The American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (5th edition, 2013), a reference healthcare providers use to diagnose mental and behavioral conditions, including autism. In the previous edition (DSM-IV), autism was divided into 5 subcategories: Autism, Asperger’s, Pervasive Developmental Disorder-NOS, Rett’s Syndrome, and Childhood Disintegrative Disorder. In the revised edition, there are no subcategories and the diagnostic designation is Autism Spectrum Disorder.
Autism is a developmental disability that typically appears during early childhood and can impact social skills, communication, relationships, and self-regulation. It is defined by a certain set of behaviors and is termed a spectrum condition because it affects people differently and to varying degrees of severity.
National Autism Association, Autism Fact Sheet
- Persistent weaknesses in social communication & social interaction in multiple situations
- Restricted, repetitive patterns of behavior, interests, or activities (hand flapping, circling, rocking, lining up toys rather than playing with them)
- Symptoms present in early developmental period (usually around 3 years old), although they may not be recognized as such until later.
- Symptoms cause significant impairment in social, occupational, or other important areas of current functioning.
- These disturbances are not better explained by an intellectual disorder or developmental delay, however intellectual disability and autism spectrum disorder frequently co-occur.
Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
There is currently no single known cause and no single test used to identify autism. Diagnosis is made from a thorough evaluation including parent interviews, child observations, and behavioral checklists. Since children develop at different rates and no two children with autism exhibit the same symptoms, diagnosis of autism is complex and requires careful observation, documentation, and research of age appropriate developmental milestones. When going through the checklist of symptoms, it is also important to note that some of the traits are more culturally driven and may not be a sign of autism (i.e. lack of eye contact).
A good evaluation requires parents be informed, prepared, and knowledgeable as the what the results mean and how to use the information to assist your child in learning. The following links will help facilitate this.
- Evaluation process
- Assessment and testing information
- Details on Intelligence tests
- Misconceptions of IQ and preparing your child for testing
Center for Disease Control (CDC.org) provides guidance in monitoring developmental milestones and information on screening and diagnostic assessments used to diagnose ASD, since early diagnosis is critical to obtain appropriate therapies and interventions.
Asperger/Autism Network (AANE.org) provides a directory of diagnosticians nationwide.
- Not respond to their name by 12 months of age
- Not point at objects to show interest (point at an airplane flying over) by 14 months
- Avoid eye contact
- Get upset by minor changes, thrives on routine and structure
- Have obsessive interests (vacuum cleaners, monster trucks, Thomas the Train)
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to sounds, smells, taste, or textures; over or under stimulated
- Plays with toys the same way every time, lines up toys, or other objects
- Likes parts of objects (e.g., wheels)
- Is very organized and gets upset when his/her things are moved
Social skills deficits are the most common symptoms in all of the types of ASD. People with ASD are not limited to social difficulties like shyness. The social issues they experience cause serious problems in everyday life.
- Prefers to play alone, even in groups of other children
- Does not share interests with others
- Only interacts to achieve a desired goal
- Has flat or inappropriate facial expressions
- Does not understand personal space boundaries
- Avoids or resists physical contact
- Is not comforted by others during distress
- Has trouble understanding other people’s feelings or talking about own feelings
Communication skills vary among those with ASD. Some can speak well, while others cannot speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.
- Delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- May use Disney lines or TV commercial jingles to communicate
- Reverses pronouns (e.g., says “you” instead of “I”)
- Gives unrelated answers to questions
- Uses few or no gestures (e.g., does not wave goodbye)
- Talks in a flat, robot-like, or sing-song voice
- Does not understand jokes, sarcasm, or teasing
Secondary symptoms might include:
- Hyperactivity (very active)
- Impulsivity (acting without thinking)
- Short attention span
- Causing self injury
- Temper tantrums/ meltdowns
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Lack of fear or more fear than expected
Center for Disease Control, Signs and Symptoms of Autism Spectrum Disorders
Johnson, C.P. Early Clinical Characteristics of Children with Autism. In: Gupta, V.B. ed: Autistic Spectrum Disorders in Children. New York: Marcel Dekker, Inc., 2004:85-123
Each child has a unique set of characteristics, therefore, it is imperative to know your child’s needs. Below are some strategies to experiment with until you find those that work best for you and your child. I am certain you will also come up with your own!
- If resistant to change> calendars, daily schedules, clocks and help with transitions (10-minute warning, use of music to signal change, timer).
- If over or under stimulated> sensory objects to play with while working, weighted vest or blankets (deep pressure), compression clothing, noise cancelling headphones, soft music, dim lighting, and a quiet place to retreat to when agitated. See processing disorders on how to work with sensory issues.
- If uncomfortable in social settings> play games that stimulate conversation, create play dates, focus on quality of friendships instead of quantity, use social stories to prepare for outings and family gatherings to reduce anxiety.
- If meltdowns occur>
- learn to identify triggers and redirect child’s attention to something else beforehand.
- create a cool down place with low lighting, a bean bag, soft blanket, low music, books, and other calming effects or preferred sensory objects.
- create a discipline chart with consequences and be consistent with it: time out, rewards with a point system, or other forms that work for you. Teach the system and stick with it.
- provide 2-4 choices when rewarding good behavior or academic accomplishments, as well as making decisions. This provides a sense of control over their environment.
- If unable to communicate effectively> use visual supports like Picture Exchange Communication System (PECS)®; Speech Generated Devices, & Accommodations
- Access and make use of appropriate assistive technology without overusing it.
TIPS: Therapy and Medical Treatment
- Therapies chosen depend on your child’s needs. Occupational, speech/language, behavioral, and physical therapy as well as art, music and hippotherapy (use of horses) may be helpful in alleviating various symptoms.
- Video Modeling assists in teaching speech, language, social skills, reading and life skills for children with autism, intellectual disabilities and other learning disabilities. Gemiini is an online video modeling system that costs $98 per month, scholarships are offered.
- Children with autism often have underlying medical issues (comorbidity) and require treatment to mitigate symptoms and behaviors. It is critical to find a physician that is knowledgeable and experienced in working with children with autism.
- National Autism Association can assist you in locating therapists and medical experts.
Autism Speaks, provides a free online screening for toddlers that parents can complete, Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
Autism Society , is a network of families and professionals sharing their knowledge and expertise to help you navigate the world of autism.
Center for Disease Control provides an app for parents to track your child’s developmental milestones @ “Learn the Signs. Act Early.”
Do2Learn: Educational Resources for Special Needs provides thousands of free pages with social skills and behavioral regulation activities and guidance, learning songs and games, communication cards, academic material, and transition guides for employment and life skills.
Aulexic specializes in picture books and short chapter books for early readers and children with language and literacy acquisition difficulties such as those associated with dyslexia, specific language impairment, and autism.
Woodbine House for books on autism related topics such as schedules, feeding and picture systems.
Path International – equine-assisted activities and therapy programs: therapeutic carriage driving; interactive vaulting, which is similar to gymnastics on horseback; equine-facilitated learning and mental health, which partner with the horse in cognitive & behavioral therapy; ground work; and stable management.