Autism Spectrum Disorder

Autism Spectrum Disorder

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a lifelong condition caused by a faulty nervous system that leads to abnormal brain function. The term spectrum in the disorder name indicates a number of possible symptoms and degrees of severity. In addition, autism spectrum disorder now includes a number of conditions that had previously been separated and include autism, Asperger’s, childhood disintegrative disorder, and more.

Just because the interactive and behavioral symptoms of those on the autism spectrum can be debilitating and cause tremendous anxiety doesn’t mean they will be similar for everyone. Getting treatment early and having a supportive family and teachers will make a tremendous difference for most people.

The CDC stated in 2020 that in the US, 1 in 54 children is diagnosed with an autism disorder, and in data from 2016, the ratio for diagnosis in girls was 1 in 144 and 1 in 34 for boys.

Asperger’s vs Autism
People often get confused between Asperger’s and autism. With Asperger syndrome, the symptoms tend to be milder compared to those of “classic” autism, and language and cognitive abilities — emotional, intellectual, mental, and subjective abilities—aren’t affected in those with ASD. Both ASD and autism fall under the category of ASD.

Symptoms of Autism Spectrum Disorder:

The symptoms of ASD can be mild, moderate, or severe. Not everyone with autism or ASD will exhibit all symptoms, nor will all experience them to an extreme degree. It is possible that the symptoms could be missed in some children by the parent and might only be identified by a teacher, caregiver, or doctor.

Common traits or characteristics of those with autism include:

  • Difficulty matching social behaviors – such as insensitivity to others’ feelings
  • Communication problems – verbal and nonverbal, such as strange word choices and poor eye contact
  • Sometimes loud repetitive behaviors – movements such as hand-flapping and head-banging
  • Restricted interests and activities, and can be obsessive about an activity or topic

Autistic behavior falls into two types: restrictive / repetitive behaviors (RRB) and social communication / interaction behaviors.


Restrictive / repetitive behaviors (RRB)

  • Spinning around in circles
  • Rocking back and forth
  • Slapping themselves over and over
  • Repeatedly opening and closing doors
  • Flicking fingers in front of their face or eyes
  • Spinning wheels
  • Flipping switches or levers
  • Lining up items like books, toys, clothes etc. in a set order
  • Having extreme reactions and anxiety to not following a routine or to changes to a class setting, a change of teacher, or change in the order of items
  • Being consumed with making a pattern of movements or arranged items
  • Abnormal, intense interest in a small set of topics including trivia like train timetables or the airplane range on a tank of gas
  • Repeating phrases or words over and over
  • Rituals for greeting people
  • Difficulty breaking routine in thinking patterns or actions
  • Uncommonly strong attachments to unusual items

Social communication / interaction behaviors

  • Not making eye contact when talking or interacting with others
  • Appearing to not, or actually not, listen when being spoken to. Slow or no response when being called by name or physically motioned to
  • Often missing social clues that others are no longer interested – for example, when their discussing their favorite topics at length
  • Difficulty accurately anticipating others’ actions or understanding their viewpoints in a conversation
  • Displaying a disconnect between others’ gestures or facial expressions and what they are saying or hearing
  • Using an overly excited tone of voice, or one that is more robotic
  • Changes in the home or school setting that cause the environment to be over stimulating
  • Not understanding the concept of how a conversation works
  • Emotional displays like affection, anger, or distress in others produces unusual responses
  • Assembling a unique vocabulary of odd word choices that have meanings which are special to the child but will not be understood in context by someone who doesn’t know the child well

Additional challenges include: Irritability; issues sleeping; digestive issues; and being hypersensitive to a range of stimuli including temperature, smell, light, sound, and touch —touch from others, and how different textures like clothing feel to them.


Unique strengths and abilities that can come with the disorder:

  • Learning to read at a very young age
  • Very honest
  • Visual thinking, strong visual learner
  • Detail oriented
  • Very punctual
  • Extremely reliable
  • Excellent at prolonged focus when the topic is of interest
  • Above-average intelligence in 44% of autistic children
  • Able to learn topics in tremendous detail
  • Able to remember information for a long time
  • Excellent sense of direction
  • Values order
  • Strong auditory learner
  • Logical thinker
  • Operates well within rules
  • Above average at science, math, art, and music
  • Extremely precise
  • Hungry for perfection
  • Thinks outside the box in problem solving
  • Suited to technical and logical academic areas like engineering, math, and science where little to no social interaction is required

Diagnosing Autism Spectrum Disorder:

ASD is typically diagnosed in children before the age of two by a specialist, such as a pediatrician or child psychiatrist, which includes observations by teachers and/or parents on the child’s behavior during play time or other social interactions.

Today, more is known about the disorder by healthcare professionals, and parents and teachers are able to identify symptoms more easily. In addition, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) made significant updates to its information on diagnosing ASD.

There are two phases to diagnosing ASD in young children.

  • Phase 1: A developmental assessment during a well-child checkup

    Newborns have regular checkups scheduled over the first two years of life to monitor their health and development. Part of this process includes screening specific to ASD at eighteen months and again at two years old. Doctors may elect to carry out screening earlier if there are known ASD risk factors.

    What parents see and hear are very important data point elements in the ASD screening process for children. Parents’ observations are often included as factors in a doctor’s diagnosis, and if developmental issues are identified, the next phase of screening will commence.

  • Phase 2: Subsequent Evaluation

    This phase is conducted by an evaluation team that could include:

    • A child psychiatrist and/or psychologist to assess child’s behavior and brain development
    • A developmental pediatrician to assess child’s accomplishment of age-appropriate child development steps
    • A speech-language pathologist to assess child’s level of communication difficulties

    Specific evaluations could include:

    • Thinking skills and cognitive capacity
    • Language skills
    • Life skills as would be appropriate for the child’s age

    Along with the complexity that ASD brings, it is not uncommon to find coexisting disorders, and very often the complete evaluation will also include a hearing test and some bloodwork for a more complete picture, and to ensure nothing has been left out of the treatment plan.

    Members of minority communities are diagnosed less often and usually when they are older.

Diagnosing ASD in Older Children 

In children previously undiagnosed and older than two, an evaluation should be made to eliminate ASD as a possibility. A successful diagnosis and treatment in young or older adults can still have a positive impact on day-to-day relationships, work, or academic life.

When ASD symptoms are not noticed in older children and adolescents until after starting school, they may be evaluated by special education teachers at the school, who will then refer them to a mental health professional.

In addition to the symptoms found in young children, symptoms in older children may include unusual difficulty in making friends and trouble understanding certain aspects of communication like body language, humor, sarcasm, or figures of speech.

ASD Diagnosis in Adults

Adults can often be aware of signs and symptoms for ASD, and if spotted, should speak with their doctor to ask about a referral for an ASD evaluation. Testing adults for ASD is not as refined or as standardized as it is for children, but that diagnosis typically takes place through observations, interactions, and interviews with mental health professionals.

Successfully diagnosing ASD in adults can be more challenging when there could be symptoms from other concurrent conditions like ADHD or schizophrenia also present.

Evaluations are structured to look for issues the individual may have like repetitive behaviors, sensory issues, challenges in communicating, concerns about social interaction, repetitive behaviors, and restricted interests. An evaluation may also involve talking with the person’s close family members.


Sample questions for the individual include:

  • Have you been told that you speak like a robot?
  • Do you find that nearly all facts stick in your memory – even those you do not understand?
  • Do you trip up or bump into things a lot?
  • Does your family have a nickname for you that portrays you as an eccentric professor?
  • Were you bullied at school?
  • Do you find it easy to look people in the eyes when in a conversation?
  • Are you aware of a tendency to make loud noises in a quiet place like a library or church?
  • Do you enjoy inventing quirky ways of saying things?
  • Do you, or have you ever had, a best friend?
  • Would you prefer to read fiction or nonfiction?
  • Do you like doing the same thing at the same time every day, and like always knowing what to expect?
  • Are you quick at math and music but not strong at other subjects?
  • Are you the first to notice a friend’s new haircut?
  • Do you understand what is meant when someone says they were embarrassed for someone else?
  • Do you prefer individual sports like golf or team sports like soccer?

Risk Factors for Autism Spectrum Disorder:

Risk factors for ASD include:

  • Age of parents – a father who is over 40 and/or a mother who is over 35
  • A sibling or twin with ASD – the chances of having another child with autism are between 2% and 18%, 31% chance for non-identical twins, and 36 to 95% chance for identical twins
  • Gender – males are far more likely to be diagnosed with autism
  • Premature birth and below average weight
  • Other contributing conditions – including tuberous sclerosis, Down Syndrome, and Fragile X syndrome have been found in 20% of children diagnosed with ASD.

Despite the popularity of the theory about a connection between vaccinations and autism, research does not support this claim.

Treatment of Autism Spectrum Disorder:

Each person is unique, and though autism is a condition with no cure, a treatment plan is made that is specific to each child. Plans typically include both medications and behavioral treatments.

Behavioral treatments for autism in toddlers and preschoolers – The sooner intensive behavioral intervention can begin, the better the child’s future. Momentum is gained with each new skill developed that involves the child’s entire family and the included mental health professionals.

Early intervention team

  • Highly trained teachers and/or therapists which includes specialties as needed — occupational therapist, physician, speech-language pathologist
  • Possible assistance from well-trained paraprofessionals while supervised by an experienced autism therapy expert
  • Therapists with an obvious respect for the family of the child as well as for the child, and for their particular viewpoints and needs
  • Opportunities for the child’s parents to be active in the treatment delivery and the decision-making process

Early intervention treatment includes:

  • At least 25 hours of structured, therapeutic activities each week
  • Therapy that incorporates learning objectives with well-defined and specific goals, and a mechanism for regular evaluation and documentation of the child’s progress
  • A focus on the specific areas — like communication, language, motor skills, daily life, social and play skills — that are presenting a challenge to the child
  • Interaction opportunities with non-autistic peers

As the child with autism ages, some treatment options will be phased out and replacement treatment plans will be more appropriate — as they address a different set of social skills and age-specific challenges.


Objective studies have scientifically confirmed the benefits of

  • The Early Start Denver model, and
  • The Lovaas model.

Other successful behavioral therapies include:

  • Verbal behavior therapy,
  • Pivotal response therapy,
  • Floortime,
  • Occupational therapy,
  • Teacch, and
  • Verbal behavior.

Medication – Treatment for physical symptoms depend on symptom severity. Medication can be prescribed for stomach issues, trouble sleeping, and seizures. Any additional coexisting conditions like ADHD, depression, OCD, or epilepsy are also treated as part of the treatment plan.

As with autism intervention treatment, there are no drugs that can cure autism; but depending on the child’s age, symptoms, and symptom severity, there are a number of options which could prove suitable including:

  • Atypical antipsychotics
  • Serotonin-norepinephrine reuptake inhibitors
  • Loop diuretics
  • Miscellaneous central nervous system agents

Whats the Outlook?

The goal of treatment, which is already possible for many and increasingly so for many more, is that the individual can live a fulfilling and independent life. Advances over the last 20 years have led to more understanding about the condition and improved ways to diagnose and treat the disorder. 

In a small number of cases, some people seem to “age out” of certain aspects of autism, or perhaps they had a flawed initial diagnosis. More research is being done into this theory. Among some of the children who once did have symptoms but no longer exhibit enough to satisfy an autism diagnosis, some may later be diagnosed with anxiety disorder, ADHD, or Asperger’s.

Other individuals still meet the criteria for diagnosis but have reached a status referred to as “best outcome.” This status is reached after assessments for language, adaptive functioning, IQ, personality, and school placement.

Symptoms of Autism Spectrum Disorder:

The symptoms of ASD can be mild, moderate, or severe. Not everyone with autism or ASD will exhibit all symptoms, nor will all experience them to an extreme degree. It is possible that the symptoms could be missed in some children by the parent and might only be identified by a teacher, caregiver, or doctor.

Common traits or characteristics of those with autism include:

  • Difficulty matching social behaviors – such as insensitivity to others’ feelings
  • Communication problems – verbal and nonverbal, such as strange word choices and poor eye contact
  • Sometimes loud repetitive behaviors – movements such as hand-flapping and head-banging
  • Restricted interests and activities, and can be obsessive about an activity or topic

Autistic behavior falls into two types: restrictive / repetitive behaviors (RRB) and social communication / interaction behaviors.


Restrictive / repetitive behaviors (RRB)

  • Spinning around in circles
  • Rocking back and forth
  • Slapping themselves over and over
  • Repeatedly opening and closing doors
  • Flicking fingers in front of their face or eyes
  • Spinning wheels
  • Flipping switches or levers
  • Lining up items like books, toys, clothes etc. in a set order
  • Having extreme reactions and anxiety to not following a routine or to changes to a class setting, a change of teacher, or change in the order of items
  • Being consumed with making a pattern of movements or arranged items
  • Abnormal, intense interest in a small set of topics including trivia like train timetables or the airplane range on a tank of gas
  • Repeating phrases or words over and over
  • Rituals for greeting people
  • Difficulty breaking routine in thinking patterns or actions
  • Uncommonly strong attachments to unusual items

Social communication / interaction behaviors

  • Not making eye contact when talking or interacting with others
  • Appearing to not, or actually not, listen when being spoken to. Slow or no response when being called by name or physically motioned to
  • Often missing social clues that others are no longer interested – for example, when their discussing their favorite topics at length
  • Difficulty accurately anticipating others’ actions or understanding their viewpoints in a conversation
  • Displaying a disconnect between others’ gestures or facial expressions and what they are saying or hearing
  • Using an overly excited tone of voice, or one that is more robotic
  • Changes in the home or school setting that cause the environment to be over stimulating
  • Not understanding the concept of how a conversation works
  • Emotional displays like affection, anger, or distress in others produces unusual responses
  • Assembling a unique vocabulary of odd word choices that have meanings which are special to the child but will not be understood in context by someone who doesn’t know the child well

Additional challenges include: Irritability; issues sleeping; digestive issues; and being hypersensitive to a range of stimuli including temperature, smell, light, sound, and touch —touch from others, and how different textures like clothing feel to them.


Unique strengths and abilities that can come with the disorder:

  • Learning to read at a very young age
  • Very honest
  • Visual thinking, strong visual learner
  • Detail oriented
  • Very punctual
  • Extremely reliable
  • Excellent at prolonged focus when the topic is of interest
  • Above-average intelligence in 44% of autistic children
  • Able to learn topics in tremendous detail
  • Able to remember information for a long time
  • Excellent sense of direction
  • Values order
  • Strong auditory learner
  • Logical thinker
  • Operates well within rules
  • Above average at science, math, art, and music
  • Extremely precise
  • Hungry for perfection
  • Thinks outside the box in problem solving
  • Suited to technical and logical academic areas like engineering, math, and science where little to no social interaction is required

Diagnosis of Autism Spectrum Disorder:

ASD is typically diagnosed in children before the age of two by a specialist, such as a pediatrician or child psychiatrist, which includes observations by teachers and/or parents on the child’s behavior during play time or other social interactions.

Today, more is known about the disorder by healthcare professionals, and parents and teachers are able to identify symptoms more easily. In addition, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) made significant updates to its information on diagnosing ASD.

There are two phases to diagnosing ASD in young children.

  • Phase 1: A developmental assessment during a well-child checkup

    Newborns have regular checkups scheduled over the first two years of life to monitor their health and development. Part of this process includes screening specific to ASD at eighteen months and again at two years old. Doctors may elect to carry out screening earlier if there are known ASD risk factors.

    What parents see and hear are very important data point elements in the ASD screening process for children. Parents’ observations are often included as factors in a doctor’s diagnosis, and if developmental issues are identified, the next phase of screening will commence.

  • Phase 2: Subsequent Evaluation

    This phase is conducted by an evaluation team that could include:

    • A child psychiatrist and/or psychologist to assess child’s behavior and brain development
    • A developmental pediatrician to assess child’s accomplishment of age-appropriate child development steps
    • A speech-language pathologist to assess child’s level of communication difficulties

    Specific evaluations could include:

    • Thinking skills and cognitive capacity
    • Language skills
    • Life skills as would be appropriate for the child’s age

    Along with the complexity that ASD brings, it is not uncommon to find coexisting disorders, and very often the complete evaluation will also include a hearing test and some bloodwork for a more complete picture, and to ensure nothing has been left out of the treatment plan.

    Members of minority communities are diagnosed less often and usually when they are older.

Diagnosing ASD in Older Children 

In children previously undiagnosed and older than two, an evaluation should be made to eliminate ASD as a possibility. A successful diagnosis and treatment in young or older adults can still have a positive impact on day-to-day relationships, work, or academic life.

When ASD symptoms are not noticed in older children and adolescents until after starting school, they may be evaluated by special education teachers at the school, who will then refer them to a mental health professional.

In addition to the symptoms found in young children, symptoms in older children may include unusual difficulty in making friends and trouble understanding certain aspects of communication like body language, humor, sarcasm, or figures of speech.

ASD Diagnosis in Adults

Adults can often be aware of signs and symptoms for ASD, and if spotted, should speak with their doctor to ask about a referral for an ASD evaluation. Testing adults for ASD is not as refined or as standardized as it is for children, but that diagnosis typically takes place through observations, interactions, and interviews with mental health professionals.

Successfully diagnosing ASD in adults can be more challenging when there could be symptoms from other concurrent conditions like ADHD or schizophrenia also present.

Evaluations are structured to look for issues the individual may have like repetitive behaviors, sensory issues, challenges in communicating, concerns about social interaction, repetitive behaviors, and restricted interests. An evaluation may also involve talking with the person’s close family members.


Sample questions for the individual include:

  • Have you been told that you speak like a robot?
  • Do you find that nearly all facts stick in your memory – even those you do not understand?
  • Do you trip up or bump into things a lot?
  • Does your family have a nickname for you that portrays you as an eccentric professor?
  • Were you bullied at school?
  • Do you find it easy to look people in the eyes when in a conversation?
  • Are you aware of a tendency to make loud noises in a quiet place like a library or church?
  • Do you enjoy inventing quirky ways of saying things?
  • Do you, or have you ever had, a best friend?
  • Would you prefer to read fiction or nonfiction?
  • Do you like doing the same thing at the same time every day, and like always knowing what to expect?
  • Are you quick at math and music but not strong at other subjects?
  • Are you the first to notice a friend’s new haircut?
  • Do you understand what is meant when someone says they were embarrassed for someone else?
  • Do you prefer individual sports like golf or team sports like soccer?

Risk Factors for Autism Spectrum Disorder:

Risk factors for ASD include:

  • Age of parents – a father who is over 40 and/or a mother who is over 35
  • A sibling or twin with ASD – the chances of having another child with autism are between 2% and 18%, 31% chance for non-identical twins, and 36 to 95% chance for identical twins
  • Gender – males are far more likely to be diagnosed with autism
  • Premature birth and below average weight
  • Other contributing conditions – including tuberous sclerosis, Down Syndrome, and Fragile X syndrome have been found in 20% of children diagnosed with ASD.

Despite the popularity of the theory about a connection between vaccinations and autism, research does not support this claim.

Treatment of Autism Spectrum Disorder:

Each person is unique, and though autism is a condition with no cure, a treatment plan is made that is specific to each child. Plans typically include both medications and behavioral treatments.

Behavioral treatments for autism in toddlers and preschoolers – The sooner intensive behavioral intervention can begin, the better the child’s future. Momentum is gained with each new skill developed that involves the child’s entire family and the included mental health professionals.

Early intervention team

  • Highly trained teachers and/or therapists which includes specialties as needed — occupational therapist, physician, speech-language pathologist
  • Possible assistance from well-trained paraprofessionals while supervised by an experienced autism therapy expert
  • Therapists with an obvious respect for the family of the child as well as for the child, and for their particular viewpoints and needs
  • Opportunities for the child’s parents to be active in the treatment delivery and the decision-making process

Early intervention treatment includes:

  • At least 25 hours of structured, therapeutic activities each week
  • Therapy that incorporates learning objectives with well-defined and specific goals, and a mechanism for regular evaluation and documentation of the child’s progress
  • A focus on the specific areas — like communication, language, motor skills, daily life, social and play skills — that are presenting a challenge to the child
  • Interaction opportunities with non-autistic peers

As the child with autism ages, some treatment options will be phased out and replacement treatment plans will be more appropriate — as they address a different set of social skills and age-specific challenges.


Objective studies have scientifically confirmed the benefits of

  • The Early Start Denver model, and
  • The Lovaas model.

Other successful behavioral therapies include:

  • Verbal behavior therapy,
  • Pivotal response therapy,
  • Floortime,
  • Occupational therapy,
  • Teacch, and
  • Verbal behavior.

Medication – Treatment for physical symptoms depend on symptom severity. Medication can be prescribed for stomach issues, trouble sleeping, and seizures. Any additional coexisting conditions like ADHD, depression, OCD, or epilepsy are also treated as part of the treatment plan.

As with autism intervention treatment, there are no drugs that can cure autism; but depending on the child’s age, symptoms, and symptom severity, there are a number of options which could prove suitable including:

  • Atypical antipsychotics
  • Serotonin-norepinephrine reuptake inhibitors
  • Loop diuretics
  • Miscellaneous central nervous system agents

Whats the Outlook?

The goal of treatment, which is already possible for many and increasingly so for many more, is that the individual can live a fulfilling and independent life. Advances over the last 20 years have led to more understanding about the condition and improved ways to diagnose and treat the disorder. 

In a small number of cases, some people seem to “age out” of certain aspects of autism, or perhaps they had a flawed initial diagnosis. More research is being done into this theory. Among some of the children who once did have symptoms but no longer exhibit enough to satisfy an autism diagnosis, some may later be diagnosed with anxiety disorder, ADHD, or Asperger’s.

Other individuals still meet the criteria for diagnosis but have reached a status referred to as “best outcome.” This status is reached after assessments for language, adaptive functioning, IQ, personality, and school placement.