Autism

What is autism?

Autism is a difference in how your child’s brain works that shapes how they interact with the world around them. We don’t know exactly why some people are autistic and others aren’t. But we do know:

• Autism isn’t a disease. This is important because healthcare providers try to “cure” diseases. With autism, the goal isn’t a cure. Instead, providers find ways to help your child make the most of their strengths while managing any challenges they face.
• Autistic people are neurodivergent. This word describes people whose brains are different from what’s expected. If your child is neurodivergent, they may excel more in certain areas and need more support in others compared to their neurotypical peers.
• Autism is a spectrum. Autistic kids and adults have a wide range of personality traits, strengths and challenges. This means there’s no one-size-fits-all approach to support. Providers tailor support to your child’s unique needs and preferences.
• Autism is often misunderstood. Myths about autism go back decades. These have harmed autistic people. We can’t erase this history, but we’ve learned from it. Today’s therapies help autistic kids gain skills without forcing them to fit into a certain mold.

When discussing autism, it’s important to acknowledge that words aren’t perfect. And sometimes, “medspeak” that healthcare providers use — like “disorder,” “symptoms” or “diagnosis” — doesn’t quite match the lived experience of autistic people or their families.

Throughout this article, we’ll use such medical terms as needed to describe how healthcare providers can support your family. But we recognize that autism is an identity, not just a diagnosis.

We use the term “autistic” to reflect the preferences of the autistic community, which largely prefers identity-first language.

What is autism spectrum disorder?

Autism spectrum disorder (ASD) is the full medical name for autism. The DSM-5-TR defines ASD as a difference in brain functioning that affects how you communicate and interact with others. For example, you may use eye contact or body language differently than someone who’s neurotypical.

This brain difference also affects various aspects of your behavior, interests or activities. For example, you may repeat movements or sounds (a behavior known as “stimming”) to regulate your emotions. You may prefer a fixed routine over change.

About 1 in every 31 kids in the U.S. has ASD.

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 some 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 taking-turn 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 initiate social interactions
• Makes little or no eye contact
• Has difficulty mixing spoken words and body language
• Has a hard time building relationships with peers
• 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 (echolalia)
• 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 the wheels of a toy car
• 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

There’s not always a clear line between what’s a feature of autism and what’s a kid simply being a kid. Lots of the things above are true for all children at one point or another. But with autism, these behaviors are more than a phase. And they may pose challenges for your child in certain settings, like school or socializing with peers.

What strengths do autistic people have?

Researchers have found a wide range of strengths among autistic people. Your child may have:

• The strength to speak out or “go against the crowd,” even if it’s not the popular thing to do
• A strong sense of right vs. wrong, leading them to follow their moral compass even when no one’s watching
• The ability to express their thoughts directly and honestly
• A knack for connecting with people of all ages
• The ability to focus for long periods of time and gain expertise on a topic
• Strong nonverbal reasoning skills

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. You might see these things described as “environmental factors” or “prenatal events.” These factors all interact to lead to the brain differences we see in autism.

Specific things that may make autism more likely in your child include:

• 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

These factors may directly change how your baby’s brain develops. Or they may affect how certain genes work, leading to brain differences, in turn.

Is autism genetic?

Yes — but the genetic causes of autism are complicated. There’s not a single, specific gene variation that’s unique to autism. This makes autism different from some other genetic conditions, like cystic fibrosis, where providers can pinpoint a specific gene variation and say, “Ah! There it is.”

Instead, many gene variations are linked to autism. This means autistic people might have one or more gene variations that play a role in their brain differences.

But there’s not always a clear genetic cause. For example, genetic testing for your child may reveal no gene variations associated with autism. This finding doesn’t change their diagnosis. And it doesn’t rule out a genetic cause. It’s possible that other gene variations contribute to autism, and researchers simply haven’t identified them yet.

Is autism inherited?

It can be. It’s easy to confuse genetics with inheritance. When we say autism is genetic, we mean variations in certain genes affect how your baby’s brain works. Those gene variations might pop up for the first time in your baby — in this case, they’re not inherited.

But it’s also possible for biological parents to pass down gene variations to their children. Experts think autism can be inherited because they see patterns among siblings.

How do healthcare providers diagnose autism?

Diagnosing autism involves several steps. Often, the process begins at a routine well-check (annual physical). 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. This specialist will talk with you and spend some time observing and interacting with your child. They’ll look for specific symptoms (characteristics) typical of 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: This is the back-and-forth nature of socializing. A common example is holding a conversation.
• Nonverbal communication: These are the movements and subtle gestures that add meaning to the words we say. Eye contact and body language are examples.
• Developing and maintaining relationships: This involves seeking people to spend time with. It also involves 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: This means doing or saying the same thing over and over, more than you might expect.
• Insist on the same routine or ways of doing things: This means relying heavily on sameness and resisting change.
• Have very intense or unusual interests: This is an interest in a certain object or topic that’s stronger or more consuming than you’d expect.
• React more than expected to sights, sounds and textures and/or seek out sensory experiences: This is when your child’s environment overwhelms or underwhelms them. If they need more sensory input, they might sniff or touch objects more than expected.

Is there an autism test?

No, not in the way you might think of a medical test. There aren’t any lab tests or specific 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 administer a standardized assessment, like the Autism Diagnostic Observation Schedule (ADOS). The ADOS is a set of questions that help 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. These therapies help your child manage any challenges they face and build on their strengths. Some therapies teach you and other family members ways to support your child.

The earlier such support begins — ideally, before age 3 — the more it can benefit your child in the long run.

Treatment for co-occurring conditions

Some autistic kids have other conditions that need support or treatment. Conditions that may co-occur with autism include:

• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety disorders
• Avoidant/restrictive food intake disorder (ARFID)
• Conduct disorder or oppositional defiant disorder
• Bipolar disorders
• Depressive disorders
• Digestive issues, like constipation
• Epilepsy
• Intellectual disabilities
• Obsessive-compulsive disorder (OCD)
• Schizophrenia spectrum disorder
• Sensory processing disorder
• Sleep disorders

Providers manage or treat these conditions with things like:

• Cognitive behavioral therapy (CBT)
• Medications
• Referrals for educational support — for example, to create an Individualized Education Plan (IEP) to meet your child’s learning needs

Is ASD a neurodevelopmental disorder?

Yes. ASD falls within the umbrella category of neurodevelopmental disorders. These are conditions affecting a child’s brain function that become noticeable early in life — often before or soon after starting school.

In the past, 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 now recognize that autism is a spectrum with a wide range of features, and autistic kids need varying levels of support. So, instead of using these other names, providers use ASD as the official diagnosis. They also describe specific features and needs unique to each child.