What is Autism Spectrum Disorder?

Autism Spectrum Disorder is a developmental difference that usually appears during early childhood and can impact a person’s social skills, communication, relationships, and self-regulation. Having an autism diagnosis means that a child has a unique pattern of brain development that differs from what’s considered usual or typical. This can bring with it remarkable strengths and gifts. It can also bring some challenges and areas where a child could benefit from more support.  

Our understanding of autism is evolving rapidly. The number of children being diagnosed with autism has been steadily increasing since the 1980s, in part because clinicians and families are better able to recognize it. About 1 in 44 children in the U.S. is diagnosed with autism spectrum disorder according to recent data from the CDC. Autism is diagnosed about four times more frequently in boys than girls.  

The medical diagnosis of autism is based on two main categories of features. The first category is related to the style of social communication and social interaction. The second is related to restricted, repetitive patterns of behavior, interests, or activities. These may include adherence to routines, resistance to change, fixed interests, and over- or under-responsiveness to sensory input. A diagnosis of autism also includes a specification of the level of support a person may need, ranging from a low to a high level of support required.  

The Autism Self-advocacy Network has stated:  

“There is no one way to be autistic. Some autistic people can speak, and some autistic people need to communicate in other ways. Some autistic people also have intellectual disabilities, and some autistic people don’t. Some autistic people need a lot of help in their day-to-day lives, and some autistic people only need a little help. All of these people are autistic because there is no right or wrong way to be autistic. All of us experience autism differently, but we all contribute to the world in meaningful ways. We all deserve understanding and acceptance.” 

What Causes Autism?

A great deal is known about the different factors that might lead to autism. The first main category of contributing factors is genetic. There are many ways that a person’s genetic information can be altered that can lead to autism. The second main category of contributing factors is non-genetic. These include certain environmental exposures, such as exposure to certain medications or infections during fetal life and certain injuries that can occur to the developing brain. Other risk factors that can increase the likelihood of autism include older parental age, shorter interpregnancy interval (the period of time between one pregnancy and the next), and certain maternal health factors. 

Genetic and non-genetic factors can interact with each other and have a combined effect. A physician can work with you to arrive at an understanding of what the contributing factors might be for your child.  

How is Autism diagnosed?

Diagnosing autism starts with an evaluation to review your child’s developmental and behavioral history to see if these meet a set of diagnostic criteria for autism, called the DSM-5 criteria. These were created by a group of experts in the field of autism. A qualified healthcare professional who specializes in autism, such as a doctor, psychologist, or nurse practitioner, can make the diagnosis. There are diagnostic assessments, that involve questionnaires, structured interviews, or observations, that are sometimes used to aid in making the diagnosis. Making an ASD diagnosis is just the beginning. Once a diagnosis is made, it opens the door to providing the right support and services so that a child can thrive.  

What are some signs of Autism Spectrum Disorder?

Some children may show signs during infancy while others can display behaviors later in development. Children can grow and develop in many different ways. There’s no single “right” developmental path. Like any journey, there are many different ways to get to the final destination!  

What might be considered an early sign of autism varies depending on a child’s age. For example, many nine-month-old children do not yet imitate others in waving “bye.” In a 2-year-old child, however, the absence of this developmental milestone is a potential early sign of autism. At one year of age, many children do not yet say single words. But by two years of age, the absence of this developmental milestone may be an early sign of autism.  

Some infants may show early signs in their first months of life, while other children may not show signs until 2 or 3 years of age. Not all children with autism will show all the signs, and many children who don’t have autism may have a few of the signs. These complexities of early child development make professional evaluation an essential step toward an accurate diagnosis. 

Here are some of the early signs of autism that might appear at different times in a child’s development. 

By 6 months of age: 

• Longer and more extreme periods of irritability compared to other infants. You might find that common strategies for consoling and calming infants don’t seem to work for your child. 

• Conversely, some children show less need for attention. You may find that your infant does not mind being left alone for long periods of time which would cause most infants to start to fuss or cry.  

• Differences in the motor system and how your child moves, such as abnormal muscle tone, asymmetry in the lying position, atypical rolling patterns, or increased head lag when being pulled from the lying to the sitting position. These symptoms may be subtle and require a specialized evaluation by a pediatric neurologist, pediatric occupational therapist, or pediatric physical therapist.  

• Limited or no smiles or positive facial expressions 

• Limited or no eye contact 

By 9 months 

• Little or no back-and-forth sharing of sounds, smiles or other facial expressions 

• Atypical sitting posture (e.g., asymmetric) 

By 12 months 

• Little or no babbling 

• Little or no back-and-forth gestures such as pointing, showing, reaching or waving 

• Little or no response to name 

• Atypical patterns of crawling  

By 16 months 

• No one-word communications 

• Atypical posture for standing or walking 

Research studies have identified a set of early signs of autism in children ages 16 to 30 months of age. These are captured in a questionnaire called the Modified Checklist for Autism in Toddlers (M-CHAT) which is increasingly used as an autism screening tool by pediatricians.  

Early signs of autism in children ages 16 to 30 months of age (from the Modified Checklist for Autism in Toddlers) 

A “no” response to the following questions may be an early sign of autism in a child between the ages of 16 to 30 months: 

• If you point at something across the room, does your child look at it? (For example, if you point at a toy or an animal, does your child look at the toy or animal?) 

• Does your child play pretend or make-believe? (For example, does your child pretend to drink from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?) 

• Does your child point with one finger to ask for something or to get help? (For example, pointing to a snack or toy that is out of reach?) 

• Does your child point with one finger to show you something interesting? (For example, pointing to an airplane in the sky or a big truck in the road?) 

• Is your child interested in other children? (For example, does your child watch other children, smile at them, or go to them?) 

• Does your child show you things by bringing them to you or holding them up for you to see – not to get help, but just to share? (For example, showing you a flower, a stuffed animal, or a toy truck?) 

• Does your child respond when you call his or her name? (For example, does he or she look up, talk or babble, or stop what he or she is doing when you call his or her name?) 

• When you smile at your child, does he or she smile back at you? 

• Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her? 

• Does your child try to copy what you do? (For example, wave bye, clap, or make a funny noise when you do) 

• If you turn your head to look at something, does your child look around to see what you are looking at? 

• Does your child try to get you to watch him or her? (For example, does your child look at you for praise, or say “look” or “watch me”?) 

• Does your child understand when you tell him or her to do something? (For example, if you don’t point, can your child understand “put the book on the chair” or “bring me the blanket”?) 

• If something new happens, does your child look at your face to see how you feel about it? (For example, if he or she hears a strange or funny noise, or sees a new toy, will he or she look at your face?) 

A “yes” response to the following questions may be an early sign of autism in a child between the ages of 16 to 30 months: 

• Does your child make unusual finger movements near his or her eyes? (For example, does your child wiggle his or her fingers close to his or her eyes?) 

• Have you ever wondered if your child might have trouble hearing? 

• Does your child get upset by everyday noises? (For example, does your child scream or cry to noise such as a vacuum cleaner or loud music?) 

What Does Quality Care for Autism Look Like?

The goal of Autism care is to support children in progressing along their own unique developmental path, to higher and higher levels of ability across all domains of learning.

Early intervention is an important part of supporting your child, and starting therapies during the preschool years can help your child learn important social, communication, functional, and behavioral skills. 

The range of home-based, center-based, and school-based supports for autism can sometimes feel overwhelming to caregivers. Having a supportive team of professionals can make a big difference.

Many children benefit from receiving a set of therapies for a period of time, usually a few years or more. These therapies may include 

• Medical care. Physicians, nurse practitioners, or other medical practitioners who specialize in autism can offer appropriate medical testing, which may include EEG, genetic testing, metabolic testing, and other tests that may be appropriate. Medical therapies can be very effective in supporting a child’s development. These can include dietary changes, nutritional supplementation, medications, and a variety of device-based therapies. About 80% of children with autism have a medical condition such as constipation, sleep disturbance, seizure, or others that can affect learning and behavior. Medical care to appropriately diagnose and treat these co-occurring conditions can have great benefits to a child’s development and behavior.  

• Developmental therapies, such as occupational therapy, music therapy, physical therapy, and speech-language therapy. These developmental therapies help children to process sensory information from the environment, to self-regulate, to coordinate fine and gross motor movements, to think, and to communicate.

• Behavior therapy based on the principles of Applied Behavior Analysis (ABA). ABA can help children learn new skills and generalize these skills to multiple settings. ABA therapists look at the precursors and consequences of behaviors and then make changes in a child’s environment to support their learning and reduce problem behaviors.

• Mental health support. Children and adults with autism may experience anxiety, difficulties with executive function, and fluctuations in mood (including depression). Support from a physician or other mental health professional can help to reduce these challenges. Mental health support to family members is also important.  

A comprehensive care program is the best approach to supporting a child with autism. Your team of professionals should collaborate closely with each other and partner with you to ensure consistency across settings and to make sure that your priorities and values are reflected in your child’s therapy program.