What is autism?

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When people hear the word “autism” they often have a specific idea of a particular behavior in their head. However, not all people with autism have these behaviors. What may apply to some people with autism does not apply to all autistic people. Plus not all autistic people belong to this classic category of autism that we might think of.


Autism often occurs during the first critical developmental years of a child, from the age of 0-6 years. The child may not follow the normal course of development of the age milestones and this may cause concern to the parents.

What is autism?


Autism is a diagnostic umbrella label given to a broad category of neurodevelopmental disorders. It is a condition that most often affects the level of communication and behavior with others. The autistic people experience difficulties:

  • in social communication differences, including verbal and nonverbal communication,
  • deficits in social interactions,
  • restricted, repetitive patterns of behavior,
  • lack of interests or activities and
  • sensory problems.


What is autism

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 revised the autism classification and so all types of autism are now merged into a single diagnosis known as “Autism Spectrum Disorder (ASD)”.

ASD refers to the wide variety of possible different skills and ability levels that can detected in Autistic people. Many of those with ASD can have:

  • Deficits in social interactions.
  • Restricted, repetitive patterns of behavior, interests or activities and sensory problems.
  • Delayed or absence of language development.
  • Intellectual disabilities.
  • Inflexible interests.
  • Insistence on obsession in environment or routine.
  • Repetitive motor and sensory behaviors, like flapping arms or rocking.
  • Increased or decreased reactions to sensory stimuli.
  • Poor motor coordination.
  • Attention weaknesses.

How well a person with ASD can function in their daily activities depends on the severity of their symptoms. As autism varies widely in severity and how they are handled on daily routine, the symptoms are not always easily recognized by everyone.

Today there is no difference between Autism and ASD, due to the general term ASD from 2013 which includes all autistic behavioral and functional disorders.

What are the Types of Autism?

The changes in terminology concern the diagnosis that has been made in recent years. However, the previous terminology has not been completely removed and in discussion can be referred to as Asperger or PDD, even by health professionals, parents and people with autism. but these terms are no longer an official diagnosis in the US classification system.

Asperger syndrome was the mild form of the autism spectrum. People with Asperger’s were often thought to have “high functionality”, with average to above-average intelligence and no speech delays. Some autistic people do not accept terms like those of high or low functionality. Children with Asperger’s autism may have smaller differences than their peers and often have satisfactory or even strong language and cognitive skills. Since 2013 it has been reclassified as Level 1 Autism Spectrum Disorder by the DSM-5 Diagnostic Manual.

Kanner Syndrome was discovered by Johns Hopkins University psychiatrist Leo Kanner in 1943 and has been described as infant autism. Doctors today describe Karren’s syndrome as a classic autistic disorder. Children with Kanner syndrome will show less of the characteristics of the disorder. This will display the following features:

  • Lack of emotional attachment with other people
  • Communication and interaction difficulties
  • Uncontrolled speech
  • Obsession with handling objects all the time
  • Even if they show up great ability of memory and visual-spatial skills experience great learning difficulties in other areas

Rett syndrome is a neurodevelopmental disorder that is discovered early in infancy. The disorder mainly affects girls but does not exclude boys. Rett syndrome affects a child’s life in almost every way. The good thing is that the child can live a good life with proper care. So the kid can live with the family and experience the family environment and with the right help to do the activities he likes.

The most common features of Rett syndrome include:

  • abnormal motor behavior and coordination problems
  • communication and speech problems
  • they might deal some difficulties in the respiratory process

Childhood Decomposition Disorder (CDD), also known as Heller’s syndrome or psychotic disorder, is a neurodevelopmental disorder defined by the delayed onset of developmental problems in language, motor skills, or social functioning. CDD or Heller syndrome is associated with children who, while growing normally, suddenly developed some relapse between the ages of two (2) and ten (10) years. It is characterized by loss of acquired cognitive abilities and by typical autistic symptoms, which is not due to a neurodegenerative disease, or schizophrenia. It is common in children with CDD to have epilepsy. The cause of CDD is unknown, although researchers have linked it to brain neurobiology. Childhood degenerative disorder is 90% more common in boys.

Children with Heller syndrome show clinically significant responses to some specific skills:

  • In language.
  • In motor skills.
  • In social relations.
  • On emotional development.
  • In adaptive behavior.

Pervasive developmental disorder not otherwise specified (PDD-NOS) or it’s also called Atypical Autism. The most common symptoms are challenges in social and language development. The diagnosis of PDD-NOS was given when a developmental disorder didn’t quite meet the criteria for autism, Asperger’s syndrome, Rett syndrome, Kanner’s syndrome, childhood disintegrative disorder, pervasive developmental disorder – not otherwise specified.

The most common features in PDD-NOS are:

  • delays in language development,
  • delys in walking,
  • delays in other motor skills
  • diffilulties in interacting with others

Severe autism is also called “level 3” in the spectrum. People with such severe autism should definitely take care of their daily functioning. They may also need care and great support in their daily lives and for the rest of their lives.

There is also The broad autism phenotype, however, is a term that is rarely used. This categorization is often described as “autistic traits” but is not usually diagnosed. The symptoms are mild and do not have a clinical picture capable of diagnosis. Research has shown that this can occur many times in relatives of people diagnosed with autism.

Also another categorization is the three “levels” of autism, with “level 1” being referred to as the mildest and “level 3” as the most severe. Thus high-functioning autism describes “mild” autism or “level 1” in the spectrum. Asperger’s syndrome is also often referred to as high-functioning autism. The symptoms of autism are here but often there is no need to support the autistic child or adult.

The three levels of ASD are:

Level 1: Usually needs support. Displays communication issues such as:

  • difficulty in social skills,
  • does not respond to or fail in social interaction with others,
  • has reduced interest in socializing, has no or is incomplete
  • ability to speak with specific and clear content and can not participate in a discussion and this makes communication difficult,
  • it is difficult to make friends.
  • flat monotone speech,
  • have difficulty expressing emotions in their speech,
  • they don’t change the tone of their speech to communicate according to the needs of the environment
  • have difficulty interacting with their peers at school or at home

The most commonly reported behavioral problems that an autistic person with ASD 

level 1 may experience include: strict and monotonous behavior that negatively interferes with general functional behavior and affects one or more contexts of daily activities,

problems switching between activities,

issues of recognition and organization of kinetic energy planning, which may make the independence of the individual impossible.

Level 2: needs substantial support of the individual at this level.

The communication issues that may exist here are:

more pronounced problems with verbal and non-verbal social communication,

sociability is limited by obvious problems despite the provision of support,

have limited social interaction,

have a reduced response to social interactions with other people,

their interactions are limited to very specific interests,

there are more significant differences in non-verbal communication

The most common behavioral problems that a person with ASD level 2 may experience include:

the behavior of these individuals is rigid in daily life activities,

the individual struggles to perceive changes and displays limited,

specific or repetitive behaviors that are strongly understood by an outside observer,

ultimately intervening in the functional action of the individual in various contexts of everyday life,

difficulty changing behavior or action in different places.

Level 3: Very substantial support required

Problems communicating with this Level 3 ASD that you may experience include:

have serious problems with both verbal and non-verbal communication, which also seriously affect functionality,

very limited practice and sociability,

minimal response to interaction with others

using very little comprehensible speech,

unusual methods of satisfying social needs and responding to others only with very direct approaches.

Recurring behavioral problems that a person with Level 3 ASD may experience include:

the behavior is extremely rigid and has extreme difficulty in coping with any changes,

specific and monotonous repetitive behaviors that significantly impede functioning in all areas of life, they face great anxiety or difficulty when changing places of action or function.

When should I wonder if my child has Autism Spectrum Disorder (ACD)?

As ASD is thought to be a disorder of very early brain development, the behavioral symptoms of autism characteristics are likely to occur between the ages of 1 and και years and 3 years.

The levels of ASD correspond to the severity of the autism symptoms described above and the degree of support required.

Why the terminology of Autism has changed?

The spectrum of autism reflects a wide range of developmental delays as well as the varying severity of symptoms.

ASD includes people who have some mild autistic characteristics to more serious autistic problems and need help with their daily routine. It also represents each level of mental ability, but also different degrees of communication and social skills.

The terminology for autism varies and may still be used by some, terms such as “mild” or “high functionality”, but these are not diagnoses or formal terminology. Some may find these terms useful, but both formally and in the autistic community they do not use them. In addition these terms also are not accurate as there is a huge range of different abilities that can exist between different autistic people but also in every autistic person.

What causes autism?

The exact cause of ASD is unknown. Today according to the most current research  there’s no single cause.

Some suspected risk factors for ASD include:

  • a family member who is autistic
  • genetic mutations
  • Fragile X syndrome and other genetic disorders
  • older parents
  • low birth weight
  • metabolic imbalances
  • exposure to heavy metals and environmental toxins
  • history of viral infections during pregnancy
  • exposure of the fetus to the drug valproic acid or thalidomide (Thalomid)

According to the National Institute of Neurological Disorders and Stroke (NINDS)Trusted Source, both genetics and environment may determine whether a person develops ASD. However, from many sources, it seems unlikly that vaccines cause ASD.

How does autism affect kids?

 Verbal delays or non verbal deficits

Children diagnosed with Autism Spectrum Disorder usually have delayed verbal expression so they may speak much later or may not speak at all. The average age at which an autistic child can speak is about two years old. However, one of the early signs of autism spectrum disorder is the delay in speech that occurs after the age of two.


Early signs in autistic children are often present from very early childhood and can affect daily functioning. According to the DSM-5, the two main categories of ASD symptoms are severe persistent lack of social communication, lack of interaction with other people, or the coexistence of both, along with limited and repetitive patterns of behavior.


Speech in autistic children can occur with an unusual tone, which does not sound normal, and that can range from high-pitched and “sing-songy” to robotic or flat. They may also show signs of hyperlexia which, contrary to what one may perceive when hearing the word, is not a positive trait. Hyperlexia is the ability to read beyond what is expected of a child’s age and is accompanied by a lack of understanding of spoken language and what they are reading. Children on the autism spectrum may learn to read earlier than their peers, sometimes as early as 2 years old and are obsessed with letters and numbers.

In general it might be noted that some common signs of ASD are:

  • Doesn’t respond to their name being called at all or responds inconsistently.
  • Doesn’t smile widely or make warm and joyful expressions by the age of 6 months.
  • Doesn’t engage in smiling, making sounds and making faces with you or other people by the age of 9 months.
  • Doesn’t babble by the age of 12 months.
  • Isn’t showing, pointing, reaching or waving by the age of 12 months.
  • Doesn’t say a word by 16 months.
  • Can’t express himself with meaningful, two-word phrases (without any imitating or repeating) by 24 months.
  • Any loss of speech, babbling or social skills at any age.
  • Not responding to their name.
  • Avoiding eye contact or not showing an awareness when others are speaking.
  • Not understanding sharing or taking turns.
  • Not looking at objects shown to them.
  • Not pointing or responding to pointing.
  • Having difficulty understanding facial expressions.
  • Performing repetitive movements (stimming).
  • Having difficulty expressing needs.
  • Preferring solo play, or having an inability to play “pretend” games.
  • Having difficulty adapting to change or having emotional meltdowns.
  • Showing hypersensitivity to sound, smell, taste, sight, or touch.
  • Needing to organize the physical environment.
  • losing previously learned skills.

How common is autism spectrum disorder (ASD)?

 Today, according to the Centers for Disease Control and Prevention (CDC), it is estimated that 1 in 54 children in the United States is diagnosed with ASD, in which boys seemed more likely to have ASD than girls. There were more than 5 million adults in the US, or 2.21% of the population, with ASD as of 2017. Government statistics suggest that the prevalence of ASD (how common it is) has risen 10% to 17% in recent years.

It is clear that many children and later adults may suffer from autism, but it is not always serious and it is important to keep in mind that the amount of support an autistic person needs can vary depending on different ages or situations.

Physiotherapy Thessaloniki Aikaterini Ziaka 

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