What is autism spectrum disorder?

Autism spectrum disorder (ASD) is a developmental disorder. It affects a person's behavior. And it makes communication and social interactions hard.

Behavior and symptoms can range from mild to severe. The type of symptoms your child has and how severe they are varies. For example, your child might prefer to play alone and avoid eye contact. Or your child may be late to develop social or verbal skills.

Children with ASD may do things because of a need for sameness or routines. For example, your child may rock his or her body. Or you may notice that your child gets attached to objects or repeats certain rituals and routines.

Some children with ASD need help in most parts of their lives. Others may learn social and verbal skills and lead independent lives as adults. Finding and treating ASD early has helped many children who have ASD to lead full lives. They can do things like go to college and have a job.

ASD now includes conditions that used to be diagnosed separately. These include:

• Autism.
• Asperger's syndrome.
• Pervasive developmental disorder.
• Childhood disintegrative disorder.

You or your doctor might use any of these terms to describe the condition.

ASD during childhood

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:

• Doesn't like to be held.
• Doesn't seem interested in playing certain games, such as peekaboo.
• Doesn't begin to talk. Or sometimes a child with ASD may start to talk at the same time as others who are the same age but then stop gaining new skills or lose their social and language skills.

During the second year of life, parents may notice that their child repeats certain phrases, rituals, or routines. For example, a child with ASD may insist on putting textbooks, notepads, and pencils in a backpack the same way every time. Or a child may insist that a game be played in a certain way. Parents may also notice that their child repeats certain behaviors. For example, a child may rock their body or flap their hands over and over again.

Parents may also be confused about their child's hearing abilities. It often seems that a child with ASD doesn't hear. But at other times, they may appear to hear a distant background noise, such as the whistle of a train.

With early and intensive treatment, most children can improve. They can improve their ability to interact with others, communicate, and help themselves as they grow older.

ASD during teen years

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 growing sexuality may be harder for teens who have ASD than for others this age.

ASD during adulthood

More and more adults who have ASD are able to work and live on their own. And many of them are going to college or vocational school.

People who have average to above-average intelligence are often successful in school and at their jobs and able to live on their own. They are able to do this even though they still have some trouble interacting with other people.

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 at a supportive living center or group home.

Behavior and symptoms of ASD in adults can range from mild to severe.

Core symptoms

How severe the symptoms are varies a lot. But adults with ASD have some symptoms in these areas:

Communication and social interactions.

Symptoms may include:

• Problems with nonverbal communication. For example, adults with ASD may have problems using or responding to gestures or pointing, facial expressions, and body posture. And they may have problems making eye contact.
• Problems with relationships. For example, adults with ASD may have a hard time making friends, bonding with their child or partner, or working with colleagues or supervisors. And they may have problems dating or forming and keeping romantic relationships.
• A lack of interest in sharing enjoyment, interests, or achievements with other people.
• A lack of empathy. Adults with ASD may have a hard time understanding someone else's feelings, such as pain or sadness.
• Problems starting a conversation. Adults with ASD have a hard time keeping a conversation going after it starts.
• Not being able to notice small differences in speech tone, pitch, and accent that alter the meaning of others' speech. For example, an adult with ASD may not know when someone is using humor. They may interpret what someone says word for word and not understand the implied meaning.
• Speech that's flat and hard to understand because it lacks tone, pitch, and accent.

Repetitive behaviors and limited interests in activities.

Symptoms may include:

• Being focused on certain topics. For example, adults with ASD may be very focused on video games, trading cards, or license plates.
• A need for sameness and routines. For example, an adult with ASD may always need to eat bread before salad. Or he or she may insist on taking the same route every day to work.
• Repetitive use of language. Adults with ASD often repeat over and over a phrase they have heard. (This is called echolalia.)
• Reacting too much or too little to one or more senses. These include touch, movement, smell, taste, vision, or sound. For example, an adult may get easily overwhelmed by bright lights, crowds, or loud noises. Or he or she may describe a light touch as painful and deep pressure as something that calms them. Others may not feel pain at all.

Some symptoms, like repetitive behaviors, may get better over time.

Other symptoms

People with ASD may also have other problems. These include:

Attention deficit hyperactivity disorder (ADHD) or symptoms similar to ADHD.

But these symptoms are more severe for people with ASD, especially problems with social relationships.

Depression, anxiety, or epilepsy.

People with ASD have an increased risk for depression and anxiety. And they may be more likely to have seizures.

Problems with coordination.

People who have ASD may lack coordination or be somewhat clumsy. They may have unusual facial expressions, body postures, and gestures. And they may have poor handwriting or have trouble with other motor skills, such as riding a bike.

Sleep problems.

It's common for people with ASD to have trouble sleeping.

Gastrointestinal problems.

These problems may include diarrhea, constipation, or belly pain.

Strong food likes and dislikes.

Adults with ASD may be sensitive to the color, taste, smell, or texture of food. For example, they often have picky eating habits. One reason for this may not be because of how the food tastes, but because of how it feels, or its texture.

Eating things that aren't food.

These may include eating chalk, dirt, hair, paint, or paper. This is a condition called pica.

Wandering off from a caregiver.

For many caregivers, this is one of the most stressful behaviors they must learn to cope with.

A few people with ASD have some form of savant skills. For example, they may have special limited gifts. This may be a musical talent or being able to memorize lists, calculate calendar dates, or draw.

Treatment for ASD involves behavioral training. This training rewards appropriate behavior to teach children social and other skills. Treatment may also include structured teaching. This involves organizing a child's day and school setting to help a child learn new skills. Some children also need things like speech therapy, physical therapy, or medicine.

Doctors use screening questions, exams, and tests to see how your child behaves and interacts with others. Talk with the doctor about what you've observed. The doctor will use all of this information, along with his or her judgment, to assess how your child is developing and look for signs of ASD.

You can best serve your child by learning about ASD and providing a supportive and loving home environment. 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.

Your child has strengths.

Like any other child, your child has strengths and weaknesses. Help build those strengths by encouraging your child to explore interests at home and at school.

Maturity may come slowly.

Children with ASD often mature more slowly than their peers. Don't always expect them to "act their age."

Routines are helpful.

Children with ASD benefit from daily routines for meals, homework, and bedtime. They also like specific rules. Consistent expectations mean less stress and confusion for them.

Sleep problems are common.

Many children with ASD have sleep problems. These problems are most often treated by staying on a routine. This includes having a set bedtime and time to get up.

Screens can interfere with sleep.

Children with ASD may be especially interested in screen-based media such as TVs, video games, and computers. If you can, keep these items out of your child's bedroom. Children with ASD who have these devices in their bedroom are likely to sleep fewer hours. If your child doesn't get enough sleep, ASD symptoms may be worse.

Textures can cause problems.

Children with ASD are very sensitive to textures. They often have picky eating habits. Or they may take a long time to acquire tastes for new foods. This may not be because of how the food tastes, but because of how it feels or its texture.

Background noises can be bothersome.

Be aware that background noises, such as a clock ticking or the hum of fluorescent lighting, may be distracting to your child.

Change can be stressful.

Change or new situations may be stressful for a child with ASD. Try to identify stress triggers. Avoid them if you can. Prepare your child in advance for difficult situations, and teach your child ways to cope.

Certain teaching styles may work best.

• Many people with ASD do best with verbal (rather than nonverbal) teaching and assignments. Visual supports, such as schedules and other organizational aids, can be helpful. A direct, concise, and straightforward manner is also helpful.
• People with ASD may benefit from a parts-to-whole teaching approach. They often have trouble understanding the "big picture." They tend to see part of a situation rather than the whole. It may help to start with part of a concept. Then add to it to demonstrate larger ideas.

ASD tends to run in families. So it may be something you inherit. The risk of having a baby with ASD is higher if either birth parent is at an older age or has another child with ASD. It occurs more often in people who have certain genetic conditions, like fragile X syndrome.

You may hear about other approaches to treat ASD, such as special diets, secretin, and auditory integration training. There is no evidence to show that these have any benefit. And some of these treatments may be harmful or have risks associated with them. Talk with your doctor before trying any of them.

Getting support can help when raising a child with autism spectrum disorder (ASD). Here are some ideas that may help.

Learn ways to help a child with ASD.

Make sure family members and caregivers get ongoing training so that they can be a part of helping manage a child's symptoms. Training can reduce family stress and help a child function better. Ask your doctor what training is available.

Use every kind of help you can find.

Family, friends, public agencies, and ASD organizations are possible resources.

Connect with other families who have children with ASD.

You can share your experiences and advice with people who will understand.

Plan breaks to connect with others in the family.

Think about respite care. This service provides a break for parents and siblings so you can recharge and be at your best for your child.

Get extra help when your child gets older.

As with all children, children with ASD may have a very hard time during the teen years. Community services and public programs can help.

People with ASD may also have other problems. These include:

• Attention deficit hyperactivity disorder (ADHD) or symptoms similar to ADHD.
• Problems with coordination. People who have ASD may lack coordination or be somewhat clumsy. They may have unusual facial expressions, body postures, and gestures. And they may have poor handwriting or have trouble with other motor skills, such as riding a bike.
• Sleep problems.
• Strong food likes and dislikes. Children with ASD may be sensitive to the color, taste, smell, or texture of food.
• Eating things that aren't food. These may include eating chalk, dirt, hair, paint, or paper. This is a condition called pica.
• Wandering off from a caregiver. For many caregivers, this is one of the most stressful behaviors they must learn to cope with. Wandering off puts the child's safety at risk.
• Depression, anxiety, or seizures.

The exact cause of ASD isn't known. But many factors may be involved. A change in certain genes or an interaction of several genes may be responsible. And something in the environment may play a role in these gene changes. Studies show that vaccines don't cause ASD.

Autism spectrum disorder (ASD) is a developmental disorder. It affects a person's behavior and makes communication and social interactions hard. Most people with ASD will always have some trouble communicating or interacting with others. But treating ASD early has helped many lead full lives. They can do things like go to college and work.