Autism spectrum disorder (ASD) is a developmental disorder that is marked by two unusual kinds of behaviors which are deficits in communication and social interaction and restricted or repetitive behaviors. These symptoms may vary greatly in severity. Although a child has autism from birth, it may not come to attention until social demands exceed a child’s limitations.
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.
Common Symptoms of Autism
- They have a lack of eye contact
- They have a narrow range of interests or intense interest in certain topics
- They do something over and over, like repeating words or phrases, rocking back and forth, or flipping a lever
- They may have high sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
- They do not look at or listen to other people as it supposed to be
- They do not look at things when another person points at them
- They do not want to be held or cuddled
- They may have problems in understanding or using speech, gestures, facial expressions, or tone of voice
- They talk in a sing-song, flat, or robotic voice
- They may have trouble adapting to changes in routine
- They may have seizures. These might not start until adolescence.
Signs of Autism in Young Children
- They do not respond to their name
- They avoid making eye contact
- They do not smile back when you smile at them
- They get- very upset if they do not like a certain taste, smell or sound
- They have repetitive movements, such as flapping their hands, flicking their fingers or rocking their body
- They do not talk as much as normally developed children
- They repeat the same phrases over and over
Signs of Autism in Older Children
- They do not seem to understand what other people are thinking or feeling
- They find it hard to say how they feel
- They like a strict daily routine and getting very upset if it changes
- They have a very keen interest in certain subjects or activities
- They may become very upset if you ask them to do something
- They find it hard to make friends or prefer to be on their own
- They take things very literally – for example, they may not understand phrases like “break a leg”
There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to in normally developed children. Researchers do not know the exact cause of autism but they are investigating a number of theories.
The exact reason why autism spectrum disorder happens is not clear. It could stem from problems in parts of your brain that interpret sensory input and process language. Autism is four times more common in boys than in girls. It can happen in people of any race, ethnicity, or social background. Family income, lifestyle, or educational level does not affect a child’s risk of autism. There may be many different factors that make a child more likely to have autism spectrum disorder, including environmental, biological, and genetic factors.
Risk factors include low birth weight, fetal exposure to valproate, and parental age. Boys are more likely to be diagnosed with an autism spectrum disorder. Some people have concerns that autism is caused by vaccinations that children receive. However, studies have shown that there is no link between receiving vaccines and developing autism.
Autism runs in families, so certain combinations of genes may increase a child’s risk. A child with an older parent has a higher risk of autism. If a pregnant woman is exposed to certain drugs or chemicals, like alcohol or anti-seizure medications, her child is more likely to be autistic. Other risk factors include maternal metabolic conditions such as diabetes and obesity. Research has also linked autism to untreated phenylketonuria (also called PKU, a metabolic disorder caused by the absence of an enzyme) and rubella (German measles).
Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria (PKU). Some harmful substances ingested during pregnancy also have been associated with an increased risk of autism.
For the diagnosis of autism, a child must display symptoms in two core areas which are social communication and social interaction, and restrictive, repetitive patterns of behavior, interests, and activities. The symptoms must be impairing and present in the early developmental period. But they may not be fully manifest until a child is older and the social demands exceed his abilities. Autism spectrum disorder can be diagnosed as early as 24 months.
In case 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 case of restrictive or repetitive patterns of behavior, a clinician will look for 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.
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 to function successfully.
Given that children with autism also frequently have 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, that child is more likely to be diagnosed with a social communication disorder.
If your child was not diagnosed with autism as a child but notice yourself showing signs or symptoms, talk to your doctor. Getting diagnosed can help the individual with autism and their parents get any extra support they might need. For this reason, you could speak to:
- a GP
- a health visitor (for children under 5)
- psychologist, psychiatrist or pedagogue
- any other health professional the child sees, such as another doctor or therapist
- special educational needs (SENCO) staff at the child’s school
For children, diagnosis usually takes two steps.
- A developmental screening will tell the child’s doctor whether the child is on track with basic skills like learning, speaking, behavior, and moving. Experts suggest that children be screened for these developmental delays during their regular checkups. Children should be routinely checked specifically for autism at their 18-month and 24-month checkups.
- If the child shows signs of a problem on these screenings, they will need a more complete evaluation. This might include hearing and vision tests or genetic tests. The doctor might want to bring in someone who specializes in autism spectrum disorders. Some psychologists can also give a test called the Autism Diagnostic Observation Schedule (ADOS).
Toddlers usually like to interact with people and the environment they live in. Parents are typically the first ones to notice that their child is showing atypical behavior or at least they can understand that there are some problems with their children even though they do not want to accept it. Parents should be aware of the early warning signs of autism, and they should share any concerns with a doctor or any kind of professional. Some of the early indicators of autism spectrum disorder include:
- They do not make eye contact. They avoid eye contact.
- They do not respond to their name usually.
- Babbling cannot be observed by 1 year of age.
- They do not smile or show any joyful expressions by 6 months of age.
- Gesturing, like pointing, showing, or waving cannot be observed by 1 year of age.
- They are not able to utter meaningful phrases by 2 years of age.
- They can show losing speech or social skills.
If parents think that their child might have autism or they notice that the child plays, learns, speaks, or acts in unusual ways, they should share their concerns with the child’s doctor without any hesitation. It is not something that they can be ashamed of or keep as a secret.
Tests are Used to Diagnose Autism
There is no test can confirm autism outright, however, professionals may use various medical tests and procedures to help with an autism diagnosis. There is not always a clinical need to do medical tests. Professionals can recommend when, or if, a test should be done.
There is no medical test for autism. An autism spectrum diagnosis is based on observed behavior and educational and psychological testing. There are several autism-specific screening tools that can be used.
Hearing: Various tests such as an audiogram, tympanogram, and the brain stem evoked response can indicate whether a person has a hearing impairment. Audiologists have methods to test the hearing of any individual by measuring responses such as turning their head, blinking, or staring when a sound is presented. If a hearing impairment is detected, treatment could involve minor surgery, use of hearing aids, or antibiotics.
Electroencephalogram (EEG): An EEG measures brain waves that can show seizure disorders. An EEG may indicate tumors or other brain abnormalities. Additional tests will be needed to make an accurate diagnosis of these conditions. If seizure activity is detected, additional testing may be required and various medications could be prescribed.
Metabolic Screening: Blood and urine lab tests measure how a person metabolizes food and its impact on growth and development. Some autism spectrum disorders can be treated with special diets.
Magnetic Resonance Imaging (MRI): An MRI involves using magnetic sensing equipment in order to create an image of the brain in extremely fine detail. The patient lies on a sliding table inside a cylinder-shaped magnetic machine and must be still during the procedure.
Computer Assisted Axial Tomography (CAT SCAN): An x-ray tube rotates around the patient taking thousands of exposures that are sent to a computer where the section of the body that is x-ray is reconstructed in great detail. CAT Scans are helpful in diagnosing structural problems with the brain.
Genetic Testing: Blood tests look for abnormalities in the genes which could cause a developmental disability.
The evaluation may also include screening tools. There are many different developmental screening tools. Of course, there is no single tool can diagnose autism spectrum disorder. Rather than that, a combination of many tools is necessary for an autism diagnosis. Some examples of screening tools include:
- Ages and Stages Questionnaires (ASQ)
- Autism Diagnostic Observation Schedule (ADOS)
- Childhood Autism Rating Scale (CARS)
- Autism Diagnostic Observation Schedule—Generic (ADOS-G)
- Pervasive Developmental Disorders Screening Test—Stage 3
- Parents’ Evaluation of Developmental Status (PEDS)
- Gilliam Autism Rating Scale
- Screening Tool for Autism in Toddlers and Young Children (STAT)
There are also specific screening tools available only for Asperger syndrome. Asperger syndrome typically involves difficulty with social and communication skills. Particular screening tools include:
- Autism Spectrum Screening Questionnaire (ASSQ)
- Childhood Asperger Syndrome Test (CAST)
Autism spectrum disorder assessments include:
- a medical and neurological examination
- a review of the child’s cognitive abilities
- assessment of the child’s speech and language abilities
- observation of the child’s behavior
- an in-depth conversation with the family about the child’s behavior and development
- questions about the child’s family history
Questions that they may be asked include:
- What kind of language skills does your child have?
- At what age did his symptoms start?
- Has he experienced a regression in skills?
- Does he have any related cognitive or learning problems?
- Does he have any challenging behaviors?
- Is he able to pay attention for extended periods?
A structured educational program and tailored behavioral therapy have been shown to be very beneficial to children with an autism spectrum disorder.
Applied behavior analysis (ABA), is the most widely accepted evidence-based autism therapy. It has been shown to help children with autism 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.
Occupational therapy (OT), is designed to help children acquire the skills needed to perform the activities of daily life, including fine and gross motor skills, sensory processing skills, self-help skills and more.
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.
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.
These might include vitamin treatments, changes in diet, supplements, facilitated communication and chelation. None of these alternative treatments have any reliable scientific evidence behind them. Although many parents insist on these types of treatment work, researchers have not scientifically proven them effective for children with autism, either for symptoms or long-term outcomes. Some, particularly chelation can be very dangerous. Because it is an attempt to remove heavy metals from the body via chemical injections. You should always discuss the safety and effectiveness of any alternative treatments with your doctor before trying them. It is important that parents who choose to pursue these therapies should do so in close consultation with a qualified physician.
There is no known cure for autism spectrum disorder. But recent research might make parents wonder if it ever goes away either through therapy or through a child simply growing older. Often after a few years of therapy, they no longer fit the diagnosis.
For parents raising a child with autism, an offer of help from a grandparent, aunt, uncle or other family member means a lot. The good news for families: If you want to help, you can. Whether you live nearby or far away, there are ways for extended family members to get involved in caring for children with autism.
If your child has just received a diagnosis of autism spectrum disorder, you are probably feeling baffled and overwhelmed. It is never easy to learn that someone you love has serious health or developmental condition. Learning all you can about the disorder and where to get help will ease your fear and confusion. It can also provide the tools you need to find the support that children with autism and you really need.
If you have a child with autism, it is important to get support. The day-to-day care of children with autism can be stressful. Making sure your child gets the help he or she needs can also pose a challenge, depending on whether quality support services are available in your area.
At the same time, you are likely to have ongoing worries about your child’s prognosis and long-term well-being. For all these reasons, you need to take care of yourself, as well as your child. You should make an effort to reach out and find the support you need.
No matter how exhausted you are, get your child out in the community. It could be a struggle with your child but getting him out so he could have a repertoire of leisure activities was crucial to his happiness and to family. It set him up for a lifetime of being able to try different things, which will set him in good stead when parents are no longer here to take him places.
If the parents have not already done so, they join a parent group and/or the school district’s special education PTA. They will make invaluable connections at both. They can try to find parents of kids with their kid’s level of autism as they are making friends. These people will be a wealth of information for you and a lifeline.
If parents who have a child with autism can afford it, they may hire an advocate to check out the child’s school program. A fresh set of eyes may see areas that need to improve or may reassure parents that they are doing all they can for their children. It is always good to know one in case parents need an advocate at an IEP meeting. If they have already met they won’t be scrambling to find one.
If it is possible, they can be a volunteer at school functions or offer to be a class mom. This is a great way to get to know the child’s teacher and the school’s administrators better. They may also make friends with other parents too.
No matter how difficult the child with autism can be, take any offer of babysitting they can and get out. They need a night off from autism once in a while. Even if it is for a few hours, a break will help.
Let’s say the child’s program is set to tackle the big issues one at a time- perhaps it’s sleeping, or eating, or potty training. If the child is in a private school there may be a BCBA on staff who can help parents. If not and parents can afford it, they can consider hiring a BCBA from an agency.
Parents should educate their friends and family as to what’s going on in their household. Perhaps they have been too tired up to this point to talk to people, not in the “tribe” about what raising a child with autism spectrum disorder is really like. It is time to tell them and ask for the support they need, even if it is just an ear to listen.
Parents should make those doctor appointments for themselves that they have been putting off. Just do it. They can get involved in an autism walk in their community. It is so powerful to meet so many families like and unlike theirs. It will give parents strength. It will raise awareness around them.
And the most important thing is that parents should take care of themselves, not just their kid. Autism is a marathon, not a sprint. They owe it to themselves and their child to be whole, healthy, and happy. They should do whatever it takes to get there.
- Educate yourself. Parents should learn all they can do. They should read about children with autism in other sections. Consult governmental and nonprofit organizations for more information on children with autism. Stay up to date on current research findings, and make sure they are looking at reputable sources of information.
- Build a support system. Parents should seek out local groups and parent network organizations for families of children with autism. They can ask the physician or child developmental specialist for referrals. They can join online chat groups for parents of children with autism.
- Make time for yourself and your relationships. They can try to schedule regular dates with their partner and outings with friends. Keep up with the activities they enjoy.
- Get help. They may seek help if they are feeling persistently overwhelmed or depressed, or the stress of caring for a disabled child is affecting the relationship. Parents’ health care provider can help them find a qualified individual, couples, or family therapist.
Working with an Autism Specialist
Screeners are often given by pediatricians, but if there are red flags that indicate further evaluation would be appropriate, it is best to work with someone who has both experience and expertise in diagnosing children on the autism spectrum. You may want someone who has seen hundreds of kids with all different stripes – typical children, intellectually disabled children, children with autism — and knows what to look for. Academic and medical centers are often good places to find experienced diagnosticians.
Parents can ask some questions to try to gauge a potential provider’s experience. For example:
- What are your training and experience?
- Have you had specific training in the assessment of people on the spectrum? How much?
- What do you plan to do as part of this assessment?
- Will you be contacting my child’s teacher or pediatrician?
- How can we help you during this assessment?
Try to find a practitioner who is able to answer parents’ questions readily and makes them feel comfortable. A clinician who takes concerns seriously and is experienced in assessing autism spectrum disorder is essential to getting an accurate diagnosis.
What School Could Be If It Were Designed for Kids With Autism Spectrum Disorder
Nationwide, more than half of students with autism ages 6 to 21 spend more than 40% of their school day in a majority-neurotypical classroom, with about 2/3 of this group spending 80% of their day in one. In general, the rest spend most of their school day in a special-education class or at a school where all students have one or more disabilities.
When a student on the spectrum is present, majority-neurotypical classrooms typically have one certified teacher and one or more teacher’s aides, who help students with special needs follow teachers’ directions and complete academic tasks. Each classroom’s two co-teachers meet weekly with occupational, speech, and physical therapists to discuss each student’s progress and share observations about what’s working and what isn’t.
The program is effective because of its focus on collaboration among the ASD teachers, school therapists, and university researchers, which results in frequent adjustments in the classroom activities and strategies tailored to every student.
Many people with autism are visual thinkers. To learn words like “up” or “down,” the teacher should demonstrate them to the child. Teachers should avoid long strings of verbal instructions. People with autism have problems with remembering the sequence. If the child can read, write the instructions down on a piece of paper. Directions with more than three steps have to be written down.
Many children with autism are good at drawing, art and computer programming. These talent areas should be encouraged. Talents can be turned into skills that can be used for future employment. And, teachers can use concrete visual methods to teach number concepts.
By the age of 5, many children can deduce that a smiling, friendly classmate is not looking to start a physical fight. Children with autism can struggle to reach that conclusion, but many special-education teachers believe that the ability to pick up on social cues can be taught in a classroom setting.
The contrasts with the traditional approach to integrating students on the spectrum into majority-neurotypical classes, which prioritizes academic development, often without addressing the social and emotional challenges that can make classroom engagement difficult. On the other hand, learning how to perceive the intentions and feelings of others and manage your own emotions is good for all students, not just children with autism.
In order to be effective, the programs the teachers follow focus on addressing students’ strengths rather than their weaknesses. Too often, programs for students on the spectrum dwell on their deficits, such as their inability to pay attention for long periods of time. Meanwhile, teachers get to know the strengths and interests of each student and then extend them to the academic domain.
The teachers shouldn’t try to change their students, eradicate their intense interests, or teach them compliance. They should help them become the most successful they can be in ways that are meaningful to them. They have focused on helping students become more independent.
Students with autism spectrum disorder also attend “social clubs,” which are intended to help demystify unstated norms, such as whispering in libraries and not talking to strangers in bathroom stalls. In social clubs, students read fiction, look at photographs, watch movie clips, and play games, trying to glean what the characters in the films and books, as well as their peers in the group, are feeling and thinking based on their facial expressions, body language, and tone of voice.
This all has been working well for the student who was practicing making inferences. If it has been applied very well, students with autism start to talk about teachers, friends, what they are learning, which is a huge change for most of the time. They can even start to teach their family members about the appropriate voice levels in different settings.