What Makes Autism Worse? 9 Key Factors to Manage

Autism spectrum disorder (ASD) is a developmental condition that is characterized by challenges with speech, non-verbal communication, and social interaction, as well as repetitive behavior and obsessive interests. ASD impacts every aspect of a person’s life, and people on the spectrum will require some level of ongoing support throughout their lifetime. Autism covers a wide spectrum of diverse symptoms, and it’s common to find multiple people sharing the diagnosis and presenting completely differently. For an autism diagnosis, a person needs to reach a certain number of symptoms, which may be a completely different set of symptoms from the next person, varying both in symptom type and severity.

As with any condition, there are certain factors, internal or external, that can exacerbate symptoms of autism and create more challenges. These factors may not be immediately obvious with a child with autism as they may show discomfort differently than typically developing peers and may not be able to communicate what is bothering them.

Autism, if left untreated and without accommodations, will get worse with age. Children with autism are extremely capable of learning functional skills and showing improvements in challenging behaviors, but they cannot do it alone. As with all children, they need to be provided with a supportive, nurturing, and calm environment tailored to their specific needs to flourish and learn.

Understanding Autism Spectrum Disorder

ASD is an umbrella term that covers a wide variety of symptoms. Typically, ASD symptoms include communication and interpersonal deficits, sensory sensitivities, and repetitive behaviors. According to a study in 2018, parents are the first to notice autism symptoms in 80% of the cases at the age of 2 years old. The first symptoms of concern are often a lack of eye contact, not responding to their name, not following a point, and repetitive behaviors with or without objects. If not treated, the symptoms get worse with age and become more challenging to treat. As well as symptoms being widely different, there is also a huge spectrum of symptom severity. Some children may present with severe symptoms and require support in all aspects of their life. These children will require intensive intervention to manage the symptoms effectively and teach functional skills. Others may have mild autism and might just require social skills training.

ASD looks different for each person, so there is no “magic pill” or a one-size-fits-all approach to supporting someone on the spectrum. Recognizing individual variability is essential to creating intervention plans that are effective and can create positive, meaningful change. Behavioral approaches, like Applied Behavior Analysis (ABA) therapy, create highly individualized interventions for each child, and data-driven treatment decisions are made depending on the progress or regression made by each specific child.

People with ASD often struggle with communicating their needs, adapting to change, and coping with sensory stimuli in their environment. With severely autistic children, this can lead to frustration and higher-than-average rates of aggression, tantrums, self-injury, breaking items, etc. Most people with autism present with cognitive difficulties, which affects the ability to plan, learn, use judgment, and make choices. Autistic people typically struggle in social settings and might have a hard time with social cues, such as facial expressions, tones of voice, and interpreting figurative language.

Environmental Factors

Environmental-factors

Sensory Overload

The term sensory overload refers to a state in which your senses are taking in more information than your brain can process, triggering a fight, flight or freeze response. This state occurs more frequently in autistic people, with studies quoting a prevalence of sensory issues between 69% to 93%. Another study published in 2014 found that, at rest, the brains of autistic children process 42% more information than typically developing children. The authors of the study linked this increased processing ability to states of withdrawal and meltdowns exhibited by people with ASD, suggesting a link between overwhelming sensory environments and a worsening of symptoms. As mentioned previously, autism is a spectrum, and what may be an overwhelming environment for one may not be for another. Smells, tastes, noises, and the way things look or feel could all be triggers. Monitoring these will be useful in providing more calm and sensory-friendly environments.

Changes in Routine

A prevalent symptom of autism is a strong preference for routines and sameness, with difficulty adapting to change and developing flexible thinking. Routines act as comfort blankets for people with autism, providing a sense of well-being and stability. The routines minimize exhaustion and help autistic people make sense of the world. Inconsistent routines or common disruptions in routines can cause significant negative impacts on people with ASD. Multiple studies have shown that feeling stressed and anxious around a lack of routines can lead to poorer self-regulation and coping strategies and an increase in challenging behaviors.

Stressful Environments

Spending time in stressful environments at home, school, or social settings can negatively impact those with ASD. Research shows a strong link between depression and anxiety diagnoses and a worsening of the core symptoms of ASD. Another study found that increased anxiety in children with ASD leads to decreased motivation to learn new skills and create social interactions with other children. The authors of the study emphasized the importance of educating teachers so they are better able to support their students with ASD and reduce the likelihood of them developing anxiety and/or depression.

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Biological Factors

Sleep Problems

Sleep problems are very common, with 50%-80% of autistic children struggling with sleep issues compared with 20-30% of neurotypical children. There are several different reasons why this could be, such as difficulty with winding down and relaxing, issues with melatonin secretion, difficulty sleeping during the night, trouble falling back asleep, etc. According to research, sleep issues worsen symptoms of autism, specifically causing disruptive behavior, greater inflexibility, and anxiety.

Gastrointestinal Issues

Children with autism are also more likely to suffer from gastrointestinal issues (GI), with the most common being abdominal pain, constipation, and diarrhea. These can often cause sleep disturbances which, as discussed, create more behavioral problems for children with ASD. Other research linked issues with more severe autism symptoms, specifying social interaction, communication, and self-injurious behaviors. At the same time, many people with ASD have restricted eating patterns and tend to eat fewer fruits, vegetables, and whole grains than their neurotypical peers. This can make it difficult to differentiate whether the GI issues are a result of their restricted eating or an underlying condition.

Co-occurring Conditions

Nearly 91% of children with autism have a co-occurring condition, such as epilepsy, ADHD, anxiety disorders, OCD, intellectual disability, etc. These conditions may not be present at the initial autism diagnosis and may appear as the child gages Monitoring for these conditions is essential, as they need to be managed and treated differently. Some of these conditions may require medication, and a lack of treatment could intensify autism symptoms and negatively affect the impact the effectiveness of other therapies on ASD.

Social Factors

Social factors can make autism worse

Lack of Understanding and Support:

Children with autism deserve calm home and school environments where they feel safe and understood. Families with a family member with ASD should receive training to understand how best to respond, teach, and support them without exacerbating their symptoms. Similarly, educators should receive training and education to include and support their students with autism and provide them with necessary accommodations. Feeling misunderstood and not having their needs met leads to an increase in anxiety, challenging behaviors, and a reduction in social behaviors, including withdrawal.

Bullying and Social Isolation

Unfortunately, bullying is very high in children with autism, with a recent study quoting the highest incidence at 94%. The most common targets of bullying were people with high-functioning autism, those exhibiting milder deficits in social understanding, and those with behavioral challenges. The research into this topic is limited, but what is available suggests children with ASD experience worsening symptoms as a result of bullying, including behavioral difficulties, refusal to attend school, regression in communication skills, lower self-confidence, and mental health issues. Research into bullying interventions for ASD is currently limited but points towards a collaborative and comprehensive model involving the children with ASD, their peers, teaching and support staff, and the broader school ideology.

Inadequate Access to Services

Access to appropriate services is one of the most important factors in predicting an autism prognosis. According to recent research published in 2024, 2 of every 3 people with an ASD diagnosis go into adulthood without having received appropriate services. The effect of this is a worsening of symptoms over time. Those who did receive therapy showed overall improved cognitive abilities, social skills, and less severe stereotyped behaviors. The children who were diagnosed and began early intervention before 24 months of age showed the most reduced symptom severity and were more likely to be integrated in less restrictive environments than those who received no or late therapy, highlighting the importance of acting on an early diagnosis and beginning early intervention.

Strategies for Mitigation

Creating Supportive Environments

Creating a sensory-friendly environment is a pretty simple way to help children with autism stay calm and regulated throughout the day. Both at home and in the classrooms, chose a quiet area with not too much foot traffic as the designated sensory area. As much as possible, have the child participate in selecting what goes into this area, such as wall color, toys, chairs, carpet, etc. Too much choice can be overwhelming, so have them choose between two options. Involving the child in the decision-making can help them gain a sense of autonomy and advocacy.

Maintaining Routines

Depending on the child, maintaining routines can be easily achieved with the use of visual or written schedules. Schedules can be reviewed as often as needed, including the night before, in the morning, etc. At the same time, coping strategies should be worked on in case there is an unexpected change so the child becomes better at managing stress effectively.

Access to Therapies

Several therapies are effective and associated with less severe symptoms of autism. ABA is a highly individualized and evidence-based therapy that targets specific behaviors. This intervention reduces the challenging behaviors often associated with ASD by teaching more functional alternatives. Behavior therapists also collaborate with other healthcare providers, such as dieticians, sleep coaches, etc, to help minimize the impact of those internal factors on symptom severity. As autism affects communication, speech therapy should also be a part of a child’s treatment plan, which targets verbal, non-verbal, and social communication. Occupational therapy is also an essential component, focusing on self-regulation and soothing techniques as well as teaching fine and gross motor activities.

Social Support and Education

Autism is a lifelong diagnosis, and it’s important families have community support to avoid burnout and fatigue. This support can take many forms, such as family acceptance, inclusive community programs, and the people in the child’s environment, such as at stores, restaurants, etc, being educated, empathetic, and encouraging. Recent studies have found a relationship between increased social support and a decrease in the impact of challenging behaviors on parental stress levels. A community study also found children with ASD have lower community involvement than typical peers and that their parents experience higher levels of stress. Community supportiveness was related to child involvement in the activities, with successful programs adapted and accommodating a variety of communication, cognitive, and social abilities. As the child’s inclusion increased, parents also experienced an improvement in their feelings of isolation. The national autistic society is a great resource to direct people to learn about autism and how to support people on the spectrum.

Navigating Healthcare and Support Services

Navigating-healthcare


Typically, obtaining an autism diagnosis is the first step in accessing specialized healthcare services for ASD. Consult with your pediatrician and follow recommendations to obtain speech, occupational, and ABA therapy. Join support groups and ask for information on specific service providers to assess whether a certain company will work for your family’s needs.

If you have insurance, you can call your insurance and obtain a list of in-network ABA, speech, and occupational therapy providers. If you do not have insurance, several resources can help cover the cost, such as Medicaid and Social Security Supplemental Income. You can also contact the service providers directly, as they may offer treatment on a sliding scale.

FAQs

Does Autism Get Worse With Age?

Autism can get worse with age if left untreated. Families should educate and empower themselves with tools for the best possible outcomes for their family members with ASD.

Does Diet Make Autism Worse?

There is currently no conclusive evidence pointing towards a certain diet over another for making autism symptoms more severe. Be vigilant of your child and potential food triggers. Consult with your pediatrician before making any drastic dietary decisions.

Conclusion

Many factors can intensify symptoms of ASD and make an autism diagnosis more difficult to manage. In this article, we covered internal, environmental, and external factors that can cause autism to get worse. Internal factors included GI issues, sleep problems, and co-occurring conditions; environmental events consisted of sensory processing issues, lack of routines, and stressful environmental factors, while external events covered a lack of understanding and support, bullying, and inadequate access to services. Being aware and vigilant of these key factors and proactively managing your child’s environment will greatly help to alleviate the challenges related to ASD.

Accepting a diagnosis is the first of many steps to provide a nurturing environment for autistic children. Research needs to continue to discover more evidence-based ways to support autistic children and create environments that accommodate their needs and help them feel safe, comfortable, and accepted.

Being your child’s advocate is one of your most important tools No one will fight for your child more than you will, so stay educated, curious, and motivated to help create a more inclusive world for people with ASD.

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