Autism Spectrum Disorder Basics
Autism spectrum disorder (ASD) is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social interaction, and restricted or repetitive behaviors. This guide outlines how to identify ASD symptoms in children and best practices for diagnosis and treatment of kids on the spectrum.
Autism: What Is It?
Autism spectrum disorder (ASD) is a condition that impacts a child’s development in two core areas: the first is social communication and social interaction, and the second is restricted, repetitive patterns of behavior and interests. Although a child has ASD from birth, it may not come to attention until social demands exceed a child’s limitations.
In the psychiatric community, thinking about autism has changed, as reflected in the new DSM-5 guidelines. What had been considered a set of distinct conditions described as pervasive developmental disorders — autism, Asperger’s disorder, childhood disintegrative disorder (CDD), and pervasive developmental disorder not otherwise specified (PDD-NOS) — are now considered one disorder that presents along a spectrum of symptoms and behaviors of varying severity.
1 in 59 children are diagnosed with ASD. Boys are diagnosed with ASD around 3 to 4 times more often than girls.
Autism: What to Look For
Children with autism spectrum disorder are characterized by a combination of two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. These symptoms may vary greatly in severity.
Social communication and social interaction: Signs of social deficits you might notice in a developing child include aversion to displays of affection like cuddling and hugging and a preference for solitary play. In younger kids, say under 3, failure to respond to their own name is a red flag, as is disinterest in giving, sharing, or showing objects of interest. In older children, warning signs include difficulty carrying on a reciprocal conversation, lack of eye contact, and difficulty using and reading body language. These children may have difficulty recognizing others’ emotions, responding appropriately to different social situations, and understanding social relationships.
Some children with autism don’t talk; others talk in a stilted, “robotic” tone, or in an exaggerated singsong. A child with autism may also repeat certain phrases without appearing to understand their significance, or possess what experts call “non-functional knowledge”—information he can recite, but not use to solve problems or carry on a conversation. Young kids with autism don’t point at objects of interest, don’t make eye contact, and don’t use gestures to communicate a need or describe something. As kids with autism age and acquire language, their tone or pattern of speech can be odd; some have a habit of reversing pronouns—a youngster asking his mom for water might say “You want water” instead of “I want water.” High-functioning children with autism may monopolize conversations while showing little capacity for reciprocity, or understanding what the other party wants or feels.
Restricted or repetitive behaviors: Key behavioral signs include the performance of repetitive actions and rituals, and fixation on minute details to the point of distraction. Children with autism can be upset by the slightest change in daily routine. In young kids, signs of autism include ordering toys instead of playing with them. In older children, the repetitive behavior can manifest as a consuming interest in a specific topic or object.
The new DSM-5 behavioral criteria include what are often called sensory processing problems. Many children with autism are unusually sensitive to sounds, lights, textures or smells. They may be overwhelmed by too much sensory input, or be disturbed and uncomfortable because of a lack of sensory input, which they may try to get by bumping into things, and excessively touching and smelling things.
16 by 16 Lookbooks is an early detection handbook that outlines gestures and actions children should acquire by 16 months of age. The handbook is free to download and comes from the FIRST WORDS Project, which is a longitudinal research investigation in the Florida State University Autism Institute.
Autism: Risk Factors
Risk factors include low birth weight, fetal exposure to valproate, and parental age. Boys are more likely to be diagnosed with autism spectrum disorder.
Some people have concerns that autism spectrum disorder is caused by vaccinations that children receive. However, studies have shown that there is no link between receiving vaccines and developing ASD. Learn more about vaccines and autism from the CDC.
For diagnosis of autism spectrum disorder, a child must display symptoms in two core areas: social communication and social interaction, and restrictive, repetitive patterns of behavior, interests, and activities. The symptoms must be impairing, and must be present in the early developmental period—they are typically recognized in a child’s second year—but they may not be fully manifest until a child is older and the social demands exceed his abilities. ASD can be diagnosed as early as 24 months.
In the category of social communication and social interaction, a clinician will look for persistent deficits in social reciprocity, such as back-and-forth conversation and sharing of interests; nonverbal communication, including body language and gestures; and difficulty developing, understanding, and participating in age-appropriate relationships.
In the category of restrictive or repetitive patterns of behavior, a clinician will look for two of the following: stereotyped movements, actions or use of speech, inflexible insistence on routines and rituals, fixated and intense interests, and sensory problems, either from too much sensory input or two little.
According to the new criteria, these symptoms must be significantly impairing, and a clinician will specify the severity of each of the symptoms on a three-tiered scale that reflects the amount of support a child would need—requiring support, substantial support, or very substantial support—to function successfully.
Given that children with autism also frequently have cognitive impairment (now called intellectual development disorder), children should not be diagnosed with autism unless their social communication deficits are greater than would be explained by their cognitive impairment.
If a child has impairment in social communication and social interaction but doesn’t have restrictive and repetitive behaviors, he is more likely to be diagnosed with a new disorder called social communication disorder.
A structured educational program and tailored behavioral therapy have been shown to be very beneficial to children with autism.
Psychotherapeutic: Applied behavior analysis, also known as ABA, is the most widely accepted evidence-based autism therapy. ABA has been shown to help autistic children develop needed skills and minimize undesired behaviors such as self-injury, and it has been shown to be successful for kids all across the autism spectrum, from mild to severe. Its effectiveness is backed up by hundreds of studies
Occupational therapy, known as OT, is designed to help children acquire the skills needed to perform the activities—or “occupations”—of daily life, including fine and gross motor skills, sensory processing skills, self-help skills and more.
Many parents find using something called “Social Stories” to be helpful as well. Social Stories are designed to be an engaging, interactive way of preparing children for social situations. The stories, written from the child’s point of view, use narration, photos and drawings to guide the child through an experience, preparing him for what to expect.
Pharmacological: There are no drugs that target the core symptoms of autism, but medications are often prescribed to help with problems that often occur alongside the disorder, such as depression, anxiety, and hyperactivity.
Alternative: It should be noted that many alternative treatments and even “cures” have been proposed for autism spectrum disorder. None of these alternative treatments—chelation, diets, supplements, facilitated communication—have any reliable scientific evidence behind them. Some, particularly chelation—an attempt to remove heavy metals from the body via chemical injections—can be very dangerous. It’s important that parents who choose to pursue these therapies should do so in close consultation with a qualified physician.
The Autism Speaks 100 Day Kit helps families of children ages four and under learn more about autism and how to access treatment. Families whose children have been diagnosed in the last 6 months may request a complimentary hard copy of the 100 Day Kit from Autism Speaks. The kit is also available in Spanish.
Autism: Other Disorders
Children with autism have certain other medical problems at a rate far above average. Epilepsy afflicts almost a third of children diagnosed with autism once they reach adulthood. Sleep disorders, allergies, and digestive problems are commonly seen, as are tic disorders like Tourette’s. Autistic children may also struggle with anxiety and depression. Kids with autism are more likely than others to be cognitively impaired.