Autism Spectrum Disorder
Autism Spectrum Disorder is marked by impairment in social interaction and communication, and by restrictive and repetitive behaviors. The symptoms are noticeable in early childhood, and can have a significant impact on general function throughout the lifetime. There is no one type of Autism Spectrum Disorder; in fact, there is great variability in presentation from person to person. Some may be severely challenged, while others may be able to function independently and have areas of giftedness. It is because of this great variability that autism is referred to as a spectrum disorder.
Autism Spectrum Disorder, or ASD, affects 1 in 54 children in the United States. It is four times more common in boys than girls, and occurs in all ethnic, racial and socio-economic groups. Just as there is no one presentation of ASD, there is no one cause of ASD. Research points to many different environmental, biological and genetic factors that may interact to result in the development of ASD. Some risk factors that make one more susceptible to ASD include having older parents or a sibling with ASD, low birth weight, and genetic conditions such as Down syndrome, fragile X syndrome, and Rett syndrome.
Signs of ASD are noticeable as early as the first year of life and most often before age three. Social deficits are a hallmark symptom of ASD. Babies, toddlers and young children may make little to no eye contact, may not look at or listen to people who are speaking, and may be slow to respond when others call their name or try to get their attention. Behaviors that indicate object enjoyment, such as pointing at things or showing things to others, may be absent. Toddlers with ASD may not enjoy common social games, such as pee-a-boo and pattycake.
Back and forth conversation may be difficult for those with ASD. They may have difficulty understanding another’s point of view or another’s feelings. It may be difficult to understand personal space and they may stand too close to others. They may prefer to be alone over interacting with others; or, they may wish to socially interact but not understand how to develop friendships. For example, many children with ASD have a hard time taking turns and sharing, and other children may not want to play with them as a result.
People with ASD may be easily upset by even minor changes to their typical routine. For example, children with ASD may have a melt-down if a parent makes an unexpected stop on the way home from school. Also, some routines preferred by those with ASD may seem unusual to others. Nevertheless, if kept from the preferred routine, this too will cause frustration and accompanying melt-downs.
Communication challenges are also common in ASD. Those with ASD may have delayed speech and language skills, may repeat words or phrases they hear, and may respond to questions with answers that are not related to the subject matter. They may talk at length about a subject they really like, without noticing others are not interested, or may not give others an opportunity to respond. They may speak with an unusual tone, for example in a sing-song fashion or in a flat, robot-like manner, or have inappropriate facial expressions. Some children might sound more like adults than children when they speak, failing to pick up on the nuances of speech common to children. They may not understand jokes, sarcasm or teasing. Their gestures may not match what they are saying, for example, they might smile while saying something sad.
ASD is also marked by unusual interests and behaviors. For example, children with ASD may have obsessive interests. They may like parts of objects, such as the wheels of toy cars. They may obsess over organization, needing their toys to be lined up a certain way. Those with ASD may be sensitive and react strongly to sensory input, including light, noise, textures, and temperatures. They may flap their hands, rock their body, or spin in circles, referred to as self-stimulatory behaviors.
Finally, other symptoms commonly seen among those with ASD include hyperactivity (excessive movement, hard to stay still), impulsivity (react without thinking), short attention span, irritability and aggression, tantrums, and unusual eating and sleeping habits. Also, children with ASD might have unusual fear responses, being afraid of harmless things yet not afraid of more dangerous things. They may dislike physical touch and get little comfort from cuddling with loved ones.
Though the challenges are many, those with ASD may have many strengths. They may be exceptionally skilled at learning things in detail, and remembering information for long periods of time. They may excel in certain subjects, such as math, science, music or art. They may be very good at putting puzzles together and solving computer problems.
There are three conditions that fall under the term ASD: autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). These are distinguished by the presence and severity of autism symptoms. For example, those with autistic disorder may have significant language delays, social and communication deficits, and unusual behaviors as described above, along with an intellectual disability. Those with Asperger syndrome may present with social challenges and unusual behaviors or interests, though no language delays or intellectual deficits. Those with PDD-NOS may have only social and communication challenges.
Because of the great variability in this spectrum disorder, there is no one size fits all treatment. Research indicates, and all professionals agree, that early intervention is essential. Though there is no cure, behavioral, psychological, and educational therapies are all interventions that can help reduce challenging behaviors, build upon existing strengths, and help in the development of social, communication and language skills.
If you suspect your child may have ASD, the first step is to speak with your child’s pediatrician. Ask for a referral to a specialist who can complete an in-depth evaluation, for example a developmental pediatrician, a child neurologist, or a child psychologist. In addition, you can request a free evaluation through your state’s public early childhood system. It is every school district’s duty to evaluate and potentially serve all children age 0 to 21. You do not need a referral from your doctor, or a medical diagnosis, to make this call.