Understanding autism spectrum disorders
Spotting early signs & symptoms
Catching autism early—ideally by the age of eighteen months—can make a huge difference. Learn what to look for in babies, toddlers, and young children.
Autism is not a single disorder, but a spectrum of closely-related disorders with a shared core of symptoms. Every individual on the autism spectrum has problems to some degree with social skills, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.
If you’re a parent dealing with a child on the autism spectrum, you may hear many different terms including high-functioning autism, atypical autism, autism spectrum disorder, and pervasive developmental disorder. These terms can be confusing, not only because there are so many, but because doctors, therapists, and other parents may use them in dissimilar ways.
But no matter what doctors, teachers, and other specialists call the autism spectrum disorder, it’s your child’s unique needs that are truly important. No diagnostic label can tell you exactly what problems your child will have. Finding treatment that addresses your child’s needs, rather than focusing on what to call the problem, is the most helpful thing you can do. You don’t need a diagnosis to start getting help for your child’s symptoms.
Sometimes “autism” really means “autism spectrum disorder”
When people use the term autism, it can mean one of two things. They may actually be referring to autistic disorder, or classical autism. But autism is often used in a more general sense to refer to all autism spectrum disorders. So if someone is talking about your child’s autism, don’t assume that he or she is implying that your child has autistic disorder, rather than another autism spectrum disorder. If you’re unsure what is meant, don’t be afraid to ask.
The autism spectrum disorders belong to an “umbrella” category of five childhood-onset conditions known as pervasive developmental disorders (PDD). Some autism specialists use the terms pervasive developmental disorder and autism spectrum disorder interchangeably. However, when most people talk about the autism spectrum disorders, they are referring to the three most common PDDs:
- Asperger's Syndrome
- Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)
Childhood disintegrative disorder and Rett Syndrome are the other pervasive developmental disorders. Because both are extremely rare genetic diseases, they are usually considered to be separate medical conditions that don't truly belong on the autism spectrum.
Where does your child fall on the autism spectrum?
The three autism spectrum disorders share many of the same symptoms, but they differ in their severity and impact. Classic autism, or autistic disorder, is the most severe of the autism spectrum disorders. Milder variants are Asperger’s Syndrome, sometimes called high-functioning autism, and PDD-NOS, or atypical autism. According to the Autism Spectrum Resource Center, only 20% of people on the autism spectrum have classic autism. The overwhelming majority fall somewhere on the milder range of the spectrum.
Since the autism spectrum disorders share many similar symptoms, it can be difficult to distinguish one from the other, particularly in the early stages. If your child is developmentally delayed or exhibits other autism-like behaviors, you will need to visit a medical professional for a thorough evaluation. Your doctor can help you figure out where, or even if, your child fits on the autistic spectrum.
In both children and adults, the signs and symptoms of the autism spectrum disorders include problems with social skills, speech and language, and restricted activities and interests. However, there are enormous differences when it comes to the severity of the symptoms, their combinations, and the patterns of behavior.
Keep in mind that just because your child has a few autism-like symptoms, it doesn’t mean he or she has an autism spectrum disorder. The autism spectrum disorders are diagnosed based on the presence of multiple symptoms that disrupt your child’s ability to communicate, form relationships, explore, play, and learn.
Signs and symptoms of autism spectrum disorders: Social skills
Basic social interaction can be difficult for children with autism spectrum disorders. Symptoms may include:
- Unusual or inappropriate body language, gestures, and facial expressions (e.g. avoiding eye contact or using facial expressions that don’t match what he or she is saying).
- Lack of interest in other people or in sharing interests or achievements (e.g. showing you a drawing, pointing to a bird).
- Unlikely to approach others or to pursue social interaction; comes across as aloof and detached; prefers to be alone.
- Difficulty understanding other people’s feelings, reactions, and nonverbal cues.
- Resistance to being touched.
- Difficulty or failure to make friends with children the same age.
Signs and symptoms of autism spectrum disorders: Speech and language
Problems with speech and language comprehension are a telltale sign of the autism spectrum disorders. Symptoms may include:
- Delay in learning how to speak (after the age of 2) or doesn’t talk at all.
- Speaking in an abnormal tone of voice, or with an odd rhythm or pitch.
- Repeating words or phrases over and over without communicative intent.
- Trouble starting a conversation or keeping it going.
- Difficulty communicating needs or desires.
- Doesn’t understand simple statements or questions.
- Taking what is said too literally, missing humor, irony, and sarcasm.
Signs and symptoms of autism spectrum disorders: Restricted behavior and play
Children with autism spectrum disorders are often restricted, rigid, and even obsessive in their behaviors, activities, and interests. Symptoms may include:
- Repetitive body movements (hand flapping, rocking, spinning); moving constantly.
- Obsessive attachment to unusual objects (rubber bands, keys, light switches).
- Preoccupation with a specific topic of interest, often involving numbers or symbols (maps, license plates, sports statistics).
- A strong need for sameness, order, and routines (e.g. lines up toys, follows a rigid schedule). Gets upset by change in their routine or environment.
- Clumsiness, abnormal posture, or odd ways of moving.
- Fascinated by spinning objects, moving pieces, or parts of toys (e.g. spinning the wheels on a race car, instead of playing with the whole car).
How children with autism spectrum disorders play
Children with autism spectrum disorders tend to be less spontaneous than other kids. Unlike a typical curious little kid pointing to things that catch his or her eye, autistic children often appear disinterested or unaware of what's going on around them. They also show differences in the way they play. They may have trouble with functional play, or using toys that have a basic intended use, such as toy tools or cooking set. They usually don't "play make-believe," engage in group games, imitate others, or use their toys in creative ways.
While not part of autism’s official diagnostic criteria, children with autism spectrum disorders often suffer from one or more of the following problems:
- Sensory problems – Many children with autism spectrum disorders either underreact or overreact to sensory stimuli. At times they may ignore people speaking to them, even to the point of appearing deaf. However, at other times they may be disturbed by even the softest sounds. Sudden noises such as a ringing telephone can be upsetting, and they may respond by covering their ears and making repetitive noises to drown out the offending sound. Children on the autism spectrum also tend to be highly sensitive to touch and to texture. They may cringe at a pat on the back or the feel of certain fabric against their skin.
- Emotional difficulties – Children with autism spectrum disorders may have difficulty regulating their emotions or expressing them appropriately. For instance, your child may start to yell, cry, or laugh hysterically for no apparent reason. When stressed, he or she may exhibit disruptive or even aggressive behavior (breaking things, hitting others, or harming him or herself). The National Dissemination Center for Children with Disabilities also notes that autistic kids may be unfazed by real dangers like moving vehicles or heights, yet be terrified of harmless objects such as a stuffed animal.
- Uneven cognitive abilities – The autism spectrum disorders occur at all intelligence levels. However, even kids with normal to high intelligence often have unevenly developed cognitive skills. Not surprisingly, verbal skills tend to be weaker than nonverbal skills. In addition, children with Autism spectrum disorders typically do well on tasks involving immediate memory or visual skills, while tasks involving symbolic or abstract thinking are more difficult.
Savant skills in autism spectrum disorders
Approximately 10% of people with autism spectrum disorders have special “savant” skills, such as Dustin Hoffman portrayed in the film Rain Man. The most common savant skills involve mathematical calculations, artistic and musical abilities, and feats of memory. For example, an autistic savant might be able to multiply large numbers in his or her head, play a piano concerto after hearing it once, or quickly memorize complex maps.
The road to an autism diagnosis can be difficult and time-consuming. In fact, it is often 2 to 3 years after the first symptoms of autism are recognized before an official diagnosis is made. This is due in large part to concerns about labeling or incorrectly diagnosing the child. However, an autism diagnosis can also be delayed if the doctor doesn’t take a parent’s concerns seriously or if the family isn’t referred to health care professionals who specialize in developmental disorders.
If you’re worried that your child has autism, it’s important to seek out a medical diagnosis. But don’t wait for that diagnosis to get your child into treatment. Early intervention during the preschool years will improve your child’s chances for overcoming his or her developmental delays. So look into treatment options and try not to worry if you’re still waiting on a definitive diagnosis. Putting a potential label on your kid’s problem is far outweighed by the need to treat the symptoms.
Diagnosing autism spectrum disorders
In order to determine whether your child has autism, a related autism spectrum disorder, or another developmental condition, clinicians look carefully at the way your child socializes, communicates, and behaves. Diagnosis is based on the patterns of behavior that are revealed.
If you are concerned that your child has an autism spectrum disorder and developmental screening confirms the risk, ask your family doctor or pediatrician to refer you immediately to an autism specialist or team of specialists for a comprehensive evaluation. Since the diagnosis of an autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area.
The team of specialists involved in diagnosing your child may include:
- Child psychologists
- Child psychiatrists
- Speech pathologists
- Developmental pediatricians
- Pediatric neurologists
- Physical therapists
- Special education teachers
- Child psychologists
- Child psychiatrists
- Speech pathologists
- Developmental pediatricians
- Pediatric neurologists
- Physical therapists
- Special education teachers
Diagnosing an autism spectrum disorder is not a brief process. There is no single medical test that can diagnose it definitively; instead, in order to accurately pinpoint your child's problem, multiple evaluations and tests are necessary.
|Getting Evaluated for an Autism Spectrum Disorder|
Parent interview – In the first phase of the diagnostic evaluation, you will give your doctor background information about your child’s medical, developmental, and behavioral history. If you have been keeping a journal or taking notes on anything that concerned you, turn over that information. The doctor will also want to know about your family’s medical and mental health history.
Medical exam – The medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. Your child will undergo this full screening to determine the cause of his or her developmental problems and to identify any co-existing conditions.
Hearing test – Since hearing problems can result in social and language delays, they need to be excluded before an autism spectrum disorder can be diagnosed. Your child will undergo a formal audiological assessment where he or she is tested for any hearing impairments, as well as any other hearing issues or sound sensitivities that sometimes co-occur with autism.
Observation – Developmental specialists will observe your child in a variety of settings to look for unusual behavior associated with the autism spectrum disorders. They may watch your child playing or interacting with other people.
Lead screening – Because lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children with developmental delays be screened for lead poisoning.
Depending on your child's & symptoms and their severity, the diagnostic assessment may also include speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs:
- Speech and language evaluation – A speech pathologist will evaluate your child's speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.
- Cognitive testing – Your child may be given a standardized intelligence test or an informal cognitive assessment. Cognitive testing can help differentiate autism from other disabilities.
- Adaptive functioning assessment – Your child may be evaluated for their ability to function, problem-solve, and adapt in real life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.
- Sensory-motor evaluation – Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child's fine motor, gross motor, and sensory processing skills.
Resources & References
General information about autism spectrum disorders
Autism Spectrum Disorders – What should you know? Autism spectrum disorders homepage. (Centers for Disease Control and Prevention)
Pervasive Developmental Disorders – Guide to the symptoms, causes, diagnosis, and treatment of the pervasive developmental disorders, including autism. (National Dissemination Center for Children with Disabilities)
What is Autism Spectrum Disorder? – Read about the symptoms and red flags of ASD in children, teens, and adults. (vKool.com)
Diagnosis of autism spectrum disorders
Diagnosing and Evaluating Autism Part I (PDF) – Learn about the medical tests involved in the diagnosis of the autism spectrum disorders. (Center for Autism and Related Disabilities)
Diagnosing and Evaluating Autism Part II (PDF) – Discusses direct observation and standardized tests used to diagnosis autism. (Center for Autism and Related Disabilities)
Asperger’s Disorder – Guide to the characteristics of Asperger’s syndrome, diagnosis, educational issues, and what the disorder looks like in adults. (Autism Society of America)
How Might Asperger's Appear to a Parent? – Excerpt from the book “School Success for Kids With Asperger’s Syndrome” describes what Asperger’s disorder looks like. (Prufrock Press Inc.)
Asperger's Syndrome – Guide to the signs, symptoms, causes, and treatment of Asperger’s syndrome. (Kid’s Health)
Asperger's Syndrome – Comprehensive overview of Asperger’s syndrome, including symptoms, diagnosis, and treatment. (Yale Developmental Disabilities Clinic)
Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
Pervasive Developmental Disorders Information Page – Jumping off point to a wealth of resources on Pervasive Developmental Disorder. (NINDS)
Pervasive Developmental Disorder - Not Otherwise Specified – Provides a definition of PDD-NOS and a case study of a child with the diagnosis. (Yale Developmental Disabilities Clinic)