Key information about autism spectrum disorder

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TORONTO – Autism has been a major topic of discussion in the past two months, sparked by the Ontario government’s changes to its funding program to support the families of people on the autism spectrum. There are some basic elements as to how autism and its main types of therapy function, important to understanding some of the discussion about the neurodevelopmental disorder that affects one in 66 Canadian children.

Autism spectrum disorder (ASD) does not discriminate against people of any particular background or lifestyle. People on the autism spectrum (or people diagnosed with autism—not “autistic people,” as is often said) are born with neurological differences from their peers and have brains that process the world around them in unique ways.

The spectrum nature of the condition means that autism can take many forms that vary in severity and their impact on an individual. Someone with less-severe autism may have little to no difficulty communicating and may have above-average intelligence, but may struggle to relate to others. This end of the spectrum was previously known as Asperger syndrome or high-functioning autism. It is now classified as Level 1 ASD.

Level 2 ASD refers to people who have greater social challenges and more difficulties with their communication skills. They may not respond in a conventional way to social interactions and have intense focus on a particular interest, such as trains or obscure sports facts about a certain team.

Level 3 ASD is the most severe case, where individuals have severe communication challenges and are often non-verbal and do not begin social interactions with others. They have the greatest challenges of the three levels when their daily routines change and often use repetitive behaviours for comfort.

Treating ASD varies widely between an individual’s needs and the therapy to which they best respond. Generally speaking, for those toward the more severe end of the spectrum, the best treatment outcomes only occur when intensive therapy is begun as early as possible—starting by age two or by age five at the latest. 

The treatment method for less-severe cases is applied behavioural analysis (ABA), which involves therapy sessions that are tailored to a child’s needs and aim to teach communication and social skills. ABA can be done in small groups, as long as the groups are tailored toward a child’s individual program goals. 

Intensive Behavioural Intervention (IBI) is based on the same principles as ABA but its schedule is much more vigorous—the Geneva Centre for Autism recommends a minimum of 25 hours of therapy per week in a one-on-one ratio or very small group setting only, but many experts recommend as much as 40 hours per week in order to have the greatest impact on a child’s future.

The most intensive therapy for children on the autism spectrum can range from an annual cost of $60,000 to $100,000 per year. But that’s only one part of the total expenditures. Many of the children require learning or communication aids, require transportation assistance because they cannot use public transit, have to pay for drugs and other special education programs or additional therapies. Further, when they become adults, many are unable to work to support themselves.