Autism

{{Short description|Condition involving social and behavioral differences}} {{For|the academic journal with the same name|Autism (journal){{!}}''Autism'' (journal)}} {{Pp-semi-indef|small=yes}} {{Pp-move}} {{cs1 config|name-list-style=vanc}} {{Use American English|date=June 2025}} {{Use dmy dates|date=September 2025}} {{Infobox medical condition | name = | synonyms = {{plainlist| * Autism spectrum disorder,{{efn|name=medical term|Medical diagnosis term. See [[#Classification|§ Classification]].}} autism spectrum condition * '''Formerly''': [[Kanner syndrome]]/autistic disorder/childhood autism, [[Asperger syndrome]], [[childhood disintegrative disorder]], [[pervasive developmental disorder not otherwise specified]] }} | field = [[Psychiatry]] ([[neuropsychiatry]]), [[clinical psychology]], [[pediatrics]], [[occupational medicine]] | symptoms = Difficulties in [[social interaction]], verbal and [[nonverbal communication]]; inflexible routines; [[special interest (autism)|focused interests]]; [[stereotypy|repetitive body movements]]; [[Sensory processing disorder|unusual sensory responses]] | complications = [[Social isolation]], educational and [[Employment of autistic people|employment problems]], [[Anxiety disorder|anxiety]], [[Stress (biology)|stress]], [[bullying]], [[Major depressive disorder|depression]], [[self-harm]], [[Suicide among autistic individuals|suicidality]] | image = {{Multiple image |align = center |perrow=2/2 |total_width=300 |image1=Autism-stacking-cans 2nd edit.jpg |image2=Skating her Hart to the Olympics 121128-F-AH552-001.jpg |image3=Autism somali Center 13.jpg |image4=Donald_Triplett.jpg |border=infobox |footer=Autism has many presentations around the world.<br/> From top left: an autistic toddler stacking cans; an autistic [[Figure skating|figure skater]] competitor; a child using an [[abacus]] at school run by Autism Somalia Center; banker [[Donald Triplett]], the first person to be diagnosed with autism. }} | alt = | caption = | onset = Early childhood | onset_always = Yes | duration = Lifelong | causes = [[Causes of autism|Multifactorial]], with many uncertain factors | risks = [[Family history (medicine)|Family history]], certain [[Genetic disorder|genetic conditions]], having older parents, certain prescribed drugs, [[Prenatal development#Factors influencing development|perinatal]] and [[Infant#Health issues|neonatal]] health issues | diagnosis = Based on a combination of clinical observation of behavior and development and comprehensive diagnostic testing completed by a team of qualified professionals. For adults, the use of a patient's written and oral history of autistic traits becomes more important | differential = [[Attention deficit hyperactivity disorder]], [[intellectual disability]], [[language disorder]]s, [[social (pragmatic) communication disorder]], [[selective mutism]], [[stereotypic movement disorder]], [[Rett syndrome]], [[anxiety disorder]]s, [[obsessive–compulsive disorder]], [[schizophrenia]], [[fragile X syndrome]], [[personality disorder]]s{{sfn|DSM-5-TR}} | management = [[Applied behavior analysis]], [[cognitive behavioral therapy]], [[occupational therapy]], [[speech–language pathology]] | frequency = One in 100 people (1%) worldwide<ref name="Autism-Research">{{cite journal |last1=Zeidan |first1=Jinan |last2=Fombonne |first2=Eric |last3=Scorah |first3=Julie |last4=Ibrahim |first4=Alaa |last5=Durkin |first5=Maureen S. |last6=Saxena |first6=Shekhar |last7=Yusuf |first7=Afiqah |last8=Shih |first8=Andy |last9=Elsabbagh |first9=Mayada |date=15 May 2022 |title=Global prevalence of autism: A systematic review update |journal=[[Autism Research]] |volume=15 |issue=5 |pages=778–790 |doi=10.1002/aur.2696 |pmc=9310578 |pmid=35238171}}</ref><ref name="World Health Organization-2022" /> }} '''Autism''', also known as '''autism spectrum disorder''' ('''ASD'''),<noinclude>{{efn|name=medical term}}</noinclude> is<noinclude> a condition</noinclude> characterized by impairment in social communication and interaction,{{Sfn|ICD-11|}}{{Sfn|DSM-5-TR|}} as well as a need or strong preference for predictability and routine, sensory processing differences, [[Special interest (autism)|focused interests]], or repetitive behaviors.{{Under discussion inline|What is Autism?}} Features of autism are present from early childhood and the condition typically persists throughout life.<ref>{{Cite journal |last1=Whiteley |first1=Paul |last2=Carr |first2=Kevin |last3=Shattock |first3=Paul |date=7 October 2019 |title=Is Autism Inborn And Lifelong For Everyone? |journal=Neuropsychiatric Disease and Treatment |language=English |volume=15 |pages=2885–2891 |doi=10.2147/NDT.S221901 |pmid=31632036 |pmc=6789180 |doi-access=free }}</ref><ref name="Steinhausen-2016">{{Cite journal |last1=Steinhausen |first1=H.-C. |last2=Mohr Jensen |first2=C. |last3=Lauritsen |first3=M. B. |date=13 January 2016 |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 |doi=10.1111/acps.12559 |pmid=26763353}}</ref> Autism is classified as a [[neurodevelopmental disorder]],<ref>{{Cite journal |last=Kamp-Becker |first=Inge |date=March 2024 |title=Autism spectrum disorder in ICD-11—a critical reflection of its possible impact on clinical practice and research |journal=[[Molecular Psychiatry]] |language=en |volume=29 |issue=3 |pages=633–638 |doi=10.1038/s41380-023-02354-y |pmc=11153155 |pmid=38273107 |quote=In DSM-5 as well as in ICD-11, ASD is assigned to the category "neurodevelopmental disorders", characterized by impairments in cognition, communication, behavior and/or motor skills resulting from abnormal brain development.}}</ref> and a [[Medical diagnosis|diagnosis]] requires professional assessment that these characteristics cause significant challenges in daily life beyond what is expected given a person's age and [[social environment]].<ref>{{cite web|url=https://www.nice.org.uk/guidance/cg170/resources/autism-spectrum-disorder-in-under-19s-support-and-management-pdf-35109745515205|title=Autism spectrum disorder in under 19s: support and management|publisher=UK National Institute for Health & Care Excellence|date=28 August 2013|access-date=22 April 2026|postscript=. Updated 14 June 2021}}</ref><ref name="iacc.hhs.gov">{{Cite web |title=DSM-5 Diagnostic Criteria |url=https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml |access-date=1 August 2024 |publisher=Interagency Autism Coordinating Committee |date=2016}}</ref><ref name="ESCAP">{{cite journal |url=https://www.autismeurope.org/wp-content/uploads/2020/09/Fuentes2020_Article_ESCAPPracticeGuidanceForAutism.pdf |title=ESCAP practice guidance for autism: a summary of evidence‑based recommendations for diagnosis and treatment |vauthors=Fuentes J, Hervás A, Howlin P, ((ESCAP ASD Working Party)) |journal=[[European Child & Adolescent Psychiatry]] |year=2020 |volume=30 |issue=6 |pages=961–984 |doi=10.1007/s00787-020-01587-4 |doi-access=free |pmid=32666205 |pmc=8140956}}</ref>{{sfn|ICD-11}} Because autism is a [[spectrum disorder]], presentations vary and support needs range from minimal assistance to full-time, 24-hour care.<ref name="iacc.hhs.gov"/>{{sfn|ICD-11}}<ref>{{Cite journal |last1=Waizbard-Bartov |first1=Einat |last2=Fein |first2=Deborah |last3=Lord |first3=Catherine |last4=Amaral |first4=David G. |date=2023 |title=Autism severity and its relationship to disability |journal=[[Autism Research]] |language=en |volume=16 |issue=4 |pages=685–696 |doi=10.1002/aur.2898 |pmc=10500663 |pmid=36786314}}</ref><ref>{{cite journal |pmid=38434761 |date=2024 |title=Autism spectrum disorder: Pathogenesis, biomarker, and intervention therapy |journal=Medcomm |volume=5 |issue=3 |article-number=e497 |doi=10.1002/mco2.497 |pmc=10908366 |vauthors=Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L}}</ref>

[[Epidemiology of autism|Autism diagnoses have risen]] since the 1990s, largely because of broader [[diagnostic criteria]], greater awareness, and wider access to [[Diagnosis of autism|assessment]].<ref name="Autism-Research" /> Changing social demands may also play a role.<ref name="Anderson-Chavarria-2022">{{Cite journal |last=Anderson-Chavarria |first=Melissa |date=14 September 2022 |title=The autism predicament: models of autism and their impact on autistic identity |journal=[[Disability & Society]] |volume=37 |issue=8 |pages=1321–1341 |doi=10.1080/09687599.2021.1877117 }}</ref><ref name="Ogundele-2025">{{Cite journal |last1=Ogundele |first1=Michael O. |last2=Morton |first2=Michael J. S. |date=3 April 2025 |title=Subthreshold Autism and ADHD: A Brief Narrative Review for Frontline Clinicians |journal=Pediatric Reports |volume=17 |issue=2 |page=42 |doi=10.3390/pediatric17020042 |doi-access=free |pmc=12030661 |pmid=40278522}}</ref> The [[World Health Organization]] estimates that about 1 in 100 children were diagnosed between 2012 and 2021, noting an increasing trend.{{Efn|This figure may reflect an underestimate of prevalence in low- and middle-income countries.}}<ref name="Autism-Research" /><ref name="World Health Organization-2022" /> Surveillance studies suggest a similar share of the adult population would meet diagnostic criteria if formally assessed.<ref name="Hirota-2023">{{Cite journal |last1=Hirota |first1=Tomoya |last2=King |first2=Bryan H. |date=10 January 2023 |title=Autism Spectrum Disorder: A Review |journal=JAMA |volume=329 |issue=2 |pages=157–168 |doi=10.1001/jama.2022.23661 |pmid=36625807}}</ref> Autism is highly [[Heritability of autism|heritable]] and [[polygenic|involves many genes]], while environmental factors appear to play a smaller, mainly [[Prenatal development|prenatal]] role.<ref name="Tick-2016">{{Cite journal |last1=Tick |first1=Beata |last2=Bolton |first2=Patrick |last3=Happé |first3=Francesca |last4=Rutter |first4=Michael |last5=Rijsdijk |first5=Frühling |date=2016 |title=Heritability of autism spectrum disorders: a meta-analysis of twin studies |journal=Journal of Child Psychology and Psychiatry |language=en |volume=57 |issue=5 |pages=585–595 |doi=10.1111/jcpp.12499 |pmc=4996332 |pmid=26709141}}</ref><ref>{{Cite journal |last1=Hodges |first1=Holly |last2=Fealko |first2=Casey |last3=Soares |first3=Neelkamal |date=February 2020 |title=Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation |journal=Translational Pediatrics |volume=9 |issue=Suppl 1 |pages=S55–S5S65 |doi=10.21037/tp.2019.09.09 |doi-access=free |pmid=32206584 |pmc=7082249 }}</ref><ref>{{Cite journal |last=Ratajczak |first=Helen V. |date=March 2011 |title=Theoretical aspects of autism: Causes—A review |journal=Journal of Immunotoxicology |volume=8 |issue=1 |pages=68–79 |doi=10.3109/1547691X.2010.545086 |pmid=21299355 }}</ref><ref name="Mandy-2016">{{cite journal |vauthors=Mandy W, Lai MC |title=Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition |journal=[[Journal of Child Psychology and Psychiatry, and Allied Disciplines]] |oclc=01307942 |volume=57 |issue=3 |pages=271–292 |date=March 2016 |pmid=26782158 |doi=10.1111/jcpp.12501 }}</ref> Boys are diagnosed [[Sex and gender differences in autism|several times more often than girls]], with girls being better at [[Autistic masking|hiding autistic traits]].<ref name="Autism-Research" /><ref name="Loomes-2017" /><ref>{{cite journal |last1=Alaghband-rad |first1=Javad |last2=Hajikarim-Hamedani |first2=Arman |last3=Motamed |first3=Mahtab |title=Camouflage and masking behavior in adult autism |journal=Frontiers in Psychiatry |date=2023 |volume=14 |issue=16 |article-number=1108110 |doi=10.3389/fpsyt.2023.1108110 |doi-access=free |pmid=37009119 |pmc=10060524 }}</ref> Conditions such as [[Anxiety disorder|anxiety]], [[Major depressive disorder|depression]], [[attention deficit hyperactivity disorder]] (ADHD), [[epilepsy]], as well as [[intellectual disability]], are more common among autistic people.<ref>{{cite book |last1=Bertelli |first1=Marco O. |last2=Azeem |first2=Muhammad Waqar |last3=Underwood |first3=Lisa |last4=Scattoni |first4=Maria Luisa |last5=Persico |first5=Antonio M. |last6=Ricciardello |first6=Arianna |last7=Sappok |first7=Tanja |last8=Bergmann |first8=Thomas |last9=Keller |first9=Roberto |last10=Bianco |first10=Annamaria |last11=Corti |first11=Serafino |last12=Miselli |first12=Giovanni |last13=Lassi |first13=Stefano |last14=Croce |first14=Luigi |last15=Bradley |first15=Elspeth |last16=Munir |first16=Kerim |title=Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder |chapter=Autism Spectrum Disorder |date=2022 |pages=369–455 |doi=10.1007/978-3-319-95720-3_16 |isbn=978-3-319-95719-7 |chapter-url={{GBurl|4mtvEAAAQBAJ|p=391}} |quote-page=391 |quote=Persons with autism spectrum disorder and/or other neurodevelopmental problems are more likely than the general population to have [[transgender]] identity, [[non-heterosexual]] sexual orientation, and other [[gender non-conformities]]. }}</ref><ref name="Lord-2022">{{Cite journal |last1=Lord |first1=Catherine |last2=Charman |first2=Tony |last3=Havdahl |first3=Alexandra |last4=Carbone |first4=Paul |last5=Anagnostou |first5=Evdokia |last6=Boyd |first6=Brian |last7=Carr |first7=Themba |last8=de Vries |first8=Petrus J |last9=Dissanayake |first9=Cheryl |author-link9=Cheryl Dissanayake |last10=Divan |first10=Gauri |last11=Freitag |first11=Christine M |display-authors=10 |date=2022 |title=The Lancet Commission on the future of care and clinical research in autism |journal=[[The Lancet]] |volume=399 |issue=10321 |pages=299–300 |doi=10.1016/s0140-6736(21)01541-5 |pmid=34883054 |hdl=11250/2975811 |hdl-access=free }}</ref><ref name="Graham Holmes-2022">{{cite journal |last1=Graham Holmes |first1=Laura |last2=Ames |first2=Jennifer L. |last3=Massolo |first3=Maria L. |last4=Nunez |first4=Denise M. |last5=Croen |first5=Lisa A. |date=April 2022 |title=Improving the Sexual and Reproductive Health and Health Care of Autistic People |journal=[[Pediatrics (journal)|Pediatrics]] |publisher=[[American Academy of Pediatrics]] |volume=149 |issue=Supplement 4 |pages=e2020049437J |doi=10.1542/peds.2020-049437J |pmid=35363286 |quote=A substantial proportion of autistic adolescents and adults are LGBTQIA+. Autistic people are more likely to be transgender or gender nonconforming compared with non-autistic people, and findings from a recent autism registry study suggest that among autistic people able to self-report on a survey, up to 18% of men and 43% of women may be sexual minorities. |doi-access=}}</ref> Certain [[Savant syndrome|savant]] abilities are also more common in autistic people than in other groups.<ref>{{cite journal |last1=Happé |first1=Francesca |title=Why are savant skills and special talents associated with autism? |journal=World Psychiatry |date=2018 |volume=17 |issue=3 |pages=280–281 |doi=10.1002/wps.20552 |pmid=30192091 |pmc=6127767 }}</ref>

There is no cure for autism.<ref name="nhs.uk-2019" /> Several [[autism therapies]] aim to improve self-care, social, and language skills.<ref name="Treat">{{Cite web |last=CDC |date=18 July 2024 |title=Treatment and Intervention for Autism Spectrum Disorder |url=https://www.cdc.gov/autism/treatment/index.html |access-date=28 November 2024 |website=Autism Spectrum Disorder (ASD) |language=en-us|archive-url=https://web.archive.org/web/20250412010515/https://www.cdc.gov/autism/treatment/index.html|archive-date=12 April 2025}}</ref> Reducing environmental and social barriers helps autistic people participate more fully in [[education]], [[Employment of autistic people|employment]], and other aspects of life.<ref name="Mukerji-2013">{{Citation |last1=Mukerji |first1=Cora |title=Enhanced Perceptual Functioning |date=2013 |pages=1117–1118 |editor-last=Volkmar |editor-first=Fred R. |location=New York |publisher=Springer |language=en |doi=10.1007/978-1-4419-1698-3_723 |isbn=978-1-4419-1698-3 |last2=Mottron |first2=Laurent |last3=McPartland |first3=James C. |encyclopedia=Encyclopedia of Autism Spectrum Disorders}}</ref><ref name="Doyle-2020" /><ref name="Doherty-2023" /> No medication addresses the core features of autism, but some are used to help manage commonly [[comorbid|co-occurring]] conditions, such as anxiety, depression, irritability, ADHD, and epilepsy.<ref>{{cite web |date=19 April 2021 |title=Medication Treatment for Autism |url=https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment |url-status=live |archive-url=https://web.archive.org/web/20230207142659/https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment |archive-date=7 February 2023 |access-date=21 February 2023 |website=[[National Institute of Child Health and Human Development]] |language=en}}</ref><ref>{{Cite journal |last1=Rzepka-Migut |first1=Beata |last2=Paprocka |first2=Justyna |date=2020 |title=Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder—A Review of the Literature |journal=[[Brain Sciences]] |volume=10 |issue=4 |page=219 |doi=10.3390/brainsci10040219 |doi-access=free |pmid=32272607 |pmc=7226342}}</ref>

The idea of autism as a disorder has been challenged by the [[neurodiversity]] framework, which frames autistic traits as a healthy variation of the human condition.<ref>Kapp, Steven K. Autistic community and the neurodiversity movement: Stories from the frontline. Springer Nature, 2020.</ref> This perspective, promoted by the [[autism rights movement]], has attracted increasing research attention,<ref>{{Cite journal |last1=Happé |first1=Francesca |last2=Frith |first2=Uta |date=2020 |title=Annual Research Review: Looking back to look forward - changes in the concept of autism and implications for future research |journal=[[Journal of Child Psychology and Psychiatry, and Allied Disciplines]] |volume=61 |issue=3 |pages=218–232 |doi=10.1111/jcpp.13176 |pmid=31994188 |url=https://discovery.ucl.ac.uk/id/eprint/10091945/ }}</ref> but is debated and remains controversial among autistic people, advocacy groups, healthcare providers, and charities.<ref>{{cite journal |last1=Zamzow |first1=Rachel |title=Disorder or difference? Autism researchers face off over field's terminology |journal=Science |date=7 February 2023 |doi=10.1126/science.adh0585 }}</ref><ref>{{Cite journal |last=Rodríguez Mega |first=Emiliano |date=10 May 2023 |title='I am not a broken version of normal' — autistic people argue for a stronger voice in research |journal=[[Nature (journal)|Nature]] |volume=617 |issue=7960 |pages=238–241 |doi=10.1038/d41586-023-01549-1 |pmid=37165246 }}</ref>

== Signs and characteristics == Autism is primarily characterized by differences and difficulties in social interaction and communication, alongside restricted or repetitive patterns of interests, activities, or behaviors ([[stimming]]), and, in many cases, distinctive reactions to sensory input. The specific presentation varies widely.<ref name="www.canada.ca-2025" /><ref name="CDC Autism 2020">{{cite web |author= |date=25 March 2020 |title=What is Autism Spectrum Disorder? |url=https://www.cdc.gov/ncbddd/autism/facts.html |archive-url=https://web.archive.org/web/20230921231100/https://www.cdc.gov/ncbddd/autism/facts.html |archive-date=21 September 2023 |access-date=24 October 2021 |website=Centers for Disease Control and Prevention}}</ref> Clinicians often consider assessment for autism when these characteristics are present, especially if they are associated with difficulty obtaining or sustaining employment or education, difficulty initiating or maintaining social relationships, involvement with mental health or learning disability services, or a history of neurodevelopmental conditions (including learning disabilities and [[ADHD]]) or mental health conditions.<ref name="NICE adult 2021">{{citation |title=Autism spectrum disorder in adults: diagnosis and management |date=14 June 2021 |url=https://www.nice.org.uk/guidance/cg142 |access-date=24 October 2021 |archive-url=https://web.archive.org/web/20230902193040/https://www.nice.org.uk/guidance/cg142 |archive-date=2 September 2023 |url-status=live |publisher=[[NICE]] |id=CG142}}</ref><ref name="Canada Health ASD 2018">{{cite web |date=18 January 2016 |title=About autism spectrum disorder (ASD) |url=https://www.canada.ca/en/public-health/services/diseases/autism-spectrum-disorder-asd/about-autism-spectrum-disorder-asd.html |url-status=live |archive-url=https://web.archive.org/web/20230326225043/https://www.canada.ca/en/public-health/services/diseases/autism-spectrum-disorder-asd/about-autism-spectrum-disorder-asd.html |archive-date=26 March 2023 |access-date=4 November 2021 |website=[[Government of Canada]] |language=en}}</ref> In most cases, signs of autism are first observable in infancy or early childhood and remain throughout life.<ref name="ICD-10-F84.0">{{ICD10|F84}}</ref> Autistic people may be significantly disabled in some respects, but average—or, in some cases, [[Savant syndrome|superior]]—in others.<ref>{{cite book |title=Handbook of Pragmatic Language Disorders |vauthors=Loukusa S |date=2021 |publisher=Springer |isbn=978-3-030-74984-2 |veditors=Cummings L |location=Cham, Switzerland |pages=45–78 |chapter=Autism Spectrum Disorder |doi=10.1007/978-3-030-74985-9_3 |oclc=1269056169 }}</ref><ref>{{cite book |title=Biopsychology |vauthors=Pinel JP |publisher=Pearson |year=2011 |isbn=978-0-205-03099-6 |edition=8th |location=Boston, Massachusetts |page=235 |oclc=1085798897}}</ref><ref>{{cite book |title=Autism Spectrum Disorders |date=2018 |publisher=[[American Psychiatric Association]] |isbn=978-1-61537-192-1 |veditors=Hollander E, Hagerman R, Fein D |chapter=Cognitive Assessment |doi=10.1176/appi.books.9781615371921}}</ref>

=== Social and communication skills === Autistic people may have differences in social communication and interaction, which can lead to challenges in environments structured around non-autistic norms. Diagnostic criteria for autism require difficulties across three social domains: social-emotional reciprocity, nonverbal communication, and developing and maintaining relationships.{{sfn|DSM-5-TR}}

==== Social–emotional reciprocity ==== {{Further|Empathy in autistic people}} Common early signs of autism include little or no [[babbling]] in infancy.<ref name="www.canada.ca-2025">{{Cite web |date=12 February 2025 |title=Autism: Signs and characteristics |url=https://www.canada.ca/en/public-health/services/diseases/autism-spectrum-disorder-asd/signs-characteristics.html |url-status=live |archive-url=https://web.archive.org/web/20250430193025/https://www.canada.ca/en/public-health/services/diseases/autism-spectrum-disorder-asd/signs-characteristics.html |archive-date=30 April 2025 |access-date=30 April 2025 |website=www.canada.ca}}</ref> Difficulties may also be apparent in traditional forms of reciprocal social interaction, such as games like [[peek-a-boo]]<ref name="www.canada.ca-2025" /> or [[pat-a-cake (game)|pat-a-cake]],<ref name="CDC-2024">{{Cite web |last=CDC |date=19 July 2024 |title=Signs and Symptoms of Autism Spectrum Disorder |url=https://www.cdc.gov/autism/signs-symptoms/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/autism/signs.html |archive-url=https://web.archive.org/web/20250430193654/https://www.cdc.gov/autism/signs-symptoms/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/autism/signs.html |archive-date=30 April 2025 |access-date=30 April 2025 |website=Autism Spectrum Disorder (ASD) |language=en-us}}</ref> as well as in [[shared attention]] to objects of interest;<ref name="www.canada.ca-2025" /> this may distinguish autistic from non-autistic infants.<ref name="John2007">{{cite journal |vauthors=Johnson CP, Myers SM |date=November 2007 |title=Identification and evaluation of children with autism spectrum disorders |journal=[[Pediatrics (journal)|Pediatrics]] |volume=120 |issue=5 |pages=1183–1215 |doi=10.1542/peds.2007-2361 |pmid=17967920 |bibcode=2007Pedia.120.1183J |doi-access=free }}</ref>

Historically, autistic children were said to be delayed in developing a [[theory of mind]], and the [[empathizing–systemizing theory]] proposed that while autistic people may have compassion ([[affective empathy]]) for others with similar autistic traits, they often have limited, though not necessarily absent, [[Social cognition|cognitive empathy]].<ref>{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |page=35 }}</ref> This may present as social naïvety,<ref>{{cite journal |last1=El-Salahi |first1=Shama |last2=Khaki |first2=Zahra |last3=Vohora |first3=Reena |title=Experiences of Inclusive School Settings for Children and Young People on the Autism Spectrum in the UK: a Systematic Review |journal=Review Journal of Autism and Developmental Disorders |date=September 2025 |volume=12 |issue=3 |pages=517–534 |doi=10.1007/s40489-023-00405-2 |doi-access=free }}</ref> lower-than-average intuitive perception of the meaning or utility of [[body language]], social reciprocity,<ref>{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |pages=32–79 }}</ref> or social expectations, including the [[Habitus (sociology)|habitus]], [[social cue]]s, and certain aspects of sarcasm,<ref name="American Psychiatric Association-2013">{{cite Q|Q3064664}}</ref> which to some degree may be influenced by co-occurring [[alexithymia]].<ref>{{cite book |vauthors=Hogeveen J, Grafman J |title=Disorders of Emotion in Neurologic Disease |chapter=Alexithymia |series=Handbook of Clinical Neurology |volume=183 |pages=47–62 |date=2021 |pmid=34389125 |pmc=8456171 |doi=10.1016/b978-0-12-822290-4.00004-9 |publisher=[[Elsevier]] |isbn=978-0-12-822290-4}}</ref> A 2019 meta-analysis found that alexithymia commonly co-occurs in autism (49.93%) and infrequently in neurotypicals (4.89%); the random effects risk ratio (6.50) was statistically significant (p<0.001).<ref>{{Cite journal |last1=Kinnaird |first1=Emma |last2=Stewart |first2=Catherine |last3=Tchanturia |first3=Kate |date=January 2019 |title=Investigating alexithymia in autism: A systematic review and meta-analysis |journal=European Psychiatry |volume=55 |pages=80–89 |doi=10.1016/j.eurpsy.2018.09.004 |pmid=30399531 |pmc=6331035 }}</ref>

Recent research has increasingly questioned these earlier interpretations,<ref name="Long-2025">{{Cite journal |last1=Long |first1=Emily L. |last2=Catmur |first2=Caroline |last3=Bird |first3=Geoffrey |date=9 January 2025 |title=The theory of mind hypothesis of autism: A critical evaluation of the status quo |journal=[[Psychological Review]] |doi=10.1037/rev0000532 |pmid=39786849 |url=https://discovery.ucl.ac.uk/10203828/1/Bird_2025-63789-001.pdf }}</ref> as the [[double empathy problem]] theory (2012) proposes that misunderstandings arise mutually between autistic and non-autistic people, rather than solely from autistic deficits in empathy or social cognition.<ref>{{Citation |last1=Milton |first1=Damian Elgin Maclean |title=Double Empathy |date=2021 |encyclopedia=Encyclopedia of Autism Spectrum Disorders |pages=1509–1517 |publisher=Springer, Cham |doi=10.1007/978-3-319-91280-6_102273 |isbn=978-3-319-91280-6 |last2=Heasman |first2=Brett |last3=Sheppard |first3=Elizabeth }}</ref><ref name="Milton-2022">{{cite journal |last1=Milton |first1=Damian |last2=Gurbuz |first2=Emine |last3=López |first3=Beatriz |date=November 2022 |title=The 'double empathy problem': Ten years on |journal=[[Autism (journal)|Autism]] |language=en |volume=26 |issue=8 |pages=1901–1903 |doi=10.1177/13623613221129123 |pmid=36263746 }}</ref><ref name="Marocchini & Baldin">{{cite journal |last1=Marocchini |first1=Eleonora |last2=Baldin |first2=Irene |title=Cross-neurotype communication from an autistic point of view: Insights on autistic Theory of Mind from a focus group study |journal=International Journal of Language & Communication Disorders |date=31 July 2024 |volume=59 |issue=6 |pages=2465–2482 |doi=10.1111/1460-6984.13095 |pmid=39083290 }}</ref> This perspective has contributed to a growing recognition that autistic behavior and communication may reflect different, rather than deficient, social behavior and communication styles.<ref name="Long-2025" /><ref name="Milton-2022" /><ref name="Marocchini & Baldin"/> Autistic interests and conversational styles are often characterized by a strong focus on specific topics, a phenomenon known as [[monotropism]].<ref>{{cite encyclopedia |last=Murray |first=Dinah |title=Monotropism: An Interest-Based Account of Autism |date=2021 |encyclopedia=Encyclopedia of Autism Spectrum Disorders |pages=2954–2956 |editor-last=Volkmar |editor-first=Fred R. |location=Cham |publisher=Springer International Publishing |doi=10.1007/978-3-319-91280-6_102269 |isbn=978-3-319-91280-6 }}</ref><ref>{{Cite web |date=2024-09-20 |title=Being Monotropic: Definition, Examples, and Benefits |url=https://psychcentral.com/autism/monotropic |access-date=2025-10-22 |website=Psych Central |language=en}}</ref>

==== Spoken communication ==== Differences in verbal communication often become noticeable in early childhood, as many autistic children develop language skills at an uneven pace. Speech may emerge later than is typical or not at all ([[non-speaking autism]]), while reading ability may be present before school age ([[hyperlexia]]).<ref name="NIH2017Com" /> Infants may show delayed onset of babbling, atypical gestures, lower responsiveness, or vocal patterns that are less synchronized with caregivers. During the second and third years, autistic children may produce less frequent and less varied babbling, consonants, words, and word combinations, and may integrate gestures with speech less often. They are less likely to make requests or share experiences, and more likely to repeat others' words or phrases ([[echolalia]]).<ref name="Tager-Flusberg">{{cite journal |vauthors=Tager-Flusberg H, Caronna E |date=June 2007 |title=Language disorders: autism and other pervasive developmental disorders |journal=[[Pediatric Clinics of North America]] |volume=54 |issue=3 |pages=469–81, vi |doi=10.1016/j.pcl.2007.02.011 |pmid=17543905 }}</ref> About 25–35% of autistic school-age children are non-speaking or minimally speaking.<ref name="Byrne-2024">{{Cite journal |last1=Byrne |first1=Katherine |last2=Sterrett |first2=Kyle |last3=Lord |first3=Catherine |date=December 2024 |title=Examining the Transition from Single Words to Phrase Speech in Children with ASD: A Systematic Review |journal=[[Clinical Child and Family Psychology Review]] |volume=27 |issue=4 |pages=1031–1053 |doi=10.1007/s10567-024-00507-1 |pmid=39550470 |pmc=11609125 }}</ref> The age at which speech develops and the complexity of early language development are significant predictors of verbal communication abilities in later life.<ref name="Byrne-2024" />

==== Nonverbal communication ====

Autistic people often display atypical behaviors or differences in [[nonverbal communication]]. Some may make infrequent [[eye contact]], even when called by name, or avoid it altogether because they find it uncomfortable, distracting, or overstimulating.<ref>{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |page=60 }}</ref> Conversely, some autistic people make eye contact that others perceive as intense or unrelenting.<ref name="Trevisan">{{cite journal |last1=Trevisan |first1=Dominic A. |last2=Roberts |first2=Nicole |last3=Lin |first3=Cathy |last4=Birmingham |first4=Elina |title=How do adults and teens with self-declared Autism Spectrum Disorder experience eye contact? A qualitative analysis of first-hand accounts |journal=PLOS ONE |date=2017 |volume=12 |issue=11 |article-number=e0188446 |doi=10.1371/journal.pone.0188446 |doi-access=free |pmid=29182643 |pmc=5705114 |bibcode=2017PLoSO..1288446T }}</ref><ref name="Middleton">{{cite book |last1=Middleton |first1=Ellie |title=Unmasked: The ultimate guide to ADHD, autism and neurodivergence |date=2023 |publisher=Random House}}</ref>{{Clarify|reason=This probably refers to masking or eye contact that is perceived as atypical and "too intense" by non-autistic people.|date=April 2026}}{{Unreliable medical source|date=April 2026}} They may recognize fewer [[emotion]]s or interpret [[facial expression]]s differently, and may not respond with expressions expected by their non-autistic peers.<ref>{{cite web |title=Autism: Overview |url=https://www.asha.org/Practice-Portal/Clinical-Topics/Autism/ |publisher=American Speech-Language-Hearing Association |access-date=17 December 2017 |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423134030/https://www.asha.org/Practice-Portal/Clinical-Topics/Autism/ |url-status=live}}</ref><ref name="NIH2017Com">{{cite web |date=18 August 2015 |title=Autism Spectrum Disorder: Communication Problems in Children |url=https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children |access-date=17 December 2017 |website=NIDCD |archive-date=22 December 2017 |archive-url=https://web.archive.org/web/20171222090623/https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children |url-status=live}}</ref> They can also have difficulty inferring social context or subtext in conversation or text, resulting in different interpretations of meaning.<ref name="iidc.indiana.edu">{{cite web |title=Social communication and language characteristics associated with high-functioning, verbal children and adults with autism spectrum disorder |url=https://www.iidc.indiana.edu/pages/Social-Communication-and-Language-Characteristics-Associated-with-High-Functioning-Verbal-Children-and-Adults-with-ASD |url-status=live |archive-url=https://web.archive.org/web/20181214181341/https://www.iidc.indiana.edu/pages/Social-Communication-and-Language-Characteristics-Associated-with-High-Functioning-Verbal-Children-and-Adults-with-ASD |archive-date=14 December 2018 |access-date=17 December 2017 |publisher=Indiana Resource Center for Autism |vauthors=Vicker B}}</ref> Speech characteristics such as volume, rhythm, and intonation ([[Prosody (linguistics)|prosody]]) can vary,<ref name="Fusaroli 2017" /> and atypical prosody is estimated to occur in at least half of autistic children.<ref name="Fusaroli 2017">{{cite journal |vauthors=Fusaroli R, Lambrechts A, Bang D, Bowler DM, Gaigg SB |date=March 2017 |title=Is voice a marker for Autism spectrum disorder? A systematic review and meta-analysis |journal=[[Autism Research]] |volume=10 |issue=3 |pages=384–407 |doi=10.1002/aur.1678 |pmid=27501063 |url=https://pure.au.dk/ws/files/101709535/046565.full.pdf }}</ref>

==== Developing and sustaining relationships ==== Signs of autism in childhood include less apparent interest in other children or caregivers, possibly with more interest in objects.<ref name="www.canada.ca-2025" /> Behaviors that may appear as indifference to non-autistic people often reflect autistic differences in recognizing others' personalities, perspectives, and interests.<ref name="iidc.indiana.edu" /> Most research has focused on [[interpersonal relationship]] difficulties between autistic and non-autistic people and on teaching [[social skills]] to address these gaps, but newer studies indicate that autistic people often form satisfying relationships with other autistic people, which can enhance quality of life.<ref name="Watts-2024">{{Cite journal |last1=Watts |first1=Georgina |last2=Crompton |first2=Catherine |last3=Grainger |first3=Catherine |last4=Long |first4=Joseph |last5=Botha |first5=Monique |last6=Somerville |first6=Mark |last7=Cage |first7=Eilidh |date=3 June 2024 |title='A certain magic' – autistic adults' experiences of interacting with other autistic people and its relation to Quality of Life: A systematic review and thematic meta-synthesis |journal=[[Autism (journal)|Autism]] |volume=29 |issue=9 |article-number=13623613241255811 |doi=10.1177/13623613241255811 |pmid=38829019 |pmc=12332227 |hdl=1893/36127 |hdl-access=free}}</ref>

Children on the autism spectrum are more likely than their non-autistic peers to be involved in [[bullying]], most often as victims.<ref>{{Cite journal |last1=Maïano |first1=Christophe |last2=Normand |first2=Claude L. |last3=Salvas |first3=Marie-Claude |last4=Moullec |first4=Grégory |last5=Aimé |first5=Annie |date=2016 |title=Prevalence of School Bullying Among Youth with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis |journal=Autism Research|volume=9 |issue=6 |pages=601–615 |doi=10.1002/aur.1568 |pmid=26451871}}</ref> Among autistic people who seek friendships, reduced friendship quality and quantity are often associated with increased loneliness.<ref>{{Cite journal |last1=Grace |first1=Kana |last2=Remington |first2=Anna |last3=Lloyd-Evans |first3=Brynmor |last4=Davies |first4=Jade |last5=Crane |first5=Laura |date=November 2022 |title=Loneliness in autistic adults: A systematic review |journal=Autism |volume=26 |issue=8 |pages=2117–2135 |doi=10.1177/13623613221077721 |pmid=35257592 |pmc=9597154 }}</ref> Autistic people also face greater challenges in developing romantic relationships than non-autistic people.<ref>{{Cite journal |last1=Yew |first1=Rui Ying |last2=Samuel |first2=Priscilla |last3=Hooley |first3=Merrilyn |last4=Mesibov |first4=Gary B. |last5=Stokes |first5=Mark A. |date=2021 |title=A systematic review of romantic relationship initiation and maintenance factors in autism |journal=Personal Relationships |volume=28 |issue=4 |pages=777–802 |doi=10.1111/pere.12397 |url=https://figshare.com/articles/journal_contribution/20651463 }}</ref>

Over time, many autistic people learn to observe and form models of social patterns, and develop [[coping]] strategies, such as "[[autistic masking|masking]]".<ref name="Cook-2021">{{Cite journal |last1=Cook |first1=Julia |last2=Hull |first2=Laura |last3=Crane |first3=Laura |last4=Mandy |first4=William |date=November 2021 |title=Camouflaging in autism: A systematic review |journal=Clinical Psychology Review |volume=89 |article-number=102080 |doi=10.1016/j.cpr.2021.102080 |pmid=34563942 |url=https://discovery.ucl.ac.uk/id/eprint/10134806/ }}</ref> Masking is associated with poorer mental health outcomes as well as delayed diagnosis, which can limit access to appropriate supports.<ref name="Cook-2021" />

=== Restricted and repetitive behaviors === [[File:Autistic-sweetiepie-boy-with-ducksinarow.jpg|alt=Sleeping boy beside a dozen or so toys arranged in a line|thumb|A young autistic boy who has arranged his toys in a row]]

The second core feature of autism is a pattern of restricted and repetitive behaviors, activities, and interests. To be diagnosed with autism under the DSM-5-TR, a person must exhibit at least two of the following behaviors: repetitive behaviors, resistance to change, focused interests and sensory reactivity.{{sfn|DSM-5-TR}}<ref name="Lord 2018">{{cite journal |vauthors=Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J |date=August 2018 |title=Autism spectrum disorder |journal=[[The Lancet]] |volume=392 |issue=10146 |pages=508–520 |doi=10.1016/S0140-6736(18)31129-2 |pmc=7398158 |pmid=30078460 |bibcode=2018Lanc..392..508L }}</ref>

It is increasingly argued that these characteristics should be accepted, which is supported by their recognized functions, such as self-regulation.<ref>{{Cite journal |last1=Lung |first1=Stephanie Lock Man |last2=Picard |first2=Ève |last3=Soulières |first3=Isabelle |last4=Bertone |first4=Armando |date=September 2024 |title=Identifying the functions of restricted and repetitive behaviours and interests in Autism: A scoping review |journal=[[Research in Autism Spectrum Disorders]] |volume=117 |article-number=102458 |doi=10.1016/j.rasd.2024.102458 }}</ref> Focused interests can also provide personal fulfillment and contribute to the development of specialized knowledge.<ref name="Is This Autism" /> A distinction should be made between these features and those of [[obsessive–compulsive disorder]], which can co-occur with autism and involve compulsions or obsessions aimed at preventing feared outcomes.<ref>{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |pages=178–179 }}</ref> [[File:James arranging brads.jpg|thumb|An autistic boy arranging [[Brass fastener|brads]] on a cork coaster]]

==== Repetitive behaviors ==== Repetitive behaviors found in autism include rocking, hand flapping, finger flicking, head banging, and repeating phrases or sounds (including [[echolalia]]<ref name="CDC-2024" />).<ref>{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |pages=101–115 |chapter=Repetitive or idiosyncratic behavior }}</ref> These behaviors may occur consistently or primarily when the person is stressed, anxious, or upset. They are also known as [[stimming]]. Other examples include playing with toys in ways others might consider limited or unusual<ref name="www.canada.ca-2025" /> (e.g., arranging toys in a row<ref name="CDC-2024" />).

In adults with autism, stimming is also used as a coping mechanism.<ref>{{cite journal |last1=Kapp |first1=Steven K |last2=Steward |first2=Robyn |last3=Crane |first3=Laura |last4=Elliott |first4=Daisy |last5=Elphick |first5=Chris |last6=Pellicano |first6=Elizabeth |last7=Russell |first7=Ginny |title='People should be allowed to do what they like': Autistic adults' views and experiences of stimming |journal=Autism |date=October 2019 |volume=23 |issue=7 |pages=1782–1792 |doi=10.1177/1362361319829628 |pmid=30818970 |pmc=6728747 }}</ref> Many adults learn to suppress (or "mask") these behaviors, which can increase their stress and anxiety.<ref>{{Cite web |last=Levine|first=Hallie|date=2024-12-03|title=Autism: The challenges and opportunities of an adult diagnosis|url=https://www.health.harvard.edu/mind-and-mood/autism-the-challenges-and-opportunities-of-an-adult-diagnosis|access-date=2026-04-22|website=Harvard Health|language=en}}</ref>

==== Resistance to change ==== Autistic people may have a strong preference for routine, such as performing daily tasks in a specific order or showing distress in response to changes others may consider minor.<ref name="Henderson-2023">{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |pages=116–133 |chapter=Flexibility }}</ref> They may become distressed if their routine changes or is disrupted.<ref name="Henderson-2023" />

==== Focused interests ==== {{Main|Special interest (autism)}}

Autistic people may have an intense interest in a particular activity, topic, or hobby, often accompanied by sustained attention and deep knowledge; for example, a strong attachment to certain objects{{sfn|DSM-5-TR}} or frequent discussion of a certain topic.<ref name="Is This Autism">{{cite book |last1=Henderson |first1=Donna |last2=Wayland |first2=Sarah |last3=White |first3=Jamell |title=Is This Autism? |date=2023 |doi=10.4324/9781003242130 |isbn=978-1-003-24213-0 |pages=134–149 |chapter=Intense or atypical interests }}</ref>

==== Sensory reactivity ==== Atypical responses may arise in autistic people in response to certain sensory input, such as aversion to specific sounds or textures, fascination with lights or movement, or apparent indifference to pain or temperature.{{sfn|DSM-5-TR|loc="Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)"}} This is experienced by 90% of autistic people.<ref>{{cite journal |last1=Balasco |first1=Luigi |last2=Provenzano |first2=Giovanni |last3=Bozzi |first3=Yuri |title=Sensory Abnormalities in Autism Spectrum Disorders: A Focus on the Tactile Domain, From Genetic Mouse Models to the Clinic |journal=Frontiers in Psychiatry |date=28 January 2020 |volume=10 |article-number=1016 |doi=10.3389/fpsyt.2019.01016 |pmid=32047448 |doi-access=free |pmc=6997554 }}</ref> They can be hyperactive or hypoactive in response to sensory input. Some underreact to pain and temperature while others have a stronger reaction to it.

=== Self-injury === [[Self-harm]] occurs about three times more often in autistic people than in non-autistic people.<ref name="Blanchard-2021">{{Cite journal |last1=Blanchard |first1=Ashley |last2=Chihuri |first2=Stanford |last3=DiGuiseppi |first3=Carolyn G. |last4=Li |first4=Guohua |date=October 2021 |title=Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis |journal=JAMA Network Open |volume=4 |issue=10 |pages=e2130272 |doi=10.1001/jamanetworkopen.2021.30272 |pmc=8527356 |pmid=34665237 }}</ref> Behaviors can include head-banging, hand-biting, and skin-picking, and can lead to serious injury or, in rare cases, death.<ref name="Mins20142">{{cite journal |vauthors=Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ |date=April 2014 |title=The association between self-injurious behaviors and autism spectrum disorders |journal=[[Psychology Research and Behavior Management]] |volume=7 |pages=125–36 |doi=10.2147/PRBM.S44635 |pmc=3990505 |pmid=24748827 |doi-access=free}}</ref> Several explanations have been proposed for the development and persistence of self-harm among people with developmental conditions such as autism.<ref name="Oliver20152">{{cite journal |vauthors=Oliver C, Richards C |date=October 2015 |title=Practitioner Review: Self-injurious behaviour in children with developmental delay |journal=[[Journal of Child Psychology and Psychiatry]] |type=Review |volume=56 |issue=10 |pages=1042–54 |doi=10.1111/jcpp.12425 |pmid=25916173 |url=https://research.birmingham.ac.uk/en/publications/b511897e-5285-4447-8a90-1c5690dd3ca1 }}</ref> Communication difficulties may lead some autistic people to use self-injury to express needs, distress, or other feelings.<ref name="Mins20142" /> Self-harm may also help regulate sensory input<ref>{{Cite journal |last1=Vandewalle |first1=Katie |last2=Melia |first2=Yvonne |date=March 2021 |title=Psychosocial and behavioural factors associated with self injurious behaviour (SIB) in individuals with autism spectrum disorders (ASD) |journal=[[Research in Autism Spectrum Disorders]] |volume=81 |article-number=101713 |doi=10.1016/j.rasd.2020.101713 }}</ref> or modulate pain perception, particularly for those with chronic discomfort or medical conditions.<ref name="Oliver20152" /> Neurological factors are also under investigation, with atypical [[basal ganglia]] connectivity suggested as a potential biological predisposition in some autistic people.<ref name="Oliver20152" />

=== Wandering (elopement) === Some autistic people "wander" off—a behavior known as ''[[wikt:elopement|elopement]]''—and put themselves in danger. About half of families with autistic children report elopement.<ref name=":0">{{Cite encyclopedia |title=Encyclopedia of Autism Spectrum Disorders |entry=Elopement |publisher=Springer International Publishing AG |location=Cham |date=2021 |editor-last=Volkmar |editor-first=Fred R. |edition=2nd |isbn=978-3-319-91280-6 |last2=Lipkin |first2=Paul H. |last3=Law |first3=J. Kiely |first1=Allan M. |last1=Andersen}}</ref> The propensity for elopement increases with the severity of the autism.<ref name=":0" /> Siblings unaffected by autism show much lower rates of elopement.<ref name=":0" /> [[Drowning]], a leading cause of death for autistic children,<ref>{{Cite report |url=https://www.mass.gov/doc/fy24-child-fatality-review-annual-report/download |title=Massachusetts Child Fatality Review |last1=Thomas |first1=Bekah |last2=Crowley |first2=Meg |last3=Riley |first3=Samantha |last4=Rezendes |first4=Johnny |date=2024 |access-date=2026-02-05 |archive-url=http://web.archive.org/web/20250910105448/https://www.mass.gov/doc/fy24-child-fatality-review-annual-report/download |archive-date=2025-09-10 |website=www.mass.gov}}</ref> and [[traffic injuries]] are among the dangers associated with elopement.<ref name=":0" />

=== Fatigue, burnout, inertia, meltdown, shutdown === Several non-diagnostic models have been used to describe challenges that autistic people face in their daily lives.<ref name="White-2023" /> These concepts lack formal clinical criteria but are widely described by autistic people themselves.<ref name="White-2023" /><ref name="Lai-2023" />

Autistic fatigue or burnout is a prolonged state of mental and physical exhaustion.<ref name="Jahandideh-2025">{{Cite journal |last1=Jahandideh |first1=Pardis |last2=Seyedmirzaei |first2=Homa |last3=Rasoulian |first3=Pegah |last4=Memari |first4=Amirhossein |date=3 May 2025 |title=Low Battery Alarm; A Scoping Review of Autistic Burnout |journal=[[Journal of Autism and Developmental Disorders]] |language=en |doi=10.1007/s10803-025-06860-6 |pmid=40317352 }}</ref><ref name="Lai-2023" /><ref name="White-2023" /><ref>{{Cite web |title=Autistic fatigue and burnout {{!}} Autism Space |url=https://www.leicspart.nhs.uk/autism-space/health-and-lifestyle/autistic-fatigue-and-burnout/ |access-date=27 July 2025 |website=Leicestershire Partnership NHS Trust |language=en-GB|archive-url=https://web.archive.org/web/20250414204235/https://www.leicspart.nhs.uk/autism-space/health-and-lifestyle/autistic-fatigue-and-burnout/|archive-date=14 April 2025}}</ref> It is described as distinct from but similar to [[occupational burnout]] and is often linked to the pressure to hide autistic traits in social interactions.<ref name="Lai-2023" /><ref name="Jahandideh-2025" /> The term "autistic burnout" was first used in 2008, with research into the phenomenon undertaken in the 2020s.<ref name="Jahandideh-2025" /> Several researchers have proposed characterizations of autistic burnout, but no consensus definition exists. [[Depression (mood)|Depression]] can be misattributed to autistic burnout, as they have several overlapping criteria. Reported coping strategies include reduced masking, increased stimming, engaging in special interests and familiar activities, and seeking stress relief. Some affected people temporarily withdraw from social contact as a recovery strategy; while providing relief, interpersonal withdrawal can also result in loneliness and worsening mental health. There is limited data on professional interventions.<ref name="Jahandideh-2025" />

Autistic inertia is a difficulty experienced among autistic people with initiating, transitioning between, or stopping activities or mental states.<ref name="Lai-2023">{{Cite journal |last=Lai |first=Meng-Chuan |date=2023 |title=Mental health challenges faced by autistic people |journal=[[Nature Human Behaviour]] |language=en |volume=7 |issue=10 |pages=1620–1637 |doi=10.1038/s41562-023-01718-2 |pmid=37864080 }}</ref> It may manifest as a feeling of being "stuck": people find it challenging to begin a task, shift focus to a different activity, or disengage from an action, even when they want to.<ref name="White-2023">{{Cite journal |last1=White |first1=Susan W. |last2=Siegle |first2=Greg J. |last3=Kana |first3=Rajesh |last4=Rothman |first4=Emily F. |date=August 2023 |title=Pathways to Psychopathology Among Autistic Adults |journal=[[Current Psychiatry Reports]] |volume=25 |issue=8 |pages=315–325 |doi=10.1007/s11920-023-01429-5 |pmid=37378790 |pmc=11078254 }}</ref>

A meltdown may occur if, upon processing large amounts of information, an autistic person experiences anxiety or feels overwhelmed.<ref name="MS">{{cite web|access-date=22 January 2025 |language=en |title=Understanding autistic meltdowns and shutdowns, Autism Space |url=https://www.leicspart.nhs.uk/autism-space/health-and-lifestyle/meltdowns-and-shutdowns/ |website=[[Leicestershire Partnership NHS Trust]]|archive-url=https://web.archive.org/web/20250403231518/https://www.leicspart.nhs.uk/autism-space/health-and-lifestyle/meltdowns-and-shutdowns/|archive-date=3 April 2025}}</ref> Triggers may be sensory or social, and often include unpredictability, unmet basic needs, and emotional situations, which tend to accumulate.<ref name="MS" /> A meltdown can be expressed audibly (e.g., screaming or crying) or physically.<ref name="MS" /> The person often shows signs of distress beforehand, such as pacing, asking repetitive questions, trembling, or sweating.<ref name="MS" /> An autistic shutdown is similar, but inward; the person is often unable to speak or withdraws completely.<ref name="MS" /> Meltdowns or shutdowns may be prevented by eliminating the distressing factors.<ref name="MS" /> They may be ameliorated by avoiding further questions or pressure, showing the person that one is there to help, and allowing the person to calm down by leaving the situation or breathing slowly.<ref name="MS" />

=== Cognitive profile === Autistic people often show an uneven or "spiky" cognitive profile, with relative strengths in some cognitive domains alongside difficulties in others.<ref>{{Cite journal |last=Wilson |first=Alexander C |date=June 2024 |title=Cognitive Profile in Autism and ADHD: A Meta-Analysis of Performance on the WAIS-IV and WISC-V |journal=Archives of Clinical Neuropsychology |volume=39 |issue=4 |pages=498–515 |doi=10.1093/arclin/acad073 |pmid=37779387 |pmc=11110614 }}</ref> The otherwise rare [[savant syndrome]], characterized by an isolated skill in a narrow area, is more common among autistic people, but studies of its prevalence have found different results. These special skills are related to prodigious memory. Most common are splinter skills, such as memorization of sports trivia or historical facts.<ref>{{cite journal |vauthors=Treffert DA |date=May 2009 |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 |doi=10.1098/rstb.2008.0326 |pmc=2677584 |pmid=19528017}}</ref><ref>{{cite book |last1=Heaton |first1=Pamela |title=Encyclopedia of Autism Spectrum Disorders |chapter=Autistic Savants |date=2021 |pages=554–555 |doi=10.1007/978-3-319-91280-6_1372 |isbn=978-3-319-91279-0 }}</ref> Research has also reported enhanced performance by autistic participants on certain perceptual and attentional tasks.<ref>{{cite journal |vauthors=Plaisted Grant K, Davis G |date=May 2009 |title=Perception and apperception in autism: rejecting the inverse assumption |journal=[[Philosophical Transactions of the Royal Society B|Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences]] |volume=364 |issue=1522 |pages=1393–1398 |doi=10.1098/rstb.2009.0001 |pmc=2677593 |pmid=19528022}}</ref>

=== Other features === Autistic people may exhibit traits or characteristics that are not part of the formal diagnostic criteria but can nonetheless affect their personal well-being or family dynamics.<ref name="Filipek">{{cite journal |display-authors=6 |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 |date=December 1999 |title=The screening and diagnosis of autistic spectrum disorders |journal=[[Journal of Autism and Developmental Disorders]] |volume=29 |issue=6 |pages=439–484 |doi=10.1023/A:1021943802493 |pmid=10638459 }} This paper represents a consensus of representatives from nine professional and four parent organizations in the US.</ref> * An estimated 60–80% of autistic people have motor signs that include [[Hypotonia|poor muscle tone]], [[Apraxia|poor motor planning]], and [[toe walking]];<ref name="Geschwind-2009">{{cite journal |author-link=Daniel Geschwind |vauthors=Geschwind DH |year=2009 |title=Advances in autism |journal=[[Annual Review of Medicine]] |volume=60 |pages=367–380 |doi=10.1146/annurev.med.60.053107.121225 |pmc=3645857 |pmid=19630577}}</ref><ref name="Gargot2022">{{cite journal |vauthors=Gargot T, Archambault D, Chetouani M, Cohen D, Johal W, Anzalone SM |date=10 January 2022 |title=Automatic Assessment of Motor Impairments in Autism Spectrum Disorders: A Systematic Review |journal=Cognitive Computation |volume=14 |issue=2 |pages=624–659 |doi=10.1007/s12559-021-09940-8 |url=https://hal.science/hal-03520967 }}</ref> difficulties in motor coordination appear common across the autism spectrum.<ref>{{cite journal |vauthors=Fournier KA, Hass CJ, Naik SK, Lodha N, Cauraugh JH |date=October 2010 |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 |doi=10.1007/s10803-010-0981-3 |pmid=20195737 }}</ref><ref>{{cite journal |last1=Wang |first1=Leah A. L. |last2=Petrulla |first2=Victoria |last3=Zampella |first3=Casey J. |last4=Waller |first4=Rebecca |last5=Schultz |first5=Robert T. |date=2022 |title=Gross motor impairment and its relation to social skills in autism spectrum disorder: A systematic review and two meta-analyses |journal=[[Psychological Bulletin]] |language=en |volume=148 |issue=3–4 |pages=273–300 |doi=10.1037/bul0000358 |pmc=9894569 |pmid=35511567 }}</ref> * Unusual or atypical eating behavior occurs in about 70% of children on the autism spectrum,<ref name="Baraskewich-2021">{{Cite journal |last1=Baraskewich |first1=Jessica |last2=von Ranson |first2=Kristin M |last3=McCrimmon |first3=Adam |last4=McMorris |first4=Carly A |date=August 2021 |title=Feeding and eating problems in children and adolescents with autism: A scoping review |journal=Autism |volume=25 |issue=6 |pages=1505–1519 |doi=10.1177/1362361321995631 |pmid=33653157 |pmc=8323334 }}</ref> to the extent that it was once considered a diagnostic indicator.<ref name="Filipek" /> Selectivity is the most common characteristic, although eating rituals and food refusal are also reported.<ref name="Baraskewich-2021" /> * Several studies report moderate correlations between autism, [[Internet addiction disorder]], and [[video game addiction]].<ref>{{cite journal |last1=Murray |first1=Alayna |last2=Koronczai |first2=Beatrix |last3=Király |first3=Orsolya |last4=Griffiths |first4=Mark D. |last5=Mannion |first5=Arlene |last6=Leader |first6=Geraldine |last7=Demetrovics |first7=Zsolt |year=2021 |title=Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review |journal=Review Journal of Autism and Developmental Disorders |publisher=Springer |volume=9 |pages=120–140 |doi=10.1007/s40489-021-00243-0 |hdl-access=free |hdl=10379/16762}}</ref>

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

The exact causes of autism are unknown,<ref>{{cite book |last1=MacOun |first1=Sarah J. |last2=Bedir |first2=Buse |last3=Sheehan |first3=John |title=Handbook of Autism and Pervasive Developmental Disorder |chapter=Autism across the Ages: An Abbreviated History |series=Autism and Child Psychopathology Series |date=2022 |pages=3–28 |doi=10.1007/978-3-030-88538-0_1 |isbn=978-3-030-88537-3 |oclc=1341298051 |quote-page=18 |quote=To date no one genetic feature or environmental cause has proven etiological in explaining most cases autism or has been able to account for rising rates of autism. }}</ref><ref>{{cite book |last1=Sauer |first1=Ann Katrin |title=Autism spectrum disorders |last2=Stanton |first2=Janelle E. |last3=Hans |first3=Sakshi |last4=Grabrucker |first4=Andreas M. |publisher=Exon Publications |isbn=978-0-6450017-8-5 |editor-last=Grabrucker |editor-first=Andreas M. |location=Brisbane |date=2021 |pages=1–16 |language=en |chapter=Autism Spectrum Disorders: Etiology and Pathology |doi=10.36255/exonpublications.autismspectrumdisorders.2021.etiology |oclc=1280592589 |pmid=34495611 |quote=The cause of ASD is unknown, but several genetic and non-genetic risk factors have been characterized that, alone or in combination, are implicated in the development of ASD. |doi-access=free}}</ref><ref>{{cite journal |last1=Kałużna-Czaplińska |first1=Joanna |last2=Żurawicz |first2=Ewa |last3=Jóźwik-Pruska |first3=Jagoda |year=2018 |title=Focus on the Social Aspect of Autism |journal=Journal of Autism and Developmental Disorders |language=en |publisher=[[Springer Nature]] |publication-date=29 November 2017 |volume=48 |issue=5 |pages=1861–1867 |doi=10.1007/s10803-017-3407-7 |pmc=5889772 |pmid=29188587 |quote=Despite extensive ASD research lasting more than 60 years, its causes are still unknown.}}</ref><ref>{{cite journal |last1=Medavarapu |first1=Srinivas |last2=Marella |first2=Lakshmi Lavanya |last3=Sangem |first3=Aneela |last4=Kairam |first4=Ram |year=2019 |title=Where is the Evidence? A Narrative Literature Review of the Treatment Modalities for Autism Spectrum Disorders |journal=[[Cureus]] |publisher=[[Springer Nature]] |publication-date=16 January 2019 |volume=11 |issue=1 |doi=10.7759/cureus.3901 |pmc=6424545 |pmid=30911457 |quote=It is important to realize that the etiology of autism is unknown and at present, there is no cure, although there are interventions that may be effective in alleviating some symptoms and improving skills that may help autistic persons lead more productive lives. |doi-access=free |article-number=e3901}}</ref> with genetics likely being the largest contributing factor. It was long presumed a single cause at the genetic, cognitive, and neural levels underpinned the social and non-social features,<ref name="Happé-2008">{{cite journal |vauthors=Happé F, Ronald A |date=December 2008 |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 |doi=10.1007/s11065-008-9076-8 |pmid=18956240 }}</ref> but autism is increasingly thought to be a complex condition with distinct, often co-occurring, causes for its core aspects.<ref name="Happé-2008" /><ref name="HappeTime2">{{cite journal |vauthors=Happé F, Ronald A, Plomin R |date=October 2006 |title=Time to give up on a single explanation for autism |journal=Nature Neuroscience |volume=9 |issue=10 |pages=1218–1220 |doi=10.1038/nn1770 |pmid=17001340 |doi-access=}}</ref> It is unlikely that autism has a single cause;<ref name="HappeTime2" /> research has identified many factors as potential contributors,<ref name="Modabbernia-2017">{{Cite journal |last1=Modabbernia |first1=Amirhossein |last2=Velthorst |first2=Eva |last3=Reichenberg |first3=Abraham |date=17 March 2017 |title=Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses |journal=Molecular Autism |volume=8 |issue=1 |page=13 |doi=10.1186/s13229-017-0121-4 |pmc=5356236 |pmid=28331572 |doi-access=free }}</ref> including genetics,<ref name="Lord 2018" /> [[Prenatal development|prenatal]] and perinatal (shortly after birth) history,<ref name="Modabbernia-2017" /> [[Neuroanatomy|neuroanatomical]] anomalies, changing social demands in the workplace or in school,<ref name="Anderson-Chavarria-2022" /> and environmental influences.<ref name="Modabbernia-2017" /> It is possible to identify general factors but difficult to determine specific ones.<ref name="Tager-Flusberg 20102">{{cite journal |vauthors=Tager-Flusberg H |year=2010 |title=The origins of social impairments in autism spectrum disorder: studies of infants at risk |journal=[[Neural Networks (journal)|Neural Networks]] |volume=23 |issue=8–9 |pages=1072–6 |doi=10.1016/j.neunet.2010.07.008 |pmc=2956843 |pmid=20800990}}</ref> Research into causes is complex due to challenges in identifying distinct biological subgroups in the autistic population.<ref>{{cite journal |vauthors=Altevogt BM, Hanson SL, Leshner AI |date=June 2008 |title=Autism and the environment: challenges and opportunities for research |journal=[[Pediatrics (journal)|Pediatrics]] |volume=121 |issue=6 |pages=1225–1229 |doi=10.1542/peds.2007-3000 |pmid=18519493 }}</ref>

=== Genetics === {{Main|Heritability of autism}}

[[File:Autism susceptibility genes effect on brain structure.png|alt=|thumb|upright=1.6|Hundreds of different genes are implicated in the likelihood of being autistic, most of which influence the brain structure in a similar way.]] Autism has a strong genetic basis, but the [[Heritability of autism|genetics of autism]] are complex and it is unclear whether autism is explained more by rare [[mutation]]s with major effects or by rare multi-gene interactions of common genetic variants.<ref name="Abrahams">{{cite journal |vauthors=Abrahams BS, Geschwind DH |date=May 2008 |title=Advances in autism genetics: on the threshold of a new neurobiology |journal=Nature Reviews. Genetics |volume=9 |issue=5 |pages=341–355 |doi=10.1038/nrg2346 |pmc=2756414 |pmid=18414403}}</ref><ref>{{cite journal |vauthors=Buxbaum JD |year=2009 |title=Multiple rare variants in the etiology of autism spectrum disorders |journal=Dialogues in Clinical Neuroscience |volume=11 |issue=1 |pages=35–43 |doi=10.31887/DCNS.2009.11.1/jdbuxbaum |pmc=3181906 |pmid=19432386}}</ref> Twin studies indicate that autism is highly heritable, with genetic factors explaining most of the risk and shared environmental effects playing a minor role.<ref name="Tick-2016" /> Numerous genes have been found to be associated with autism, with most loci individually explaining less than 1% of autism cases<ref>{{cite journal |vauthors=Persico AM, Napolioni V |date=August 2013 |title=Autism genetics |journal=Behavioural Brain Research |volume=251 |pages=95–112 |doi=10.1016/j.bbr.2013.06.012 |hdl=11380/1250884 |pmid=23769996 |hdl-access=free }}</ref> and having only small effects.<ref name="Abrahams" /> While these genetic variants are associated with a higher likelihood of being autistic, they do not individually determine whether someone will be autistic.<ref>{{Cite journal |last1=Goh |first1=Shuxiang |last2=Thiyagarajan |first2=Lavvina |last3=Dudding-Byth |first3=Tracy |last4=Pinese |first4=Mark |last5=Kirk |first5=Edwin P. |date=January 2025 |title=A systematic review and pooled analysis of penetrance estimates of copy-number variants associated with neurodevelopment |journal=[[Genetics in Medicine]] |volume=27 |issue=1 |doi=10.1016/j.gim.2024.101227 |pmid=39092588 |article-number=101227}}</ref> Complexity arises from interactions among multiple genes, the environment, and heritable [[Epigenetics|epigenetic]] factors (which influence [[gene expression]] without changing [[DNA]] sequence).<ref name="Rapin">{{cite journal |vauthors=Rapin I, Tuchman RF |date=October 2008 |title=Autism: definition, neurobiology, screening, diagnosis |journal=[[Pediatric Clinics of North America]] |volume=55 |issue=5 |pages=1129–46, viii |doi=10.1016/j.pcl.2008.07.005 |pmid=18929056}}</ref>

Typically, autism is not traceable to a single-gene ([[Mendelian inheritance|Mendelian]]) mutation or [[chromosome anomaly]], and no known genetic syndrome selectively causes autism.<ref name="Abrahams" /> If autism is one characteristic of a broader medical condition, such as [[fragile X syndrome]], it is called [[syndromic autism]], as opposed to non-syndromic or idiopathic autism, which is typically polygenic without a known cause.<ref>{{Cite journal |last1=Fernandez |first1=Bridget A. |last2=Scherer |first2=Stephen W. |date=2017 |title=Syndromic autism spectrum disorders: moving from a clinically defined to a molecularly defined approach |journal=Dialogues in Clinical Neuroscience |volume=19 |issue=4 |pages=353–371 |doi=10.31887/DCNS.2017.19.4/sscherer |pmc=5789213 |pmid=29398931}}</ref> Syndromic autism is present in approximately 25% of autistic people.<ref>{{Cite journal |last1=Wiśniowiecka-Kowalnik |first1=Barbara |last2=Nowakowska |first2=Beata Anna |date=February 2019 |title=Genetics and epigenetics of autism spectrum disorder—current evidence in the field |journal=Journal of Applied Genetics |language=en |volume=60 |issue=1 |pages=37–47 |doi=10.1007/s13353-018-00480-w |pmc=6373410 |pmid=30627967}}</ref> Research has suggested that autistic people with intellectual disability tend to have rarer, more impactful, genetic mutations than those found in people diagnosed solely with autism.<ref>{{Cite journal |last1=Woodbury-Smith |first1=Marc |last2=Scherer |first2=Stephen W |date=2018 |title=Progress in the genetics of autism spectrum disorder |journal=Developmental Medicine & Child Neurology |volume=60 |issue=5 |pages=445–451 |doi=10.1111/dmcn.13717 |pmid=29574884 }}</ref> A number of genetic syndromes causing intellectual disability may also co-occur with autism, including [[Fragile X syndrome|fragile X]], [[Down syndrome|Down]], [[Prader–Willi]], [[Angelman]], [[Williams syndrome]],<ref>{{cite journal |vauthors=Zafeiriou DI, Ververi A, Vargiami E |date=June 2007 |title=Childhood autism and associated comorbidities |journal=Brain & Development |volume=29 |issue=5 |pages=257–272 |doi=10.1016/j.braindev.2006.09.003 |pmid=17084999 }}</ref> and [[SYNGAP1-related intellectual disability]].<ref>{{cite book |last1=Holder |first1=J. Lloyd |last2=Hamdan |first2=Fadi F. |last3=Michaud |first3=Jacques L. |title=GeneReviews® |date=1993 |publisher=University of Washington, Seattle |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK537721/ |chapter=SYNGAP1-Related Intellectual Disability |pmid=30789692 }}</ref>

Research suggests that autism is associated with genes that influence neural development and connectivity. These are involved in key neuronal processes such as [[Protein biosynthesis|protein synthesis]], synaptic activity, [[cell adhesion]], and the formation and remodeling of [[synapse]]s, as well as the regulation of excitatory and inhibitory [[neurotransmission]]. Studies have identified lower expression of genes linked to the inhibitory neurotransmitter [[GABA|gamma-aminobutyric acid]], alongside higher expression of genes associated with [[glia]]l (e.g., [[astrocyte]]s) and immune (e.g., [[microglia]]) cells, correlating with higher numbers of these cells in post-mortem brain tissue. Genes associated with variation in the [[mTOR]] signaling pathway, which is involved in cell growth and survival, are also under investigation.<ref name="Chen2015">{{cite journal |vauthors=Chen JA, Peñagarikano O, Belgard TG, Swarup V, Geschwind DH |date=2015 |title=The emerging picture of autism spectrum disorder: genetics and pathology |journal=[[Annual Review of Pathology: Mechanisms of Disease]] |type=Review |volume=10 |pages=111–44 |doi=10.1146/annurev-pathol-012414-040405 |pmid=25621659 |doi-access=}}</ref> Some hypotheses in [[evolutionary psychiatry]] suggest that autism-associated genes may persist because of proposed links to traits such as intelligence, systematizing abilities, or innovation.<ref>{{cite book |title=The pattern seekers: how autism drives human invention |vauthors=Baron-Cohen S |date=10 November 2020 |publisher=[[Basic Books]] |isbn=978-1-5416-4713-8 |oclc=1204602315}}</ref>

If parents have one autistic child, the chance of having a second autistic child ranges from 7% to 20%.<ref name="Lord 2018" /> Though autism is highly heritable, many autistic people have only non-autistic family members. In some cases, this may be explained by [[Structural variation in the human genome|de novo structural variations]]—such as [[Deletion (genetics)|deletions]], [[Gene duplication|duplications]], or [[Chromosomal inversion|inversions]]—that arise spontaneously during [[meiosis]] and are not present in the parents' genomes.<ref>{{cite journal |vauthors=Cook EH, Scherer SW |date=October 2008 |title=Copy-number variations associated with neuropsychiatric conditions |journal=Nature |volume=455 |issue=7215 |pages=919–923 |bibcode=2008Natur.455..919C |doi=10.1038/nature07458 |pmid=18923514 }}</ref><ref name="Beaudet-2007">{{cite journal |vauthors=Beaudet AL |date=May 2007 |title=Autism: highly heritable but not inherited |journal=Nature Medicine |volume=13 |issue=5 |pages=534–536 |doi=10.1038/nm0507-534 |pmid=17479094 }}</ref> The likelihood of being autistic is greater with older fathers than with older mothers; two potential explanations are the known increase in the number of mutations in older sperm and the hypothesis that men marry later if they carry a genetic predisposition and show some signs of autism.<ref>{{Cite journal |last=Geschwind |first=Daniel H. |date=31 October 2008 |title=Autism: Many Genes, Common Pathways? |journal=Cell |language=English |volume=135 |issue=3 |pages=391–395 |doi=10.1016/j.cell.2008.10.016 |pmc=2756410 |pmid=18984147 }}</ref>

=== Evolutionary perspectives === {{See also|Evolutionary psychology|Pleiotropy#Autism and schizophrenia}}

Research on the evolutionary advantages of autism and associated genes has suggested that autistic people may have contributed uniquely to human development, particularly in technological innovation (such as tool-making) and in detailed observation and analysis of the natural environment.<ref>{{cite book |title=Recent Advances in Autism Spectrum Disorders |vauthors=Spikins P |date=6 March 2013 |veditors=Fitzgerald M |volume=II |language=en |chapter=The Stone Age Origins of Autism}}</ref> Systematic reviews emphasize that these ideas remain speculative and that no single evolutionary explanation has been established.<ref>{{Cite journal |last=Nesse |first=Randolph M. |date=June 2023 |title=Evolutionary psychiatry: foundations, progress and challenges |journal=World Psychiatry |language=en |volume=22 |issue=2 |pages=177–202 |doi=10.1002/wps.21072 |pmc=10168175 |pmid=37159362 }}</ref>

=== Social factors === Social factors such as upbringing are not known to cause autism, but it is possible that increasing demands for flexibility and social interaction in education, or in one's personal and professional life, may cause people to exhibit pronounced difficulties that would not have led to diagnosis in a different setting.<ref name="Anderson-Chavarria-2022" /><ref name="Ogundele-2025" />

Recent studies show that social diffusion can lead to increased autism prevalence.<ref name=":02">{{cite journal |last1=Liu |first1=Ka-Yuet |last2=King |first2=Marissa |last3=Bearman |first3=Peter S. |title=Social Influence and the Autism Epidemic |journal=American Journal of Sociology |date=March 2010 |volume=115 |issue=5 |pages=1387–1434 |doi=10.1086/651448 |pmid=20503647 |pmc=2927813 }}</ref> Proximity for children that have the same severity of autism can increase prevalence due to increased expression of symptoms of autism. This is seen in children with high-functioning autism.<ref name=":02" />

=== Neurocognitive theories === Various theoretical frameworks attempt to integrate underlying genetic and environmental causes with observed neurobiological findings and behavioral traits.

* The '''Intense World Theory''' proposes that a higher neural responsiveness in autism leads to more intense sensory perception, attention, memory, and emotional responses, shaping the person's experience.<ref>{{Cite journal |last1=Markram |first1=Kamila |last2=Markram |first2=Henry |date=21 December 2010 |title=The Intense World Theory – A Unifying Theory of the Neurobiology of Autism |journal=Frontiers in Human Neuroscience |language=English |volume=4 |page=224 |doi=10.3389/fnhum.2010.00224 |pmc=3010743 |pmid=21191475 |doi-access=free }}</ref> * The Enhanced Perceptual Functioning model of autism posits that superior and more independent functioning of auditory and visual perception is the root cause of the specific pattern of cognitive, behavioral, and neural performance observed in autistic people.<ref name="Mukerji-2013" /> The model asserts the importance of perception, arguing it is more central to the autistic phenotype than social or higher-order cognitive processes.<ref name="Mukerji-2013" />

Beyond models of causation and brain function, cognitive theories have been developed to explain patterns of information processing common in autistic people, to better understand the autistic phenotype.<ref name="Fletcher-Watson-2019">{{Cite book |last1=Fletcher-Watson |first1=Sue |title=Autism: A New Introduction to Psychological Theory and Current Debate |last2=Happé |first2=Francesca |date=2019 |publisher=Taylor & Francis Group |isbn=978-1-138-10612-3 |edition=2nd |location=Milton}}</ref> While these cognitive accounts describe how autistic traits may manifest, they are generally viewed as explanations of the behavioral and cognitive consequences of the underlying neurobiological development rather than primary causes themselves.<ref name="Fletcher-Watson-2019" /> * The [[weak central coherence theory]] suggests a tendency to focus on details over broader context.<ref name="Fletcher-Watson-2019" /> * The [[empathising–systemising theory]] posits that autistic people have distinct cognitive styles related to analyzing systems versus empathizing with others.<ref name="Fletcher-Watson-2019" />

=== Early life and prenatal or perinatal factors === {{see also|Acetaminophen autism mass tort}} Certain factors during pregnancy and birth may increase the likelihood of autism,<ref>{{cite journal |last1=Wang |first1=Chengzhong |last2=Geng |first2=Hua |last3=Liu |first3=Weidong |last4=Zhang |first4=Guiqin |year=2017 |title=Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis |journal=Medicine |publisher=Lippincott Williams & Wilkins |volume=96 |issue=18 |doi=10.1097/MD.0000000000006696 |pmc=5419910 |pmid=28471964 |article-number=e6696}}</ref> although no single factor is conclusive and study results are often inconsistent.<ref name="Garder, Spiegelman, Buka">{{cite journal |vauthors=Gardener H, Spiegelman D, Buka SL |date=August 2011 |title=Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis |journal=[[Pediatrics (journal)|Pediatrics]] |volume=128 |issue=2 |pages=344–55 |doi=10.1542/peds.2010-1036 |pmc=3387855 |pmid=21746727 |bibcode=2011Pedia.128..344G }}</ref> These factors include advanced parental age,<ref>{{cite journal |last1=Sandin |first1=Sven |last2=Hultman |first2=Christina M. |last3=Kolevzon |first3=Alexander |last4=Gross |first4=Raz |last5=MacCabe |first5=James H. |last6=Reichenberg |first6=Abraham |year=2012 |title=Advancing Maternal Age Is Associated With Increasing Risk for Autism: A Review and Meta-Analysis |journal=[[Journal of the American Academy of Child & Adolescent Psychiatry]] |publisher=Elsevier |volume=51 |issue=5 |pages=477–486.e1 |doi=10.1016/j.jaac.2012.02.018 |pmid=22525954}}</ref><ref>{{cite journal |last1=de Kluiver |first1=Hilde |last2=Buizer-Voskamp |first2=Jacobine E. |last3=Dolan |first3=Conor V. |last4=Boomsma |first4=Dorret I. |year=2017 |title=Paternal age and psychiatric disorders: A review |journal=[[American Journal of Medical Genetics]] |publisher=[[Wiley-Blackwell]] |volume=174 |issue=3 |pages=202–213 |doi=10.1002/ajmg.b.32508 |pmc=5412832 |pmid=27770494}}</ref> maternal health conditions (e.g., [[gestational diabetes]], infections such as [[rubella]],<ref>{{Cite journal |last1=Jash |first1=Sukanta |last2=Sharma |first2=Surendra |date=2022-04-29 |title=Viral Infections and Temporal Programming of Autism Spectrum Disorders in the Mother's Womb |journal=Frontiers in Virology |language=English |volume=2 |doi=10.3389/fviro.2022.863202 |doi-access=free |article-number=863202}}</ref> inflammation<ref name="VohrPoggiDavis2017">{{cite journal |vauthors=Vohr BR, Poggi Davis E, Wanke CA, Krebs NF |date=April 2017 |title=Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings |journal=[[Pediatrics (journal)|Pediatrics]] |type=Review |volume=139 |issue=Suppl 1 |pages=S38–S49 |doi=10.1542/peds.2016-2828F |pmid=28562247 }}</ref>), exposure to certain medications (e.g., [[valproate]]<ref name="Garder, Spiegelman, Buka" />), and some environmental exposures like significant [[air pollution]] during pregnancy.<ref>{{cite journal |display-authors=6 |vauthors=Lam J, Sutton P, Kalkbrenner A, Windham G, Halladay A, Koustas E, Lawler C, Davidson L, Daniels N, Newschaffer C, Woodruff T |year=2016 |title=A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder |journal=[[PLOS ONE]] |volume=11 |issue=9 |bibcode=2016PLoSO..1161851L |doi=10.1371/journal.pone.0161851 |pmc=5031428 |pmid=27653281 |doi-access=free |article-number=e0161851}}</ref> While many environmental factors have been investigated, few have established links,<ref name="Garder, Spiegelman, Buka" /> and some prominent claims (e.g., [[vaccine]]s or [[refrigerator mother theory|parenting styles]]) have been disproven.<ref>{{Cite journal |last=Amaral |first=David G. |date=2017 |title=Examining the Causes of Autism |journal=Cerebrum: The Dana Forum on Brain Science |volume=2017 |pages=cer–01–17 |pmc=5501015 |pmid=28698772}}</ref>

==== Disproven refrigerator mother hypothesis ==== Work on autism in the mid-20th century proposed the "frigid mother" or [[Refrigerator mother theory|refrigerator mother hypothesis]], according to which poor parenting or lack of emotional support from parents leads to autism.<ref name="Gyawali-2019">{{Cite journal |last1=Gyawali |first1=Shreeya |last2=Patra |first2=Bichitra Nanda |date=February 2019 |title=Trends in concept and nosology of autism spectrum disorder: A review |journal=Asian Journal of Psychiatry |volume=40 |pages=92–99 |doi=10.1016/j.ajp.2019.01.021 |pmid=30776666 }}</ref> When it was proposed, the hypothesis contributed to considerable media attention about autism, which had previously been mostly ignored.<ref name="In a Different Key, Donvan, Zucker, 2016">{{cite book |last1=Donvan |first1=John |last2=Zucker |first2=Caren |title=In a Different Key: The Story of Autism |date=2017 |publisher=Crown |isbn=978-0-307-98570-5 |pages=89–91 |url=https://books.google.com/books?id=QB6-DQAAQBAJ&q=%22It+was+confounding.++If+Kanner+now+blamed+parents%2C+that+represented+a+significant+about-face+on+his+part.%22&pg=PA90 }}</ref> The hypothesis has since fallen out of favor, and has not garnered support when studied.<ref name="Gyawali-2019" /> But the blame placed on parents of children on the autism spectrum, especially mothers, has contributed to substantial stigma.<ref>{{Cite journal |last=Waltz |first=Mitzi M. |date=April 2015 |title=Mothers and Autism: The Evolution of a Discourse of Blame |journal=AMA Journal of Ethics |language=en |volume=17 |issue=4 |pages=353–358 |doi=10.1001/journalofethics.2015.17.4.mhst1-1504 |hdl=1871.1/30a6ed23-a4eb-485b-9007-50246fc33e27 |pmid=25901704 |hdl-access=free |url=https://research.vu.nl/en/publications/30a6ed23-a4eb-485b-9007-50246fc33e27 }}</ref><ref>{{Cite journal |last1=Cleary |first1=Michelle |last2=West |first2=Sancia |last3=Mclean |first3=Loyola |date=September 2022 |title=From 'Refrigerator Mothers' to Empowered Advocates: The Evolution of the Autism Parent |journal=Issues in Mental Health Nursing |volume=44 |issue=1 |pages=64–70 |doi=10.1080/01612840.2022.2115594 |pmid=36049183 |url=https://figshare.com/articles/journal_contribution/22492933 }}</ref>

Early social experiences, such as caregiver interactions or deprivation, may shape the development of autism, potentially via [[gene–environment correlation]]s, and are distinct from the discredited refrigerator mother hypothesis.<ref name="Mandy-2016" />

==== Disproven vaccines hypothesis ==== {{Main|Vaccines and autism|MMR vaccine and autism}}

Parents may first become aware of autistic characteristics in their child around the time of a routine vaccination. This has led to theories{{snd}}subsequently disproven{{snd}}blaming [[Vaccine controversy#Vaccine overload|vaccine "overload"]], the [[Thiomersal and vaccines|vaccine preservative thiomersal]], or the [[MMR vaccine and autism|MMR vaccine]] for causing autism.<ref name="GerberOffit2009">{{cite journal |vauthors=Gerber JS, Offit PA |date=February 2009 |title=Vaccines and autism: a tale of shifting hypotheses |journal=Clinical Infectious Diseases |volume=48 |issue=4 |pages=456–461 |doi=10.1086/596476 |pmc=2908388 |pmid=19128068}}</ref> In 1998, British physician [[Andrew Wakefield]] led a fraudulent, litigation-funded study that suggested that the [[MMR vaccine]] may cause autism.<ref>{{cite news |date=8 February 2009 |title=MMR doctor Andrew Wakefield fixed data on autism |url=https://www.thetimes.co.uk/article/mmr-doctor-andrew-wakefield-fixed-data-on-autism-mgj82qsk50g |url-status=live |archive-url=https://web.archive.org/web/20170320003216/http://www.thesundaytimes.co.uk/sto/public/news/article148992.ece |archive-date=20 March 2017 |access-date=19 January 2019 |newspaper=The Sunday Times |vauthors=Deer B}}</ref><ref>{{cite news |date=2 February 2010 |title=Lancet retracts 'utterly false' MMR paper |url=https://www.theguardian.com/society/2010/feb/02/lancet-retracts-mmr-paper |url-status=live |archive-url=https://web.archive.org/web/20210117232206/https://www.theguardian.com/society/2010/feb/02/lancet-retracts-mmr-paper |archive-date=17 January 2021 |access-date=19 January 2019 |newspaper=[[The Guardian]] |vauthors=Boseley S}}</ref><ref>{{cite book |url=https://www.nap.edu/read/13164/ |title=Adverse Effects of Vaccines: Evidence and Causality |date=August 2011 |publisher=Institute of Medicine/National Academies Press |others=Committee to Review Adverse Effects of Vaccines, Board on Population Health and Public Health Practice |isbn=978-0-309-21435-3 |veditors=Stratton K, Ford A, Rusch E, Clayton EW |location=Washington, D.C. |chapter=Influenza Vaccine |bibcode=2011nap..book13164I |doi=10.17226/13164 |pmid=24624471 |access-date=19 January 2019 |editor-link4=Ellen Wright Clayton |chapter-url=https://nap.nationalacademies.org/read/13164/chapter/8 |archive-url=https://web.archive.org/web/20210827234139/https://www.nap.edu/read/13164/chapter/1 |archive-date=27 August 2021 |url-status=live}}</ref><ref>{{cite journal |vauthors=Flaherty DK |date=October 2011 |title=The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science |journal=[[The Annals of Pharmacotherapy]] |volume=45 |issue=10 |pages=1302–1304 |doi=10.1345/aph.1Q318 |pmid=21917556 }}</ref><ref name="Godlee2011">{{cite journal |vauthors=Godlee F, Smith J, Marcovitch H |date=January 2011 |title=Wakefield's article linking MMR vaccine and autism was fraudulent |journal=[[British Medical Journal]] |volume=342 |doi=10.1136/bmj.c7452 |pmid=21209060 |article-number=c7452}}</ref> His co-authors have since recanted the claims made in the study.<ref>{{cite magazine |last=McKee |first=Maggie |date=4 March 2004 |title=Controversial MMR and autism study retracted |url=https://www.newscientist.com/article/dn4743-controversial-mmr-and-autism-study-retracted/ |archive-url=https://web.archive.org/web/20070813055100/http://www.newscientist.com/article.ns?id=dn4743 |archive-date=13 August 2007 |access-date=21 October 2015 |magazine=[[New Scientist]]}}</ref> Wakefield was [[struck off]] the British medical register for "serious professional misconduct" after determination that his involvement in the study amounted to fraud, leading to the loss of his right to practice medicine.<ref name="gmc-uk_Wakefield_SPM2">{{cite web |title=General Medical Council, Fitness to Practise Panel Hearing, 24 May 2010, Andrew Wakefield, Determination of Serious Professional Misconduct |url=http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |archive-url=https://web.archive.org/web/20110809092833/http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |archive-date=9 August 2011 |access-date=18 September 2011 |website=[[General Medical Council]]}}</ref>

Two versions of the vaccine causation hypothesis were that autism results from brain damage caused by either the MMR vaccine itself,<ref name="Annual Review of Virology">{{cite journal |vauthors=DeStefano F, Shimabukuro TT |date=September 2019 |title=The MMR Vaccine and Autism |journal=[[Annual Review of Virology]] |volume=6 |issue=1 |pages=585–600 |doi=10.1146/annurev-virology-092818-015515 |pmc=6768751 |pmid=30986133}}</ref> or by [[Thiomersal|mercury]] used as a vaccine preservative.<ref name="Food and Drug Administration">{{cite web |title=Understanding Vaccines, Mercury and Thimerosal |url=https://www.fda.gov/media/83535/download |archive-url=https://web.archive.org/web/20230506050839/https://www.fda.gov/media/83535/download |archive-date=6 May 2023 |access-date=6 July 2023 |website=[[Food and Drug Administration]]}}</ref> No convincing scientific evidence supports these claims.<ref name="Annual Review of Virology" /> They are biologically implausible,<ref name="GerberOffit2009" /> and further evidence continues to refute them, including the observation that the rate of autism continues to climb despite elimination of [[thimerosal]] from most routine vaccines given to children from birth to 6 years of age.<ref name="Food and Drug Administration" /><ref>{{cite journal |last=Dona |first=Asif |date=2006 |title=Immunizations and Autism: A Review of the Literature |journal=[[Canadian Journal of Neurological Sciences]] |volume=33 |issue=4 |pages=341–346 |doi=10.1017/S031716710000528X |pmid=17168158 }}</ref><ref>{{cite web |date=18 February 2021 |title=Thimerosal questions and answers |url=https://www.fda.gov/vaccines-blood-biologics/vaccines/thimerosal-vaccines-questions-and-answers |archive-url=https://web.archive.org/web/20230418195953/https://www.fda.gov/vaccines-blood-biologics/vaccines/thimerosal-vaccines-questions-and-answers |archive-date=18 April 2023 |access-date=6 July 2023 |website=US FDA}}</ref><ref name="Waterhouse 2008">{{cite journal |vauthors=Waterhouse L |date=December 2008 |title=Autism overflows: increasing prevalence and proliferating theories |journal=[[Neuropsychology Review]] |volume=18 |issue=4 |pages=273–286 |doi=10.1007/s11065-008-9074-x |pmid=19015994 }}</ref><ref>{{cite web |date=16 September 2022 |title=87% of Flu Vaccine Doses have Reduced or "no" (only trace amounts of) Thimerosal |url=https://www.cdc.gov/flu/prevent/vaxsupply.htm |url-status=live |archive-url=https://web.archive.org/web/20230707162416/https://www.cdc.gov/flu/prevent/vaxsupply.htm |archive-date=7 July 2023 |access-date=6 July 2023 |website=[[Centers for Disease Control and Prevention]]}}</ref>

A 2014 meta-analysis examined ten major studies on autism and vaccines involving 1.25 million children worldwide; it concluded that neither the vaccine preservative thimerosal ([[Mercury (element)|mercury]]), nor the MMR vaccine, which has never contained thimerosal,<ref>{{cite web |title=Frequently Asked Questions about Thimerosal |url=https://www.cdc.gov/vaccinesafety/concerns/thimerosal/faqs.html |url-status=live |archive-url=https://web.archive.org/web/20190507032946/https://www.cdc.gov/vaccinesafety/concerns/thimerosal/faqs.html |archive-date=7 May 2019 |access-date=21 February 2017 |publisher=Centers for Disease Control and Prevention}}</ref> lead to autism.<ref name="Taylor 2014">{{cite journal |vauthors=Taylor LE, Swerdfeger AL, Eslick GD |date=June 2014 |title=Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies |journal=[[Vaccine (journal)|Vaccine]] |volume=32 |issue=29 |pages=3623–3629 |doi=10.1016/j.vaccine.2014.04.085 |pmid=24814559}}</ref> Despite this, misplaced parental concern has led to lower rates of [[childhood immunizations]], [[MMR vaccine and autism#Disease outbreaks|outbreaks of previously controlled childhood diseases]] in some countries, and the preventable deaths of several children.<ref name="vaccines">Vaccines and autism:

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

[[Anti-vaccine activism|Anti-vaccine activists]] have spread false claims about the absence of autism in [[North America]]'s [[Amish]] population due to lower vaccination rates. A 2010 study revealed that autism is present in 1 out of every 271 [[Amish]] children.<ref>{{cite news|access-date=2025-12-07 |archive-date=2025-09-28 |archive-url=http://web.archive.org/web/20250928224639/https://factcheck.afp.com/doc.afp.com.76JJ7G3 |language=en |periodical=Fact Check |title=Trump falsely claims Amish 'have essentially no autism' |url=https://factcheck.afp.com/doc.afp.com.76JJ7G3}}</ref><ref>{{cite web|access-date=2025-12-07 |date=2023-07-21 |first=Saranac Hale |language=en-US |last=Spencer |title=False Claim About Cause of Autism Highlighted on Pennsylvania Senate Panel |url=https://www.factcheck.org/2023/07/scicheck-false-claim-about-cause-of-autism-highlighted-on-pennsylvania-senate-panel/ |website=FactCheck.org}}</ref><ref>{{cite news |title=Anti-vaccine myth that Amish children don't have autism resurfaces |url=https://publichealthcollaborative.org/alerts/anti-vaccine-myth-that-amish-children-dont-have-autism-resurfaces/ |work=Public Health Communications Collaborative |date=28 June 2023 }}</ref><ref>{{cite news |title=Amish people do vaccinate - and autism exists in Amish communities |url=https://fullfact.org/health/amish-autism-vaccines/ |work=Full Fact |date=29 October 2025 }}</ref>

== Mechanism == {{Excerpt|Mechanism of autism}}

== Diagnosis == {{Main|Diagnosis of autism}}

=== Classification === The [[DSM-5]] and [[ICD-11]] are the two main frameworks for [[classification of mental disorders]] in use today. Autism spectrum disorder is classified in both as a [[neurodevelopmental disorder]], with its definition encompassing a spectrum of highly varied presentations.{{sfn|ICD-11}}<ref name="American Psychiatric Association-2013" /> The spectrum concept signals diversity rather than a simple range from mild to severe.<ref>{{cite journal |vauthors=Wing L |date=December 1997 |title=The autistic spectrum |journal=[[The Lancet]] |volume=350 |issue=9093 |pages=1761–1766 |doi=10.1016/S0140-6736(97)09218-0 |pmid=9413479 }}</ref> Before the [[DSM-5]] (2013) and [[ICD-11#ICD-11 CDDR|ICD-11/ICD-11 CDDR]] (2019/2024),{{sfn|ICD-11}}<ref>{{cite book |title=Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders |date=2024 |publisher=World Health Organization |isbn=978-92-4-007726-3 |url=https://www.who.int/publications/i/item/9789240077263 }}{{page needed|date=January 2026}}</ref> autism fell within a broader [[pervasive developmental disorder]] category that included labels such as [[Asperger syndrome]] and [[classic autism]] (also called childhood autism or Kanner syndrome). Because these diagnoses overlapped, the manuals unified them under "autism spectrum disorder" (ASD).<ref>{{Cite journal |last1=Sturmey |first1=Peter |last2=Dalfern |first2=Samantha |date=December 2014 |title=The Effects of DSM5 Autism Diagnostic Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorders: A Systematic Review |journal=Review Journal of Autism and Developmental Disorders |volume=1 |issue=4 |pages=249–252 |doi=10.1007/s40489-014-0016-7 }}</ref>

Since 1980, the committees behind both manuals have aimed for greater convergence, incorporating biological research while keeping behavior-based criteria.<ref name="Pickett & Anderson">{{cite report |url=https://ncvhs.hhs.gov/wp-content/uploads/2018/08/ICD-11_WHO-v_7-17-2018.pdf |title=Status on ICD-11: The WHO Launch |date=18 July 2018 |publisher=[[Centers for Disease Control and Prevention|CDC]]/[[National Center for Health Statistics|NCHS]] |access-date=22 October 2021 |archive-url=https://web.archive.org/web/20230315022814/https://ncvhs.hhs.gov/wp-content/uploads/2018/08/ICD-11_WHO-v_7-17-2018.pdf |archive-date=15 March 2023 |url-status=live |vauthors=Pickett D, Anderson RN}}</ref><ref name="APA">{{cite news |date=2009 |title=ICD vs. DSM |url=https://www.apa.org/monitor/2009/10/icd-dsm |url-status=live |archive-url=https://web.archive.org/web/20221229093045/https://www.apa.org/monitor/2009/10/icd-dsm |archive-date=29 December 2022 |access-date=22 October 2021 |newspaper=APA Monitor |publisher=[[American Psychological Association]] |page=63 |volume=40 |number=9}}</ref><ref name="Mezzich">{{cite journal |vauthors=Mezzich JE |date=2002 |title=International surveys on the use of ICD-10 and related diagnostic systems |journal=Psychopathology |volume=35 |issue=2–3 |pages=72–75 |doi=10.1159/000065122 |pmid=12145487 }}</ref><ref name="Goldberg">{{cite journal |vauthors=Goldberg D |date=January 2010 |title=The classification of mental disorder: a simpler system for DSM–V and ICD–11 |journal=Advances in Psychiatric Treatment |volume=16 |pages=14–19 |doi=10.1192/apt.bp.109.007120 |doi-access=free |number=1}}</ref> ICD-11 instead records whether the person has co-occurring intellectual disability or language impairment.<ref>{{cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse/2025-01/mms/en#437815624 |website=World Health Organization |access-date=25 February 2026}}</ref>

Some researchers have questioned whether existing criteria capture the full phenomenon, prompting proposals for prototype descriptions, transdiagnostic biological markers, or distinctions between common behavioral traits and rarer genetic or environmental factors.<ref name="Waterhouse2023">{{cite journal |last1=Waterhouse |first1=Lynn |last2=Mottron |first2=Laurent |date=2 May 2023 |title=Editorial: Is autism a biological entity? |journal=[[Frontiers in Psychiatry]] |volume=14 |doi=10.3389/fpsyt.2023.1180981 |pmc=10185896 |pmid=37200904 |doi-access=free |article-number=1180981}}</ref> Others have proposed alternatives to the disorder-focused spectrum model that deconstruct autism into separate phenomena: a non-pathological spectrum of behavioral traits in the general population,<ref name="Chawner2022">{{cite journal |last1=Chawner |first1=Samuel |date=2 September 2022 |title=Autism: A model of neurodevelopmental diversity informed by genomics |journal=[[Frontiers in Psychiatry]] |volume=13 |doi=10.3389/fpsyt.2022.981691 |pmc=9479184 |pmid=36117659 |doi-access=free |article-number=981691}}</ref> and rare genetic mutations or environmental factors influencing neurodevelopmental and psychological conditions.<ref name="Chawner2022" />

==== 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 latest version.<ref>{{Cite web |title=DSM |url=https://www.psychiatry.org/psychiatrists/practice/dsm |archive-url=https://web.archive.org/web/20250822111317/https://www.psychiatry.org/psychiatrists/practice/dsm |archive-date=22 August 2025 |access-date=22 August 2025 |website=Psychiatry.org |language=en}}</ref> Its fifth edition—[[DSM-5]], released in 2013—was the first to define ASD as a single diagnosis,<ref>{{Cite journal |last1=Grzadzinski |first1=Rebecca |last2=Huerta |first2=Marisela |last3=Lord |first3=Catherine |date=15 May 2013 |title=DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes |journal=Molecular Autism |volume=4 |issue=1 |page=12 |doi=10.1186/2040-2392-4-12 |pmc=3671160 |pmid=23675638 |quote=Consequently, the fifth edition of the DSM (DSM-5) replaces the multi-categorical system with a single diagnostic dimension: ASD. |doi-access=free}}</ref><ref name="Lai-2013">{{Cite journal |last1=Lai |first1=Meng-Chuan |last2=Lombardo |first2=Michael V. |last3=Chakrabarti |first3=Bhismadev |last4=Baron-Cohen |first4=Simon |date=23 April 2013 |title=Subgrouping the Autism 'Spectrum': Reflections on DSM-5 |journal=PLOS Biology |language=en |volume=11 |issue=4 |doi=10.1371/journal.pbio.1001544 |pmc=3635864 |pmid=23630456 |quote=New in DSM-5 is the explicit recognition of the "spectrum" nature of autism, subsuming and replacing the DSM-IV Pervasive Developmental Disorder (PDD) categorical subgroups of "autistic disorder," "Asperger's disorder," "pervasive developmental disorder not otherwise specified," and "childhood disintegrative disorder" into a single umbrella term "Autism Spectrum Disorder" (ASD). |doi-access=free |article-number=e1001544}}</ref> combining the previously distinct diagnoses of [[classic autism]], [[Asperger syndrome]], [[childhood disintegrative disorder]], and [[pervasive developmental disorder not otherwise specified]] (PDD-NOS).<ref name="Lai-2013" />{{sfn|DSM-5-TR|loc="Autism spectrum disorder encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner's autism, [[high-functioning autism]], [[atypical autism]], pervasive developmental disorder not otherwise specified, childhood disintegrative disorder, and Asperger's disorder"}} This is still the case in the DSM-5-TR.{{sfn|DSM-5-TR}}{{Primary source inline|date=September 2025}}

The DSM-5 and DSM-5-TR adopt a dimensional approach, with one diagnostic category for disorders that fall under the autism spectrum umbrella. Within that category, the DSM-5 has a framework that differentiates individuals by dimensions of symptom severity and by associated features (i.e., the presence of other conditions or factors that may contribute to the symptoms, other neurodevelopmental or mental conditions, intellectual disability, or language impairment).{{sfn|DSM-5-TR}} The two core symptom domains are (a) social communication and (b) restricted, repetitive behaviors. Clinicians may specify separate severity levels for each domain based on the degree to which symptoms affect daily functioning, rather than providing a single overall severity rating.{{sfn|DSM-5-TR|loc="It may be helpful to note level of support needed for each of the two core psychopathological domains in Table 2 (e.g., 'requiring very substantial support for deficits in social communication and requiring substantial support for restricted, repetitive behaviors')"}}

Before the fifth edition, the DSM separated social deficits and communication deficits into two domains.<ref>{{cite journal |vauthors=Kulage KM, Smaldone AM, Cohn EG |date=August 2014 |title=How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis |journal=[[Journal of Autism and Developmental Disorders]] |volume=44 |issue=8 |pages=1918–1932 |doi=10.1007/s10803-014-2065-2 |pmid=24531932 }}</ref> The DSM-5 also revised the onset criteria to specify that symptoms appear in the early developmental period, noting that symptoms may manifest later when social demands exceed capabilities; the previous edition had required onset before age three.<ref name="IACC">{{cite web |title=DSM-5 Diagnostic Criteria |url=https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml#autism-spectrum-disorder |url-status=live |archive-url=https://web.archive.org/web/20170211004905/https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml#autism-spectrum-disorder |archive-date=11 February 2017 |access-date=17 May 2017 |publisher=U.S. Department of Health & Human Services [[Interagency Autism Coordinating Committee]]}}</ref> These revisions remain in the DSM-5-TR.{{sfn|DSM-5-TR}}

==== ICD ==== The [[World Health Organization]]'s [[International Classification of Diseases]] (11th revision), [[ICD-11]], was released in 2018 and came into full effect in 2022.<ref name="WHO 2021">{{cite web |title=WHO releases new International Classification of Diseases (ICD 11) |url=https://www.who.int/news/item/18-06-2018-who-releases-new-international-classification-of-diseases-(icd-11) |url-status=live |archive-url=https://web.archive.org/web/20211225230744/https://www.who.int/news/item/18-06-2018-who-releases-new-international-classification-of-diseases-(icd-11) |archive-date=25 December 2021 |access-date=29 October 2021 |website=World Health Organization |type=Press Release}}</ref><ref name="Pickett & Anderson" /> Its classification of autism spectrum disorder ({{ICD11|6A02}}) is based on whether intellectual impairment is present as well as the level, if any, of language impairment, as follows:{{sfn|ICD-11}} {| class="wikitable" |+ICD-11 classification of autism spectrum disorder |- ! !with mild or no impairment of functional language !with impaired functional language !with complete, or almost complete, absence of functional language |- !without Disorder of Intellectual Development |6A02.0 |6A02.3 | |- !with Disorder of Intellectual Development |6A02.1 |6A02.4 |6A02.5 |}

== Screening == {{Excerpt|Diagnosis of autism|Screening}}

== Management == {{Main|Management of autism}} There is no cure for autism.<ref name="nhs.uk-2019">{{cite web |date=2 May 2019 |title=Fake and harmful autism 'treatments' |url=https://www.nhs.uk/conditions/autism/autism-and-everyday-life/fake-and-harmful-treatments/ |url-status=live |archive-url=https://web.archive.org/web/20221201180111/https://www.nhs.uk/conditions/autism/autism-and-everyday-life/fake-and-harmful-treatments/ |archive-date=1 December 2022 |access-date=29 April 2022 |website=nhs.uk |language=en}}</ref> From the perspective of [[neurodiversity]], "curing" or otherwise treating autism may not be an appropriate goal.<ref name="England">{{Cite web |last=England |first=N. H. S. |title=NHS England » 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=3 May 2025 |website=www.england.nhs.uk |language=en-US}}</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 |url-status=live |archive-url=https://web.archive.org/web/20220307130201/https://www.autism.org.uk/what-we-do/help-and-support/how-to-talk-about-autism |archive-date=7 March 2022 |access-date=29 April 2022 |website=autism.org.uk |language=en}}</ref>

Interventions targeting specific challenges or co-occurring conditions associated with autism are widely regarded as important.<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 |url-status=live |archive-url=https://web.archive.org/web/20230602113739/https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2020-college-reports/cr228 |archive-date=2 June 2023 |access-date=29 April 2022 |website=Royal College of Psychiatrists (UK) |language=en}}</ref> Perspectives on the goals of these interventions vary: the [[medical model of disability]] often focuses on addressing core characteristics such as social communication difficulties and restricted/repetitive behaviors.<ref name="Chapman-2022">{{cite book |last1=Chapman |first1=Robert |chapter=Neurodiversity, Advocacy, Anti-Therapy |date=2022 |title=Handbook of Autism and Pervasive Developmental Disorder: Assessment, Diagnosis, and Treatment |pages=1519–1536 |editor-last=Matson |editor-first=Johnny L. |location=Cham |publisher=[[Springer International Publishing]] |doi=10.1007/978-3-030-88538-0_67 |isbn=978-3-030-88538-0 |last2=Bovell |first2=Virginia |editor2-last=Sturmey |editor2-first=Peter }}</ref> The neurodiversity movement supports interventions aimed at enhancing functional communication (spoken or non-spoken), managing related issues like [[anxiety]] or inertia, or addressing behaviors considered harmful, rather than seeking to alter core autistic features.<ref>{{Cite journal |last1=Leadbitter |first1=Kathy |last2=Buckle |first2=Karen Leneh |last3=Ellis |first3=Ceri |last4=Dekker |first4=Martijn |date=12 April 2021 |title=Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice |journal=Frontiers in Psychology |volume=12 |article-number=635690 |doi=10.3389/fpsyg.2021.635690 |doi-access=free |pmid=33912110 |pmc=8075160 }}</ref><ref name="Chapman-2022" />

Studies of interventions have methodological problems that prevent definitive conclusions about [[efficacy]],<ref>{{cite journal |display-authors=6 |vauthors=Ospina MB, Krebs Seida J, Clark B, Karkhaneh M, Hartling L, Tjosvold L, Vandermeer B, Smith V |year=2008 |title=Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review |journal=PLOS ONE |volume=3 |issue=11 |article-number=e3755 |bibcode=2008PLoSO...3.3755O |doi=10.1371/journal.pone.0003755 |pmc=2582449 |pmid=19015734 |doi-access=free}}</ref> but the development of evidence-based interventions has advanced.<ref name="Smith-2015">{{cite journal |vauthors=Smith T, Iadarola S |date=2015 |title=Evidence Base Update for Autism Spectrum Disorder |journal=[[Journal of Clinical Child and Adolescent Psychology]] |publisher=[[Taylor & Francis]] |volume=44 |issue=6 |pages=897–922 |doi=10.1080/15374416.2015.1077448 |pmid=26430947}}</ref> Several therapies can help autistic children,<ref>{{Cite web |date=4 November 2020 |title=10 Facts about Autism Spectrum Disorder (ASD) |url=https://acf.gov/ecd/10-facts-about-asd |website=Office of Early Childhood Development}}</ref> and they are typically tailored to the child's needs.<ref name="Myers 20074">{{cite journal |vauthors=Myers SM, Johnson CP |date=November 2007 |title=Management of children with autism spectrum disorders |journal=[[Pediatrics (journal)|Pediatrics]] |volume=120 |issue=5 |pages=1162–1182 |doi=10.1542/peds.2007-2362 |pmid=17967921 |doi-access= |url=https://works.bepress.com/john-duby/5 }}</ref> The main goals of therapy are to lessen associated difficulties and family distress, and to increase [[quality of life]] and functional independence. In general, higher [[IQ]]s correlate with higher responsiveness to interventions and larger intervention outcomes.<ref>{{cite journal |vauthors=Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S |date=May 2009 |title=Meta-analysis of Early Intensive Behavioral Intervention for children with autism |journal=[[Journal of Clinical Child and Adolescent Psychology]] |publisher=[[Taylor & Francis]] |volume=38 |issue=3 |pages=439–450 |citeseerx=10.1.1.607.9620 |doi=10.1080/15374410902851739 |pmid=19437303 }}</ref><ref name="Smith-2015" /> Behavioral, psychological, educational, and skill-building interventions may be used to help autistic people learn skills for living independently, as well as other social, communication, and language skills.<ref name="Treat" /> Therapy also aims to reduce behaviors perceived as inappropriate and to build upon strengths.<ref>{{cite web |title=NIMH » Autism Spectrum Disorder |url=https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder |url-status=live |archive-url=https://web.archive.org/web/20210423081752/https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder/index.shtml |archive-date=23 April 2021 |access-date=8 April 2021 |website=National Institute of Mental Health (US) |publisher=[[National Institutes of Health]] (US)}}</ref> Medications have not been found to reduce autism's core features, but may be used for associated difficulties, such as irritability or inattention.<ref name="Ji20152">{{cite journal |vauthors=Ji N, Findling RL |date=March 2015 |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 |doi=10.1097/YCO.0000000000000132 |pmid=25602248 }}</ref>

=== Non-pharmacological interventions === Certain interventions, such as intensive, sustained [[special education]], [[remedial education]] programs, and [[behavior therapy]], are considered beneficial early in life for autistic children to acquire self-care, social, and job skills.<ref>{{Cite journal |last1=Sandbank |first1=Micheal |last2=Bottema-Beutel |first2=Kristen |last3=LaPoint |first3=Shannon Crowley |last4=Feldman |first4=Jacob I. |last5=Barrett |first5=D. Jonah |last6=Caldwell |first6=Nicolette |last7=Dunham |first7=Kacie |last8=Crank |first8=Jenna |last9=Albarran |first9=Suzanne |last10=Woynaroski |first10=Tiffany |date=14 November 2023 |title=Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis |journal=BMJ |volume=383 |article-number=e076733 |doi=10.1136/bmj-2023-076733 |pmc=10644209 |pmid=37963634}}</ref> Available approaches include [[applied behavior analysis]], [[Developmental social-pragmatic model|developmental models]], [[Treatment and Education of Autistic and Related Communication Handicapped Children|structured teaching]], [[speech and language therapy]], [[cognitive behavioral therapy]],<ref name="Wang Zhao Huang Chen 2021 p.">{{cite journal |display-authors=6 |vauthors=Wang X, Zhao J, Huang S, Chen S, Zhou T, Li Q, Luo X, Hao Y |date=May 2021 |title=Cognitive Behavioral Therapy for Autism Spectrum Disorders: A Systematic Review |journal=[[Pediatrics (journal)|Pediatrics]] |publisher=[[American Academy of Pediatrics]] (AAP) |volume=147 |issue=5 |article-number=e2020049880 |doi=10.1542/peds.2020-049880 |pmid=33888566 }}</ref> social skills therapy, and [[occupational therapy]].<ref name="Myers 20074"/> These interventions may either target autistic features comprehensively or focus on a specific area of difficulty.<ref name="Smith-2015"/>

====Applied behavior analysis==== {{Technical|date=August 2025|section}} [[File:Autistic boy receiving ABA therapy.jpg|thumb|An autistic boy works with a behavioral therapist to identify different letters of the alphabet as part of a language therapy program.]] [[Applied behavior analysis]] (ABA) is a behavioral therapy that aims to teach autistic children certain social and other behaviors by [[Discrete trial training|prompting]] using rewards and [[reinforcement]] learning. This includes learning fine and gross motor and language skills through play, expressive labeling, and requesting. It also seeks to reduce aggressive and self-injurious behavior by assessing its environmental causes and reinforcing replacement behaviors. Early, intensive ABA therapy has demonstrated effectiveness in enhancing preschool children's language skills, adaptive functioning, and intellectual performance.<ref name="Cochrane">{{cite journal |vauthors=Brignell A, Chenausky KV, Song H, Zhu J, Suo C, Morgan AT |date=November 2018 |title=Communication interventions for autism spectrum disorder in minimally verbal children |journal=[[Cochrane Library#The Cochrane Database of Systematic Reviews|The Cochrane Database of Systematic Reviews]] |volume=2018 |issue=11 |article-number=CD012324 |doi=10.1002/14651858.CD012324.pub2 |pmc=6516977 |pmid=30395694 |doi-access=free}}</ref><ref name=EIBIQualityOutcomes>{{cite journal |vauthors=Langh U, Perry A, Eikeseth S, Bolte S |title=Quality of early intensive behavioral intervention as a predictor of children's outcome |journal=Behavior Modification |volume=45 |issue=6 |pages=911–928 |date=November 2021 |pmid=32436396 |doi=10.1177/0145445520923998}}</ref><ref name=AutismResearch2023Study>{{cite journal |vauthors=Kasari C, Shire S, Shih W, Landa R, Levato L, Smith T |title=Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches |journal=[[Autism Research]] |volume=16 |issue=6 |pages=1236–1246 |date=June 2023 |pmid=37070270 |pmc=10460274 |doi=10.1002/aur.2932}}</ref><ref>{{cite journal |last1=Reichow |first1=Brian |last2=Hume |first2=Kara |last3=Barton |first3=Erin E. |last4=Boyd |first4=Brian A. |title=Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD) |journal=Cochrane Database of Systematic Reviews |date=2018 |volume=5 |issue=10 |article-number=CD009260 |doi=10.1002/14651858.CD009260.pub3 |pmid=29742275 |pmc=6494600 }}</ref> Another review reported a lack of adverse event monitoring, although such adverse effects may be common.<ref name="Sandbank-2023">{{Cite journal |last1=Sandbank |first1=Micheal |last2=Bottema-Beutel |first2=Kristen |last3=LaPoint |first3=Shannon Crowley |last4=Feldman |first4=Jacob I. |last5=Barrett |first5=D. Jonah |last6=Caldwell |first6=Nicolette |last7=Dunham |first7=Kacie |last8=Crank |first8=Jenna |last9=Albarran |first9=Suzanne |last10=Woynaroski |first10=Tiffany |date=14 November 2023 |title=Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis |journal=[[BMJ]] |volume=383 |article-number=e076733 |doi=10.1136/bmj-2023-076733 |pmid=37963634 |pmc=10644209 }}</ref>

Interventions for early childhood may be based on different theoretical frameworks, such as ABA (with its [[Discrete trial training|structured]] and [[Pivotal response treatment|naturalistic]] approaches) and [[Developmental social-pragmatic model|Developmental Social Pragmatic]] (DSP) models.<ref name="Smith-2015"/> Research indicates that in acquiring spoken language, autistic children with higher [[Language processing in the brain|receptive language skills]] tend to make progress with fewer hours (2.5 to 20 per week) of a naturalistic approach, whereas those with lower receptive language skills tend to show more progress only with a greater intensity of intervention (25 hours per week) using discrete trial training, a structured form of ABA.<ref name="Cochrane"/><ref name=AutismResearch2023Study/>

ABA has faced criticism.<ref name="Cogent Psychology">{{Cite journal |last1=Sandoval-Norton |first1=Aileen Herlinda |last2=Shkedy |first2=Gary |last3=Shkedy |first3=Dalia |date=January 2019 |editor-last=Rushby |editor-first=Jacqueline Ann |title=How much compliance is too much compliance: Is long-term ABA therapy abuse? |journal=Cogent Psychology |language=en |volume=6 |issue=1 |article-number=1641258 |doi=10.1080/23311908.2019.1641258 |doi-access=free}}</ref><ref>{{Cite journal |last1=Shkedy |first1=Gary |last2=Shkedy |first2=Dalia |last3=Sandoval-Norton |first3=Aileen H. |date=June 2021 |title=Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane |journal=Advances in Neurodevelopmental Disorders |language=en |volume=5 |issue=2 |pages=126–134 |doi=10.1007/s41252-021-00201-1 |doi-access=free}}</ref><ref>{{Cite journal |last=Anderson |first=Laura K |date=April 2023 |title=Autistic experiences of applied behavior analysis |journal=[[Autism (journal)|Autism]] |volume=27 |issue=3 |pages=737–750 |doi=10.1177/13623613221118216 |pmid=35999706 }}</ref> Sandoval-Norton et al. describe it as unethical and argue that it has unintended consequences, such as prompt dependency, susceptibility to psychological abuse, and overemphasis on compliance, which can create challenges in the transition to adulthood.<ref name="Cogent Psychology" /> Increasingly, ABA is also criticized for trying to reduce or eliminate autistic behaviors to make children appear less autistic, rather than respecting [[neurodiversity]].<ref name="BA">{{Cite journal |last=Kirkham |first=Patrick |date=April 2017 |title='The line between intervention and abuse' – autism and applied behaviour analysis |journal=History of the Human Sciences |volume=30 |issue=2 |pages=107–126 |doi=10.1177/0952695117702571 }}</ref> A problem with unreported [[Conflict of interest in the healthcare industry|conflicts of interest]] in ABA research has been described, with potential effects on the quality of evidence.<ref name="Bottema-Beutel-2021">{{Cite journal |last1=Bottema-Beutel |first1=Kristen |last2=Crowley |first2=Shannon |last3=Sandbank |first3=Micheal |last4=Woynaroski |first4=Tiffany G. |date=2021 |title=Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=62 |issue=1 |pages=5–15 |doi=10.1111/jcpp.13249 |pmc=7606324 |pmid=32353179}}</ref> In response, some ABA advocates suggest that instead of discontinuing the therapy, efforts should focus on increasing protections and ethical compliance.<ref>{{Cite journal |last1=Gorycki |first1=Kathryn A. |last2=Ruppel |first2=Paula R. |last3=Zane |first3=Thomas |date=31 December 2020 |editor-last=Navalta |editor-first=Carryl P. |title=Is long-term ABA therapy abusive: A response to Sandoval-Norton and Shkedy |journal=Cogent Psychology |volume=7 |issue=1 |article-number=1823615 |doi=10.1080/23311908.2020.1823615 |hdl-access=free |hdl=1808/31691 }}</ref>

A related type of intervention is parent training models.<ref name="Smith-2015"/> These teach parents to implement various ABA and DSP techniques themselves. Several parent-mediated behavioral therapies target social communication difficulties, while their effect on restricted and repetitive behaviors (RRBs) is uncertain.<ref>{{cite journal |vauthors=Harrop C |date=August 2015 |title=Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors |journal=[[Autism (journal)|Autism]] |language=en-US |volume=19 |issue=6 |pages=662–72 |doi=10.1177/1362361314545685 |pmid=25186943 }}</ref> Similarly, teacher-implemented interventions that combine [[Pivotal response treatment|naturalistic ABA]] with a developmental social pragmatic approach have been associated with effects on young children's social-communication behaviors, although there is limited evidence regarding effects on broader autistic characteristics.<ref name="Smith-2015"/>

===Inclusion in education and the workplace=== [[Inclusion (education)|Inclusive education]] models strive to support autistic students in mainstream educational settings, moving away from segregated [[special education]] environments toward participation alongside their peers.<ref name=":ducarre">{{Cite journal |last=Ducarre |first=Lucie Margot |date=10 July 2024 |title=Redefining the Right to Quality Education for Autistic Children Through a Neurodiverse Perspective |journal=Scandinavian Journal of Disability Research |volume=26 |issue=1 |pages=366–379 |doi=10.16993/sjdr.1043 |hdl=11250/3154312 |hdl-access=free}}</ref> Despite these efforts, autistic students can face significant barriers, sometimes leading to [[School refusal|trauma or emotionally-based school non-attendance]].<ref name=":ducarre" /><ref name="Prosser-2024">{{Cite journal |last1=Prosser |first1=Rebecca |last2=Birchwood |first2=James |date=July 2024 |title=A systematic review identifying factors associated with emotionally based school non-attendance in autistic children and young people |journal=Educational and Child Psychology |volume=41 |issue=1 |pages=31–54 |doi=10.53841/bpsecp.2024.41.1.31 }}</ref> This avoidance is often rooted in overwhelming sensory environments, social anxieties, communication breakdowns, [[bullying]], or lack of adequate support and understanding, rather than defiance.<ref name=":ducarre" /><ref name="Prosser-2024" />

Central to successful inclusion is the application of frameworks like [[Universal Design for Learning]] (UDL), which proactively designs [[Curriculum|curricula]] and learning environments to be accessible and engaging for all students, including those who are autistic.<ref name=":mitchell">{{Cite journal |last=Mitchell |first=Fiona |date=14 December 2023 |title=Promoting inclusive practice for autistic learners: Universal design for learning |journal=Kairaranga |volume=24 |issue=2 |pages=30–51 |doi=10.54322/j7wy5s57 |doi-access=free}}</ref> UDL principles accommodate varied learning styles, sensory sensitivities, and communication preferences often present in autistic people.<ref name=":mitchell" />

The SPACE framework (sensory, predictability, acceptance, communication, empathy) developed by Doherty et al., primarily for healthcare settings, offers a lens for identifying and addressing common environmental barriers that can contribute to distress and avoidance behaviors for autistic people.<ref name="Doherty-2023">{{Cite journal |last1=Doherty |first1=Mary |last2=McCowan |first2=Sue |last3=Shaw |first3=Sebastian CK |date=2 April 2023 |title=Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings |journal=[[British Journal of Hospital Medicine]] |volume=84 |issue=4 |pages=1–9 |doi=10.12968/hmed.2023.0006 |pmid=37127416 |doi-access=free |url=https://sussex.figshare.com/articles/journal_contribution/Autistic_SPACE_a_novel_framework_for_meeting_the_needs_of_autistic_people_in_healthcare_settings/23495825/1/files/41204015.pdf }}</ref> [[Accessibility|Accommodations]] may include providing quiet spaces as a retreat for people feeling overwhelmed.<ref>{{Cite journal |last1=McVey |first1=Alana J. |last2=Jones |first2=Desiree R. |last3=Waisman |first3=T. C. |last4=Raymaker |first4=Dora M. |last5=Nicolaidis |first5=Christina |last6=Maddox |first6=Brenna B. |date=31 August 2023 |title=Mindshift in autism: a call to professionals in research, clinical, and educational settings |journal=[[Frontiers in Psychiatry]] |language=en |volume=14 |article-number=1251058 |doi=10.3389/fpsyt.2023.1251058 |doi-access=free |pmid=37720894 |pmc=10500440 }}</ref> Autistic students may also need help initiating and maintaining social relationships with their peers if they wish to do so.<ref name=":ducarre" /> Especially in higher education, some autistic students may need help with [[Executive functions|executive functioning]], e.g., managing their own work, and the ability to initiate and complete tasks.<ref>{{Cite journal |last1=Clouder |first1=Lynn |last2=Karakus |first2=Mehmet |last3=Cinotti |first3=Alessia |last4=Ferreyra |first4=María Virginia |last5=Fierros |first5=Genoveva Amador |last6=Rojo |first6=Patricia |date=October 2020 |title=Neurodiversity in higher education: a narrative synthesis |journal=Higher Education |volume=80 |issue=4 |pages=757–778 |doi=10.1007/s10734-020-00513-6 |url=https://pureportal.coventry.ac.uk/en/publications/15ff4edd-256a-4c58-8dfb-b39afa9277ca }}</ref>

Transitioning to adulthood, autistic people often encounter substantial barriers to securing and maintaining meaningful employment, leading to high rates of [[unemployment]] and [[underemployment]] compared to the general population.<ref name="Doyle-2020">{{Cite journal |last=Doyle |first=Nancy |date=14 October 2020 |title=Neurodiversity at work: a biopsychosocial model and the impact on working adults |journal=British Medical Bulletin |volume=135 |issue=1 |pages=108–125 |doi=10.1093/bmb/ldaa021 |pmc=7732033 |pmid=32996572 }}</ref> Challenges can include navigating traditional interview processes,<ref>{{Cite journal |last1=Whelpley |first1=Christopher E. |last2=May |first2=Cynthia P. |date=April 2023 |title=Seeing is Disliking: Evidence of Bias Against Individuals with Autism Spectrum Disorder in Traditional Job Interviews |journal=[[Journal of Autism and Developmental Disorders]] |language=en |volume=53 |issue=4 |pages=1363–1374 |doi=10.1007/s10803-022-05432-2 |pmid=35294714 }}</ref> difficulties with unspoken social rules in the workplace, sensory sensitivities to office environments (e.g., lighting, noise), and needs for clear, direct communication and structured tasks.<ref name="Doyle-2020" /><ref name="Smith-2021">{{Cite book |last=Smith |first=Theo |title=Neurodiversity at work: drive innovation, performance and productivity with a neurodiverse workforce |date=2021 |publisher=Kogan Page |isbn=978-1-3986-0026-3 |editor-last=Kirby |editor-first=Amanda |location=London, United Kingdom New York, NY New Delhi}}</ref> Effective workplace inclusion involves implementing reasonable adjustments such as flexible working hours or locations, providing [[Noise-cancelling headphones|noise-canceling headphones]], staff training, and [[mentorship]] programs.<ref name="Doyle-2020" /><ref name="Smith-2021" /> Working from home can help to avoid overwhelming sensory or social situations, even if this means losing desirable social contact.<ref>{{Cite journal |last1=Goldfarb |first1=Yael |last2=Gal |first2=Eynat |last3=Golan |first3=Ofer |date=January 2022 |title=Implications of Employment Changes Caused by COVID-19 on Mental Health and Work-Related Psychological Need Satisfaction of Autistic Employees: A Mixed-Methods Longitudinal Study |journal=Journal of Autism and Developmental Disorders |language=en |volume=52 |issue=1 |pages=89–102 |doi=10.1007/s10803-021-04902-3 |pmc=7908957 |pmid=33635422}}</ref><ref>{{Cite journal |last1=Tomczak |first1=Michał T. |last2=Mpofu |first2=Elias |last3=Hutson |first3=Nathan |date=2 September 2022 |title=Remote Work Support Needs of Employees with Autism Spectrum Disorder in Poland: Perspectives of Individuals with Autism and Their Coworkers |journal=International Journal of Environmental Research and Public Health |volume=19 |issue=17 |article-number=10982 |doi=10.3390/ijerph191710982 |doi-access=free |pmc=9518488 |pmid=36078696}}</ref> [[Employment of autistic people|Autism-friendly workplaces]] not only allow autistic employees to utilize their unique skills and perspectives but also benefit employers through increased innovation, problem-solving capabilities, and employee loyalty.<ref name="Smith-2021" /><ref>{{Cite book |last=Dunne |first=Maureen |title=The Neurodiversity Edge: The Essential Guide to Embracing Autism, ADHD, Dyslexia, and Other Neurological Differences for Any Organization |date=2024 |publisher=[[John Wiley & Sons]] |isbn=978-1-394-19928-0 |edition=1st |location=Newark}}</ref>

=== Pharmacological interventions === Autistic people may be prescribed medication to manage specific co-occurring conditions or behaviors, such as [[ADHD]], [[Anxiety disorder|anxiety]], aggression, or self-injurious behaviors, particularly when non-pharmacological interventions alone have been insufficient.<ref name="San2016">{{cite journal |vauthors=Sanchack KE, Thomas CA |date=December 2016 |title=Autism Spectrum Disorder: Primary Care Principles |journal=American Family Physician |volume=94 |issue=12 |pages=972–979 |pmid=28075089}}</ref><ref>{{cite journal |last1=Iffland |first1=Michelle |last2=Livingstone |first2=Nuala |last3=Jorgensen |first3=Mikaela |last4=Hazell |first4=Philip |last5=Gillies |first5=Donna |date=9 October 2023 |editor-last=Cochrane Developmental, Psychosocial and Learning Problems Group |title=Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD) |journal=[[Cochrane Library#The Cochrane Database of Systematic Reviews|The Cochrane Database of Systematic Reviews]] |language=en |volume=2023 |issue=10 |article-number=CD011769 |doi=10.1002/14651858.CD011769.pub2 |pmc=10561353 |pmid=37811711}}</ref> Medications are not routinely recommended for autism's core features, such as social and communication difficulties or restricted and repetitive behaviors.<ref name="Siafis2022">{{cite journal |vauthors=Siafis S, Çıray O, Wu H, Schneider-Thoma J, Bighelli I, Krause M, Rodolico A, Ceraso A, Deste G, Huhn M, Fraguas D, San José Cáceres A, Mavridis D, Charman T, Murphy DG, Parellada M, Arango C, Leucht S |date=2022 |title=Pharmacological and dietary-supplement treatments for autism spectrum disorder: a systematic review and network meta-analysis |journal=[[Molecular Autism]] |volume=13 |issue=1 |article-number=10 |doi=10.1186/s13229-022-00488-4 |pmc=8896153 |pmid=35246237 |doi-access=free}}</ref>

More than half of autistic children in the United States are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s.<ref name="PT">{{cite journal |vauthors=Doyle CA, McDougle CJ |date=September 2012 |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 |doi=10.31887/DCNS.2012.14.3/cdoyle |pmc=3513681 |pmid=23226952}}</ref> Commonly used drug classes include [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref name="PT" /> Among antipsychotics, [[risperidone]] and [[aripiprazole]] are the only medications approved by the U.S. [[Food and Drug Administration]] specifically for reducing irritability, aggression, and self-injurious behaviors in autistic people.<ref name="Ji20152"/><ref>{{cite journal |vauthors=Leskovec TJ, Rowles BM, Findling RL |year=2008 |title=Pharmacological treatment options for autism spectrum disorders in children and adolescents |journal=Harvard Review of Psychiatry |volume=16 |issue=2 |pages=97–112 |doi=10.1080/10673220802075852 |pmid=18415882 }}</ref> These drugs can have significant side effects and responses to them may vary.<ref name="Ji20152"/> The UK's [[National Health Service]] cautions against the [[Overmedication|overprescription]] of antipsychotics and recommends their use only for specific indications, at the lowest effective dose and for the shortest duration necessary.<ref>{{Cite web |last=England |first=N. H. S. |title=NHS England » Stopping over medication of people with a learning disability and autistic people (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP) |url=https://www.england.nhs.uk/learning-disabilities/improving-health/stomp-stamp/ |access-date=29 April 2025 |website=www.england.nhs.uk |language=en-US|archive-url=https://web.archive.org/web/20250402155326/https://www.england.nhs.uk/learning-disabilities/improving-health/stomp-stamp/|archive-date=2 April 2025}}</ref>

Some research suggests that risperidone and aripiprazole may also reduce restricted and repetitive behaviors, such as hand-flapping or body-rocking.<ref name="Siafis2022" /> The evidence supporting this use has limitations, including study size and scope, alongside concerns about adverse effects.<ref>{{cite journal |display-authors=6 |vauthors=Ameis SH, Kassee C, Corbett-Dick P, Cole L, Dadhwal S, Lai MC, Veenstra-VanderWeele J, Correll CU |date=November 2018 |title=Systematic review and guide to management of core and psychiatric symptoms in youth with autism |journal=Acta Psychiatrica Scandinavica |volume=138 |issue=5 |pages=379–400 |doi=10.1111/acps.12918 |pmid=29904907 }}</ref> A meta-analysis found no significant efficacy of these antipsychotics or [[SSRI]] antidepressants in reducing these behaviors.<ref>{{Cite journal |last1=Yu |first1=Yanjie |last2=Chaulagain |first2=Ashmita |last3=Pedersen |first3=Sindre Andre |last4=Lydersen |first4=Stian |last5=Leventhal |first5=Bennett L. |last6=Szatmari |first6=Peter |last7=Aleksic |first7=Branko |last8=Ozaki |first8=Norio |last9=Skokauskas |first9=Norbert |date=12 March 2020 |title=Pharmacotherapy of restricted/repetitive behavior in autism spectrum disorder: a systematic review and meta-analysis |journal=BMC Psychiatry |volume=20 |issue=1 |page=121 |doi=10.1186/s12888-020-2477-9 |doi-access=free |pmc=7068977 |pmid=32164636}}</ref> Stimulant medications like [[methylphenidate]] may reduce inattention or hyperactivity in some autistic children, particularly when [[ADHD]] is also present.<ref name="Myers 20074"/> But methylphenidate's efficacy is lower in autistic people with ADHD compared to non-autistic people with ADHD, and side effects are more common.<ref>{{Cite book |last1=King |first1=Bryan H. |title=The Oxford handbook of autism and co-occurring psychiatric conditions |last2=Rynkiewicz |first2=Agnieszka |last3=Janas-Kozik |first3=Matgorzata |last4=Tyszkiewicz-Nwafor |first4=Marta |date=2020 |publisher=Oxford University Press |isbn=978-0-19-091076-1 |editor-last=White |editor-first=Susan Williams |series=Oxford library of psychology |location=New York, NY |pages=371–387 |language=en |chapter=Medications to Treat Co-Occurring Psychiatric Conditions in Autism Spectrum Disorder |editor-last2=Maddox |editor-first2=Brenna B. |editor-last3=Mazefsky |editor-first3=Carla A.}}</ref>

=== Alternative medicine === Alternative therapies have been researched and implemented, and many have resulted in harm to autistic people.<ref name="Myers 20074" /> For example, [[chelation therapy]] is not recommended as a treatment for autism, with risks outweighing potential benefits.<ref name="JamesStevenson2015">{{cite journal |vauthors=James S, Stevenson SW, Silove N, Williams K |date=May 2015 |title=Chelation for autism spectrum disorder (ASD) |journal=[[Cochrane Library#The Cochrane Database of Systematic Reviews|The Cochrane Database of Systematic Reviews]] |type=Review |issue=5 |article-number=CD010766 |doi=10.1002/14651858.CD010766 |pmid=26106752 |doi-access= |veditors=James S}}</ref> Reports of death from botched chelation therapy as treatment for autism have been documented.<ref name="pmid18775371">{{cite journal |vauthors=Levy SE, Hyman SL |date=October 2008 |title=Complementary and alternative medicine treatments for children with autism spectrum disorders |journal=Child and Adolescent Psychiatric Clinics of North America |type=Review |volume=17 |issue=4 |pages=803–20, ix |doi=10.1016/j.chc.2008.06.004 |pmc=2597185 |pmid=18775371}}</ref><ref>{{cite journal |vauthors=Brown MJ, Willis T, Omalu B, Leiker R |date=August 2006 |title=Deaths resulting from hypocalcemia after administration of edetate disodium: 2003-2005 |journal=[[Pediatrics (journal)|Pediatrics]] |volume=118 |issue=2 |pages=e534–e536 |doi=10.1542/peds.2006-0858 |pmid=16882789 }}</ref> Medical authorities have condemned [[bleach]]-based approaches, such as [[chlorine dioxide]] solutions marketed as [[Miracle Mineral Supplement|Miracle Mineral Solution]], as dangerous and ineffective.<ref>{{Cite web |last=Commissioner |first=Office of the |date=24 March 2020 |title=FDA warns consumers about the dangerous and potentially life threatening side effects of Miracle Mineral Solution |url=https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-about-dangerous-and-potentially-life-threatening-side-effects-miracle-mineral |archive-url=https://web.archive.org/web/20190819172207/https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-about-dangerous-and-potentially-life-threatening-side-effects-miracle-mineral |archive-date=19 August 2019 |access-date=29 April 2025 |website=FDA |language=en}}</ref> The British [[National Health Service|NHS]] also warns against [[CEASE therapy]], which rejects vaccinations and recommends potentially harmful amounts of [[dietary supplement]]s.<ref>{{Cite web |date=8 March 2023 |title=Treatments that are not recommended for autism |url=https://www.nhs.uk/conditions/autism/autism-and-everyday-life/treatments-that-are-not-recommended-for-autism/ |access-date=25 July 2025 |website=nhs.uk |language=en}}</ref> There is also no evidence for the efficacy of [[Hyperbaric medicine|hyperbaric oxygen therapy]] and its use is not recommended.<ref>{{Cite journal |last1=Sakulchit |first1=Teeranai |last2=Ladish |first2=Chris |last3=Goldman |first3=Ran D. |date=June 2017 |title=Hyperbaric oxygen therapy for children with autism spectrum disorder |journal=Canadian Family Physician |volume=63 |issue=6 |pages=446–448 |pmc=5471082 |pmid=28615394}}</ref>

Although sometimes used for autistic people, no reliable evidence indicates a [[Gluten-free, casein-free diet|gluten- and casein-free diet]] as a standard intervention.<ref name="GogouKolios2018">{{cite journal |vauthors=Gogou M, Kolios G |date=June 2018 |title=Are therapeutic diets an emerging additional choice in autism spectrum disorder management? |journal=World Journal of Pediatrics |type=Review |volume=14 |issue=3 |pages=215–223 |doi=10.1007/s12519-018-0164-4 |pmid=29846886 |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 |date=December 2014 |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 |doi=10.1177/0883073814531330 |pmid=24789114 |hdl-access=free |hdl=10171/37087}}</ref> Autistic children's preference for unconventional foods as well as gastrointestinal problems and lack of exercise can lead to reduction in bone cortical thickness, and this risk is greater in those on casein-free diets, as a consequence of the low intake of [[calcium]] and [[vitamin D]].<ref name="TyeRunicles2018">{{cite journal |vauthors=Tye C, Runicles AK, Whitehouse AJ, Alvares GA |year=2019 |title=Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review |journal=Frontiers in Psychiatry |type=Review |volume=9 |article-number=751 |doi=10.3389/fpsyt.2018.00751 |pmc=6354568 |pmid=30733689 |doi-access=free}}</ref>

=== Emerging evidence-based interventions ===

Interventions for autistic adults have limited evidence; cognitive behavioral approaches and [[mindfulness]] are considered promising.<ref name="SR">{{cite journal |display-authors=6 |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 |date=August 2020 |title=Interventions to address health outcomes among autistic adults: A systematic review |journal=Autism |volume=24 |issue=6 |pages=1345–1359 |doi=10.1177/1362361320913664 |pmc=7787674 |pmid=32390461 |doi-access=free}}</ref> [[Music therapy]] for autistic people likely improves overall autism severity, global functioning, and quality of life, but evidence is unclear for social and communication skills.<ref>{{cite journal |vauthors=Geretsegger M, Fusar-Poli L, Elefant C, Mössler KA, Vitale G, Gold C |date=May 2022 |title=Music therapy for autistic people |journal=[[Cochrane Library#The Cochrane Database of Systematic Reviews|The Cochrane Database of Systematic Reviews]] |volume=2022 |issue=5 |article-number=CD004381 |doi=10.1002/14651858.CD004381.pub4 |pmc=9082683 |pmid=35532041}}</ref> [[Animal-assisted therapy|Animal-assisted activities and therapies]] show promise in improving social communication, irritability, hyperactivity, and word usage in autistic people.<ref>{{Cite journal |last1=Xiao |first1=Ningkun |last2=Bagayi |first2=Vaishnavi |last3=Yang |first3=Dandan |last4=Huang |first4=Xinlin |last5=Zhong |first5=Lei |last6=Kiselev |first6=Sergey |last7=Bolkov |first7=Mikhail A. |last8=Tuzankina |first8=Irina A. |last9=Chereshnev |first9=Valery A. |date=2024 |title=Effectiveness of animal-assisted activities and therapies for autism spectrum disorder: a systematic review and meta-analysis |journal=Frontiers in Veterinary Science |volume=11 |article-number=1403527 |doi=10.3389/fvets.2024.1403527 |doi-access=free |pmc=11184216 |pmid=38895710}}</ref>

=== Caregivers === Families who care for an autistic child often experience greater stress.<ref name="Volkmar">{{cite book |url={{Google books|4yzqAgAAQBAJ|page=301|plainurl=yes}} |title=Handbook of Autism and Pervasive Developmental Disorders: Volume Two: Assessment, Interventions, and Policy |publisher=[[John Wiley & Sons]] |year=2014 |isbn=978-1-118-28220-5 |veditors=Volkmar FR, Paul R, Pelphrey KA, Rogers SJ |edition=4th |volume=2 |location=Hoboken, New Jersey |page=301 |lccn=2013034363 |oclc=946133861 |access-date=1 March 2019}}</ref> Parents may struggle to understand their child and to find appropriate care options.{{Medical citation needed|date=July 2025}} Affiliate [[Social stigma|stigma]] can also reduce quality of life, where negative attitudes toward the autistic child are extended to those close to them.<ref>{{Cite journal |last1=Papadopoulos |first1=Chris |last2=Lodder |first2=Annemarie |last3=Constantinou |first3=Georgina |last4=Randhawa |first4=Gurch |date=April 2019 |title=Systematic Review of the Relationship Between Autism Stigma and Informal Caregiver Mental Health |journal=Journal of Autism and Developmental Disorders |language=en |volume=49 |issue=4 |pages=1665–1685 |doi=10.1007/s10803-018-3835-z |pmc=6450836 |pmid=30569408}}</ref> Family members who are themselves autistic may be better able to understand the autistic child.<ref name="Watts-2024" />

== Prognosis == {{Main|Prognosis of autism}} The prognosis after diagnosis of autism in childhood is poorly understood.<ref name="Steinhausen-2016" /> Some core diagnostic symptoms, including restricted and repetitive behaviors, are stable, but some gradual symptom changes occur.<ref>{{cite journal |last1=Tafolla |first1=Maira |last2=Singer |first2=Hannah |last3=Lord |first3=Catherine |title=Autism Spectrum Disorder Across the Lifespan |journal=Annual Review of Clinical Psychology |date=7 May 2025 |volume=21 |issue=1 |pages=193–220 |doi=10.1146/annurev-clinpsy-081423-031110 |pmid=39836874 |doi-access=free }}</ref> Among children diagnosed before age 6, about 9 in 10 continue to meet diagnostic criteria one year later.<ref name=":1">{{cite journal |last1=Brignell |first1=Amanda |last2=Harwood |first2=Rachael C |last3=May |first3=Tamara |last4=Woolfenden |first4=Susan |last5=Montgomery |first5=Alicia |last6=Iorio |first6=Alfonso |last7=Williams |first7=Katrina |title=Overall prognosis of preschool autism spectrum disorder diagnoses |journal=Cochrane Database of Systematic Reviews |date=28 September 2022 |volume=2022 |issue=9 |article-number=CD012749 |doi=10.1002/14651858.cd012749.pub2 |pmid=36169177 |pmc=9516883 }}</ref> Some report that those with limited support needs are likely to have lessened autistic features over time,<ref name="Woodbury-Smith2">{{cite journal |vauthors=Woodbury-Smith MR, Volkmar FR |date=June 2008 |title=Asperger syndrome |journal=[[European Child & Adolescent Psychiatry]] |volume=18 |issue=1 |pages=2–11 |doi=10.1007/s00787-008-0701-0 |pmid=18563474 |url=https://hal.science/hal-00478064 }}</ref> while others argue that this perception is likely due to [[Autistic masking|masking]]—hiding autistic characteristics to avoid stigma.<ref>{{cite book |last1=Kapp |first1=Steven K. |chapter=Lobbying Autism's Diagnostic Revision in the DSM-5 |date=2020 |title=Autistic Community and the Neurodiversity Movement: Stories from the Frontline |pages=167–194 |editor-last=Kapp |editor-first=Steven K. |location=Singapore |publisher=Springer |language=en |doi=10.1007/978-981-13-8437-0_13 |isbn=978-981-13-8437-0 |last2=Ne'eman |first2=Ari |doi-access=free}}</ref> Long-term outcomes vary, in part due to variability in presentation between individuals and across affected domains.<ref name=":1" /> Autistic adults are more likely to be unemployed and have greater mental health service needs than the general population.<ref name="Hirota-2023" /> About 85% of autistic people need support with independent living in adulthood.<ref name="Kar2012">{{cite journal |vauthors=Karst JS, Van Hecke AV |date=September 2012 |title=Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation |journal=[[Clinical Child and Family Psychology Review]] |volume=15 |issue=3 |pages=247–77 |doi=10.1007/s10567-012-0119-6 |pmid=22869324 }}</ref> Factors such as developing spoken language before age six, having an [[Intelligence quotient|IQ]] above 50, and possessing marketable skills are associated with higher likelihood of independent living in adulthood.<ref>{{cite journal |vauthors=Tidmarsh L, Volkmar FR |date=September 2003 |title=Diagnosis and epidemiology of autism spectrum disorders |journal=Canadian Journal of Psychiatry |volume=48 |issue=8 |pages=517–525 |doi=10.1177/070674370304800803 |pmid=14574827 |doi-access=free}}</ref> Mortality among autistic people is approximately twice that of the general population, particularly among those with co-occurring neurologic or psychiatric disorders.<ref name="Hirota-2023" />

=== Suicide === {{Main|Suicide among people with autism}}

Risk factors for self-harm and [[suicidality]] include circumstances that could affect anyone but are more common among autistic people, such as [[mental health problems]] (e.g., [[anxiety disorder]]) and social problems (e.g., [[unemployment]] and [[social isolation]]). In addition, there are autism-specific factors, such as exhausting attempts to behave like a non-autistic person to avoid stigma and negative reactions of society towards autistic people ([[Autistic masking|masking]]).<ref name="Newell-2023">{{Cite journal |last1=Newell |first1=Victoria |last2=Phillips |first2=Lucy |last3=Jones |first3=Chris |last4=Townsend |first4=Ellen |last5=Richards |first5=Caroline |last6=Cassidy |first6=Sarah |date=15 March 2023 |title=A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability |journal=[[Molecular Autism]] |volume=14 |issue=1 |page=12 |doi=10.1186/s13229-023-00544-7 |pmc=10018918 |pmid=36922899 |doi-access=free}}</ref> Autistic people are also at significantly increased risk of victimization, including bullying, sexual assault, and other forms of criminal abuse.<ref>{{Cite journal |last1=Trundle |first1=Grace |last2=Jones |first2=Katy A. |last3=Ropar |first3=Danielle |last4=Egan |first4=Vincent |date=October 2023 |title=Prevalence of Victimisation in Autistic Individuals: A Systematic Review and Meta-Analysis |journal=[[Trauma, Violence & Abuse]] |volume=24 |issue=4 |pages=2282–2296 |doi=10.1177/15248380221093689 |pmc=10486169 |pmid=35524162}}</ref> A 2019 meta-analysis found autistic people to be four times more likely to have depression than non-autistic people.<ref>{{cite journal |last1=Hudson |first1=Chloe C |last2=Hall |first2=Layla |last3=Harkness |first3=Kate L |date=2019 |title=Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis |journal=[[Journal of Abnormal Child Psychology]] |volume=47 |issue=1 |pages=165–175 |doi=10.1007/s10802-018-0402-1 |pmid=29497980}}</ref>

Rates of suicidality vary significantly depending upon what is being measured.<ref name="Newell-2023" /> This is partly because questionnaires developed for non-autistic subjects are not always valid for autistic people.<ref name="Newell-2023" /> As of 2023, the Suicidal Behaviours Questionnaire–Autism Spectrum Conditions (SBQ-ASC) is the only test [[Test validity|validated]] for autistic people.<ref name="Newell-2023" /> According to some estimates, about a quarter of autistic youth<ref name="Suicide">{{Cite journal |last1=O'Halloran |first1=L. |last2=Coey |first2=P. |last3=Wilson |first3=C. |date=April 2022 |title=Suicidality in autistic youth: A systematic review and meta-analysis |journal=Clinical Psychology Review |volume=93 |doi=10.1016/j.cpr.2022.102144 |pmid=35290800 |doi-access=free |article-number=102144}}</ref> and a third of all autistic people<ref name="Newell-2023" /><ref name="Prevalence">{{Cite journal |last1=Huntjens |first1=Anne |last2=Landlust |first2=Annemiek |last3=Wissenburg |first3=Sophie |last4=van der Gaag |first4=Mark |date=March 2024 |title=The Prevalence of Suicidal Behavior in Autism Spectrum Disorder |journal=Crisis |volume=45 |issue=2 |pages=144–153 |doi=10.1027/0227-5910/a000922 |hdl=1871.1/2e96e0d9-7230-421a-bb77-834a9c4ae2bb |pmid=37668055 |hdl-access=free}}</ref> have experienced [[suicidal ideation]] at some point. Autistic people are about three times as likely as non-autistic people to make a [[suicide attempt]].<ref name="Blanchard-2021" /><ref name="burden">{{Cite journal |last1=Santomauro |first1=Damian F. |last2=Hedley |first2=Darren |last3=Sahin |first3=Ensu |last4=Brugha |first4=Traolach S. |last5=Naghavi |first5=Mohsen |last6=Vos |first6=Theo |last7=Whiteford |first7=Harvey A. |last8=Ferrari |first8=Alize J. |last9=Stokes |first9=Mark A. |date=November 2024 |title=The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021 |journal=[[Psychiatry Research]] |volume=341 |doi=10.1016/j.psychres.2024.116150 |pmid=39197224 |doi-access=free |article-number=116150|url=https://figshare.com/articles/journal_contribution/27042124 }}</ref> Almost 10% of autistic youth<ref name="Suicide" /> and 15% to 25% of autistic adults<ref name="Newell-2023" /><ref name="Prevalence" /> have attempted suicide. Rates of suicide attempts and suicidal ideation are the same for people formally diagnosed with autism and people who have typical intelligence and are believed to be autistic but have not been diagnosed.<ref name="Newell-2023" /> The suicide risk is higher for autistic people who are not [[cisgender]] males and do not have [[intellectual disabilities]].<ref name="Newell-2023" /><ref name="burden" />

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

Most professionals believe that race, ethnicity, and socioeconomic background have limited effect on the occurrence of autism.<ref>{{cite journal |vauthors=Bertoglio K, Hendren RL |date=March 2009 |title=New developments in autism |journal=[[Psychiatric Clinics of North America]] |volume=32 |issue=1 |pages=1–14 |doi=10.1016/j.psc.2008.10.004 |pmid=19248913}}</ref>

Research [[Autism and LGBTQ identities|indicates that autistic people]] are significantly more likely to be [[LGBTQ people|LGBTQ]] than the general population.<ref>{{Cite journal |last1=Graham Holmes |first1=Laura |last2=Ames |first2=Jennifer L. |last3=Massolo |first3=Maria L. |last4=Nunez |first4=Denise M. |last5=Croen |first5=Lisa A. |date=April 2022 |title=Improving the Sexual and Reproductive Health and Health Care of Autistic People |journal=[[Pediatrics (journal)|Pediatrics]] |volume=149 |issue=Supplement 4 |pages=e2020049437J |doi=10.1542/peds.2020-049437J |pmid=35363286 }}</ref> Autistic people are also significantly more likely to be [[Nontheism|non-theistic]] or [[Irreligion|non-religious]].<ref>{{Cite journal |last1=Caldwell-Harris |first1=Catherine |last2=Murphy |first2=Caitlin Fox |last3=Velazquez |first3=Tessa |last4=McNamara |first4=Patrick |date=2011 |title=Religious Belief Systems of Persons with High Functioning Autism |url=https://escholarship.org/uc/item/6zh3j3pr |journal=Proceedings of the Annual Meeting of the Cognitive Science Society |volume=33 |issue=33 }}</ref>

=== Co-occurring conditions === {{Main|Conditions comorbid to autism}}

[[File:Overlapping clinical phenotypes in genes associated with monogenic forms of autism spectrum disorder (ASD), dystonia, epilepsy and schizophrenia.svg|thumb|[[Euler diagram]] showing overlapping [[clinical phenotype]]s in genes associated with [[monogenic disease|monogenic forms]] of autism, [[dystonia]], [[epilepsy]] and [[schizophrenia]]: {{legend|#007fff|Genes associated with epilepsy}} {{legend|#007f7f|Genes associated with schizophrenia}} {{legend|#d4aaff|Genes associated with autism}} {{legend|#ff0000|Genes associated with dystonia}}]] Several conditions can co-occur with autism at a higher rate than in the rest of the population.<ref name="Levy 2009">{{cite journal |vauthors=Levy SE, Mandell DS, Schultz RT |date=November 2009 |title=Autism |journal=[[The Lancet]] |volume=374 |issue=9701 |pages=1627–1638 |doi=10.1016/S0140-6736(09)61376-3 |pmc=2863325 |pmid=19819542}}{{Erratum|doi=10.1016/S0140-6736(11)61666-8|checked=yes}}</ref> This may be referred to as [[comorbidity]], and may increase with age, causing difficulties for youth on the autism spectrum, and can make interventions and therapies more challenging. Features of autism and other diagnoses often overlap, and autism's characteristics can make traditional diagnostic procedures more difficult.<ref name="Underwood 2010">{{cite journal |vauthors=Underwood L, McCarthy J, Tsakanikos E |date=September 2010 |title=Mental health of adults with autism spectrum disorders and intellectual disability |journal=[[Current Opinion in Psychiatry]] |volume=23 |issue=5 |pages=421–6 |doi=10.1097/YCO.0b013e32833cfc18 |pmid=20613532 }}</ref><ref name="Helverschou 2011">{{cite book |last1=Helverschou |first1=Sissel Berge |last2=Bakken |first2=Trine Lise |last3=Martinsen |first3=Harald |title=International Handbook of Autism and Pervasive Developmental Disorders |chapter=Psychiatric Disorders in People with Autism Spectrum Disorders: Phenomenology and Recognition |date=2011 |pages=53–74 |doi=10.1007/978-1-4419-8065-6_5 |isbn=978-1-4419-8064-9 |oclc=746203105 }}</ref> This is sometimes known as [[Diagnostic overshadowing in autism|diagnostic overshadowing]].<ref>{{Cite book |last=White |first=Susan W. |title=The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions |date=2020 |publisher=Oxford University Press, Incorporated |others=Brenna Maddox, Carla Mazefsky |isbn=978-0-19-091076-1 |edition=1st |series=Oxford Library of Psychology Series |location=Oxford |page=8 |language=en}}</ref> Common co-occurring conditions are: * [[ADHD]] is seen in between 25% to 32% of autistic people.<ref name="MH">{{Cite journal |last1=Lai |first1=Meng-Chuan |last2=Kassee |first2=Caroline |last3=Besney |first3=Richard |last4=Bonato |first4=Sarah |last5=Hull |first5=Laura |last6=Mandy |first6=William |last7=Szatmari |first7=Peter |last8=Ameis |first8=Stephanie H. |date=October 2019 |title=Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis |journal=The Lancet Psychiatry |language=English |volume=6 |issue=10 |pages=819–829 |doi=10.1016/S2215-0366(19)30289-5 |pmid=31447415 |url=https://discovery.ucl.ac.uk/id/eprint/10081954/ }}</ref> Characteristics similar to those of ADHD can be part of an autism diagnosis.<ref name="Rommelse et al.">{{cite journal |vauthors=Rommelse NN, Franke B, Geurts HM, Hartman CA, Buitelaar JK |date=March 2010 |title=Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder |journal=European Child & Adolescent Psychiatry |volume=19 |issue=3 |pages=281–95 |doi=10.1007/s00787-010-0092-x |pmc=2839489 |pmid=20148275}}</ref> * [[Epilepsy]] occurs in about 10% of autistic people.<ref>{{Cite journal |last1=Liu |first1=Xian |last2=Sun |first2=Xin |last3=Sun |first3=Caihong |last4=Zou |first4=Mingyang |last5=Chen |first5=Yiru |last6=Huang |first6=Junping |last7=Wu |first7=Lijie |last8=Chen |first8=Wen-Xiong |date=2022 |title=Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis |journal=Autism: The International Journal of Research and Practice |volume=26 |issue=1 |pages=33–50 |doi=10.1177/13623613211045029 |pmid=34510916}}</ref> The risk is higher for older autistic people and those with intellectual disability.<ref>{{cite journal |vauthors=Spence SJ, Schneider MT |date=June 2009 |title=The role of epilepsy and epileptiform EEGs in autism spectrum disorders |journal=[[Pediatric Research]] |volume=65 |issue=6 |pages=599–606 |doi=10.1203/PDR.0b013e31819e7168 |pmc=2692092 |pmid=19454962}}</ref> * [[Intellectual disability|Intellectual disabilities]] are some of the most common co-occurring conditions with autism (30% to 40%).<ref>{{cite journal |last1=Sala |first1=G. |last2=Hooley |first2=M. |last3=Attwood |first3=T. |date=2019 |title=Autism and Intellectual Disability: A Systematic Review of Sexuality and Relationship Education |journal=Sexuality and Disability |volume=37 |issue=3 |pages=353–382 |doi=10.1007/s11195-019-09577-4 |url=https://figshare.com/articles/journal_contribution/20750584 }}</ref> As autism diagnosis is increasingly given to people with lower support needs, there is a tendency for the proportion with co-occurring intellectual disability to decrease over time. * Various [[anxiety disorder]]s can co-occur with autism, with overall co-occurring rates of 17% to 23%.<ref name="MH" /> Many anxiety disorders have characteristics better explained by autism itself, or are hard to distinguish from autism's features.<ref>{{cite journal |vauthors=White SW, Oswald D, Ollendick T, Scahill L |date=April 2009 |title=Anxiety in children and adolescents with autism spectrum disorders |journal=Clinical Psychology Review |volume=29 |issue=3 |pages=216–229 |doi=10.1016/j.cpr.2009.01.003 |pmc=2692135 |pmid=19223098}}</ref> * Rates of co-occurring [[Depression (mood)|depression]] in autistic people range from 9% to 13%.<ref name="MH" /> * [[Obsessive–compulsive disorder]] (OCD) occurs in 7% to 10% of autistic people.<ref name="MH" /> * Starting in adolescence, some autistic people fall under the criteria for the similar-looking [[schizoid personality disorder]], which is characterized by a [[Asociality|lack of interest in social relationships]], a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy.<ref>{{cite book |title=Integrated Treatment for Co-Occurring Disorders: Personality Disorders and Addiction |vauthors=Ekleberry SC |publisher=[[Routledge]] |year=2008 |isbn=978-0-7890-3693-3 |pages=31–32 |chapter=Cluster A - Schizoid Personality Disorder and Substance Use Disorders |chapter-url=https://books.google.com/books?id=O5HY1xcfjEcC&pg=PA31}}</ref> * [[Genetic disorder|Genetic condition]]s: About 10% of autistic people are diagnosed with a rare genetic syndrome such as [[Prader–Willi syndrome|Prader–Willi]], [[Angelman syndrome|Angelman]], [[Fragile X syndrome|Fragile X]], or [[16p11.2 deletion syndrome]].<ref>{{Cite journal |last1=Yasuda |first1=Yuka |last2=Matsumoto |first2=Junya |last3=Miura |first3=Kenichiro |last4=Hasegawa |first4=Naomi |last5=Hashimoto |first5=Ryota |date=2023 |title=Genetics of autism spectrum disorders and future direction |journal=Journal of Human Genetics |volume=68 |issue=3 |pages=193–197 |doi=10.1038/s10038-022-01076-3 |pmid=36038624 }}</ref> * [[Gastrointestinal disease|Gastrointestinal problems]] are among the most commonly reported co-occurring medical conditions in autistic people, and occur at higher rates than in the general population.<ref name="IsraelyanMargolis2018">{{cite journal |vauthors=Israelyan N, Margolis KG |date=June 2018 |title=Serotonin as a link between the gut-brain-microbiome axis in autism spectrum disorders |journal=[[Pharmacological Research]] |type=Review |volume=132 |pages=1–6 |doi=10.1016/j.phrs.2018.03.020 |pmc=6368356 |pmid=29614380}}</ref><ref>{{Cite journal |last1=McElhanon |first1=Barbara O. |last2=McCracken |first2=Courtney |last3=Karpen |first3=Saul |last4=Sharp |first4=William G. |date=May 2014 |title=Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis |journal=Pediatrics |volume=133 |issue=5 |pages=872–883 |doi=10.1542/peds.2013-3995 |pmid=24777214}}</ref> Frequently reported issues include chronic constipation, diarrhea, abdominal pain, gastroesophageal reflux, and functional gastrointestinal disorders.<ref name="David M 2021">{{Cite journal |last1=James |first1=David M. |last2=Davidson |first2=Elizabeth A. |last3=Yanes |first3=Julio |last4=Moshiree |first4=Baharak |last5=Dallman |first5=Julia E. |date=2021 |title=The Gut-Brain-Microbiome Axis and Its Link to Autism: Emerging Insights and the Potential of Zebrafish Models |journal=Frontiers in Cell and Developmental Biology |volume=9 |article-number=662916 |doi=10.3389/fcell.2021.662916 |doi-access=free |pmc=8081961 |pmid=33937265}}</ref> Gastrointestinal symptoms in autistic people have been associated with increased irritability, distress, sleep disturbances, and challenges in communication, particularly in children who have limited spoken language.<ref name="IsraelyanMargolis2018" /><ref name="RaoGershon2016">{{cite journal |vauthors=Rao M, Gershon MD |date=September 2016 |title=The bowel and beyond: the enteric nervous system in neurological disorders |journal=Nature Reviews. Gastroenterology & Hepatology |type=Review |volume=13 |issue=9 |pages=517–528 |doi=10.1038/nrgastro.2016.107 |pmc=5005185 |pmid=27435372 |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}}</ref><ref>{{Cite journal |last1=Sotelo-Orozco |first1=Jennie |last2=Hertz-Picciotto |first2=Irva |date=2025-07-01 |title=The Association Between Gastrointestinal Issues and Psychometric Scores in Children with Autism Spectrum Disorder, Developmental Delays, Down Syndrome, and Typical Development |journal=Journal of Autism and Developmental Disorders |volume=55 |issue=7 |pages=2452–2462 |doi=10.1007/s10803-024-06387-2 |pmc=11557733 |pmid=38739245}}</ref><ref>{{Cite web |last=Research |title=Autistic children more likely to experience persistent gastrointestinal problems |url=https://health.ucdavis.edu/research/news/headlines/autistic-children-more-likely-to-experience-persistent-stomach-problems/2025/09 |access-date=2025-12-21 |website=research |language=en}}</ref> The underlying mechanisms are not fully understood and are likely multifactorial, involving interactions between diet, gut motility, sensory sensitivities, stress responses, and the gut-brain axis.<ref>{{Cite journal |last1=Holingue |first1=Calliope |last2=Newill |first2=Carol |last3=Lee |first3=Li-Ching |last4=Pasricha |first4=Pankaj J. |last5=Daniele Fallin |first5=M. |date=January 2018 |title=Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence |journal=Autism Research|volume=11 |issue=1 |pages=24–36 |doi=10.1002/aur.1854 |pmc=5773354 |pmid=28856868}}</ref><ref name="David M 2021"/> * Sleep problems affect about two-thirds of autistic people at some point in childhood. These most commonly include symptoms of [[insomnia]], such as difficulty falling asleep, frequent [[nocturnal awakenings]], 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 autism diagnosis.<ref>{{cite journal |vauthors=Richdale AL, Schreck KA |date=December 2009 |title=Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies |journal=[[Sleep Medicine Reviews]] |volume=13 |issue=6 |pages=403–411 |doi=10.1016/j.smrv.2009.02.003 |pmid=19398354}}</ref> * Motor difficulties, including features of [[developmental coordination disorder|dyspraxia]], are highly prevalent in autistic people,<ref>{{Cite journal |last1=Kangarani-Farahani |first1=Melika |last2=Malik |first2=Myrah Anum |last3=Zwicker |first3=Jill G. |date=May 2024 |title=Motor Impairments in Children with Autism Spectrum Disorder: A Systematic Review and Meta-analysis |journal=[[Journal of Autism and Developmental Disorders]] |volume=54 |issue=5 |pages=1977–1997 |doi=10.1007/s10803-023-05948-1 |pmid=36949273 }}</ref> and there is a significantly higher rate of [[Hypermobility (joints)|joint hypermobility]]/[[hypermobility spectrum disorder]]s/[[Ehlers–Danlos syndrome|Ehlers-Danlos syndrome]] in autistic people.<ref>{{Cite journal |last1=Baeza-Velasco |first1=Carolina |last2=Vergne |first2=Judith |last3=Poli |first3=Marianna |last4=Kalisch |first4=Larissa |last5=Calati |first5=Raffaella |date=August 2025 |title=Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes: A systematic review and prevalence meta-analyses |journal=[[Autism (journal)|Autism]] |volume=29 |issue=8 |pages=1939–1958 |doi=10.1177/13623613251328059 |pmid=40145613 }}</ref> * There is tentative evidence that [[gender dysphoria]] occurs more frequently in autistic people.<ref>{{cite journal |vauthors=Van Der Miesen AI, Hurley H, De Vries AL |year=2016 |title=Gender dysphoria and autism spectrum disorder: A narrative review |journal=[[International Review of Psychiatry]] |volume=28 |issue=1 |pages=70–80 |doi=10.3109/09540261.2015.1111199 |pmid=26753812 |doi-access=free|url=https://pure.amsterdamumc.nl/ws/files/160601866/Gender-dysphoria-and-autism-spectrum-disorder.pdf }}</ref><ref>{{cite journal |vauthors=Glidden D, Bouman WP, Jones BA, Arcelus J |date=January 2016 |title=Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature |journal=[[Sexual Medicine Reviews]] |volume=4 |issue=1 |pages=3–14 |doi=10.1016/j.sxmr.2015.10.003 |pmid=27872002 |url=https://dspace.lboro.ac.uk/2134/20811 }}</ref>

=== Prevalence === The World Health Organization notes that reports on prevalence vary widely. It estimates that about 1 in 127 children were autistic between 2012 and 2021 with a trend of increasing prevalence over time. This may reflect an underestimate of prevalence in [[Least developed countries|low-]] and [[Newly industrialized country|middle-income countries]].<ref name="Autism-Research" /><ref name="World Health Organization-2022">{{cite web |date=30 March 2022 |title=Autism |url=https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders |access-date=8 May 2022 |website=[[World Health Organization]] |language=en |archive-date=10 April 2020 |archive-url=https://web.archive.org/web/20200410103835/https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders |url-status=live}}</ref> Surveillance studies in community samples of adults suggest a similar share of the adult population would meet diagnostic criteria if formally assessed.<ref name="Hirota-2023" /> The number of people diagnosed has increased since the 1990s, likely due to a combination of increased recognition of autism, better availability of diagnosis, and changes to the diagnostic criteria.<ref name="Autism-Research" /> The increase in autism is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness,<ref name="Fombonne-2009">{{cite journal |vauthors=Fombonne E |date=June 2009 |title=Epidemiology of pervasive developmental disorders |journal=[[Pediatric Research]] |volume=65 |issue=6 |pages=591–598 |doi=10.1203/PDR.0b013e31819e7203 |pmid=19218885 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Wing L, Potter D |year=2002 |title=The epidemiology of autistic spectrum disorders: is the prevalence rising? |journal=Developmental Disabilities Research Reviews |volume=8 |issue=3 |pages=151–161 |doi=10.1002/mrdd.10029 |pmid=12216059}}</ref><ref>{{cite journal |vauthors=Gernsbacher MA, Dawson M, Goldsmith HH |date=April 2005 |title=Three Reasons Not to Believe in an Autism Epidemic |journal=Current Directions in Psychological Science |volume=14 |issue=2 |pages=55–58 |doi=10.1111/j.0963-7214.2005.00334.x |pmc=4232964 |pmid=25404790}}</ref> particularly among women,<ref>{{Cite book |last1=Fletcher-Watson |first1=Sue |title=Autism: A New Introduction to Psychological Theory and Current Debate |last2=Happé |first2=Francesca |date=2019 |publisher=Taylor & Francis Group |isbn=978-1-138-10612-3 |edition=2nd |location=Milton |page=42 |language=en}}</ref> though other unidentified environmental factors may exist.<ref name="Rut2005">{{cite journal |vauthors=Rutter M |date=January 2005 |title=Incidence of autism spectrum disorders: changes over time and their meaning |journal=[[Acta Paediatrica]] |volume=94 |issue=1 |pages=2–15 |doi=10.1111/j.1651-2227.2005.tb01779.x |pmid=15858952 }}</ref>

The [[Centers for Disease Control]]'s Autism and Developmental Disabilities Monitoring Network reported that approximately 1 in 31 children in the United States is diagnosed with autism, based on data collected in 2022.<ref name="DS">{{Cite web |last=CDC |date=18 April 2025 |title=Data and Statistics on Autism Spectrum Disorder |url=https://www.cdc.gov/autism/data-research/index.html |access-date=25 April 2025 |website=Autism Spectrum Disorder (ASD) |language=en-us}}</ref> For 2016 data, the estimate was 1 in 54, compared to 1 in 68 in 2010 and 1 in 150 in 2000.<ref name="DS" /> Diagnostic criteria for autism have changed significantly since the 1980s; for example, [[special education in the United States|U.S. special-education]] autism classification was introduced in 1994.<ref name="Newschaffer 2007">{{cite journal |display-authors=6 |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 |year=2007 |title=The epidemiology of autism spectrum disorders |journal=[[Annual Review of Public Health]] |volume=28 |issue=1 |pages=235–58 |doi=10.1146/annurev.publhealth.28.021406.144007 |pmid=17367287 |bibcode=2007ARPH...28..235N |doi-access=}}</ref>

=== Sex ratio === Males are about three times more likely to be diagnosed with autism than females.<ref name="Loomes-2017">{{Cite journal |last1=Loomes |first1=Rachel |last2=Hull |first2=Laura |last3=Mandy |first3=William Polmear Locke |date=June 2017 |title=What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=56 |issue=6 |pages=466–474 |doi=10.1016/j.jaac.2017.03.013 |pmid=28545751 |url=https://discovery.ucl.ac.uk/id/eprint/1558343/ }}</ref> [[Sex differences in autism|Several theories]] about the higher prevalence in males have been investigated.<ref name="Chaste">{{cite journal |vauthors=Chaste P, Leboyer M |date=September 2012 |title=Autism risk factors: genes, environment, and gene-environment interactions |journal=[[Dialogues in Clinical Neuroscience]] |volume=14 |issue=3 |pages=281–292 |doi=10.31887/DCNS.2012.14.3/pchaste |pmc=3513682 |pmid=23226953}}</ref> Prevalence differences may be mainly due to a result of differences in expression of characteristics between males and females, with [[Sex and gender differences in autism|autistic women and girls]] showing less atypical behaviors and therefore being less likely to be diagnosed with autism.<ref>{{Cite journal |last1=Lockwood Estrin |first1=Georgia |last2=Milner |first2=Victoria |last3=Spain |first3=Debbie |last4=Happé |first4=Francesca |last5=Colvert |first5=Emma |date=December 2021 |title=Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review |journal=Review Journal of Autism and Developmental Disorders |volume=8 |issue=4 |pages=454–470 |doi=10.1007/s40489-020-00225-8 |pmid=34868805 |pmc=8604819 }}</ref>

== History == {{Excerpt|History of autism|paragraphs=1}}

=== Etymology === In 1911, Swiss psychiatrist [[Eugen Bleuler|Paul Eugen Bleuler]] [[Neologism|coined]] the German term ''Autismus'' to characterize the social withdrawal he observed in people with [[schizophrenia]].<ref>{{Cite journal |last=Evans |first=Bonnie |date=2013 |title=How Autism became Autism |journal=History of the Human Sciences |volume=26 |issue=3 |pages=3–31 |doi=10.1177/0952695113484320 |pmc=3757918 |pmid=24014081}}</ref> Rendered in English as ''autism'', the term derives from the Greek word [[wikt:auto|autos]] ("self").<ref name="www.britannica.com-2025">{{Cite web |date=21 June 2025 |title=Autism {{!}} Definition, Symptoms, Neuropathology, & Diagnosis {{!}} Britannica |url=https://www.britannica.com/science/autism |access-date=4 July 2025 |website=www.britannica.com |language=en |quote=The term autism (from the Greek autos, meaning "self") was coined in 1911 by Swiss psychiatrist Eugen Bleuler, who used it to describe withdrawal into one's inner world, a phenomenon he observed in individuals with schizophrenia.}}</ref> Bleuler used the term for a symptom of adult schizophrenia: a person's retreat from reality into their own subjective world. He also mentioned "autistic thinking" as a fleeting, illogical thought process everyone experiences. In the mid-1920s, German psychiatrist [[Fritz Künkel]] categorized over 100 schizophrenic patients into four groups, one of which he labeled "autistic", highlighting disturbances in emotional life. In 1926, building on his work and Bleuler's, [[Grunya Sukhareva]] published an article about six boys who were musically gifted and had a tendency toward abstract thinking. She called their affects "flattened" and their tendency to avoid other children an "autistic attitude".<ref>{{Cite journal |last=Vicedo |first=Marga |date=17 January 2024 |title=Moving beyond the search for the first discoverer of autism |journal=[[Frontiers in Psychiatry]] |volume=15 |page=02 |article-number=1266486 |doi=10.3389/fpsyt.2024.1266486 |pmid=38299189 |pmc=10827938 |doi-access=free}}</ref> Scholars have credited Sukhareva with making observations that closely mirror ASD as described by the [[DSM-5]] and [[ICD-11]].<ref name="Sher-2023">{{Cite journal |last1=Sher |first1=David Ariel |last2=Gibson |first2=Jenny L. |date=March 2023 |title=Pioneering, prodigious and perspicacious: Grunya Efimovna Sukhareva's life and contribution to conceptualising autism and schizophrenia |journal=[[European Child & Adolescent Psychiatry]] |volume=32 |issue=3 |pages=475–490 |doi=10.1007/s00787-021-01875-7 |pmc=10038965 |pmid=34562153}}</ref> Her work expanded on the definition throughout her career while making great strides in differentiating ASD and schizophrenia nearly 30 years before the establishment of separate classifications for these diagnoses with the 1980 publication of the [[DSM-III]].<ref>{{cite thesis |last1=Simmonds |first1=Charlotte |title=G. E. Sukhareva's place in the history of autism research: Context, reception, translation |date=2019 |doi=10.26686/wgtn.17136701 |url=https://openaccess.wgtn.ac.nz/articles/thesis/G_E_Sukhareva_s_place_in_the_history_of_autism_research_Context_reception_translation/17136701/1/files/31690595.pdf }}{{page needed|date=January 2026}}</ref>

== Society and culture == {{Main|Societal and cultural aspects of autism}}

[[File:Greta_Thunberg_in_2022.jpg|thumb|alt=Greta Thunberg has balayage hair, she smiles.|In 2021, Swedish climate activist [[Greta Thunberg]] likened her autism to a "superpower", crediting her success to her [[Special interest (autism)|focused interests]].<ref name="Hattenstone-2021">{{Cite news |title=Greta Thunberg: 'I really see the value of friendship. Apart from the climate, almost nothing else matters' |url=https://www.theguardian.com/environment/ng-interactive/2021/sep/25/greta-thunberg-i-really-see-the-value-of-friendship-apart-from-the-climate-almost-nothing-else-matters |access-date=16 June 2024 |work=[[The Guardian]] |date=25 September 2021 |language=en |vauthors=Hattenstone S, Fischer H |archive-url=https://web.archive.org/web/20250406060618/https://www.theguardian.com/environment/ng-interactive/2021/sep/25/greta-thunberg-i-really-see-the-value-of-friendship-apart-from-the-climate-almost-nothing-else-matters |archive-date=6 April 2025}}</ref>]] The [[autism rights movement|autistic rights]] and [[neurodiversity]] movements argue autism should be accepted as a difference to be accommodated instead of cured,<ref>{{cite news |date=26 June 2006 |title=Autism Movement Seeks Acceptance, Not Cures |url=https://www.npr.org/templates/story/story.php?storyId=5488463 |access-date=10 November 2015 |work=[[NPR]] |vauthors=Shapiro J |archive-date=10 May 2019 |archive-url=https://web.archive.org/web/20190510154818/https://www.npr.org/templates/story/story.php?storyId=5488463 |url-status=live}}</ref><ref>{{cite magazine |title=Autistic and proud of it |url=https://www.newscientist.com/article/mg18625041-500-autistic-and-proud-of-it/ |access-date=10 November 2015 |publisher=Reed Elsevier |magazine=[[New Scientist]] |vauthors=Trivedi B |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423120053/https://www.newscientist.com/article/mg18625041-500-autistic-and-proud-of-it/ |url-status=live}}</ref><ref name="Solomon" /><ref>{{cite book |title=The Economic World |publisher=Chronicle Publishing Company |year=1917 |location=New York city |page=366}}</ref><ref name="Silverman 2008"> {{cite journal |vauthors=Silverman C |year=2008 |title=Fieldwork on another planet: social science perspectives on the autism spectrum |journal=[[BioSocieties]] |volume=3 |issue=3 |pages=325–341 |doi=10.1017/S1745855208006236 }}</ref> although a minority of autistic people might still accept a cure.<ref>{{cite web |date=23 March 2022 |title=Results and Analysis of the Autistic Not Weird 2022 Autism Survey - Autistic Not Weird |url=https://autisticnotweird.com/autismsurvey/ |access-date=29 April 2022 |language=en-GB |archive-date=8 June 2023 |archive-url=https://web.archive.org/web/20230608144053/https://autisticnotweird.com/autismsurvey/ |url-status=live}}</ref> Social-science scholars study autistic people in hopes of learning more about "autism as a culture, transcultural comparisons ... and research on social movements".<ref name="Silverman 2008" /> Events related to autism include [[World Autism Awareness Day]], [[Autism Sunday]], [[Autistic Pride Day]], [[Autism Network International|Autreat]], and others.<ref>{{cite web |title=World Autism Awareness Day, 2 April |url=https://www.un.org/en/events/autismday/ |access-date=17 November 2015 |publisher=[[United Nations]] |archive-date=31 March 2018 |archive-url=https://web.archive.org/web/20180331054119/https://www.un.org/en/events/autismday/ |url-status=live}}</ref><ref>{{cite web |date=18 June 2015 |title=Autistic Pride Day 2015: A Message to the Autistic Community |url=http://autisticadvocacy.org/2015/06/autistic-pride-day-2015-a-message-to-the-autistic-community/ |access-date=18 November 2015 |vauthors=Bascom J |archive-date=19 November 2015 |archive-url=https://web.archive.org/web/20151119190817/http://autisticadvocacy.org/2015/06/autistic-pride-day-2015-a-message-to-the-autistic-community/ |url-status=live}}</ref><ref>{{cite web |year=2010 |title=Autism Sunday – Home |url=http://www.autismsunday.co.uk/ |archive-url=https://web.archive.org/web/20100303043146/http://www.autismsunday.co.uk/ |archive-date=3 March 2010 |access-date=17 November 2015 |website=Autism Sunday}}</ref><ref>{{cite web |year=2013 |title=About Autreat |url=http://www.autreat.com/autreat.html |access-date=17 November 2015 |publisher=Autreat.com |archive-date=1 December 2015 |archive-url=https://web.archive.org/web/20151201181250/http://www.autreat.com/autreat.html |url-status=live}}</ref>

[[Special interest (autism)|Focused interests]] are commonly found in autistic people and can include activism. Environmental activist [[Greta Thunberg]] has spoken favorably about her autism diagnosis, saying that autism can be a source of [[life purpose]], as well as the basis of careers, hobbies, and friendships.<ref>{{Cite web |last=Silberman |first=Steve |date=6 May 2019 |title=Greta Thunberg became a climate activist not in spite of her autism, but because of it |url=https://www.vox.com/first-person/2019/5/6/18531551/greta-thunberg-autism-aspergers |access-date=16 June 2024 |website=Vox |language=en-US}}</ref><ref>{{Cite web |last=Ryan |first=Maggie |date=12 April 2024 |title=These 12 Celebrities With Autism Are Opening Up About Life on the Spectrum |url=https://www.sheknows.com/health-and-wellness/slideshow/2992980/celebrities-with-autism/ |access-date=16 June 2024 |website=SheKnows |language=en-US}}</ref><ref name="Hattenstone-2021"/> Entrepreneur and co-founder of [[Microsoft]] [[Bill Gates]] has written, "If I were growing up today, I probably would be diagnosed on the autism spectrum."<ref>{{Cite web |last=Gates |first=Bill |date=25 January 2025 |title=Essay {{!}} Exclusive {{!}} Bill Gates: I Coded While I Hiked as a Teenager. Was I on the Spectrum? Probably. |url=https://www.wsj.com/arts-culture/bill-gates-memoir-410d7ff5 |access-date=5 July 2025 |website=WSJ |language=en-US}}</ref>

=== Legal implications of diagnosis === In Sweden, people with an autism diagnosis are required to provide additional proof of suitability to apply for a driver's license<ref name="Autism Sverige">{{Cite web |title=Översyn av körkortskrav vid autism och adhd |url=https://www.autism.se/aktuellt/oversyn-av-korkortskrav-vid-autism-och-adhd/ |access-date=13 August 2025 |website=Autism Sverige |language=sv}}</ref> and may face [[Military service and conscription for autistic people|barriers to entering military service]].<ref name="www.do.se">{{Cite web |title=Personer med ADHD och autism nekades möjlighet att prövas för militärtjänst |url=https://www.do.se/rattsfall-beslut-lagar-stodmaterial/tvister-domar-tillsynsbeslut/ovrigt/personer-med-adhd-och-autism-nekades-mojlighet-att-provas-for-militartjanst |access-date=13 August 2025 |website=www.do.se |language=sv}}</ref>

In the United Kingdom, an autistic police officer was rejected from firearms training, which a tribunal later ruled was illegal discrimination.<ref name="Rowsell-2023">{{Cite web |date=6 December 2023 |first=Juliette |last=Rowsell |title=Police officer rejected from firearms training because of autism diagnosis was discriminated against, tribunal rules |url=https://www.peoplemanagement.co.uk/article/1850180 |access-date=13 August 2025 |website=www.peoplemanagement.co.uk |language=en}}</ref>

In the United States, autism is generally a "disqualifying condition" for joining the military, but autistic people can apply for a medical waiver.<ref>{{Cite web |last=Donvan |first=John etc. |title=People with autism navigate roadblocks to serving in the military |url=https://abcnews.go.com/US/people-autism-navigate-roadblocks-serving-military/story?id=109748037 |access-date=2026-01-18 |website=ABC News |language=en}}</ref>

=== Discrimination === [[Discrimination against autistic people]] occurs in various forms, both directly and indirectly, in a variety of settings, professional, educational, or clinical.<ref name="Cleary-2023">{{Cite journal |last1=Cleary |first1=Michelle |last2=West |first2=Sancia |last3=Kornhaber |first3=Rachel |last4=Hungerford |first4=Catherine |date=2 September 2023 |title=Autism, Discrimination and Masking: Disrupting a Recipe for Trauma |journal=Issues in Mental Health Nursing |volume=44 |issue=9 |pages=799–808 |doi=10.1080/01612840.2023.2239916 |pmid=37616302 |doi-access=free |url=https://researchoutput.csu.edu.au/en/publications/105aaf68-a0ff-43e4-ba28-181de288dd20 }}</ref> Such discrimination is often initiated after other people identify the autistic person as different from themselves, which may occur very quickly.<ref name="Cleary-2023" /> This discrimination sometimes leads to [[violence]], [[assault]], or [[social exclusion]].<ref name="Cleary-2023" /> Various legal limitations on people with an autism diagnosis have also been considered discriminatory.<ref name="Autism Sverige" /><ref name="Rowsell-2023" />

=== Neurodiversity movement === [[File:Pastel Neurodiversity Symbol.png|thumb|The neurodiversity movement has many symbols, but is often represented by the [[infinity symbol]]. ]] Some autistic people and affiliated researchers<ref name="Pellicano">{{cite journal |vauthors=Pellicano E, den Houting J |date=April 2022 |title=Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science |journal=[[Journal of Child Psychology and Psychiatry, and Allied Disciplines]] |volume=63 |issue=4 |pages=381–396 |doi=10.1111/jcpp.13534 |oclc=01307942 |pmc=9298391 |pmid=34730840 }}</ref> have advocated a shift in attitudes toward the view that autism is a difference, rather than a disease that ought to be treated or cured.<ref>{{cite journal |journal=[[Disability & Society]] |year=2007 |volume=22 |issue=7 |pages=761–76 |title='Surplus suffering': differences between organizational understandings of Asperger's syndrome and those people who claim the 'disorder' |vauthors=Clarke J, van Amerom G |doi=10.1080/09687590701659618 }}</ref><ref>{{cite journal |last1=Baron-Cohen |first1=Simon |title=Is Asperger Syndrome Necessarily Viewed as a Disability? |journal=Focus on Autism and Other Developmental Disabilities |date=August 2002 |volume=17 |issue=3 |pages=186–191 |doi=10.1177/10883576020170030801 }}</ref><ref>{{cite journal |last1=Baron-Cohen |first1=Simon |title=Is Asperger syndrome/high-functioning autism necessarily a disability? |journal=Development and Psychopathology |date=September 2000 |volume=12 |issue=3 |pages=489–500 |doi=10.1017/S0954579400003126 |pmid=11014749 }}</ref> Critics have bemoaned the entrenchment of some of these groups' opinions, and that they speak to a select group of autistic people with limited difficulties.<ref name="Solomon" /><ref name="Morgan-2016">{{cite journal |vauthors=Morgan J |date=October 2016 |title=Autism spectrum disorder: difference or disability? |journal=[[The Lancet Neurology]] |language=en |volume=15 |issue=11 |page=1126 |doi=10.1016/S1474-4422(16)30002-3 }}</ref><ref name="Silverman 2008" /><ref>{{cite news |title=A medical condition or just a difference? The question roils autism community. |language=en-US |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/national/health-science/a-medical-condition-or-just-a-difference-the-question-roils-autism-community/2019/05/03/87e26f7e-6845-11e9-8985-4cf30147bdca_story.html |access-date=15 October 2021 |archive-url=https://web.archive.org/web/20250723071522/https://www.washingtonpost.com/national/health-science/a-medical-condition-or-just-a-difference-the-question-roils-autism-community/2019/05/03/87e26f7e-6845-11e9-8985-4cf30147bdca_story.html|archive-date=23 July 2025}}</ref><ref name="HV" /> Clinical and policy guidance in Australia, the United States, and the United Kingdom now promote [[neurodiversity]]-affirming language—for example, using "characteristics" instead of "symptoms" and avoiding words such as "cure".<ref>{{Cite web |title=Second edition overview {{!}} Assessment and Diagnosis Guideline |url=https://www.autismcrc.com.au/best-practice/assessment-and-diagnosis/second-edition |access-date=6 May 2025 |website=Autism CRC |language=en}}</ref><ref name="England" /><ref>{{Cite web |date=27 February 2025 |title=Autism |url=https://www.nih.gov/nih-style-guide/autism |archive-url=https://web.archive.org/web/20250514145835/https://www.nih.gov/nih-style-guide/autism |archive-date=14 May 2025 |access-date=6 May 2025 |website=National Institutes of Health (NIH) |language=EN}}</ref>

The neurodiversity movement and the [[autism rights movement]] are [[social movement]]s within the context of [[disability rights]], emphasizing the concept of neurodiversity, according to which autism is a result of healthy and valuable variations in the [[human brain]] rather than a disorder to be cured.<ref name="Solomon">{{cite news |last=Solomon |first=Andrew |date=25 May 2008 |title=The autism rights movement |url=https://nymag.com/news/features/47225/ |url-status=live |archive-url=https://web.archive.org/web/20080527025140/http://nymag.com/news/features/47225/ |archive-date=27 May 2008 |access-date=27 May 2008 |work=[[New York Magazine]] }}</ref><ref name="The Guardian">{{cite news |last=Hill |first=Amelia |date=31 July 2023 |title=Autism could be seen as part of personality for some diagnosed, experts say |url=https://www.theguardian.com/society/2023/jul/31/autism-could-be-seen-as-part-of-personality-for-some-diagnosed-experts-say |url-status=live |archive-url=https://web.archive.org/web/20230801022836/https://www.theguardian.com/society/2023/jul/31/autism-could-be-seen-as-part-of-personality-for-some-diagnosed-experts-say |archive-date=1 August 2023 |access-date=1 August 2023 |newspaper=[[The Guardian]]}}</ref> The autism rights movement advocates including greater acceptance of autistic behaviors, therapies that focus on coping skills rather than [[autistic masking|imitating the behaviors]] of non-autistic people,<ref name="Bigthink">{{cite web |vauthors=Ratner P |title=Should Autism Be Cured or Is "Curing" Offensive? |url=https://bigthink.com/paul-ratner/should-autism-be-cured-or-is-curing-offfensive |website=Big Think |access-date=16 June 2019 |date=10 July 2016}}</ref> and the recognition of the autistic community as a [[minority group]].<ref name="Bigthink" /><ref name="HV" /> Autism rights or neurodiversity advocates believe the autism spectrum is genetic and should be accepted as a healthy variation in the [[human genome]].<ref name="Solomon" /> A common argument against neurodiversity activists is that most have relatively few support needs or are [[self-diagnosed]], and do not represent the views of autistic people with more support needs.<ref name="HV" /><ref>{{cite journal |vauthors=McGee M |date=August 2012 |title=Neurodiversity |journal=Contexts |volume=11 |issue=3 |pages=12–13 |doi=10.1177/1536504212456175 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Sarrett J |date=April 2016 |title=Biocertification and Neurodiversity the Role and Implications of Self-Diagnosis in Autistic Communities |journal=Neuroethics |volume=9 |pages=23–36 |doi=10.1007/s12152-016-9247-x }}</ref> It has been argued that only autistic people with lower support needs should be included under the neurodiversity banner, as autism with high support needs "may rightfully be viewed as a disability".<ref name="HV">{{cite journal |last1=Jaarsma |first1=Pier |last2=Welin |first2=Stellan |date=March 2012 |title=Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement |journal=Health Care Analysis |language=en |volume=20 |issue=1 |pages=20–30 |doi=10.1007/s10728-011-0169-9 |pmid=21311979 |url=http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-72172 }}</ref> The concept of neurodiversity is contentious in autism advocacy and research groups and has led to infighting.<ref name="Morgan-2016" /><ref name="Silverman 2008" />

=== Driving === Many autistic teenagers and adults struggle to learn to drive a car.<ref name=":2">{{cite journal |last1=Mercier |first1=Alecia |last2=Sherrod |first2=Gabriela |last3=Ennis |first3=Robin |last4=Clay |first4=Olivio J. |last5=Richter |first5=Caroline G. |last6=Stavrinos |first6=Despina |title=The Driving Profile of Autistic Drivers and Their Driving Experiences: A Systematic Review |journal=Journal of Autism and Developmental Disorders |date=June 2025 |volume=55 |issue=6 |pages=2141–2156 |doi=10.1007/s10803-024-06586-x |pmid=39395127 }}</ref> By age 21, about 20% of autistic people in the US have a [[driver's license]], compared to more than 60% of non-autistic people.<ref name=":3">{{Cite journal |last1=Curry |first1=Allison E |last2=Yerys |first2=Benjamin E |last3=Huang |first3=Patty |last4=Metzger |first4=Kristi B |date=May 2018 |title=Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder |journal=Autism |language=en |volume=22 |issue=4 |pages=479–488 |doi=10.1177/1362361317699586 |pmc=5767541 |pmid=28374599 |quote=Table 2. }}</ref> They are less likely to start learning, likely to do it later than non-autistic peers, and less likely to proceed to the next stage.<ref name=":3" />

The differences are due to the characteristics of autism such as being slower to recognize [[pedestrians]],<ref name=":4">{{cite journal |last1=Silvi |first1=Clara |last2=Scott-Parker |first2=Bridie |last3=Jones |first3=Christian |title=A Literature Review of the Likely Effects of Autism Spectrum Disorder on Adolescent Driving Abilities |journal=Adolescent Research Review |date=December 2018 |volume=3 |issue=4 |pages=449–465 |doi=10.1007/s40894-017-0068-x }}</ref> having a slower [[reaction time]],<ref name=":4" /><ref name=":2" /> worse [[executive function]],<ref name=":2" /> worse [[motor coordination]],<ref name=":2" /> and poorer [[situational awareness]] (e.g., remembering that another vehicle is in their [[Vehicle blind spot|blind spot]]).<ref name=":4" /> Autistic drivers report difficulty with [[motor control]],<ref name=":2" /> [[sensory processing]] (e.g., the [[Glare (vision)|glare]] of oncoming headlights),<ref name=":2" /> [[visual-motor coordination]],<ref name=":2" /> [[Rigidity (psychology)|mental inflexibility]] (e.g., failing to yield the [[Traffic#Passage_priority_(right_of_way)|right of way]]),<ref name=":2" /> and difficulty with social cues (e.g., understanding how to communicate and cooperate with other drivers to navigate a road hazard).<ref name=":2" />

Although these problems mean that most autistic people do not learn how to drive, those autistic people who have earned driver's licenses have about the same chance as anyone else of being involved in a traffic collision and a lower risk of some problems, including driving at an [[Speeding|unsafe speed]] or having their license suspended.<ref name=":2" />

=== Parental reactions to a child's diagnosis === Parents' reactions to having their children diagnosed with autism vary. Many experience grief.<ref name=":12">{{cite journal |last1=Galán-Vera |first1=Ingrid Zugey |last2=Robles-Bello |first2=María Auxiliadora |last3=Sarhani-Robles |first3=Aziz |last4=Valencia-Naranjo |first4=Nieves |title=Experiences and coping strategies of parents with children diagnosed with autism spectrum disorder in early care with emphasis on social skills and family cultural values: A qualitative study |journal=Archives of Psychiatric Nursing |date=June 2025 |volume=56 |article-number=151864 |doi=10.1016/j.apnu.2025.151864 |pmid=40467274 |doi-access=free }}</ref> A study in Spain found that children diagnosed with autism and their parents faced stigma and societal challenges.<ref name=":12" /> Stigma is created by societal standards that influence how parents think of autism.<ref>{{cite journal |last1=Turnock |first1=Alice |last2=Langley |first2=Kate |last3=Jones |first3=Catherine R.G. |title=Understanding Stigma in Autism: A Narrative Review and Theoretical Model |journal=Autism in Adulthood |date=March 2022 |volume=4 |issue=1 |pages=76–91 |doi=10.1089/aut.2021.0005 |pmid=36605561 |pmc=8992913 }}</ref> Cultural values can influence how a parent feels; many feel defeated because they think they failed as a parent.<ref name=":12" /> Spain has early intervention programs to help parents adapt to their children's diagnoses.<ref name=":12" /> Stigma causes many parents to hide their children's condition, so their experiences are minimized or denied.<ref name=":12" />

=== Diagnosis in adulthood === Since the 1990s, the number of people without co-occurring intellectual disability who are diagnosed with autism (including Asperger's syndrome and ASD) has increased. Some autistic adults of average or above-average intelligence were not diagnosed in childhood because the condition was less well-understood. Diagnosis in adulthood can have effects very different from those experienced by people diagnosed in childhood. A late diagnosis produces an emotional reaction and a phase of readjustment. Late-diagnosed adults often report a history of being treated for anxiety and depression. Many report lifelong feelings of isolation and alienation. After a period of readjustment, a late diagnosis is often viewed favorably, allowing previously unidentified needs to be met and support and accommodations to be requested.<ref>Huang, Y; Arnold, SRC; Foley, KR; Trollor, JN (2020) "Diagnosis of autism in adulthood: A scoping review", ''Autism'', Vol. 24 Chapter 6, pp. 1311 - 1327 1362-3613 (ISSN); 1461-7005 (ISSN)</ref><ref>Steven D. Stagg & Hannah Belcher (2019) "Living with autism without knowing: receiving a diagnosis in later life," ''Health Psychology and Behavioral Medicine,'' 7:1, 348-361, DOI: 10.1080/21642850.2019.1684920</ref><ref>Murphy, C. M., Wilson, E. C., Robertson, D. M., Ecker, C., Daly, E. M., Hammond, N., McAlonan, G. M. (2016). "Autism spectrum disorder in adults: Diagnosis, management and health service development." ''Neuropsychiatric Disease and Treatment'', 12, 1669–1686. doi 10.2147/NDT.S65455</ref>

== See also == {{div col|colwidth=15em}} * [[Intellectual giftedness]] * [[Animal model of autism]] * [[Autism and memory]] * [[Autism-friendly]] * [[Autism in popular culture]] * [[Autism in psychoanalysis]] * [[Autistic art]] * [[Controversies in autism]] * [[Diagnostic substitution]] * [[Global perceptions of autism]] * [[List of autistic fictional characters]] * [[List of films about autism]] * [[Outline of autism]] * [[Twice exceptional]] * [[Violence and autism]] {{div col end}}

== Notes == {{Notelist}}

== References == {{Reflist|colwidth=20em}}

=== Sources === * {{cite book |title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) |title-link=DSM-5-TR |chapter=Neurodevelopmental Disorders |publisher=[[American Psychiatric Association]] |location=Washington, DC |date=18 March 2022 |lccn=2021051782 |isbn=978-0-89042-577-0 |ref={{harvid|DSM-5-TR}}}} * {{cite encyclopedia |title=6A02 Autism spectrum disorder |date=February 2022 |orig-date=adopted in 2019 |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/437815624 |encyclopedia=International Classification of Diseases 11th Revision (ICD-11) |publisher=World Health Organization |access-date=14 May 2022 |id={{ICD11|6A02|437815624}} |ref={{harvid|ICD-11}}}}

== Further reading == {{refbegin |30em}} *{{cite book |last=Grandin |first=Temple |author-link=Temple Grandin |title=The Autistic Brain: Thinking Across the Spectrum |publisher=Mariner Books |year=2013 |isbn=978-0-544-22773-6 }} * {{cite book |last=Silberman |first=Steve |author-link=Steve Silberman |title=NeuroTribes: The Legacy of Autism and the Future of Neurodiversity |publisher=Avery |year=2015 |isbn=978-1-58333-467-6 }} * {{cite book |last1=Prizant |first1=Barry M |last2=Fields-Meyer|first2=Tom|title=Uniquely Human: A Different Way of Seeing Autism |publisher=Simon & Schuster |year=2015 |isbn=978-1-4767-7624-8 }} *{{cite book |last=Baron-Cohen |first=Simon |author-link=Simon Baron-Cohen |title=The Pattern Seekers: How Autism Drives Human Invention |publisher=Basic Books |year=2020 |isbn=978-1-5416-4713-8 }} * {{cite book |last=Higashida |first=Naoki |title=The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism |publisher=Random House |year=2013 |isbn=978-0-8129-8515-3 }} * {{cite book |last1=Marble |first1=John |title=Autism For Dummies |publisher=For Dummies |year=2025 |isbn=978-1-394-30100-3}} * {{cite book |last=Price |first=Devon |title=Unmasking Autism: Discovering the New Faces of Neurodiversity |publisher=Harmony |year=2022 |isbn=978-0-593-23523-2 }} * {{cite book |last=Garcia |first=Eric |title=We're Not Broken: Changing the Autism Conversation |publisher=Mariner Books |year=2021 |isbn=978-0-358-69714-5 }} * {{cite book |last=Ballou |first=Emily Paige |title=Sincerely, Your Autistic Child: What People on the Autism Spectrum Wish Their Parents Knew About Growing Up, Acceptance, and Identity |publisher=Beacon Press |year=2021 |isbn=978-0-8070-2568-0 }} * {{cite book |last=Pang |first=Camilla |author-link=Camilla Pang |title=Explaining Humans: What Science Can Teach Us About Life, Love and Relationships |publisher=[[Penguin Books]] |year=2020 |isbn=978-0-241-40960-2 }} {{refend}}

== External links == {{Library resources box |onlinebooks=yes}} {{Subject bar|c=Category:Autism|b=y|q=Autism|n=Category:Autism|wikt=autism spectrum|d=y}} * [https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders World Health Organization fact sheet on autism]

{{Medical condition classification and resources  | ICD11 = {{ICD11|6A02}} | ICD10 = {{ICD10|F84.0}} | ICD9 = {{ICD9|299.00}} | OMIM = 209850 | MeSH = D000067877  | Curlie = Health/Mental_Health/Disorders/Neurodevelopmental/Autism_Spectrum | MedlinePlus = 001526 | eMedicine_mult = {{eMedicine2|ped|180}} | PatientUK = autism }} {{Pervasive developmental disorders}} {{Autism resources}} {{Mental and behavioural disorders|selected=neurological}} {{Digital media use and mental health}} {{Nonverbal communication}}

[[Category:Autism]] [[Category:Pervasive developmental disorders]] [[Category:Learning disabilities]] [[Category:Spectrum disorders]]