Autism spectrum disorder (ASD) is a developmental disability that affects communication, behavior, and social skills. Symptoms in kids can begin in early childhood, and doctors may diagnose autism as early as 18 months to 2 years old. We don’t know what causes autism, but genetics and having older parents are associated with a higher risk. Autism affects about 1 in 44 children, and it has no cure. But there are treatments, and the sooner a child gets help, the better the outcome.

IN THIS ARTICLE

• What is autism? 
• How can I tell if my child has autism? 
• Autism symptoms in kids 
• What causes autism? 
• Treatment for autism 

What is autism?

Autism spectrum disorder (ASD) is a complex condition that includes a range of social, communication, and behavioral challenges. ASD is a “spectrum disorder” because the condition causes different symptoms in different people, requiring different levels of intervention and support. In people with autism, learning, thinking, and problem-solving abilities can range from gifted to severely challenged.

Autism is very common. The U.S. Centers for Disease Control and Prevention (CDC) reports that ASD affects about 1 in 44 children. It’s diagnosed about four times more often in boys than in girls.

Why are more children being diagnosed with ASD? In part this is because the expanding definition of ASD now includes children with milder symptoms who might not have been counted as having autism in the past. Also, more kids are getting screened for autism, and more parents are aware of the symptoms.

But other factors are at play. People are having babies at later ages, which is associated with a higher risk for autism. Researchers are studying other possibilities, too, such as whether in vitro fertilization (IVF) is a risk factor and which environmental toxins – in combination with genetic factors – may play a role in the increased prevalence.

There are racial, ethnic, and community differences in autism diagnosis, too. For example, fewer Hispanic children are identified as autistic than Black or white children, and a higher percentage of Black children with autism are identified with intellectual disability (rather than ASD) compared to white or Hispanic children with autism.

Systemic barriers to healthcare and racial and gender bias contribute to differences in rates. Less access to healthcare in general – and services for diagnosing and treating autism specifically – influences the number of children diagnosed. (While the autism diagnostic rate in California is 1 in 26 children, the rate in Missouri is 1 in 60.) So does a lack of awareness of autism and developmental delays in some communities. In addition, until recently, research has focused largely on boys and men.

How can I tell if my child has autism?

There’s no blood test to diagnose ASD. A child’s developmental history, plus clinical observation of their behavior, are used to make a diagnosis. Doctors also ask parents to describe unusual behaviors they observe in their child, such as not smiling or babbling, not making eye contact, or not responding to their name.

There are some markers found in saliva that can help identify a child’s likelihood of ASD. A saliva test is available for children 18 months through 6 years and may be helpful – in combination with behavioral observations – in making a diagnosis. The test is available via prescription and is administered by a healthcare provider. It may not be covered by insurance.

Children can sometimes be diagnosed with ASD younger than 18 months, and they can be reliably diagnosed between 18 months and age 2. The American Academy of Pediatrics (AAP) strongly recommends that all children be screened for autism at their 18-month and 24-month doctor visits. Parents can also request an assessment if they’re concerned about their child. The Affordable Care Act (ACA), a federal law signed in 2010, states that all children are entitled to free screening for ASD at 18 and 24 months.

If you have any concerns about your child’s development or behavior – at any age – talk with their doctor. Ask for a referral to a specialist who can evaluate and diagnose your child.

Autism symptoms in kids

Possible warning signs typically appear in early childhood and last throughout life. If your child has any delay in development or shows even just a few symptoms of autism, have them evaluated.

Autism symptoms include problems with:

Communication

• Not reciprocating sounds, smiles, or other facial expressions by 9 months
• Not babbling by 12 months
• Not responding to name by 12 months
• Not reciprocating gestures (like waving) around 12 months
• Not pointing to objects to show interest by 14 months and not looking at objects when another person points at them
• Losing the ability to babble, speak, or develop social skills at any age
• Difficulty using or understanding nonverbal cues, such as facial expressions, body postures, and gestures
• Language delay or an inability to speak
• Inability to start or sustain a conversation
• Repetitive or peculiar use of language. Gives unrelated answers to questions.

Social skills

• Avoids eye contact
• Wants to be left alone, not liking to be touched or held
• Failure to develop relationships with other children due to lack of interest or ability to relate
• Inability to share interests or achievements with others, such as not sharing or pointing out objects of interest
• Inability to interact with others or express feelings
• Trouble understanding other people’s feelings or talking about their own feelings
• Lack of make-believe play or play that imitates social interaction

Restrictive behaviors

• Obsessive interests
• Upset by minor changes and difficulty with transitions
• Fixation on routines or rituals
• Repetitive motions, such as hand- or finger-flapping or twisting, rocking, or spinning in circles
• Preoccupation with parts of objects or things that spin or shine
• Unusual reactions to the way things taste, look, smell, or feel
• Impaired gross or fine motor skills, such as difficulty running or holding a crayon
• Unusual sensory response to the way things sound, smell, taste, look, or feel

Children with autism also commonly share conditions and symptoms that aren’t used to diagnose ASD, such as sleep disorders, seizures, ADHD, anxiety, and mood and behavioral disorders – such as aggression, food refusal, and self-injury. About 30 percent of children with ASD also have an intellectual disability, and 30 percent are minimally verbal.

What causes autism?

No one knows exactly what causes autism spectrum disorder. It’s a complex interaction between multiple genetic and environmental factors. Experts think that the critical period for developing ASD occurs before, during, and immediately after birth. Studies are ongoing but have so far linked ASD with:

• Genetics. One study that examined almost 2 million people in five countries concluded that 80 percent of autism risk can be traced to inherited genes. Children with a sibling with ASD are at higher risk of also having ASD, and children with certain genetic or chromosomal conditions (such as fragile X syndrome or tuberous sclerosis) may have a greater chance of having ASD.
• Older parents. Children born to older parents are at greater risk of ASD. One analysis of 27 studies concluded that an increase of 10 years in maternal and paternal age is associated with an 18 percent and 21 percent higher risk of autism.
• Certain drugs. Children born to women who took the prescription drugs valproic acid and thalidomide during pregnancy may have a higher risk of ASD.

Some parents worry that common childhood vaccines, such as the measles, mumps, rubella (MMR) vaccine, could cause autism. Many large studies have not found any link between autism and vaccines. According to the Institute of Medicine, the AAP, and the CDC, there’s no evidence that vaccines cause autism.

Treatment for autism

There’s no cure for autism, but the sooner a child begins treatment, the better the outcome. A critical window of brain development occurs in the first few years of life – when the brain has the most flexibility to adapt and change. Progress can still be made at later ages, but the earlier the treatment starts, the better the chance of maximizing a child’s potential.

The goal of treatment is to minimize symptoms and make the most of abilities. Treatment may help a child learn important skills and may range from speech therapy for language delays to occupational therapy for play, learning, and self-care.

A team of people may help the child and family, including the child’s doctor, a developmental pediatrician, a teacher, a child psychologist or psychiatrist, a child neurologist, and a speech and/or occupational therapist.  

Autism therapies

Applied behavior analysis (ABA): Encourages desired behavior (such as self-control and self-monitoring) and teaches skills (such as life skills and social skills).

Cognitive behavioral therapy (CBT): Helps a child understand their environment and behave appropriately by managing their emotions and moods. It’s often used to help reduce anxiety and fear, particularly in high-functioning children. Applied Behavior Analysis is the most studied and well-known behavioral therapy for children with ASD.

DIR/Floortime: Involves following the child’s lead in activities. DIR stands for the Developmental Individual-difference Relationship-based model. The child’s parents and/or therapist gets down on the floor to interact with the child at their level, on their own terms. This therapy focuses on emotional connection and development.

Naturalistic Developmental Behavioral Interventions (NDBI): Teaches functional skills, motivation, and engagement. Seeks opportunities to teach in the natural environment, alongside peers and in everyday routines. Follows the child’s lead and interests when choosing activities and teaching materials.

Nutritional therapy: Ensures children get enough nutrients and calories for healthy development, usually with the help of a registered dietitian or nutritionist. A customized meal plan can help address problems caused by food aversions, constipation, and side effects of medication. It can also help with digestive problems, a common issue for autistic children.

Occupational therapy (OT): Helps the child cope with sensory issues, develop learning and play skills, and learn self-care. Teaches practical skills for everyday life, such as bathing, getting dressed, eating, staying safe, and managing routine social interactions. It also helps children with hand-eye coordination, fine motor skills needed to write or grasp toys, and strategies for positive behavior. It often involves sensory integration therapy as well.

Physical therapy (PT): Provides strategies to help with movement and motion, such as toe-walking, repetitive movements, weak muscles, and difficulty planning and carrying out actions. PT also improves motor skills such as balance, coordination, and walking.

Sensory integration therapy: Helps children who are very sensitive to certain sensory experiences, such as sound, touch, sights, or smells, by teaching them ways to regulate and control their reaction. It’s often part of occupational therapy. In some small studies, children have shown improvements in self-care and certain social behaviors, along with reduced responsiveness to stimuli.

Speech and language therapy: Focuses on communication skills to help children express themselves better, which can decrease frustration and improve behavior. Speech therapy can help children participate in conversations, follow directions, write, and ask for help. Children who don’t speak may learn to use gestures, pictures, and sign language to communicate.

Social skills groups: Teaches social skills for interacting successfully with others in small groups led by a therapist.

Family education: Teaches behavioral techniques for parents to use at home and builds support for parents, siblings, and children with ASD.

TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped Children): Provides teachers with ways to help an autistic child succeed in the classroom. It focuses on organizing the child’s environment and using visual cues to help the child understand and carry out tasks and activities.

Medication for autism

No medicine cures autism, but sometimes children with ASD also have behavioral or medical problems that may be helped with medication.

For example:

• Antidepressants such as SSRIs may help with anxiety, irritability, tantrums, and aggressive behavior. Tricyclics (another type of antidepressants) are used to treat depression and obsessive-compulsive behaviors.
• Anti-psychotic or psychoactive medications are used to help manage irritability, tantrums, self-harm, hyperactivity, and aggression. Risperidone and aripiprazole are two prescription medications that are used to treat autism symptoms in children ages 5 to 16 (risperidone) and 6 to 17 (aripiprazole).
• Anticonvulsants treat seizures and seizure disorders. Almost one-third of people with autism have seizures or seizure disorders.
• Stimulants are helpful for those with mild ASD symptoms. They can help decrease hyperactivity and increase focus.
• Antianxiety medications are used to help treat anxiety and panic disorders.

Alternative treatments for autism

Complementary and alternative treatments for autism are often used to supplement more traditional approaches. Some are safe and may be worth trying to see if they help with your child’s ASD symptoms. Others are dangerous.

Important: Talk with your child’s doctor before trying alternative treatments, both to make sure they’re safe for your child and for guidance that will help you make the most of them.

Here are some of the most commonly considered alternative therapies:

• Music therapy
• Yoga
• Massage
• Therapeutic horseback riding
• Gluten- and casein-free diets
• Nutrient supplementation
• Melatonin

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