Autism spectrum disorder (ASD) is a developmental disorder. It affects a person's behavior and makes communication and social interactions difficult.
ASD can range from mild to severe. The type of symptoms a person has and how severe they are varies. Some children may not be able to function without a lot of help from parents and other caregivers. Others may develop social and verbal skills and lead independent lives as adults.
Most people with ASD will always have some trouble communicating or interacting with others. But early diagnosis and treatment have helped more and more people who have ASD lead full lives and do things such as going to college and having a job.
ASD now includes conditions that used to be diagnosed separately. These include autism, Asperger's syndrome, pervasive developmental disorder, and childhood disintegrative disorder. Any of these terms might still be used by you or your doctor to describe your condition.
The exact cause of ASD is not known.
False claims in the news have made some parents concerned about a link between ASD and vaccines. But studies have found no link between vaccines and ASD. It's important to make sure that your child gets all childhood vaccines. They help keep your child from getting serious diseases that can cause harm or even death.footnote 1
ASD tends to run in families, so experts think it may be something that you inherit. Scientists are trying to find out exactly which genes may be responsible for passing down ASD in families. ASD tends to occur more often in people who have certain genetic conditions. These may include fragile X syndrome and tuberous sclerosis.
Some things increase the chance that you'll have a baby with ASD. These things are called risk factors.
The risk of having a baby with ASD is higher if either birth parent:
Symptoms usually are noticed by the time a child is 2 years old. But if symptoms are severe, a parent may notice them as early as when a child is 12 months old.
In most cases, parents first notice that their toddler has not started talking yet and is not acting like other children the same age. Sometimes a child with ASD may start to talk at the same time as others the same age. But then they may stop gaining new skills or lose their social and language skills.
Symptoms of ASD include:
Behavior and symptoms can range from mild to severe. Parents often say that their child with ASD prefers to play alone and doesn't make eye contact with other people.
People with ASD may also have other problems, such as speech and language issues, sleep problems, and seizures. They may also have attention deficit hyperactivity disorder (ADHD), depression, or anxiety.
There is no single test to diagnose ASD. Diagnosing ASD involves a combination of screening questions, assessments, and evaluation of the way a child behaves and interacts with others.
As a parent, you know your child best and are their best advocate. If you are concerned, share your observations with your doctor. Your input could help your child get the help they need.
Screening questions are usually asked at the 18-month and 24-month well-child visits. But they may be asked sooner if you are concerned that your child may have signs of ASD. The questions cover how your child talks, moves, and interacts with others. The answers help your doctor understand how your child is developing and if there are signs of a problem that might be related to ASD.
If your doctor thinks your child may have ASD, he or she may refer you to a specialist, such as a developmental pediatrician, child psychiatrist or psychologist, or neuropsychologist.
A specialist will ask about your child's health history and do a physical exam. A specialist will also:
This can help you know if your child has ASD or if he or she has a different problem, such as a language delay or ASD and another condition. Testing also helps identify how severe the symptoms are and what your child's strengths and weaknesses are. All of this can help your doctor decide on the best way to treat your child.
The goals of treatment for ASD are to:
Treating ASD early gives you the tools and support to help your child lead the best life possible.
What type of treatment your child may need depends on the symptoms. These are different for each child. And treatment may change over time. Because people with ASD are so different, something that helps one person may not help another. Work with everyone involved in your child's education and care to find the best way to help manage symptoms and help your child thrive to the best of his or her ability.
Treatment may include:
An important part of your child's treatment plan is to make sure that other family members get training about ASD and how to help manage symptoms. Training can reduce family stress and help your child function better. Some families need more help than others.
Take advantage of every kind of help you can find. Talk to your doctor about what help is available where you live. Family, friends, public agencies, and ASD organizations are all possible resources.
Remember these tips:
How severe the symptoms are varies a lot. But all people with autism spectrum disorder (ASD) have some core symptoms in the areas of:
People who have ASD are born with it. In most cases, symptoms are noticed by the time a child is 2 years old. But if symptoms are severe, a parent may notice them as early as when a child is 12 months old.
Parents often become concerned when their toddler:
During the second year of life, parents may notice that their child repeats certain phrases, rituals, or routines. For example, a child may rock his or her body or flap his or her hands over and over again. Or a child may get very upset if a toy is out of place.
Parents also may be confused about their child's hearing abilities. It often seems that a child with ASD does not hear. But at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability to interact with others, communicate, and help themselves as they grow older.
During the teen years, the patterns of behavior often change. Many teens gain skills. But they still lag behind in how well they can interact with and understand others. For example, they may not pick up on social cues. They may not be able to read others' body language, start a conversation or keep it going, and take turns talking. They may not understand a joke or may take a sarcastic comment literally.
Puberty and emerging sexuality may be harder for teens who have ASD than for others this age.
More and more adults who have ASD are able to work and live on their own.
But some adults need help. This is especially true for those with below-average intelligence who are unable to speak. They may need part- or full-time supervision provided by a supportive living center or group home. People who have average to above-average intelligence are often successful in their jobs and able to live on their own. They are able to do this even though they continue to have some trouble interacting with other people.
People with ASD may:
There is no single test to diagnose autism spectrum disorder (ASD). The diagnosis is based on an evaluation that includes screening questions, assessments, and evaluation of how your child behaves and interacts with others.
As a parent, you know your child best and are their best advocate. If you are concerned, share your observations with your doctor. Your input could help your child get the help they need.
Screening questions are usually asked at the 18-month and 24-month well-child visits. But they may be asked sooner if you are concerned that your child may have signs of ASD. The questions cover how your child talks, moves, and interacts with others. The answers help your doctor understand how your child is developing and if your child has signs of a developmental problem related to ASD.
All doctors who do well-child visits should watch for early signs of developmental disorders. A child who has these signs of developmental delays should be evaluated:
But if there are no clear signs of problems from the screening tests, most children do not need more evaluation until the next well-child visit.
If your child is at a higher risk for ASD—such as having a sibling with ASD or having a genetic condition such as fragile X syndrome—he or she may need more screening and need to be screened more often.
Anyone who develops problems with socialization, learning, or behavior should also be evaluated.
If your doctor thinks your child may have ASD, he or she may refer you to a specialist. This may include a developmental pediatrician, child psychiatrist or psychologist, or neuropsychologist. Your child may also see other specialists, such as a speech or occupational therapist, for a complete evaluation.
The goals of testing are to:
Your doctor relies on a combination of exams, tests, and other information to diagnose ASD. All of this can help your doctor decide on the best way to treat your child. Exams and tests include:
Other lab tests may be done in certain cases. These tests include:
The goals of treatment for autism spectrum disorder (ASD) are to:
Treating ASD early gives you the tools and support to help your child lead the best life possible.
What type of treatment your child may need depends on the symptoms. These are different for each child. Treatment may change over time. Because people with ASD are so different, something that helps one person may not help another. Work with everyone involved in your child's education and care to find the best way to help manage symptoms and help your child thrive to the best of his or her ability.
In general, children with ASD respond best to treatment that is very structured and specialized. A good program helps parents know how to care for their child. It helps with a child's behavior and improves his or her ability to communicate, learn, be social, and adapt to new situations.
Treatment may include:
Treatment may also address other problems related to ASD, like seizures or sleep problems. For example, medicines may be used to treat seizures. In most cases, sleep problems are treated by staying on a routine. This means having a set bedtime and time to get up.
If you're concerned about your child's development, you don't have to wait for a diagnosis of ASD to start treatment. Each state offers early intervention programs to children under the age of 3 who show signs of developmental delays. These programs can help children develop age-appropriate skills and behaviors. And they can help children get back some of the skills and abilities they may have lost to prevent further delays. Ask your doctor about getting a referral to one of these programs. Or visit www.ectacenter.org/contact/ptccoord.asp to find out what programs are available in your area.
You may hear about other approaches to ASD treatment such as complementary or alternative practices. These may include special diets, secretin, and auditory integration training. There is no evidence to show that these things have any benefit. And some of these treatments may be harmful or have risks associated with them.
When you are thinking about any type of treatment, find out about the source of the information and about whether the treatments are backed up by science. Stories by people who were helped by a treatment are not enough evidence to support using a treatment. Talk with your doctor about any complementary health practice that you would like to try or are already using.
Parenting a child who has autism spectrum disorder (ASD) requires taking a proactive approach to learning about the condition and its treatment. You also need to take care of yourself so that you are able to face the many challenges of having a child with ASD. Here are some things that may help.
Close communication with others involved in your child's education and care will help everyone. The best treatment for children with ASD is a team approach and a consistent, structured program both at home and at school. Everyone involved needs to work together to set goals for:
Work closely with the health professionals involved in your child's care.
You can best serve your child by learning about ASD and by providing a supportive and loving home. Flexibility, creativity, and a willingness to keep learning will help you as you raise your child. Here are some things to know about this condition and some ways you can help your child.
Learn ways to handle the normal range of emotions, fears, and concerns that go along with raising a child who has ASD. The daily and long-term challenges put you and your other children at more risk for depression or stress-related illnesses. The way you handle these issues influences other family members.
Citations
- Taylor LE, et al. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccines, 32(29): 3623–3629.
Other Works Consulted
- Raviola GJ, et al. (2015). Autism spectrum disorder. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 176–183. Philadelphia: Elsevier.
- Volkmar F, et al. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2): 237–257. DOI: 10.1016/j.jaac.2013.10.013. Accessed November 8, 2018.
- Zwaigenbaum L, et al. (2015). Early intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. Pediatrics, 136(1): S60–S81. DOI: 10.1542/peds.2014-3667E. Accessed November 8, 2018.
- Zwaigenbaum L, et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136(1): S41–S59. DOI: 10.1542/peds.2014-3667D. Accessed November 8, 2018.
- American Psychiatric Association (2013). Neurodevelopmental disorders. In Diagnostic and Statistical Manual of Mental Disorders, 5th ed., pp. 31–86. Washington, DC: American Psychiatric Association.
- Harrington JW, Allen K (2014). The clinician's guide to autism. Pediatrics in Review, 35(2): 62–113. DOI: 10.1542/pir.35-2-62. Accessed December 11, 2018.
- Myers SM, et al. (2007, reaffirmed 2010). American Academy of Pediatrics clinical report: Management of children with autism spectrum disorders. Pediatrics, 120(5): 1162–1182.
- Sanchack KE, Thomas CA (2016). Autism spectrum disorder: Primary care principles. American Academy of Family Physicians, 94(12): 972–979. https://www.aafp.org/afp/2016/1215/p972.html. Accessed November 8, 2018.
Current as of: September 23, 2020
Author: Healthwise Staff
Medical Review:John Pope MD - Pediatrics & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Louis Pellegrino MD - Developmental Pediatrics
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