Autism Spectrum Disorder

Autism spectrum disorder is a neurodevelopmental disorder that usually appears during the first three years of life. Children with this disorder may have problems in social understanding and communication, they may have a limited range of interests, and they may show repetitive behavior patterns. The symptoms and severity can vary by child.

About one in 68 children in the U.S. have an autism spectrum disorder, according to the CDC. Autism is more prevalent in boys than girls, with four to five times as many boys affected than girls.

Scientists do not know the exact cause of autism. Research suggests that genes play a major role in autism and several genes are being studied and considered as increasing the likelihood that an individual may develop autism. Despite these studies, the contribution of genetics in the development of autism is not clear. Research studies in autism have also found a variety of abnormalities in brain structure and function and in some chemicals in the brain, but not all findings have been consistent. Learn about the autism research happening at CHOC.

Parenting behaviors are not the cause of autism or a contributing factor to it.

Video: What is autism?

Autism is a behavior situation where a child is not as interactive. In this segment from American Health Journal, Chris Koutures, MD, of CHOC Children’s, explains more about what autism is.

What are the symptoms of autism?

The following are the most common symptoms of autism:

  • Social-Communication:
    – Lack of responding to name by 12 months of age
    – Lack of pointing and use of other gestures, such as waving hi and bye-bye
    – Delayed language development (infrequently, some children will “regress” in language skills)
    – Immediate or delayed echolalia (repeating words while learning to speak)
    – Poor eye contact during interactions
    – Trouble understanding the perspective of others
    – Challenges with reciprocity during play, social interactions and conversations
    – Lack of peer interest
  • Repetitive behaviors and restricted interests:
    – Has repetitive motor movements (such as rocking and hand or finger flapping)
  • Is preoccupied by certain objects or topics
  • Sensory interests (e.g., interest in the objects with lights, that move or make sounds)
  • Sensitive to sounds, textures or tastes
  • Has rituals
  • Requires routines.

How is autism diagnosed?

Standard guidelines have been developed to help identify autism in children before the age of 24 months. In the past, diagnosis of autism was often not made until late preschool-age or later. The guidelines can help identify children with autism early, which means earlier, more effective treatment for the disorder.

The American Academy of Pediatrics recommends that all children should be screened for autism spectrum disorders at 18 months and 24 months, regardless of whether any signs are apparent or any concerns have surfaced about a child’s developmental progress. By screening children early for autism, those diagnosed with the disorder can be treated immediately and aggressively.

At this initial screening, a child’s doctor should check for the following developmental deficits:

  • No babbling, pointing or gesturing by age 12 months
  • No single words spoken by age 16 months
  • No two-word spontaneous expressions by age 24 months (not merely repeating the sounds of others)
  • Loss of any language or social skills at any age
  • No eye contact at 3 to 4 months.

If a child is identified as developmentally delayed, a second screening will give a more in-depth evaluation that can differentiate autism from other developmental disorders. This screening may include more formal diagnostic procedures by clinicians skilled in diagnosing autism, including medical history; psychological assessment and when appropriate; neurological evaluation; genetic testing; metabolic testing; electrophysiologic testing, such as CT scan, MRI or PET scan.

Genetic testing involves an evaluation by a medical geneticist, a doctor who has specialized training and certification in clinical genetics. This is because symptoms of autism may be caused by several genetic syndromes, including Fragile-X, untreated phenylketonuria (PKU), neurofibromatosis, tuberous sclerosis and a variety of chromosome abnormalities. A geneticist can determine whether the symptoms of autism are caused by a genetic disorder, or whether the symptoms have no known genetic cause. If a genetic disorder is diagnosed, other health problems may be involved. The chance for recurrence in a future pregnancy would depend on the syndrome found. For example, PKU is an autosomal recessive disorder with a reoccurrence risk of one in four, or 25 percent, chance, while tuberous sclerosis is an autosomal dominant disorder, with a reoccurrence risk of 50 percent.

In cases where no genetic cause for the autism is identified, the couple has a slightly increased chance for having another child with autism. The reason for this increase over the general population is thought to be because autism may result from several genes inherited from both parents acting in combination, in addition to unknown environmental factors. There is no action or inaction known that parents could have done, or did not do, to cause autism to occur in a child.

How is autism treated?

There is no known cure for autism; however, many therapies have been found to be effective in treating the core symptoms of autism. These therapies include behavioral therapy/applied behavior analysis, speech therapy and occupational therapy. Behavioral therapy is used to teach a range of developmental skills including cognitive (thinking), social and play, language and adaptive skills while also reducing behaviors that may interfere with learning and development. Individualized treatment for behavioral therapy is important as children with autism vary greatly in their needs. Intensive behavior therapy during early childhood and home-based approaches that involve parents are considered to produce the best results.

Highly structured special education programs focus on developing cognitive and social, speech, language, self-care and job skills. Medication can be helpful in treating some symptoms associated with autism. Mental health professionals provide parent counseling, social skills training and individual therapy. They also help families identify and participate in treatment programs based on an individual child’s treatment needs.

References: Autism Speaks. (2008). First 100 days kit.

Interacting with a Child Who Has Autism Spectrum Disorder

Children with an autism spectrum disorder (ASD) have trouble relating to other people. They may have difficulty making eye contact and may seem uninterested in relating to family members. On the other hand, some children with ASD may love talking at length with family members, friends and even strangers about a subject they are interested in. If you are a parent or grandparent of a child with an ASD, you may find it difficult to connect with him or her. But learning more about these disorders and what has helped others should help you and your relationship.

Breaking Through the Barriers of ASD

Although ASD has no cure, there is hope through treatment. Many children are able to learn to communicate and interact. Doctors and mental health experts have learned a lot about how to best interact with and teach individuals impacted by autism.

Communication and Interaction Tips for ASD

There are no hard-and-fast rules on how to communicate with an ASD child, but many family members of a child with ASD have had success with these tips:

  • Be patient. It often takes a child with an ASD longer to process information, so you may need to slow down your conversation to his or her speed.
  • Teach the child how to express anger without engaging in inappropriate behaviors that may include aggression. Children with an ASD should know that they don’t have to hold their anger and frustration inside.
  • Be persistent yet resilient. Don’t let your feelings get hurt if the child does not respond to you as you’d like. Children with ASD may have trouble both showing and controlling their emotions and can be blunt in their responses—don’t take this personally.
  • Always stay positive. Children with an ASD respond best to positive reinforcement, so be sure to mention or reward good behavior as soon as you see it.
  • Ignore irritating attention-getting behavior. Children with ASD may act badly at times to get you to focus on them. Ignoring this behavior is often the best way to prevent it.
  • Interact through physical activity. Running around and playing outside may be a good way of sharing time together. It will also allow them to relax and feel calmer.
  • Be affectionate. Children with an ASD often need a hug, just like other children.
  • Show your love and interest. Children with an ASD may have trouble showing their feelings, but they still need to know that you love them. Go out of your way to express your interest, caring and support.

Interacting with your ASD child or grandchild may be challenging at times, but it is one of the most important things you can do to help them learn. Research shows that early, frequent and loving intervention from family members is one of the best ways to help children with an ASD.

Health Feature: Kids and Autism

Autism spectrum disorders (ASDs) are typically diagnosed in toddlers or young children based on certain behavioral patterns; there is no medical diagnostic test. “There are changes in three areas of behavior that lead to a diagnosis,” Dr. Philip Schwartz says. “One is communication and the others are sociability and repetitive behaviors, where the child does the same thing over and over. These children have trouble communicating. They don’t make that connection. There’s little eye contact or emotional content in their interactions with other people, including their parents.”

Boy smiling at the park

Living with Autism

Raising a Child with Autism:
What I Wish I Knew Sooner

Teri Book shares what she’s learned as a nurse caring for children with autism, and also as a mother of a child with autism.

A First-Hand Account of Autism
In this CHOC Radio podcast, three local children with autism share what life is like for them at home and at school, and offer tips that can help teachers, parents and other children with autism.

5 Things Parents Should Do
After an Autism Diagnosis

In the days and weeks following a diagnosis, families experience a wide range of emotions. Clinical social worker Maureen Dillon offers tips for parents that have a child recently diagnosed with autism.