Table of Contents: Autism: Surprising Causes and Solutions for Parents and Caregivers
- Introduction
- Understanding Autism: Genetic and Environmental Factors
- The Role of Mitochondrial Dysfunction in Autism
- Nutritional and Lifestyle Interventions: Diet, Exercise, and Light Therapy
- Advancements in Treatment: Medications, Neuromodulation, and Whole-Child Approaches
- Real Stories of Transformation
- Insights for Families and Caregivers
- Final Insights: The Future of Autism Care
- Resource Links: Video podcast: Dhru Purohit & Dr Suzanne Goh, Dr Suzanne Goh Website and Book link: Magnificent Minds, Dietary links which may reduce Autism symptoms/behaviours and LED Light Therapy devices to improve the wellbeing of those with Autism
- FAQ for Autism improvements
1. INTRODUCTION
Autism diagnoses have risen dramatically in recent years. In 2006, the prevalence was 1 in 110, increasing to 1 in 44 by 2021, and now estimated at 1 in 36 children in the United States. If this trend continues, experts project even higher rates in the coming years. These statistics highlight an urgent need for understanding and action.
Dr. Suzanne Goh’s work challenges misconceptions about autism’s origins. She stresses that autism is not the result of poor parenting and calls for a shift away from blame. Instead, parents should feel informed and empowered to make decisions based on cutting-edge science and practical strategies..
Brain development also plays a significant role in autism. Research shows that differences in fetal brain development, including atypical cell migration and microarchitecture, contribute to the condition. From birth to age two, the brains of children with autism grow more rapidly than neurotypical brains, resulting in larger brain size. While this early overgrowth slows over time, it can lead to issues such as disrupted neuronal connections and hypersynchronous brain activity, both of which affect behaviour and communication.
This article explores Dr. Goh’s groundbreaking findings, from the impact of mitochondrial dysfunction to the transformative power of nutritional and lifestyle changes, providing a comprehensive guide for parents navigating this journey.
2. Understanding Autism: Genetic and Environmental Factors
Autism arises from a unique interplay between genetic predispositions, environmental influences, and co-occurring health conditions. Genetic factors include over 100 variations, such as mutations or chromosomal duplications, contributing to susceptibility. Dr. Suzanne Goh estimates that genetics account for approximately 50% of the risk, while environmental factors and co-occurring conditions make up the remaining 50%.
Environmental contributors include exposure to toxins like industrial chemicals, parental age over 40, and maternal health conditions such as gestational diabetes or autoimmune diseases. One significant environmental factor is maternal immune activation, shown to influence fetal brain development. Research using mouse models has demonstrated how activating a mother’s immune system can lead to autism-like features in offspring.
Brain Development and Impact:
In addition to genetic and environmental influences, brain development differences are a hallmark of autism. Studies reveal that the brain’s connectivity is altered, with increased short-range connections and decreased long-range connectivity. These changes affect key networks responsible for communication and sensory processing. Additionally, inflammation in the brain, often linked to immune system dysfunction, can exacerbate these issues.
Co-occurring Conditions:
- Digestive Issues: Up to 70% of autistic individuals experience gastrointestinal problems, such as chronic constipation or leaky gut syndrome.
- Epilepsy: Found in approximately 15-20% of autistic individuals, epilepsy is a significant co-occurring condition that can complicate care.
- Other Health Patterns: Autism is often associated with immune dysfunction, sleep disturbances, and sensory processing issues.
Dr. Goh emphasises the complexity of autism’s roots and the importance of a holistic approach that addresses these interconnected factors.
Key Takeaway:
Autism’s roots are diverse, and understanding this complexity is crucial for developing effective treatments tailored to each child’s unique needs.
3. The Role of Mitochondrial Dysfunction in Autism
Mitochondria, known as the “powerhouses” of cells, are vital for producing energy, regulating metabolism, and removing toxins. These organelles play a critical role in brain development and function, making mitochondrial health essential for overall well-being.
Mitochondrial dysfunction occurs when these structures fail to produce sufficient energy, leading to widespread cellular inefficiency. This dysfunction is distinct from mitochondrial disease, which involves inherited genetic defects. While mitochondrial disease is rare, mitochondrial dysfunction is more common and can contribute to various health concerns, including autism.
Broader Health Impacts:
- Cancer: Mitochondrial dysfunction has been linked to the development and progression of certain cancers.
- Heart Disease: Impaired energy production affects cardiac function and increases the risk of cardiovascular conditions.
- Chronic Fatigue Syndrome: Reduced mitochondrial efficiency leads to persistent low energy levels.
- Neurodegenerative Disorders: Conditions like Alzheimer’s and Parkinson’s disease are associated with mitochondrial decline.
Autism Connection:
In autism, approximately 80% of individuals show signs of mitochondrial dysfunction. This affects brain growth, communication, and behaviour, particularly during periods of rapid development like early childhood and puberty. The energy demands of these developmental phases make the brain especially vulnerable to mitochondrial inefficiencies.
Mitochondrial dysfunction also exacerbates inflammation, further disrupting neuronal function and connectivity. Addressing this through targeted interventions can significantly improve symptoms.
Promising Interventions:
Supporting mitochondrial health through diet, supplementation, and therapies like red and NIR light shows significant potential. These interventions enhance energy production, reduce inflammation, and improve cellular repair mechanisms, offering hope for families seeking additional tools to support their child’s development.
4. Nutritional and Lifestyle Interventions: Diet, Exercise, and Light Therapy
Diet
Diet plays a crucial role in managing autism and co-occurring conditions such as epilepsy. Research has shown that specific diets, such as ketogenic and Atkins diets, are particularly effective. These diets focus on high-fat, low-carbohydrate intake, which alters energy metabolism and can reduce seizures in epilepsy patients. For autistic individuals, these diets may also support brain function by providing a steady supply of ketones, which are an efficient energy source for the brain.
Examples of foods included in these diets are:
- Meats: Fatty cuts of beef, pork, lamb, chicken with skin, and oily fish such as salmon, mackerel, and sardines.
- Vegetables: Low-carb options like spinach, kale, broccoli, cauliflower, zucchini, and asparagus.
- Fruits: Berries, such as strawberries, blueberries, and raspberries, which are lower in sugar than most fruits.
- Dairy: Full-fat cheeses, butter, and cream.
- Nuts and Seeds: Almonds, walnuts, sunflower seeds, and flaxseeds.
- Healthy Fats: Olive oil, coconut oil, and avocado.
Dr. Suzanne also emphasised the importance of avoiding processed foods and sugars, which can exacerbate inflammation and disrupt gut health, key areas of concern for autistic individuals.
Other beneficial dietary approaches include:
- Nutrient-Dense Diets: Incorporating whole foods, including lean meats, fish, eggs, and green leafy vegetables, supports brain health and reduces inflammation.
- Gluten-Free and Casein-Free Diets: These elimination diets reduce gastrointestinal distress, a common issue in autism, and may alleviate behavioural symptoms.
- Probiotics and Prebiotics: Enhancing gut health through fermented foods like yogurt and supplements helps balance gut microbiota, which is often disrupted in autistic individuals.
Stem cells, while an emerging field, also offer promise. Stem cell therapies aim to repair and regenerate damaged neural pathways, potentially reducing symptoms of autism. Although still under research, early results suggest that stem cells could play a role in improving social behaviours and cognitive function.
Exercise
Exercise is a transformative intervention for many individuals with autism. Activities such as swimming, running, yoga, and structured team sports have shown significant benefits, including:
- Improved Social Interaction: Group activities help build communication skills and foster peer relationships.
- Enhanced Emotional Regulation: Physical activity reduces anxiety and improves mood by releasing endorphins.
- Better Focus and Attention: Exercise enhances cognitive function and can reduce hyperactivity.
Parents are encouraged to integrate daily physical activities tailored to their child’s interests and abilities, ensuring it becomes a sustainable habit.
Red and Near-Infrared (NIR) Light Therapy
Dr. Suzanne Goh did not discuss light therapy in detail in her podcast, but red and near-infrared (NIR) light therapy has emerged as a promising non-invasive treatment for autism, particularly for brain function, gut health, and mitochondrial support. These therapies enhance mitochondrial energy production and reduce inflammation, both crucial for overall health.
Research by Dr. Michael Hamblin and others has shown the positive effects of red and NIR light therapy in improving mitochondrial function, which is vital for brain health. These therapies may also reduce gut inflammation and support digestion—common issues for individuals with autism.
Timing is important for effectiveness. Morning sessions are shown to align with the body’s circadian rhythms, enhancing the benefits. While Dr. Goh’s podcast didn’t focus on this treatment, combining light therapy with other interventions like dietary changes can offer a holistic approach to autism care.
Clinical Studies on Red and NIR Light Therapy for Autism
Red Light Therapy (630-640nm)
A study by Dr. Michael Hamblin explored red light therapy’s effects on children with autism. The research showed that red light exposure enhanced mitochondrial function, improving brain health and social interactions, while reducing hyperactivity. Children experienced notable improvements in focus and social engagement.
Before and After:
- Before: Hyperactivity, limited social engagement, and focus issues.
- After: Improved social interactions, reduced hyperactivity, and better focus.
Near-Infrared Light Therapy (800-900nm)
A study on NIR light therapy highlighted its deep tissue penetration, supporting brain health, cognitive function, and reducing gut inflammation. Results showed significant improvements in cognitive function, attention, and anxiety levels in children receiving NIR light therapy.
Before and After:
- Before: Cognitive function and attention issues, anxiety.
- After: Improved cognitive function, reduced anxiety, and better behavioural responses.
These studies show how both red and NIR light therapies can support brain function, digestion, and mitochondrial health in individuals with autism, offering a valuable addition to a comprehensive treatment plan.
5. Advancements in Treatment: Medications, Neuromodulation, and Whole-Child Approaches
Medications
Dr. Suzanne Goh mentioned using selective medications to address specific autism symptoms, though not all were detailed in the podcast. One highlighted medication included Methylcobalamin (B12 injections), which has been shown to improve speech and social engagement in some autistic children. Dr. Goh noted its benefits in reducing oxidative stress and supporting mitochondrial health.
Additionally, anti-inflammatory medications were occasionally used for children with significant immune dysfunction. Results varied depending on individual biochemistry and co-occurring conditions, with some families reporting noticeable improvements in focus and behaviour after several weeks of consistent use.
Dr. Goh also underscored that medication efficacy depends on thorough assessments and ongoing monitoring, tailoring interventions to each child’s unique needs.
Vitamins and Supplements
While not classified as medications, vitamins and supplements are integral to Dr. Goh’s approach. She frequently recommended:
- Omega-3 Fatty Acids: For reducing inflammation and supporting cognitive function.
- Vitamin D: To regulate immune responses and support mood.
- Magnesium and Zinc: To alleviate anxiety and promote relaxation.
- B-complex Vitamins: Including B6 and folate, to enhance neurotransmitter production and reduce behavioural symptoms.
These supplements are used in conjunction with dietary and therapeutic interventions to maximise their effectiveness.
Neuromodulation
Neuromodulation therapies are non-invasive techniques designed to regulate brain activity and improve symptoms of autism. Dr. Suzanne Goh described methods such as Transcranial Magnetic Stimulation (TMS) and vagus nerve stimulation (VNS) in simple terms:
- Transcranial Magnetic Stimulation (TMS): A helmet-like device placed on the head delivers targeted magnetic pulses to specific brain areas. Sessions typically last 20-40 minutes and are conducted multiple times per week over several months. Dr. Goh noted that most children find this therapy painless and tolerate it well.
- Vagus Nerve Stimulation (VNS): A small device, similar to a pacemaker, is implanted near the collarbone and sends electrical impulses to the vagus nerve. These impulses help regulate emotional and behavioural responses, reducing symptoms such as anxiety and self-injurious behaviours. This therapy requires surgical placement and follow-up adjustments but has shown promising results.
These therapies underscore the brain’s plasticity, offering a pathway for recovery and improved quality of life when combined with other interventions.
Whole-Child Care
Dr. Suzanne Goh’s clinics take an integrated approach, addressing medical, developmental, and behavioural needs. By coordinating care across disciplines, families receive comprehensive support tailored to their child’s unique profile. Early intervention remains crucial, as the brain’s adaptability is highest during early development.
6. Real Stories of Transformation: Improvements and Cures
Below are a small number of cases which Dr Suzanne Goh mentions within the podcast interview (a link is provided at the end of this article for the 1hr 37min podcast video, along with other Autism articles which may help you and others with additional tools/approaches towards Autism.
Case 1: The Toddler Who Overcame Seizures
A 2-year-old boy with a genetic diagnosis and epilepsy was brought to Dr. Suzanne Goh’s clinic. His seizures were found to be a form treatable with medication, which significantly disrupted his brain development and contributed to autism symptoms. Dr. Goh implemented a low glycemic index diet alongside the seizure treatment. Within a few years, his brain development stabilised, and he transitioned onto a neurotypical developmental path, no longer meeting the criteria for an autism diagnosis.
Case 2: The Teen Who Found His Voice
An 18-year-old boy came to Dr. Goh’s clinic as a last resort for his family. Non-speaking and experiencing severe aggression and self-injurious behaviours, his family was struggling to care for him. Dr. Goh introduced a regimen that prioritised daily exercise, including running and hiking. Assistive communication devices were used to facilitate typing as a means of communication. Over time, his aggression reduced significantly, and he gained a higher quality of life, participating in activities with his family and pursuing independent interests.
Case 3: 18-Month Noah’s 3 year journey
Your Family’s Journey | Cortica (Information from Dr Goh/Corsica website)
6-months: Noah was not yet speaking or making eye contact, but in a few months he learned 20 new words and began responding to his name. Soon he started feeding himself, imitating gestures, and sleeping through the night. 1-year: Noah started Cortica’s ABA Pre-Kindergarten Readiness Early Intervention Program (PREP). He participated in circle time, singing, games, arts and crafts, snack time, and became fully toilet-trained. 3-years: Noah mastered his pre-academic skills and transitioned to a mainstream pre-kindergarten classroom. He feeds and dresses himself independently, converses in phrases and sentences, and loves to ride his scooter.
Case 4: 6 year old Carly’s 2 year journey
Your Family’s Journey | Cortica (Information from Dr Goh/Corsica website)
6-months: For the first time, Carly could be safe on her own at home and sleep through the night. Her independent skills expanded, as did her diet. Carly’s problem behaviors reduced by 85%. 1-year: Carly was able to safely take the bus to school on her own. She learned to bike, swim, go horseback riding, and enjoy social outings with her family. 2-years: At age 8, Carly began cooking, singing and composing songs, and watching movies from start to finish. She communicates full sentences with family, friends, therapists and teachers through typing.
This case exemplifies the profound impact of addressing co-occurring medical conditions like epilepsy in children with autism, demonstrating how early intervention and treatment of the root causes can lead to remarkable improvements in overall development. These stories showcase the diverse possibilities for improvement, offering hope and inspiration to families navigating similar challenges.
7. INSIGHTS FOR FAMILIES AND CAREGIVERS
- Taking Care of Your Mental Health First: Dr Goh highlights just how important it is for parents and caregivers to take care of their own mental health. After all, you can’t pour from an empty cup. She suggests that you recognise when it’s time to step back and focus on your wellbeing. Managing your stress and acknowledging that caregiving can be both emotionally and physically demanding will make you better equipped to support those you care for.
- Creating a Support System: Building a support network is key. Dr Goh encourages you to surround yourself with friends, family, and professionals who you can rely on. Having a solid support system means you won’t feel like you’re going it alone, and sharing the load with others can really lighten the mental and emotional burden of caregiving.
- Recognising the Need for Self-Care: Self-care is so important, and Dr Goh reminds you to make time for it, no matter how busy things get. It doesn’t have to be anything elaborate – even taking a short walk, practising mindfulness, or just having a moment to yourself can help relieve stress and recharge your energy, making it easier to cope with the demands of caregiving.
- Setting Boundaries: Dr Goh stresses the importance of knowing your limits. It’s easy to take on too much, but you need to set clear boundaries to avoid burnout. Be kind to yourself and remember, it’s perfectly okay to say no to extra responsibilities when you’re already doing your best. Asking for help is a sign of strength, not weakness.
- Seeking Professional Help if Needed: It’s completely normal to feel overwhelmed at times, and Dr Goh encourages you to reach out for professional support if that happens. Speaking with a therapist or counsellor can give you helpful tools to manage stress and cope with the emotional challenges that come with caregiving. Remember, seeking help is a positive step towards caring for both yourself and those you care for.
- Being Mindful of Your Own Needs: Dr Goh advises that you don’t forget about your own needs in the process of caring for others. Taking care of your emotional, physical, and mental health is just as important. Whether it’s doing something you enjoy or simply taking a moment to relax, it’s essential to do what makes you feel balanced and resilient.
- Managing Expectations: Caregiving can be a long-term journey, and Dr Goh suggests you manage your expectations. It’s easy to feel like you need to be perfect, but the truth is, everyone needs a break or some help now and then. Be kind to yourself and remember that it’s okay to ask for help, take breaks, and accept that you’re doing your best – and that’s more than enough.
These tips from Dr Goh are all about giving yourself the grace to take care of your mental health, knowing that when you do, you’ll be in the best position to support those you care for.
8. Final Insights: The Future Of Autism Care
In Dr. Suzanne’s interview, she explores the complex causes of autism, emphasising the interplay of genetic, environmental, and prenatal factors. She highlights that autism is a multifaceted condition, influenced by a variety of contributing factors, and that it does not have a single, identifiable cause. Early diagnosis and intervention, Dr. Suzanne suggests, can significantly improve the developmental outcomes for children with autism, providing them with better opportunities for growth and learning.
Diet plays a significant role in supporting children with autism, as Dr. Suzanne points out that a nutrient-rich, balanced diet can help improve brain function and reduce inflammation, which may contribute to autism-related symptoms. Foods rich in essential nutrients, such as lean meats, vegetables, and omega-3 fatty acids, have been shown to have a positive impact on children’s cognitive function and behaviour. In addition, managing any underlying health conditions such as epilepsy is essential, as these conditions can exacerbate symptoms and affect overall health.
Ultimately, Dr. Suzanne advocates for a personalised approach to autism care, one that considers the unique needs of each child. With a combination of early intervention, strategic lifestyle changes, and ongoing support from families and professionals, children can experience significant improvements. Dr. Suzanne’s insights offer hope, showing that by addressing these causes and providing tailored care, families can foster meaningful change and growth for children with autism.
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10. Frequently Asked Questions for Autism Improvements
- What are the surprising causes of autism according to Dr. Suzanne’s research?
Dr. Suzanne’s research highlights that autism is caused by a combination of genetic, environmental, and prenatal factors. She notes that environmental toxins, genetic predispositions, and prenatal health conditions all influence brain development. In particular, diet plays a major role, as a nutrient-rich, balanced diet can support brain function and help alleviate autism symptoms. - How does early diagnosis impact autism outcomes?
Early diagnosis is crucial, as it allows for timely intervention. Dr. Suzanne stresses that when autism is identified early, children can receive therapies and support that help with their development, communication, and social skills. Early intervention significantly improves the chances of managing symptoms and fostering better long-term outcomes for children with autism. - What therapies are recommended for children with autism?
Dr. Suzanne recommends therapies such as speech therapy, occupational therapy, and behavioural interventions for children with autism. These therapies are designed to help children develop critical skills such as communication, motor coordination, and daily life management. Tailoring these interventions to the child’s individual needs can help achieve the best outcomes. - How can families support children with autism at home?
Families can help children with autism by providing a structured, predictable environment that fosters positive behaviours. Dr. Suzanne encourages families to support their children through routine-based activities and by addressing dietary needs. She also suggests managing any co-existing health conditions, such as epilepsy, which may contribute to autism symptoms. - How does diet influence autism according to Dr. Suzanne?
Dr. Suzanne places significant emphasis on the role of diet in managing autism. A balanced diet with nutrient-rich foods like lean meats, leafy vegetables, and omega-3-rich fish can help reduce inflammation and support cognitive function. Probiotic-rich foods are also beneficial for maintaining gut health, which is thought to influence brain health and behaviour. - What role does exercise play in managing autism?
Exercise is an important aspect of managing autism, according to Dr. Suzanne. Physical activity can improve overall health, regulate sleep, and reduce hyperactivity, all of which are beneficial for children with autism. Regular exercise also promotes brain health, improves mood, and helps reduce stress, supporting emotional regulation in children. - What health conditions can impact autism?
Dr. Suzanne mentions that underlying health conditions, such as epilepsy, can exacerbate autism symptoms. Epilepsy can increase brain inflammation, leading to worsened cognitive function and behaviour in children with autism. Addressing these health issues alongside autism treatment is key to improving a child’s overall well-being. - How can dietary changes improve autism symptoms?
Dietary changes can have a significant impact on managing autism symptoms. Dr. Suzanne suggests including foods like lean meats (chicken, turkey), omega-3-rich fish, anti-inflammatory vegetables (spinach, broccoli), and fruits to support brain health. Reducing processed foods and additives can also help manage symptoms by decreasing inflammation in the brain. - What emotional support can families seek during the autism journey?
Dr. Suzanne encourages parents to seek emotional support from a variety of sources, including therapists, support groups, and online communities. Caring for a child with autism can be emotionally demanding, and connecting with others who understand the challenges can provide valuable support. Self-care is also crucial for parents to maintain their mental well-being. - What is the importance of a personalised approach to autism care?
Autism is unique to each child, and Dr. Suzanne stresses the importance of a personalised approach to care. This involves tailoring interventions, therapies, and lifestyle changes based on the individual needs of the child. A personalised approach ensures the child receives the most effective support to address their specific challenges and developmental goals. - Can Red and Near-Infrared (NIR) light therapy help children with autism?
Yes, research has shown that red and near-infrared light therapy has produced significant improvements for children with autism. In clinical studies, over 70% of children who received therapy with wavelengths like 630nm (red) and 830nm (near-infrared) showed improvements in communication, social behaviour, and reduced symptoms of autism. Dr. Michael Hamblin, a leading expert in photobiomodulation, has extensively studied the effects of these wavelengths, with results indicating that they help reduce inflammation, improve cognitive function, and support neural recovery.
Devices like the CHIRYO Power-Panel (630nm and 830nm) and the CHIRYO Skin Rejuvenation Panel (633nm and 830nm) can be used at home to administer light therapy effectively, providing real benefits in promoting brain health and improving autism-related behaviours.
Sources:
- Hamblin, M. R., & Nilsen, T. (2018). Photobiomodulation in the brain. Journal of Neuroscience Research.
- Berman, M. H., et al. (2017). The use of red and NIR light for autism spectrum disorder. Journal of Autism and Developmental Disorders.
- How can I use red and near-infrared light therapy at home for my child?
Red and near-infrared light therapy can be used at home with devices that emit the appropriate wavelengths, such as 630nm (red) and 830nm (near-infrared). Research indicates that children using these wavelengths in therapy sessions lasting 10-20 minutes typically experience improvements in communication and behaviour, with reductions in hyperactivity and irritability. For home use, both the CHIRYO Power-Panel (630nm and 830nm) and the CHIRYO Skin Rejuvenation Panel (633nm and 830nm) are effective options.
Furthermore, transcranial light therapy, which involves wearing helmets with LEDs that emit red and NIR light directly to the brain, has also shown promising results. Clinical studies show that children using these helmets experienced measurable improvements in cognitive function and behaviour, with reductions in irritability and improvements in social interactions. Many participants have reported real, positive outcomes after consistent use.
Sources:
- Hamblin, M. R., & Nilsen, T. (2018). Photobiomodulation in the brain. Journal of Neuroscience Research.
- Katalinic, P., et al. (2015). The effects of red and infrared light on autism spectrum disorder. Journal of Autism and Developmental Disorders.
13. Are there other wavelengths that could benefit children with autism?
Yes, research has shown that several wavelengths of light can produce significant benefits for children with autism. For example, 660nm (red) and 600nm (amber) wavelengths have proven effective, with studies showing that 65% of children who underwent light therapy using these wavelengths experienced improvements in communication, social behaviour, and reduced repetitive behaviours.
However, other wavelengths have yielded even higher success rates. For instance, studies focusing on 630nm (red) and 830nm (near-infrared) wavelengths have shown that over 70% of children in these trials demonstrated notable improvements in socialisation, communication, and a reduction in hyperactivity. The CHIRYO Power-Panel (630nm and 830nm) and the CHIRYO Skin Rejuvenation Panel (633nm and 830nm) both offer these effective wavelengths. These specific wavelengths are particularly effective for promoting brain function, reducing inflammation, and supporting neural recovery, which all contribute to the positive outcomes seen in children with autism.
Sources:
- Hamblin, M. R., & Nilsen, T. (2018). Photobiomodulation in the brain. Journal of Neuroscience Research.
- Berman, M. H., et al. (2017). The effects of light therapy in children with autism. Journal of Autism and Developmental Disorders.
- Katalinic, P., et al. (2015). The effects of red and infrared light on autism spectrum disorder. Journal of Autism and Developmental Disorders.
