Autism Spectrum Disorder (ASD)

What is autism spectrum disorder in children?

Autism spectrum disorder (ASD) is a problem that affects a child’s nervous system and growth and development. It often shows up during a child’s first 3 years of life.

Some children with ASD seem to live in their own world. They are not interested in other children and lack social awareness. A child with ASD focuses on following a routine that may include normal behaviors. A child with the disorder also often has problems communicating with others. They may not start speaking as soon as other children. They may not want to make eye contact with other people.

ASD can keep a child from developing social skills. This is in part because a child with ASD may not be able to understand facial expressions or emotions in other people. A child with ASD may:

• Not want to be touched

• Want to play alone

• Not want to change routines

A child with ASD may also repeat movements. This might be flapping their hands or rocking. They may also have abnormal attachments to objects. But a child with ASD may also do certain mental tasks very well. For example, the child may be able to count or measure better than other children. Children with ASD may do well in art or music, or be able to remember certain things very well.

What causes ASD in a child?

Experts don’t know what causes ASD. It may be caused by certain genes. A child with ASD may also have problems with their brain structure or with certain chemicals in the brain. Researchers do know that ASD is not caused by what a parent does to raise a child. It is also not linked to any vaccines given to children.

Much less often, other things that may cause ASD include:

• Being exposed to toxins in the environment before or after birth

• Severe infections such as meningitis or encephalitis that result in brain damage

• Problems during delivery

• Infections before birth

Which children are at risk for ASD?

ASD occurs in all racial, ethnic, and socioeconomic groups. The disorder happens much more often in boys than girls. Four to 5 times as many boys as girls have ASD.

Certain gene disorders that run in families can raise a child’s risk for ASD. These include:

• Fragile-X

• Phenylketonuria (PKU)

• Neurofibromatosis

• Tuberous sclerosis

• Chromosome problems

Your child may need genetic testing to help find out if another problem has contributed. The testing is done by a medical geneticist. This is a healthcare provider with special training in genetics and inherited problems. They can let you know the chances of having another child with the gene problem. For example, PKU carries a 1 in 4 chance of happening in another pregnancy. For tuberous sclerosis, the chances are 1 in 2.

Even when no gene problem is found, you are at a slightly higher chance of having another child with ASD. Experts think this is because several genes from both parents may act together to cause ASD.

What are the symptoms of ASD in a child?

Each child may have different symptoms. Below are the most common symptoms of ASD.

Social symptoms

• Has problems making eye contact with others

• Has problems making friends or interacting well with other children

Communication symptoms

• Does not communicate well with others

• Starts speaking at a later age than other children or doesn’t speak at all

• When the child is able to speak, doesn’t use speech in social settings

• Repeats words or phrases (echolalia) or repeats parts of dialogue from TV or movies

Behavior symptoms

• Does repeated movements, such as rocking or flapping fingers or hands

• May be too sensitive or less sensitive to certain things around them, such as lights, sounds, touch, or taste

• Has rituals

• Needs routines

The symptoms of ASD may look like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is ASD diagnosed in a child?

No single medical test can diagnose ASD. Healthcare providers use certain guidelines to help diagnose ASD in children before age 2. The guidelines can help diagnose the disorder early. Children diagnosed with ASD early can be treated right away.

The guidelines say that all children should be screened for ASD and other development disorders before age 2. The screening is done at well-child checkups. Children who have symptoms of development or behavior disorders will need to get more testing for ASD.

Healthcare providers look for the following problems during well-child visits before age 2:

• No babbling, pointing, or gesturing by age 12 months

• No single words spoken by age 16 months

• No two-word phrases by age 24 months, just repeating words or sounds of others

• Loss of any language or social skills at any age

• No eye contact at 3 to 4 months

If a child has any of the above problems, the healthcare provider will do more screening. This will help show if your child has ASD or another developmental disorder. Your child may need to see a healthcare provider with special training to diagnose and treat ASD. Your child may also need these screening tests:

• Nervous system exam

• Imaging tests such as CT scan, MRI, or PET scan

• Mental health tests

• Genetic tests to look for gene problems that cause ASD or other developmental disorders

How is ASD treated in a child?

Each child with ASD needs their own special treatment program. This is because children with ASD can vary a lot in how much help they need. Programs that work best are those that are started as early as possible and include the parents.

Treatment for ASD includes:

• Behavior change programs. These programs teach social skills, movement skills, and thinking (cognitive) skills. They can help a child change problem behaviors.

• Special education programs. These focus on social skills, speech, language, self-care, and job skills.

• Medicine. Some children need medicine to help treat some of the symptoms of ASD.

Your child and your family may also need to see a mental health provider. This provider can give you parent counseling, social skills training, and one-on-one therapy. This healthcare provider can also help you find the treatment programs that are best for your child.

How can I help prevent ASD in my child?

Experts don’t know how to prevent ASD in children. They do know that it is not caused by what a parent does to raise a child, nor is it linked to childhood vaccines. Spotting and treating ASD early can reduce symptoms and enhance your child’s normal development. It can also improve your child’s quality of life.

How can I help my child live with ASD?

ASD is a lifelong condition that can put great stress on both the person with ASD and their family. Your child’s primary care provider will play a key role in supporting you and your child. They will help you understand treatment and how to care for your child. You play a critical part in your child’s treatment and well-being. Here are things you can do to help your child:

• Keep all appointments with your child’s healthcare provider.

• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include neurologists, speech-language pathologists, occupational and physical therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on your child’s needs and how severe the symptoms of ASD are.

• Tell others about your child’s ASD. Work with your child’s healthcare provider and schools to create a treatment plan.

• Check for school resources for your child. Many times a child’s ASD seriously interferes with their ability to manage regular school settings. The Americans with Disabilities Act (ADA) and Section 504 of the Civil Rights Act can help protect children with special educational needs. Talk with your child's teacher or school principal for more information.

• Have your child wear a medical alert bracelet or necklace if they wander or have communication problems. Also think about having them carry an emergency form with contact information and communication symbols.

• Reach out for support from local community services. ASD can be stressful. Being in touch with other parents who have a child with ASD may be helpful.

• Take care of yourself and watch for signs of stress in you or your family members. The physical and emotional demands of caregiving can be overwhelming. Let family and friends help and provide respite care. A break can be helpful for both you and your child. Get additional professional support if needed.

Key points about autism spectrum disorder in children

• Autism spectrum disorder (ASD) is a problem that affects a child’s nervous system and growth and development.

• A child with ASD often has problems communicating. They may have trouble developing social skills.

• Genes may play a role in ASD.

• All children should be screened for ASD before age 2.

• Diagnosis may include imaging and genetic tests.

• Children with ASD need a special, long-term treatment plan. It may include programs that change behavior and teach social skills.

• Each child with ASD is unique and has unique experiences. Families can get help from community-based resources.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Online Medical Reviewers:

• Dan Brennan MD
• L Renee Watson MSN RN
• Paul Ballas MD