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7 things everyone should know about autism
Autism is a widely misunderstood condition surrounded by falsehoods, half-truths, and cultural assumptions.
- Autism-spectrum disorder covers a wide range of neurodevelopmental conditions that are highly individualized.
- The prevalence of autism continues to increase in the United States, not due to vaccines but increased awareness and improved diagnosis.
- Autism awareness is crucial as treatment strategies are more effective if accessed early.
Autism has captured headlines, and therefore an undue amount of cultural panic, for many years. Yet, many people remain befuddled regarding basic information of this developmental disorder.
They don't believe people with autism experience emotions. (They do.) They fear that their child may catch autism from a classmate. (No, it's not contagious.) They wonder if the parents are to blame. (They aren't.) And they always want to know what an autistic person's savant talent is. (Autistic people certainly have talents, but movies have left us with the false assumption that autism equals Rain Man.)
To help spread awareness — and cut through the falsehoods, half-truths, and misinformation — here are seven things everyone should know about autism.
1) What is autism?
Autism is a neurodevelopment disability. People with autism have difficulty communicating or interacting socially and may engage in repetitive behaviors. They interact, behave, and learn in unique ways. Their behaviors may include avoiding eye contact, having trouble processing everyday sensory intake, showing no interest in make-believe games, and not enjoying physical contact such as hugging.
It's considered a spectrum condition because it affects people differently (hence the phrase "on the spectrum"). No two people will display identical conditions nor require the same support. Some autistic people can live healthy, independent lives, while others require more extensive care and support.
Originally, the Diagnostic and Statistical Manual of Mental Disorders categorized autism under the umbrella term "pervasive developmental disorder." But when the manual was updated to its fifth edition in 2013, it revised its criteria for autism. The category is now "autism-spectrum disorder," and it combines conditions that used to be diagnosed separately. These include autistic disorder, Asperger syndrome, and pervasive development disorders not otherwise specified (or PDD-NOS).
There is no lab test, like a blood test or genetic screening, available to determine if someone has an autistic-spectrum disorder. Medical professionals must make the determination based on behavior and development observations.
2) What causes autism?
Scientists don't know what exactly causes autism. Current investigations suggest a genetic origin, though environmental factors have not been ruled out entirely.
While it's difficult to untangle the interplay between genes and the environment, a longitudinal cohort study published in JAMA Psychiatry has provided the largest attempt so far. Researchers examined health data of more than 22,000 children diagnosed with autism spectrum disorder (ASD) from five countries. They estimated the heritability of ASD to be approximately 80 percent. They also found maternal effects — that is, the idea that the condition of the mother's body makes a child more likely to develop autism — to be insignificant.
"Although families are often most concerned about environmental risk factors for autism, the reality is that genetic factors play a much larger role overall," Andrew Adesman, director of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, told HealthDay News. (Dr. Adesman was not involved in the study.)
It remains unclear how genes linked to autism are being activated, and researchers are quick to note that we can't altogether ignore potential environmental factors. After all, they are the ones we can potentially adjust or learn to avoid, and even if genes play the dominant role, the environment could still activate them.
The National Institute of Environmental Health Sciences lists the following as associated with autism:
- advanced parental age at time of conception;
- prenatal exposure to air pollution or certain pesticides;
- maternal obesity, diabetes, or immune system disorders;
- extreme prematurity or very low birth weight; and
- any birth difficulty leading to periods of oxygen deprivation to the baby's brain.
Please note: No one claims these environmental factors cause autism, but they do appear to increase a child's risk of developing it when combined with unfavorable genetic factors.
3) Are rates of autism increasing?
A graph showing the number of people with autistic-spectrum disorder in the world. (Source: IHME/Our World in Data)
Yes, they are.
The CDC's Autism and Developmental Disabilities Monitoring Network estimates the prevalence of autism among 8-year-old children in the U.S. Its estimates are based on more than 300,000 children across the U.S., with updates released every two years.
In 2016, the CDC estimated the prevalence of autism to be 1 in 68 children. By 2018, about 1 in 59 children were identified as autistic. That's a rate twice as high as 2004 (1 in 125).
Worldwide, the trend is similar. According to the Institute for Health Metrics and Evaluation, in 2014 17.92 million people were estimated to have autism. By 2016, the number had grown to 18.30. As in the United States, boys are four times more likely than girls to be diagnosed as autistic.
4) What is causing this rising prevalence?
Scientists aren't sure why the numbers keep climbing, but they know it's not something we added to the water. The likely answer is increased awareness and improved diagnosis.
For example, white children are identified as autistic more often than black or Hispanic children, but the reason for this is not genetic. Rather, income, a lack of healthcare access, and non-English primary language are all cited reasons for the discrepancy. As these barriers are reduced, the gap has shrunk.
"Autism prevalence among black and Hispanic children is approaching that of white children," Stuart Shapira, associate director for science at CDC's National Center on Birth Defects and Development Disabilities, said in a release. "The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need."
States with more extensive outreach services report higher a prevalence of autism among children, too. New Jersey has the highest reported prevalence, but it furnishes extensive resources for professionals and support services. Conversely, the rural state of Alabama reports the lowest prevalence in the nation.
And let's remember that Asperger's syndrome and other disorders on the spectrum have been folded into a single diagnosis. As such, the number of children being diagnosed under a more cohesive criteria may bolster numbers previously spread out over distinct conditions.
5) Do vaccines cause autism?
Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes - AUTISM. Many such cases!— Donald J. Trump (@Donald J. Trump)1396010150.0
No, they do not.
This isn't news, but there remains a lot of doubt and confusion. To pick one notable anti-vaxxer, President Donald Trump recently walked back this 2014 tweet linking autism to vaccines but still claims that too many vaccines in too short a time frame could have caused the rise in autism rates. He has also considered establishing a special autism commission to investigate this thoroughly-vetted practice.
A 2019 Danish cohort study look at the medical histories of more than half a million children born between 1999 and 2010. The researchers found no link between autism and the MMR vaccine (a vaccine against measles, mumps, and rubella). They also found no increased risk of the vaccine triggering autism in susceptible subgroups.
This is just one of many such studies that have failed to link the two. So again: Vaccines do not cause autism.
6) Is there a cure for autism?
No, there is no cure for autism, but the question — often phrased in this manner — is misleading.
Autism is a neurodevelopmental disorder, not a disease. It seems unlikely that we'll ever cure it with a pill; however, therapies and interventions have been developed to assist individuals and families addressing the challenges of living with autism.
"Intervention can help to lessen disruptive behaviors, and education can teach self-help skills for greater independence," writes the Autism Society. "But just as there is no one symptom or behavior that identifies people with autism, there is no single treatment that will be effective for everyone on the spectrum." [Emphasis original.]
Treatment strategies can include social skills training, speech therapy, cognitive behavioral therapies, occupational therapy, family service plans, and individualized education plans. Which psychosocial interventions are selected will depend on the individual's strengths and weaknesses.
Biomedical interventions have been proposed and utilized, but the National Institute for Health and Clinical Excellence has ruled out many of them. In children, for example, they recommend never using chelation, secretin, or hyperbaric-oxygen therapies.
While treatment strategies will vary based on the individual's needs, they are all most effective if they are accessed as soon as possible.
"The earlier a child with autism is diagnosed and connected to services, the better," Coleen Boyle, director of the CDC's National Center on Birth Defects and Developmental Disabilities, told Scientific American. "Our message to parents is, if you have a concern about how your child learns, plays, speaks, acts or moves, take action. Don't wait."
7) What does the future hold for autism?
The future looks bright. A drive toward autism awareness means more children are more likely to be diagnosed younger so they can begin therapies sooner. More communities are developing the resources necessary to support individuals and families living with autism. And a cultural shift toward neurodiversity has begun to lessen the stigma surrounding autism-spectrum disorders and other mental health conditions.
Even the increased prevalence of autism, which seems scary as a raw number, is ultimately a positive trend. The more young children diagnosed, the sooner their families can connect with the support and resources they need.
Researchers continue to look into the genetic causes of autism, too. They have begun to identify the genes linked to autism and to understand the relationship between autism, hereditable genes and de novo mutations. Revelations that may lead to new treatments and advancements in personalized medicine.
"In essence, that is personalized medicine, that is taking the genetic finding and determining what is the logical treatment and matching that patient up with an appropriate drug," said Jonathan Sebat, chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases. "If we can find a few compounds that modulate neurodevelopment in the way that we want it to, and we can understand real disease mutations and how they respond to these drugs, then that's the beginning of precision medicine."
With improved awareness, dispelled half-truths, and scientists working toward new treatment options, the future may be very bright indeed.
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Higher education faces challenges that are unlike any other industry. What path will ASU, and universities like ASU, take in a post-COVID world?
- Everywhere you turn, the idea that coronavirus has brought on a "new normal" is present and true. But for higher education, COVID-19 exposes a long list of pernicious old problems more than it presents new problems.
- It was widely known, yet ignored, that digital instruction must be embraced. When combined with traditional, in-person teaching, it can enhance student learning outcomes at scale.
- COVID-19 has forced institutions to understand that far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted.
What conditions of the new normal were already appreciated widely?<p>First, we understand that higher education is unique among industries. Some industries are governed by markets. Others are run by governments. Most operate under the influence of both markets and governments. And then there's higher education. Higher education as an "industry" involves public, private, and for-profit universities operating at small, medium, large, and now massive scales. Some higher education industry actors are intense specialists; others are adept generalists. Some are fantastically wealthy; others are tragically poor. Some are embedded in large cities; others are carefully situated near farms and frontiers.</p> <p>These differences demonstrate just some of the complexities that shape higher education. Still, we understand that change in the industry is underway, and we must be active in directing it. Yet because of higher education's unique (and sometimes vexing) operational and structural conditions, many of the lessons from change management and the science of industrial transformation are only applicable in limited or highly modified ways. For evidence of this, one can look at various perspectives, including those that we have offered, on such topics as <a href="https://www.insidehighered.com/digital-learning/blogs/rethinking-higher-education/lessons-disruption" target="_blank">disruption</a>, <a href="https://www.nytimes.com/2020/02/20/education/learning/education-technology.html" target="_blank">technology management</a>, and so-called "<a href="https://www.insidehighered.com/sites/default/server_files/media/Excerpt_IHESpecialReport_Growing-Role-of-Mergers-in-Higher-Ed.pdf" target="_blank">mergers and acquisitions</a>" in higher education. In each of these spaces, the "market forces" and "market rules" for higher education are different than they are in business, or even in government. This has always been the case and it is made more obvious by COVID-19.</p> <p>Second, with so much excitement about innovation in higher education, we sometimes lose sight of the fact that students are—and should remain—the core cause for innovation. Higher education's capacity to absorb new ideas is strong. But the ideas that endure are those designed to benefit students, and therefore society. This is important to remember because not all innovations are designed with students in mind. The recent history of innovation in higher education includes several cautionary tales of what can happen when institutional interests—or worse, <a href="https://www.insidehighered.com/news/2016/02/09/apollos-new-owners-seek-fresh-start-beleaguered-company" target="_blank">shareholder</a> interests—are placed above student well-being.</p>
Photo: Getty Images<p>Third, it is abundantly apparent that universities must leverage technology to increase educational quality and access. The rapid shift to delivering an education that complies with social distancing guidelines speaks volumes about the adaptability of higher education institutions, but this transition has also posed unique difficulties for colleges and universities that had been slow to adopt digital education. The last decade has shown that online education, implemented effectively, can meet or even surpass the quality of in-person <a href="https://link-springer-com.ezproxy1.lib.asu.edu/article/10.1007/s10639-019-10027-z" target="_blank">instruction</a>.</p><p>Digital instruction, broadly defined, leverages online capabilities and integrates adaptive learning methodologies, predictive analytics, and innovations in instructional design to enable increased student engagement, personalized learning experiences, and improved learning outcomes. The ability of these technologies to transcend geographic barriers and to shrink the marginal cost of educating additional students makes them essential for delivering education at scale.</p><p>As a bonus, and it is no small thing given that they are the core cause for innovation, students embrace and enjoy digital instruction. It is their preference to learn in a format that leverages technology. This should not be a surprise; it is now how we live in all facets of life.</p><p>Still, we have only barely begun to conceive of the impact digital education will have. For example, emerging virtual and augmented reality technologies that facilitate interactive, hands-on learning will transform the way that learners acquire and apply new knowledge. Technology-enabled learning cannot replace the traditional college experience or ensure the survival of any specific college, but it can enhance student learning outcomes at scale. This has always been the case, and it is made more obvious by COVID-19.</p>
What conditions of the new normal were emerging suspicions?<p>Our collective thinking about the role of institutional or university-to-university collaboration and networking has benefitted from a new clarity in light of COVID-19. We now recognize more than ever that colleges and universities must work together to ensure that the American higher education system is resilient and sufficiently robust to meet the needs of students and their families.</p> <p>In recent weeks, various commentators have suggested that higher education will face a wave of institutional <a href="https://www.businessinsider.com/scott-galloway-predicts-colleges-will-close-due-to-pandemic-2020-5" target="_blank">closures</a> and consolidations and that large institutions with significant online instruction capacity will become dominant.</p> <p>While ASU is the largest public university in the United States by enrollment and among the most well-equipped in online education, we strongly oppose "let them fail" mindsets. The strength of American higher education relies on its institutional diversity, and on the ability of colleges and universities to meet the needs of their local communities and educate local students. The needs of learners are highly individualized, demanding a wide range of options to accommodate the aspirations and learning styles of every kind of student. Education will become less relevant and meaningful to students, and less responsive to local needs, if institutions of higher learning are allowed to fail. </p> <p>Preventing this outcome demands that colleges and universities work together to establish greater capacity for remote, distributed education. This will help institutions with fewer resources adapt to our new normal and continue to fulfill their mission of serving students, their families, and their communities. Many had suspected that collaboration and networking were preferable over letting vulnerable colleges fail. COVID-19's new normal seems to be confirming this.</p>
President Barack Obama delivers the commencement address during the Arizona State University graduation ceremony at Sun Devil Stadium May 13, 2009 in Tempe, Arizona. Over 65,000 people attended the graduation.
Photo by Joshua Lott/Getty Images<p>A second condition of the new normal that many had suspected to be true in recent years is the limited role that any one university or type of university can play as an exemplar to universities more broadly. For decades, the evolution of higher education has been shaped by the widespread imitation of a small number of elite universities. Most public research universities could benefit from replicating Berkeley or Michigan. Most small private colleges did well by replicating Williams or Swarthmore. And all universities paid close attention to Harvard, Princeton, MIT, Stanford, and Yale. It is not an exaggeration to say that the logic of replication has guided the evolution of higher education for centuries, both in the US and abroad.</p><p>Only recently have we been able to move beyond replication to new strategies of change, and COVID-19 has confirmed the legitimacy of doing so. For example, cases such as <a href="https://www.washingtonpost.com/education/2020/03/10/harvard-moves-classes-online-advises-students-stay-home-after-spring-break-response-covid-19/" target="_blank">Harvard's</a> eviction of students over the course of less than one week or <a href="https://www.nhregister.com/news/coronavirus/article/Mayor-New-Haven-asks-for-coronavirus-help-Yale-15162606.php" target="_blank">Yale's apparent reluctance</a> to work with the city of New Haven, highlight that even higher education's legacy gold standards have limits and weaknesses. We are hopeful that the new normal will include a more active and earnest recognition that we need many types of universities. We think the new normal invites us to rethink the very nature of "gold standards" for higher education.</p>
A graduate student protests MIT's rejection of some evacuation exemption requests.
Photo: Maddie Meyer/Getty Images<p>Finally, and perhaps most importantly, we had started to suspect and now understand that America's colleges and universities are among the many institutions of democracy and civil society that are, by their very design, incapable of being sufficiently responsive to the full spectrum of modern challenges and opportunities they face. Far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted. And without new designs, we can expect postsecondary success for these same students to be as elusive in the new normal, as it was in the <a href="http://pellinstitute.org/indicators/reports_2019.shtml" target="_blank">old normal</a>. This is not just because some universities fail to sufficiently recognize and engage the promise of diversity, this is because few universities have been designed from the outset to effectively serve the unique needs of lower-income students, first-generation students and students of color.</p>
Where can the new normal take us?<p>As colleges and universities face the difficult realities of adapting to COVID-19, they also face an opportunity to rethink their operations and designs in order to respond to social needs with greater agility, adopt technology that enables education to be delivered at scale, and collaborate with each other in order to maintain the dynamism and resilience of the American higher education system.</p> <p>COVID-19 raises questions about the relevance, the quality, and the accessibility of higher education—and these are the same challenges higher education has been grappling with for years. </p> <p>ASU has been able to rapidly adapt to the present circumstances because we have spent nearly two decades not just anticipating but <em>driving</em> innovation in higher education. We have adopted a <a href="https://www.asu.edu/about/charter-mission-and-values" target="_blank">charter</a> that formalizes our definition of success in terms of "who we include and how they succeed" rather than "<a href="https://www.washingtonpost.com/opinions/2019/10/17/forget-varsity-blues-madness-lets-talk-about-students-who-cant-afford-college/" target="_blank">who we exclude</a>." We adopted an entrepreneurial <a href="https://president.asu.edu/read/higher-logic" target="_blank">operating model</a> that moves at the speed of technological and social change. We have launched initiatives such as <a href="https://www.instride.com/how-it-works/" target="_blank">InStride</a>, a platform for delivering continuing education to learners already in the workforce. We developed our own robust technological capabilities in ASU <a href="https://edplus.asu.edu/" target="_blank">EdPlus</a>, a hub for research and development in digital learning that, even before the current crisis, allowed us to serve more than 45,000 fully online students. We have also created partnerships with other forward-thinking institutions in order to mutually strengthen our capabilities for educational accessibility and quality; this includes our role in co-founding the <a href="https://theuia.org/" target="_blank">University Innovation Alliance</a>, a consortium of 11 public research universities that share data and resources to serve students at scale. </p> <p>For ASU, and universities like ASU, the "new normal" of a post-COVID world looks surprisingly like the world we already knew was necessary. Our record breaking summer 2020 <a href="https://asunow.asu.edu/20200519-sun-devil-life-summer-enrollment-sets-asu-record" target="_blank">enrollment</a> speaks to this. What COVID demonstrates is that we were already headed in the right direction and necessitates that we continue forward with new intensity and, we hope, with more partners. In fact, rather than "new normal" we might just say, it's "go time." </p>
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