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Frequently Asked Questions
The following information is sourced from the Center for Disease Control (CDC’s) website and the New York City Department of Health’s Early Intervention Program (EIP) website.
Understanding Austim
What is Autism or Autism spectrum disorder (ASD)?
Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less.
A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder.
Overview of the Signs and Symptoms of ASD
People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things. Signs of ASD begin during early childhood and typically last throughout a person’s life.
Children or adults with ASD might:
- not point at objects to show interest (for example, not point at an airplane flying over)
- not look at objects when another person points at them
- have trouble relating to others or not have an interest in other people at all
- avoid eye contact and want to be alone
- have trouble understanding other people’s feelings or talking about their own feelings
- prefer not to be held or cuddled, or might cuddle only when they want to
- appear to be unaware when people talk to them, but respond to other sounds
- be very interested in people, but not know how to talk, play, or relate to them
- repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
- have trouble expressing their needs using typical words or motions
- not play “pretend” games (for example, not pretend to “feed” a doll)
- repeat actions over and over again
- have trouble adapting when a routine changes
- have unusual reactions to the way things smell, taste, look, feel, or sound
- lose skills they once had (for example, stop saying words they were using)
Signs and Symptoms of Autism Spectrum Disorders
Possible “Red Flags”
A person with ASD might:
- 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
- Not play “pretend” games (pretend to “feed” a doll) by 18 months
- Avoid eye contact and want to be alone
- Have trouble understanding other people’s feelings or talking about their own feelings
- Have delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- Give unrelated answers to questions
- Get upset by minor changes
- Have obsessive interests
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to the way things sound, smell, taste, look, or feel
Social Skills
Social issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.
Examples of social issues related to ASD:
- Does not respond to name by 12 months of age
- Avoids eye-contact
- Prefers to play alone
- 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
Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye bye”. Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an ASD might have a very hard time learning to interact with other people.
Some people with an ASD might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an ASD have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.
People with an ASD might have problems with showing or talking about their feelings. They might also have trouble understanding other people’s feelings. Many people with an ASD are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an ASD. Anxiety and depression also affect some people w
Communications
Each person with ASD has different communication skills. Some people can speak well. Others can’t 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.1 Others might speak, but not until later in childhood.
Examples of communication issues related to ASD:
- Delayed speech and language skills
- Repeats words or phrases over and over (echolalia)
- Reverses pronouns (e.g., says “you” instead of “I”)
- Gives unrelated answers to questions
- Does not point or respond to pointing
- Uses few or no gestures (e.g., does not wave goodbye)
- Talks in a flat, robot-like, or sing-song voice
- Does not pretend in play (e.g., does not pretend to “feed” a doll)
- Does not understand jokes, sarcasm, or teasing
People with ASD who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with ASD say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with ASD, “Do you want some juice?” he or she might repeat “Do you want some juice?” instead of answering your question. Although many children without an ASD go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an ASD can speak well but might have a hard time listening to what other people say.
People with ASD might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with ASD might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an ASD might smile while saying something sad.
People with ASD might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an ASD might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.
Unusual Interests and Behaviors
Many people with ASD have unusual interest or behaviors.
Examples of unusual interests and behaviors related to ASD:
- Lines up toys or other objects
- Plays with toys the same way every time
- Likes parts of objects (e.g., wheels)
- Is very organized
- Gets upset by minor changes
- Has obsessive interests
- Has to follow certain routines
- Flaps hands, rocks body, or spins self in circles
Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an ASD might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”
People with ASD often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with ASD. They might “lose control” and have a “melt down” or tantrum, especially if in a strange place.
Some people with ASD also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.
Other Symptoms
Some people with ASD have other symptoms. These might include:
- Hyperactivity (very active)
- Impulsivity (acting without thinking)
- Short attention span
- Aggression
- Causing self injury
- Temper tantrums
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Lack of fear or more fear than expected
- Unusual reactions to the way things sound, smell, taste, look, or feel
People with ASD might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an ASD limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.
People with ASD might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.
Development
Children with ASD develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an ASD might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a “b” makes.
Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life. To learn more about developmental milestones, visit “Learn the Signs. Act Early,” a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible “red flags” for autism spectrum disorders.
Understanding the ASD Diagnosis
Diagnosis
Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.1 However, many children do not receive a final diagnosis until much older. This delay means that children with ASD might not get the early help they need.
Screening and Diagnosis of Autism Spectrum Disorder
Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s developmental history and behavior to make a diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable [1]. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults. This delay means that children with ASD might not get the early help they need.
Early signs of ASD can include, but are not limited to
- Avoiding eye contact,
- Having little interest in other children or caretakers,
- Limited display of language (for example, having fewer words than peers or difficulty with use of words for communication), or
- Getting upset by minor changes in routine.
CDC’s “Learn the Signs. Act Early.” program provides free resources to help families monitor developmental milestones and recognize signs of developmental concerns, including ASD.
As children with ASD become adolescents and young adults, they might have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may also come to the attention of healthcare providers because they have co-occurring conditions such as attention-deficit/hyperactivity disorder, obsessive compulsive disorder, anxiety or depression, or conduct disorder.
Monitoring, screening, evaluating, and diagnosing children with ASD as early as possible is important to make sure children receive the services and supports they need to reach their full potential [2]. There are several steps in this process.
Developmental Monitoring
Developmental monitoring observes how your child grows and changes over time and whether your child meets the typical developmental milestones in playing, learning, speaking, behaving, and moving. Parents, grandparents, early childhood providers, and other caregivers can participate in developmental monitoring. You can use a brief checklist of milestones to see how your child is developing. If you notice that your child is not meeting milestones, talk with your doctor or nurse about your concerns.
When you take your child to a well visit, your doctor or nurse will also do developmental monitoring. The doctor or nurse might ask you questions about your child’s development or will talk and play with your child to see if he or she is developing and meeting milestones. A missed milestone could be a sign of a problem, so the doctor or another specialist will take a closer look by using a more thorough test or exam.
Your childcare provider can also be a valuable source of information on how your child develops. More information on developmental monitoring for early childhood educators.
Developmental Screening
Developmental screening takes a closer look at how your child is developing. Your child will get a brief test, or you will complete a questionnaire about your child. The tools used for developmental and behavioral screening are formal questionnaires or checklists based on research that ask questions about a child’s development, including language, movement, thinking, behavior, and emotions. Developmental screening can be done by a doctor or nurse, but also by other professionals in healthcare, community, or school settings.
Developmental screening is more formal than developmental monitoring and normally done less often than developmental monitoring. Your child should be screened if you or your doctor have a concern. However, developmental screening is a regular part of some of the well-child visits for all children even if there is not a known concern.
The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening for all children during regular well-child visits at these ages:
- 9 months
- 18 months
- 30 months
In addition, AAP recommends that all children be screened specifically for ASD during regular well-child doctor visits at:
- 18 months
- 24 months
- Additional screening might be needed if a child is at high risk for ASD (e.g., having a sister, brother or other family member with an ASD) or if behaviors sometimes associated with ASD are present.
If your child is at higher risk for developmental problems due to preterm birth, low birthweight, environmental risks like lead exposure, or other factors, your healthcare provider may also discuss additional screening. If a child has an existing long-lasting health problem or a diagnosed condition, the child should have developmental monitoring and screening in all areas of development, just like those without special healthcare needs.
If your child’s healthcare provider does not periodically check your child with a developmental screening test, you can ask that it be done.
Comprehensive Developmental Evaluation
A brief test using a screening tool does not provide a diagnosis, but it indicates if a child is on the right development track or if a specialist should take a closer look. If the screening tool identifies an area of concern, a formal developmental evaluation may be needed. This formal evaluation is a more in-depth look at a child’s development, usually done by a trained specialist, such as a developmental pediatrician, child psychologist, speech-language pathologist, occupational therapist, or other specialist. The specialist may observe the child, give the child a structured test, ask the parents or caregivers questions, or ask them to fill out questionnaires. The results of this formal evaluation determines whether a child needs special treatments or early intervention services or both.
View and print a fact sheet on developmental monitoring and screening
Understanding Treatment
Treatment
There is currently no cure for ASD. However, research shows that early intervention treatment services can improve a child’s development.2, 3 Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services can include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has ASD or other developmental problem.
Even if your child has not been diagnosed with an ASD, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.
In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.1 However, many children do not receive a final diagnosis until much older. This delay means that children with ASD might not get the early help they need.
Treatment and Intervention Services for Autism Spectrum Disorder
Currently, no treatment has been shown to cure ASD, but several interventions have been developed and studied for use with young children. These interventions may reduce symptoms, improve cognitive ability and daily living skills, and maximize the ability of the child to function and participate in the community [1-6].
The differences in how ASD affects each person means that people with ASD have unique strengths and challenges in social communication, behavior, and cognitive ability. Therefore, treatment plans are usually multidisciplinary, may involve parent-mediated interventions, and target the child’s individual needs.
Behavioral intervention strategies have focused on social communication skill development—particularly at young ages when the child would naturally be gaining these skills—and reduction of restricted interests and repetitive and challenging behaviors. For some children, occupational and speech therapy may be helpful, as could social skills training and medication in older children. The best treatment or intervention can vary depending on an individual’s age, strengths, challenges, and differences [7].
It is also important to remember that children with ASD can get sick or injured just like children without ASD. Regular medical and dental exams should be part of a child’s treatment plan. Often it is hard to tell if a child’s behavior is related to the ASD or is caused by a separate health condition. For instance, head banging could be a symptom of ASD, or it could be a sign the child is having headaches or earaches. In those cases, a thorough physical examination is needed. Monitoring healthy development means not only paying attention to symptoms related to ASD, but also to the child’s physical and mental health.
Not much is known about the best interventions for older children and adults with ASD. There has been some research on social skills groups for older children, but there is not enough evidence to show that these are effective [8]. Additional research is needed to evaluate interventions designed to improve outcomes in adulthood. In addition, services are important to help individuals with ASD complete their education or job training, find employment, secure housing and transportation, take care of their health, improve daily functioning, and participate as fully as possible in their communities [9].
Types of Treatments
There are many types of treatments available. These include applied behavior analysis, social skills training, occupational therapy, physical therapy, sensory integration therapy, and the use of assistive technology.
The types of treatments generally can be broken down into the following categories:
- Behavior and Communication Approaches
- Dietary Approaches
- Medication
- Complementary and Alternative Medicine
When you take your child to a well visit, your doctor or nurse will also do developmental monitoring. The doctor or nurse might ask you questions about your child’s development or will talk and play with your child to see if he or she is developing and meeting milestones. A missed milestone could be a sign of a problem, so the doctor or another specialist will take a closer look by using a more thorough test or exam.
Your childcare provider can also be a valuable source of information on how your child develops. More information on developmental monitoring for early childhood educators.
Behavior and Communication Approaches
According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation [10].
Comprehensive Developmental Evaluation
A brief test using a screening tool does not provide a diagnosis, but it indicates if a child is on the right development track or if a specialist should take a closer look. If the screening tool identifies an area of concern, a formal developmental evaluation may be needed. This formal evaluation is a more in-depth look at a child’s development, usually done by a trained specialist, such as a developmental pediatrician, child psychologist, speech-language pathologist, occupational therapist, or other specialist. The specialist may observe the child, give the child a structured test, ask the parents or caregivers questions, or ask them to fill out questionnaires. The results of this formal evaluation determines whether a child needs special treatments or early intervention services or both.
View and print a fact sheet on developmental monitoring and screening
Applied Behavior Analysis (ABA)
A notable treatment approach for people with ASD is called applied behavior analysis (ABA). ABA has become widely accepted among healthcare professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors to improve a variety of skills. The child’s progress is tracked and measured.
There are different types of ABA. Here are some examples:There are different types of ABA. Here are some examples:
- Discrete Trial Training (DTT)
DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts, and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored. - Early Intensive Behavioral Intervention (EIBI)
This is a type of ABA for very young children with ASD, usually younger than 5 and often younger than 3. EIBI uses a highly structured teaching approach to build positive behaviors (such as social communication) and reduce unwanted behaviors (such as tantrums, aggression, and self-injury). EIBI takes place in a one-on-one adult-to-child environment under the supervision of a trained professional. - Early Start Denver Model (ESDM)
This is a type of ABA for children with ASD between the ages of 12-48 months. Through ESDM, parents and therapists use play and joint activities to help children advance their social, language, and cognitive skills.
- Pivotal Response Training (PRT)
PRT aims to increase a child’s motivation to learn, monitor their own behavior, and initiate communication with others. Positive changes in these behaviors are believed to have widespread effects on other behaviors. - Verbal Behavior Intervention (VBI)
VBI is a type of ABA that focuses on teaching verbal skills.
Assistive Technology
Assistive technology, including devices such as communication boards and electronic tablets, can help people with ASD communicate and interact with others. For example, the Picture Exchange Communication System (PECS) uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation. Other individuals may use a tablet as a speech-generating or communication device.
Occupational Therapy
Occupational therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people.
Social Skills Training
Social skills training teaches children the skills they need to interact with others, including conversation and problem-solving skills.
Speech Therapy
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
Medication
There are no medications that can cure ASD or treat the core symptoms. However, there are medications that can help some people with ASD function better. For example, medication might help manage high energy levels, inability to focus, anxiety and depression, behavioral reactivity, self-injury, or seizures.
Medications might not affect all children in the same way. It is important to work with a healthcare professional who has experience in treating children with ASD. Parents and healthcare professionals must closely monitor a child’s progress and reactions while he or she is taking medication to be sure that any negative side effects of the treatment do not outweigh the benefits.
Complementary and Alternative Medicine Treatments
To relieve the symptoms of ASD, some parents and healthcare professionals use treatments that are outside of what is typically recommended by pediatricians. These treatments are known as complementary and alternative medicine (CAM) treatments. CAM treatments refer to products or services that are used in addition to or instead of traditional medicine. They might include special diets, dietary supplements, chelation (a treatment to remove heavy metals such as lead from the body), biologicals (for example, secretin), or mind-body medicine [12].
Many of these treatments have not been studied for effectiveness; moreover, a review of studies on chelation found some evidence of harm and no evidence to indicate it is effective in treating children with ASD [13]. Current research shows that as many as one-third of parents of children with ASD may have tried CAM treatments, and up to 10% may be using a potentially dangerous treatment [14-17]. Before starting such a treatment, talk to your child’s doctor.
To learn more about CAM therapies for ASD, go to the National Center for Complementary and Alternative Medicine’s Autism webpage. The FDA has information about potentially dangerous treatments here
Additional Treatment Resources
The National Institute on Deafness and Other Communication Disorders has a website to help individuals with ASD who have communication challenges.
The National Institute of Dental and Craniofacial Research has resources to help caregivers and health professionals with the oral healthcare needs of individuals with ASD.
Clinical Trials.Gov lists federally funded clinical trials that are looking for participants. If you or someone you know would like to take part in an autism study, go to the website and search “autism.”