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Autism Spectrum Disorder FAQs

An ongoing series of informational entries

Frequently Asked Questions About Autism Spectrum Disorder

January 15, 2017

What is autism?

Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism is a spectrum disorder and it affects each individual differently and at varying degrees.

What are the most common characteristics of autism?

Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions. They may have difficulty initiating and/or maintaining a conversation. Their communication is often described as talking at others instead of to them. (For example, a monologue on a favorite subject that continues despite attempts by others to interject comments).41

People with autism also process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may also exhibit some of the following traits:

  • Insistence on sameness; resistance to change
  • Difficulty in expressing needs, using gestures or pointing instead of words
  • Repeating words or phrases in place of normal, responsive language
  • Laughing (and/or crying) for no apparent reason; showing distress for reasons not apparent to others
  • Preference to being alone; aloof manner
  • Tantrums
  • Difficulty in mixing with others
  • Not wanting to cuddle or be cuddled
  • Little or no eye contact
  • Unresponsive to normal teaching methods
  • Sustained odd play
  • Spinning objects
  • Obsessive attachment to objects
  • Apparent over-sensitivity or under-sensitivity to pain
  • No real fears of danger
  • Noticeable physical over-activity or extreme under-activity
  • Uneven gross/fine motor skills
  • Non-responsive to verbal cues; acts as if deaf, although hearing tests in normal range

What does it mean to be “on the spectrum”?

Autism is a spectrum disorder, which means it manifests itself in many different forms. A diagnosis can range from mild to severe, and though children who have it (i.e. are on the spectrum) are likely to exhibit similar traits, they're also as individual as the colors of a rainbow, each one managing a grab bag of symptoms. While one child may rarely speak and have difficulty learning how to read and write, another can be so high-functioning he's able to attend classes in a mainstream school. Yet another child may be so sensitive to the feel of fabric that all tags must be cut off before he wears a piece of clothing, while his friend who's also autistic may not have any sensory issues at all

How common is autism?

According to the Centers for Disease Control, autism affects as many as 1 in every 150 children in the United States. Therefore, it is estimated that 1.5 million Americans may be affected with autism. Also, government statistics suggest the rate of autism is rising 10-17 percent annually. Unfortunately, the numbers appear to be continuing their upward climb. In fact, it is the most prevalent developmental disorder to date; according to the Centers for Disease Control, of the approximately 4 million babies born every year, 24,000 of them will eventually be identified as autistic. Also, recent studies suggest boys are more susceptible than girls to developing autism. In the United States alone, 1 out of 94 boys are suspected of being on the spectrum, with perhaps more going undiagnosed to this day. That said, girls appear to manifest a more severe form of the disorder than their male counterparts

How did my child develop autism?

No one knows for sure. Though it's understandable to expect that a disorder as common as autism would have a known cause, in many ways it's still quite mysterious. Recent studies suggest a strong genetic basis for autism -- up to 20 sets of genes may play a part in its development. Genetics alone, however, can't account for all the cases, and so scientists are also looking into possible environmental origins, as well as other triggers

What causes autism?

The simple answer is we don’t know. The vast majority of cases of autism are idiopathic, which means the cause is unknown.

The more complex answer is that just as there are different levels of severity and combinations of symptoms in autism, there are probably multiple causes. The best scientific evidence available to us today points toward a potential for various combinations of factors causing autism – multiple genetic components that may cause autism on their own or possibly when combined with exposure to as yet undetermined environmental factors. Timing of exposure during the child’s development (before, during or after birth) may also play a role in the development or final presentation of the disorder.

A small number of cases can be linked to genetic disorders such as Fragile X, Tuberous Sclerosis, and Angelman’s Syndrome, as well as exposure to environmental agents such as infectious ones ( maternal rubella or cytomegalovirus) or chemical ones ( thalidomide or valproate) during pregnancy.

There is a growing interest among researchers about the role of the functions and regulation of the immune system, both within the body and the brain, in autism. Piecemeal evidence over the past 30 years suggests that people with autism may involve inflammation in the central nervous system. There is also emerging evidence from animal studies that illustrates how the immune system can influence behaviors related to autism

How can I tell if a child has autism?

No two children with autism are alike, but here are some signs that many of them share and that experts agree may be as recognizable as early as the toddler years, or even sooner. Children on the spectrum generally have difficulty relating to others; they may hardly speak, and if they do, they may not communicate in ways that other people can easily understand (they may screech loudly when they're upset, for example, instead of crying). They don't usually sustain eye contact – it's too intense -- and have trouble reading social cues. They're also prone to repetitive behaviors, flapping their hands constantly or uttering the same phrase over and over again. They may also be more sensitive than typically developing children, or dramatically less so, to sights, sounds and touch

What should I do if I suspect something is wrong with my child?

Don't wait — talk to your doctor about getting child screened for autism. New research shows that children as young as one may exhibit signs of autism, so recognizing early signs and knowing developmental milestones is important. Early intervention is key

How do I get my child the help he needs?

You can start by making sure he has a reputable healthcare team by his side. That means finding doctors, therapists, psychologists and teachers who understand and have experience with autism and can respond to his shifting needs appropriately. Ask your child's pediatrician to recommend a developmental pediatrician with whom you can consult about the next step. She, in turn, can guide you toward various intervention programs and suggest complementary therapies. It also helps to plug into an already existing network of parents facing the same challenges as you

How do I deal with this diagnosis?

First, be kind to yourself. It's not easy to recover from the shock of learning your child has a developmental disorder that has no known cause or cure. Accept any and all feelings the diagnosis may elicit, and try not to blame yourself: It would've been impossible for you to figure out a way to shield your child from autism completely. The next step is to arm yourself with all the facts about the disorder. Knowledge is power, and the more you know, the more capable you'll feel about navigating the daunting autism gauntlet. That said, it's also important to give yourself a “break” from autism when it becomes too overwhelming. And if you find that the diagnosis has been so crippling that you've been unable to get past it, consider talking to a counselor or therapist. You can't — and aren't expected to — weather this storm alone

Will my child be able to attend school?

Most likely yes. Much depends on where your child falls on the spectrum, but with your support, as well as that of doctors, therapists and teachers, your child should be able to attend school. In fact, it's his right: According to the Individuals with Disabilities Act of 1990, which mentions autistic children specifically, your child deserves access to a “free and appropriate” education funded by the government, whether it be in a mainstream or special education classroom

What is Asperger's Syndrome? What is Social Communication Disorder (SCD)?

In the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) used by the psychiatric and psychological communities, the main diagnostic criteria of Asperger’s Disorder included a “qualitative impairment in social interaction and restricted, repetitive and stereotyped patterns of behavior, interests, and activities.” These deficiencies and patterns caused “clinically significant impairment in social, occupational or other important areas of functioning.”

In the new DSM-V, the diagnosis of Asperger’s Disorder no longer exists and has been absorbed into the diagnosis of Autism Spectrum Disorder (ASD). There is also a new diagnosis called Social (Pragmatic) Communication Disorder (SCD), which falls under the category of Communication Disorders and may serve as an alternative diagnosis for someone with Asperger’s-like symptoms.

ASD is the “persistent impairment in reciprocal social communication and social interaction, AND restricted, repetitive patterns of behavior, interests or activities.” The symptoms and behaviors must be present from early childhood and negatively impact everyday functioning. According to the American Psychiatric Association, “the symptoms of people with Autistic Spectrum Disorder will fall on a continuum, with some individuals showing mild symptoms and others having much more severe symptoms.”

SCD is “characterized by a primary difficulty with pragmatics, or the social use of language and communication, as manifested by deficits in understanding and following social rules of verbal and non-verbal communication in naturalistic contexts, changing language according to the needs of the listener or situation and following rules for conversations and story-telling.”

A person diagnosed with SCD has difficulty with “effective communication and social participation, development of social relationships, academic achievement, or occupational performance.” These difficulties cannot be due to low cognitive ability.

While symptoms must be present from early childhood for both ASD and SCD, the DSM-V acknowledges that those symptoms may not be recognized until later, when a person with these limitations is faced with increased social demands.

In doing a differential diagnosis, the key difference between the two similar disorders is that Autism Spectrum Disorder includes “restricted, repetitive patterns of behavior, interests or activities and gives equal weight to both communication issues and repetitive behaviors.”

A person with ASD may have only exhibited these restricted, repetitive patterns during the early developmental period. It is imperative that a comprehensive history be obtained because any evidence of restricted/repetitive patterns of behavior, interests, or activities in addition to the communication difficulties would lead to a diagnosis of Autistic Spectrum Disorder, rather than Social (Pragmatic) Communication Disorder.

Why is early intervention so important?

Early intervention is defined as services delivered to children from birth to age 3, and research shows that it has a dramatic impact on reducing the symptoms of autism spectrum disorders. Studies in early childhood development have shown that the youngest brains are the most flexible. In autism, we see that intensive early intervention yields a tremendous amount of progress in children by the time they enter kindergarten, often reducing the need for intensive supports

What should we know about our younger or future children?

Although autism is believed to have a strong environmental component, there is little doubt that autism is a disorder with a strong genetic basis. If you are expecting another child, or have plans to expand your family in the future, you may be concerned about the development of any younger siblings of your child with autism.

Studies have estimated that families affected with one child with autism have roughly a 5-10% percent chance of having a second child with autism. This risk increases if two or more children in the family are already affected.

More recent evidence suggests that early signs of autism may be seen in some children as young as 8-10 months of age. For example, infants who later develop autism may be more passive, are more difficult to soothe, or fail to orient when their name is called. Some of these early signs may be noticed by parents, others may only be observed with the help of a trained clinician

Are all people with Autism also intellectually disabled?

No. It used to be thought that most people with autism were also intellectually disabled (ID). This is not true. In fact, people with a diagnosis of Asperger’s Syndrome often are intellectually gifted in certain areas. ID affects people with autism more than the general population, but fewer than 50% of people with autism have an intellectual disability.

Why do people with Autism not like to be touched?

Many people on the autism spectrum have over-sensitive nervous systems. For these people, it can literally hurt to be touched. This is called “tactile defensiveness” and sensory based therapy can help to control the nervous system and reduce the amount of defensiveness exhibited.

Why do people with Autism like to spin things (or themselves)?

Self-spinning or watching things spin is an activity that stimulates the vestibular system in the body which for some people with autism is very soothing. Spinning oneself or objects isn’t a concern in its own right, but can become an issue when the need for the spinning becomes overwhelming and obsessive and gets in the way of learning, playing or relating to others.

Is there medication for Autism?

There is no specific medication for Autism, per se. There are many medications that people with Autism can take to help with specific symptoms that they might exhibit – such as aggression, depression, anxiety or other medical issues. As with any medication, oversight by a trusted, knowledgeable professional is required to make sure that the medication is effective in the right dosage and that side effects are monitored.

Why do people with Autism often reject certain foods?

Many people with Autism have over-sensitive nervous systems which can cause certain foods to taste, smell or feel unappealing to them. Some people with Autism often have muscle issues that mean that chewing and/or swallowing certain textures are difficult. Sensory based therapy and oral motor therapy can help with these issues. Also, many people with Autism prefer what they know and can be rigid about trying new items. Education and therapy can help.