical nonverbal behaviors or have difficulties with nonverbal communication. they may make infrequent eye contact: an autistic person may not make eye contact when called by name, or may avoid eye contact with an observer. aversion of