Autism: 5 misconceptions that can complicate care

Patients with ASD are less likely to have ever lived on their own than those with learning disabilities, intellectual disabilities, or emotional disturbances.Randomized controlled trials of early developmental and behavioral therapy have shown some promise in decreasing symptoms associated with ASD and improving parent-child communication and social engagement.^18-21 A systematic review found that young children with ASD can improve cognitive performance, language skills, and adaptive behavioral skills through behavioral interventions or more comprehensive approaches using developmental and behavioral frameworks.²² In addition to increasing the likelihood of overall school success, early intervention programs that improve communication and social skills can have a significant impact on the individual’s eventual quality of life (QOL), employability, and independence.^23-25

TABLE
Therapeutic options for ASD: What works?^7-17

^{ASD, autism spectrum disorder; IV, intravenous; SOR, strength of recommendation.
*SOR: A, Good-quality patient-oriented evidence; B, inconsistent or limited-quality patient-oriented evidence; C, consensus, usual practice, opinion, disease-oriented evidence, case series.}

Misconception 4: Individuals with ASD are more intellectually disabled and can't function independently

As many as 96% of children with ASD have a coexisting developmental disability, such as generalized developmental delay (found in 80% of those with ASD), learning disabilities (affecting 60%), or attention-deficit/hyperactivity disorder (in 42%).²⁶ Although many parents—and some physicians—assume that children with ASD are intellectually disabled, in fact, less than one in 5 (19%) has an intellectual disability.²⁶

Individuals with ASD do, however, often have difficulty living independently. In one study of post high school living arrangements, those with ASD were less likely to have ever lived on their own than those with learning disabilities, intellectual disabilities, or emotional disturbances.²³

Another analysis found that only about half (53.4%) of young adults with ASD had ever worked for pay outside the home since leaving high school—the lowest rate among disability groups.²⁴ Of those who had worked outside the home, young adults with ASD earned an average of $8.10 per hour, significantly lower than the comparison groups. Not surprisingly, young adults with ASD who had better conversational and/or functional skills had a higher likelihood of ever having had worked for pay outside the home.²⁴

Social participation also is considered an indicator of overall QOL and independent function. Young adults with ASD were found to be significantly more likely than those with other types of developmental delays to be socially isolated—never seeing friends, getting calls from friends, or being invited to activities. Lower communication and functional skills, as well as living with a parent, were predictors of less social participation in young adults with ASD.²⁵

Misconception 5: Thimerosal vaccines cause ASD

The controversy and concern about a correlation between mercury and ASD began in the late 1990s, when a published study appeared to link thimerosal-containing vaccines to the increasing incidence of autism.²⁷ This notion appeared to be further strengthened by a 2002 study,²⁸ done by the same researchers and reaching similar conclusions. Since then, the correlation has been disproven by a number of studies and further review of the initial studies revealed them to be flawed.²⁹

Despite the lack of evidence to support any long-term effects from the minimal exposure to mercury in the preservative, in July 1999, US Public Health Service agencies, the AAP, and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.³⁰ With the exception of a limited number of multidose influenza vaccines, childhood vaccines are now thimerosal-free.

Fact: Early referral is key

When and where to refer parents for additional evaluation of a child with developmental delays depends on the resources in your community. Typically, a team of providers participates in the evaluation and management of a child with ASD, often including a developmental pediatrician, psychiatrist and other mental health professional, neurologist, speech pathologist, audiologist, physical therapist, and special education teacher.