Autism Disorder

What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Some people with ASD have a known difference, such as a genetic condition. Other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop. We still have much to learn about these causes and how they impact people with ASD.

People with ASD may behave, communicate, interact, and learn in ways that are different from most other people. There is often nothing about how they look that sets them apart from other people.  The abilities of people with ASD can vary significantly. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, although symptoms may improve over time. Some children show ASD symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months of age or later. Some children with ASD gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had.

As children with ASD become adolescents and young adults, they may have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may come to the attention of healthcare providers because they also have conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder, which occur more often in people with ASD than in people without ASD.

Signs and Symptoms

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.

Social Communication and Interaction Skills

Social communication and interaction skills can be challenging for people with ASD.

Examples of social communication and social interaction characteristics related to ASD can include

• Avoids or does not keep eye contact
• Does not respond to name by 9 months of age
• Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age
• Does not play simple interactive games like pat-a-cake by 12 months of age
• Uses few or no gestures by 12 months of age (for example, does not wave goodbye)
• Does not share interests with others by 15 months of age (for example, shows you an object that they like)
• Does not point to show you something interesting by 18 months of age
• Does not notice when others are hurt or upset by 24 months of age
• Does not notice other children and join them in play by 36 months of age
• Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age
• Does not sing, dance, or act for you by 60 months of age

Restricted or Repetitive Behaviors or Interests

People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by problems with social communication and interaction only.

Examples of restricted or repetitive behaviors and interests related to ASD can include

• Lines up toys or other objects and gets upset when order is changed
• Repeats words or phrases over and over (called echolalia)
• Plays with toys the same way every time
• Is focused on parts of objects (for example, wheels)
• Gets upset by minor changes
• Has obsessive interests
• Must follow certain routines
• Flaps hands, rocks body, or spins self in circles
• Has unusual reactions to the way things sound, smell, taste, look, or feel

Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s behavior and development to make a diagnosis. ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable. However, many children do not receive a final diagnosis until they are much older. Some people are not diagnosed until they are adolescents or adults. This delay means that people with ASD might not get the early help they need.

Treatment

Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs.  Treatment plans usually involve multiple professionals and are catered to the individual.

Risk Factors

There is not just one cause of ASD. There are many different factors that have been identified that may make a child more likely to have ASD, including environmental, biologic, and genetic factors.

Although we know little about specific causes, the available evidence suggests that the following may put children at greater risk for developing ASD:

• Having a sibling with ASD
• Having certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis
• Experiencing complications at birth
• Being born to older parents