Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) is a developmental disability caused by neurological differences in the brain. Children with autism may find even the simplest human behaviors challenging. They likely have difficulty in:

• Interacting with other people, making friends, and bonding with family members
• Communicating ideas, thoughts, and emotions verbally
• Understanding what others may think or feel

The word spectrum emphasizes the variation amongst children with autism. Children on the autism spectrum have a range of intellectual abilities and will present differently depending on their developmental stage and sex.

The various disorders on the autism spectrum share some common features, such as developmental problems, social challenges, and learning disabilities.

Some children show ASD symptoms within the first 12 months of life, while others may not have any symptoms until 24 months or later. Sometimes, children with ASD may continue to learn new skills and meet developmental milestones until 18 to 24 months of age and then stop or lose the skills they once had.

Typically, ASD manifests before the age of 3 years and is likely to impact the child throughout their lifetime. However, treatment can improve symptoms over time.

Since autism is a spectrum disorder, no two children may have the same struggles or successes. This spectrum encompasses how these children learn, think, and solve problems, ranging from highly skilled to severely challenged.

Each child with autism will be different from another child with autism. These differences may stem from how each child perceives and handles sensory issues, anxiety levels, social skills, and executive functions. 

Children with ASD are likely to deal with two broad sets of limitations as compared to a neurotypical child:

• Limited social communication and interaction
• Restrictive or repetitive patterns of behavior or interests

Depending on the severity of their condition, some children with ASD may need significant daily support, while others may need only minimal help. Another example is that some children with ASD may have advanced conversation skills, while others may be completely nonverbal.

All these factors make it essential for parents and caregivers to recognize that children with ASD will likely have different ways of learning, moving, or paying attention. The way they behave, communicate, interact, and learn are different from neurotypical children and each other too. Therefore, the type of help a child with autism needs is unique to their situation.

As children with ASD become adolescents and young adults, they may have more complex challenges in developing and maintaining friendships, communicating with peers and adults, or understanding expected behavior in formal environments like school, university, and workplace.

These challenges can trigger associated conditions in children with autism. In a lot of cases, children with autism may stand out in a group and come to the attention of their healthcare provider because they also exhibit conditions such as:

• Anxiety
• Depression
• Attention-deficit/hyperactivity disorder

While these conditions are not exclusive to children with autism, they occur more often in people with ASD than those without ASD.

Symptoms of ASD can vary widely and make life very challenging for children with autism.

Children with autism are likely to have limited social communication and interaction skills.

• The child avoids or does not maintain eye contact.
• The child does not always respond to their name or other attempts to catch their attention.
• The child does not show facial expressions to display emotions such as joy, upset, anger, and surprise.
• The child cannot use gestures to draw attention or show interest (waving or pointing to objects of interest).
• The child does not share interests with others and cannot show engagement in shared activities.
• The child cannot identify social signals when others around them communicate being hurt or upset.
• The child finds participating in interactive and imaginative play with other children challenging.

Children with autism tend to demonstrate repetitive behaviors or interests:

• The child plays with toys the same way each time or is focused on specific parts of an object, such as the wheels.
• The child tends to line up toys or other objects and gets upset when the order is disturbed.
• The child is more sensitive or less sensitive than others to sensory inputs, such as light and sound.
• The child has a single-minded (or obsessive) focus on facts and details of a subject.
• The child repeats words or phrases over and over again.
• The child feels anxious with changes in routine and is comforted when following a fixed, repeatable routine.

Other symptoms for children with autism can include:

• Delayed language, movement, and cognitive skills
• Anxiety, stress, or excessive worry

• Hyperactivity and lack of impulse control
• Epilepsy or seizure disorder
• Inattentive behavior and moodiness

ASD is diagnosed by looking at a child’s developmental history and behavior pattern. In most cases, ASD diagnosis can be confirmed before age two.

Early diagnosis of ASD is important so that children with autism can receive the needed support as early as possible, helping them reach their full potential.

This diagnosis can occur in three stages:

Observing the child and checking for typical developmental milestones are part of every parent’s process of watching their child grow. Developmental monitoring refers to this observation when done purposefully, along with conversations between parents and providers about a child’s skills and abilities.

Developmental milestones are skills most children reach by a certain age in various aspects that influence how they grow and interact with their environment. This includes playtime, learning new skills, speech, behavior, and movement.

Observations from various professionals may be included as part of the diagnostic process. This can include teachers, special educators, psychologists, speech therapists, occupational and physical therapists, and physicians.

Developmental screening is a more formal process than developmental monitoring. The American Academy of Pediatrics (AAP) recommends that developmental and behavioral screening be carried out for children during their regular scheduled visits with their pediatrician at 9, 18, and 30 months.

AAP also recommends that all children be screened for ASD during their pediatric appointments at 18 and 24 months.

This type of screening can be conducted by a doctor, nurse, or other professionals in the community or school. As part of the screening process, the parent may be asked to fill out a questionnaire with details about the child’s development with language, movement, and thinking skills, as well as their evolving behavior and emotions.