Autism Spectrum Disorder

What is it?

Autism spectrum disorder (ASD) impacts a child’s development in social communication, social interaction and restricted, repetitive patterns of behavior and interests. ASD appears in early childhood. Boys are diagnosed with ASD around 3 to 4 times more often than girls.

Signs and Symptoms

Children with autism spectrum disorder have deficits in communication and social skills as well as restricted or repetitive behaviors. Signs of social deficits in a developing child include aversion to cuddling and hugging and a preference to play alone. Children under 3 who don’t respond to their own name or aren’t interested in giving or sharing may also have autism. In older children signs include difficulty making conversation, lack of eye contact, and difficulty using and reading body language. These children may have difficulty recognizing emotions and responding in different social situations, and understanding social relationships.

Some children with autism don’t talk; others talk in a stilted tone, or in an exaggerated singsong. A child with autism may also repeat certain phrases without appearing to understand their significance, or possess what experts call “non-functional knowledge”—information they can recite, but not use to solve problems or carry on a conversation. Young children with autism don’t point at objects of interest, don’t make eye contact, and don’t use gestures to communicate a need or describe something. Their tone or pattern of speech can be odd; some reverse pronouns. High-functioning children with autism may monopolize conversations while showing little capacity for reciprocity, or understanding what the other person wants or feels.

Behavioral signs include performing repetitive actions and rituals, and fixation on minute details. Children with autism can be upset by the slightest change in daily routine. In older children,  repetitive behavior can manifest as a consuming interest in a specific topic or object.

Children with autism are unusually sensitive to sounds, lights, textures or smells. They may be overwhelmed by too much sensory input, or be disturbed and uncomfortable because of a lack of sensory input, which they may try to get by bumping into things, and excessively touching and smelling things.

Risk factors include low birth weight and parental age. Boys are more likely to be diagnosed with autism spectrum disorder.

The link between childhood vaccination and onset of autism spectrum disorder is unproven.

Diagnosis and Treatment

A child must display symptoms in social communication and social interaction, and restrictive, repetitive patterns of behavior, interests, and activities. Symptoms must be present in early development and are typically recognized in a child’s second year—but may not fully manifest until a child is older and social demands exceed his abilities.

A clinician looks for deficits in social reciprocity, such as back-and-forth conversation and sharing of interests; nonverbal communication, including body language and gestures; and difficulty developing, understanding, and participating in age-appropriate relationships. A clinician also looks for stereotyped movements, actions or use of speech, inflexible insistence on routines and rituals, fixated and intense interests, and sensory problems, either from too much sensory input or two little. These symptoms must be significantly impairing, and a clinician will specify the severity of each of the symptoms on a three-tiered scale that reflects the amount of support a child would need—requiring support, substantial support, or very substantial support—to function successfully.

Children with autism also frequently have cognitive impairment; they should not be diagnosed with autism unless their social communication deficits are greater than would be explained by cognitive impairment. If a child has social communication impairments and social interaction but doesn’t have restrictive and repetitive behaviors, he is more likely to be diagnosed with social communication disorder.

A structured educational program and tailored behavioral therapy have been shown to be very beneficial to children with autism.

Applied behavior analysis has been effective in treating autism. This therapy seeks to maximize the child’s learning and development by systematically encouraging desired social and communication behaviors, actively teaching ways of interaction other children learn intuitively in childhood. Another approach, dubbed “developmentally-based intervention,” seeks to educate and engage with a child using the subjects, words, and stimuli appropriate to the developmental stages they have in effect been excluded from, modeling the typical progression for an atypical child. Other therapies include occupational, physical, and speech-language.

Medications may be prescribed to help with problems that occur alongside the disorder, such as depression, anxiety, and hyperactivity.

What are the risk factors for children?

Children with autism have other medical problems at a rate far above average. Epilepsy afflicts almost a third of children diagnosed with autism once they reach adulthood. Sleep disorders, allergies, and digestive problems are commonly seen, as are tic disorders like Tourette’s. These children are also more likely than others to be cognitively impaired.