Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. Autism appears to have its roots in very early brain development. However, scientists still don’t know exactly what causes autism. Autism was first described in the 1940s, but very little was known about it until the last few decades. Even today, there is a great deal that we don’t know about autism. Because the disorder is so complex and no two people with autism are exactly alike, there are probably many causes for autism. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. While early identification of autism spectrum disorders is important, it is also crucial for those who work with school-age children and older individuals to understand how to screen and detect signs of an ASD.

Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is four to five times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States.

It is a spectrum condition, which means that, while all persons with autism share certain difficulties, their condition will affect them in different ways and to different extents. Some individuals with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support. About one third of people with ASD are nonverbal but can learn to communicate using other means. People on the autism spectrum may also experience over-or under-sensitivity to sounds, touch, tastes, smells, light or colors. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world.

Autism spectrum disorder is generally characterized by three areas of difficulty:

  • social impairments
  • communication impairments
  • repetitive behaviors

Individuals with ASD often require intensive parental, school, and other social support. In addition to intensive behavioral therapies, services at school ranging from individualized education plans with combinations of speech therapy, occupational therapy, social skills training and physical therapy, to individualized aides, specialized classrooms, and sometimes even specialized schools are required for most children with ASD.

The characteristics of autism vary from one person to another and in addition to the three main areas of difficulty, people with autism may also have:

  • love of routines
  • sensory sensitivity
  • special interests
  • learning disabilities

The following “red flags” may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don’t delay in asking your pediatrician or family doctor for an evaluation:

  • Communication
  • Does not respond to his/her name by 12 months of age
  • Cannot explain what he/she wants
  • Doesn’t follow directions
  • Seems to hear sometimes, but not other times
  • Doesn’t point or wave “bye-bye”
  • Used to say a few words or babble, but now does not
  • Social Behavior
  • Doesn’t smile when smiled at
  • Has poor eye contact
  • Seems to prefer to play alone
  • Gets things for him/herself only
  • Is very independent for his/her age
  • Seems to be in his/her “own world”
  • Seems to tune people out
  • Is not interested in other children
  • Doesn’t point out interesting objects by 14 months of age
  • Doesn’t like to play “peek-a-boo”
  • Doesn’t try to attract his/her parent’s attention
  • Stereotyped Behavior
  • Gets “stuck” doing the same things over and over and can’t move on to other things
  • Shows unusual attachments to toys, objects, or routines (for example, always holding a string or having to put on socks before pants)
  • Spends a lot of time lining things up or putting things in a certain order
  • Repeats words or phrases (sometimes called echolalia [pronounced ek-oh-LEY-lee-uh])
  • Other Behavior
  • Doesn’t play “make believe” or pretend by 18 months of age
  • Has odd movement patterns
  • Doesn’t know how to play with toys
  • Does things “early” compared to other children
  • Walks on his/her toes
  • Doesn’t like to climb on things such as stairs
  • Doesn’t imitate silly faces
  • Seems to stare at nothing or wander around with no purpose
  • Throws intense or violent tantrums
  • Is overly active, uncooperative, or resistant
  • Seems overly sensitive to noise
  • Doesn’t like to be swung or bounced on his/her parent’s knee, etc.

Note about these red flags: Some of these red flags apply only at certain ages, so consider what is typical for other children your child’s age.
The health care provider might use a screening test specifically for ASD. This test might be the Checklist of Autism in Toddlers (CHAT), the Modified Checklist for Autism in Toddlers (M-CHAT), or another test.

In addition, the health care provider may also recommend that your child have a blood test to help rule out some other conditions and problems.

Depending on the results of the blood test and the developmental and other screenings, your child’s health care provider will either:

  • Rule out autism or
  • Refer your child to a specialist in child development or another specialized field to diagnose the child with autism. The specialist will then do a number of tests to figure out whether your child has autism or another condition.

The American Psychiatric Association, a professional society of psychiatrists, updated the criteria for an autism diagnosis in May 2013. The criteria are published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

According to the DSM-5 criteria, a person has ASD if he or she:

  • Has problems with communication and social interactions, namely:
  • Doesn’t respond appropriately to social and emotional cues
  • Has deficits in nonverbal communication during social interactions
  • Has trouble developing friendships, keeping friends, and understanding relationships
  • Has at least two types of repetitive behavioral patterns. These might include repetitive movements, inflexible routines, very restricted interests, or unusual responses to certain sensory inputs, such as the way a particular object feels.

There is currently no one standard treatment for autism. The most effective therapies and interventions are often different for each person. However, most people with ASD respond best to highly structured and specialized programs. In some cases, treatment can help people with autism to function at near-normal levels. Research shows that early diagnosis and interventions, such as during preschool or before, are more likely to have major positive effects on symptoms and later skills. For many people with ASD, it is not too late to benefit from treatment, no matter how old they are when they are diagnosed. People of all ages, at all levels of ability, can often improve after well-designed interventions.

The available types of therapies for ASD are:

  • Behavioral management therapy
  • Cognitive behavior therapy
  • Early intervention
  • Educational and school-based therapies
  • Joint attention therapy
  • Medication treatment
  • Nutritional therapy
  • Occupational therapy
  • Parent-mediated therapy
  • Physical therapy
  • Social skills training
  • Speech-language therapy

Most children with autism are not diagnosed until after age 3, even though health care providers can often see developmental problems before that age. Research shows that early detection and early intervention greatly improve outcomes, so it’s important to look for these symptoms when a child is as young as possible. While autism is usually a life-long condition, all children and adults benefit from interventions, or therapies, that can reduce symptoms and increase skills and abilities. Although it is best to begin intervention as soon as possible, the benefits of therapy can continue throughout life.