Autism

Autism (autism spectrum disorder, or ASD) is a difference in how your child’s brain works that shapes their behaviors, interests, social interactions and ways of communicating. ASD falls under the umbrella of neurodevelopmental disorders. These are conditions affecting brain function that become noticeable early in life — often before or soon after starting school. About 1 in 31 kids in the U.S. has ASD.

In the past, healthcare providers used several different names to describe neurodevelopmental disorders with features of autism:

• Autistic disorder
• Asperger’s disorder
• Pervasive developmental disorder not otherwise specified (PDD-NOS)
• Childhood disintegrative disorder

Providers don’t use these names anymore. Instead, they recognize that autism is a spectrum, and that autistic people are neurodivergent. This means they have a wide range of personality traits, strengths and challenges, and they need varying levels of support. So, providers use ASD as the official diagnosis and describe features and needs unique to each person.

Words aren’t perfect. And sometimes, “medspeak” that healthcare providers use — like “disorder,” “symptoms” or “diagnosis” — doesn’t match the lived experience of autistic people or their families. It’s important to know that autism isn’t a disease that can be “cured,” and it’s not a mental health condition.

Throughout this article, we’ll use medical terms as needed to describe available support for your family. But we recognize that autism is an identity, not just a diagnosis. We use the term “autistic” to reflect the identity-first language preferences of the autistic community.

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Signs of autism fall into two groups: difficulties with socializing and restrictive and repetitive behaviors, interests or activities.

What are the signs and symptoms of autism?

Autism characteristics fall into two main groups:

• Difficulties with social communication and interaction that affect how your child socializes
• Restricted and repetitive behaviors, interests or activities that affect how your child acts

Below are examples of autism characteristics you might recognize in your child at different ages.

How your child socializes

You may notice your toddler:

• Doesn’t follow your gaze or look at things you’re pointing to
• Doesn’t respond to their name
• Seems uninterested in turn-taking games like peek-a-boo
• Doesn’t seek you out to share something they’ve discovered
• Looks away rather than looking you in the eye
• Uses your hand as a tool to pick up things they want
• Prefers to play by themselves (continuing beyond age 2)

You may notice your older child:

• Talks about a narrow range of topics
• Has one-sided conversations without back-and-forth talk
• Seems uninterested in starting a conversation
• Has difficulty expressing their feelings or understanding how others feel
• Has difficulty using and understanding body language — for example, they might face away from someone when speaking to them
• Speaks in a monotone or sing-song voice
• Has difficulty noticing social cues

You may notice your adolescent:

• Has trouble understanding what others mean — for example, they might not recognize sarcasm
• Doesn’t start social interactions
• Makes little or no eye contact
• Has difficulty mixing spoken words and body language
• Has a hard time building peer relationships
• Gets along more easily with younger kids or grown-ups
• Has difficulty seeing something from someone else’s point of view
• Doesn’t understand certain social rules, like greetings or personal space
• Appears standoffish when around others

How your child acts

You may notice your toddler:

• Repeats words or phrases
• Repeats motions, like flapping their hands, rocking their body or spinning in circles
• Does the same thing over and over with a toy or part of a toy, like spinning a toy car’s wheels
• Gets very upset by changes to their routine
• Lines toys or objects up in a particular order and resists anyone changing it
• Won’t eat foods of certain textures
• Reacts strongly to certain fabrics or other things on their skin
• Shows strong interest in a specific object you wouldn’t expect, like a wooden spoon or fan

You may notice your older child or adolescent:

• Repeats certain words or phrases from books, movies or TV shows
• Has difficulty switching between tasks
• Strongly prefers familiar routines or patterns of behavior
• Has intense or highly focused interests, like certain topics or collections

Many kids do these things at one point or another. But with autism, these behaviors are more than a phase. And they may pose challenges for your child when at school or socializing with peers.

What causes autism?

Experts haven’t found a single cause of autism. It’s likely a combination of genetics and certain things related to pregnancy, labor and delivery, including:

• Becoming pregnant over age 35
• Becoming pregnant within 12 months of having another baby
• Having gestational diabetes
• Having bleeding during pregnancy
• Using certain medications, like valproate, while pregnant
• Smaller-than-expected fetal size (intrauterine growth restriction)
• Reduced oxygen to the fetus during pregnancy or delivery
• Giving birth early

The genetic causes of autism are complicated. There’s not a single, specific gene variation that’s unique to autism. Instead, many gene variations are linked to autism. This means your child might have variations in one or more genes that affect how their brain works. These changes might be inherited (passed down within your biological family) or appear for the first time in your child.

How do healthcare providers diagnose autism?

Diagnosing autism involves several steps. Often, the process begins at a child’s routine well-check. The American Academy of Pediatrics recommends autism screenings at the 18-month and 24-month visits. A screening means your pediatrician will ask some questions about your child, including how they act, communicate and express emotions.

If your pediatrician notices possible signs of autism, they’ll refer you to a provider who specializes in diagnosing autism.

Providers use the criteria listed in the DSM-5-TR. This diagnostic manual breaks down symptoms into the two main groups discussed earlier: how your child socializes and how they act.

Criteria for an autism diagnosis

Your child must have difficulties in all three of the following social areas:

• Social-emotional reciprocity: The back-and-forth nature of socializing, like holding a conversation
• Nonverbal communication: The movements and subtle gestures, like body language and eye contact, that add meaning to the words we say
• Developing and maintaining relationships: Seeking people to spend time with and judging which behaviors are appropriate in different situations

AND your child must do at least two of the following:

• Engage in repetitive movements, use of objects or speech
• Insist on the same routine or ways of doing things
• Have very intense or unusual interests
• React more than expected to sights, sounds and textures and/or seek out sensory experiences

Is there an autism test?

No, not in the way you might think of a medical test. There aren’t any lab tests or markers in blood or pee for autism. Providers may do genetic testing to check for gene variations associated with autism. But genetic testing doesn’t diagnose autism. Instead, it may help narrow down the cause of your child’s brain differences.

When seeking a diagnosis, it helps to see a developmental pediatrician, who’s trained to recognize autism. They can do a standardized assessment, like the Autism Diagnostic Observation Schedule (ADOS). The ADOS is a set of questions that helps providers identify autism characteristics when observing or interacting with your child. The ADOS and similar tools are designed for providers to use in a clinical setting.

What should I know about autism treatment?

There are many different therapies available to support children with autism. Options like behavioral therapy, speech-language therapy and social skills training help your child manage any challenges they face and build on their strengths. The earlier such support begins — ideally, before age 3 — the more it can benefit your child in the long run.

Some autistic kids have other conditions that need support or treatment. There’s a wide range of conditions that may co-occur with autism, including attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, digestive issues, intellectual disabilities and obsessive-compulsive disorder (OCD).

Providers manage or treat these conditions with things like cognitive behavioral therapy, medications and referrals for educational support.

What’s the difference between autism and childhood disintegrative disorder?

Childhood disintegrative disorder was one of the names previously used to describe a specific disorder with features of autism.

In the past, a provider would diagnose a child with this disorder if they developed as expected for a period of time before they lost learned skills. This would usually occur after age 3.

Today, providers no longer give a diagnosis of childhood disintegrative disorder. Instead, a child with these features will receive a diagnosis of autism spectrum disorder.