I remember a mom, Sarah, sitting in my office, her voice quiet. “He’s… different,” she said about her little boy, Leo. “He lines up all his cars, over and over. And he doesn’t look at me much.” That feeling, that gentle nudge that something about your child’s world is unique, is often where the journey to understanding Autism begins. It’s a path many parents walk, and please know, you’re not walking it by yourself.
So, What Exactly is Autism?
Let’s talk about Autism. It’s not a sickness or something your child “caught.” Think of it more like a unique wiring in your child’s brain, something they’re born with. It shapes how they see the world, how they communicate, and how they interact. And no, it has absolutely nothing to do with how you’ve parented, or vaccines, or anything that happened after they were born. We’re still learning all the whys, but here’s what we do know:
- Autism isn’t a disease to be cured. Our goal isn’t to change who your child is. Instead, we focus on understanding their amazing strengths and finding ways to support them through any challenges.
- Autistic individuals are neurodivergent. This simply means their brains work differently from what we might call “typical.” They might be rock stars in some areas and need a bit more help in others. And that’s okay.
- Autism is a spectrum. Just like no two kids are exactly alike, no two autistic kids are either. There’s a huge range of personalities, abilities, and needs. It’s a wide, beautiful spectrum.
- Autism has been misunderstood for a long time. Even we doctors have learned so much. Old ideas about “fixing” or forcing kids to be “normal” are thankfully changing. Today, we’re all about helping your child gain skills in a way that respects who they are. But, yes, myths still linger.
We often use medical terms like “Autism Spectrum Disorder” (ASD), and you’ll hear words like “diagnosis” or “symptoms.” Sometimes these words don’t quite capture the full picture of your child’s identity and life. We’ll use them here because they help us doctors talk about how to best support your family, but always remember, your child is so much more than a label.
What is Autism Spectrum Disorder (ASD)?
Autism Spectrum Disorder (ASD) is the term doctors use. According to the main guide we use, the DSM-5-TR (that’s the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision), ASD involves differences in brain function that affect communication and social interaction. For example, an autistic child might not use eye contact or gestures in the ways other kids do.
These brain differences also influence behaviors and interests. You might see repetitive movements or sounds – we call this stimming, and it can be a way for them to manage big feelings. Or they might really love their routines and prefer things to stay the same.
How Common is Autism?
It’s more common than you might think. Current estimates suggest about 1 in 31 kids in the U.S. are autistic. You might hear that Autism is “on the rise.” That’s likely because we’re getting much better at recognizing it and understanding how to help. We have more knowledge and better tools than we did years ago, so more children are getting the support they need, which naturally means more diagnoses.
What Are the Signs of Autism in Children?
When we talk about “symptoms” of Autism, it’s more accurate to think of them as characteristics or traits. These are the kinds of things we look for to understand if a child might be autistic and what kind of support could be helpful. No child will have all of them, and they can look different from one child to the next. We usually group these characteristics into two main areas:
- How your child connects and communicates socially.
- Their patterns of behavior, interests, or activities, which might be restricted or repetitive.
Remember, these aren’t signs that something is “wrong.” They’re just signals that your child might experience and process the world differently, and might need some help navigating a world that’s often set up for neurotypical folks.
How Your Child Socializes
Socializing changes so much as kids grow! What we look for will vary by age.
You might notice your toddler (around 1-3 years old):
- Doesn’t follow your gaze when you look at something or point.
- Doesn’t seem to respond when you call their name.
- Isn’t that into back-and-forth games like peek-a-boo.
- Doesn’t bring things to you to show you, like a cool rock they found.
- Tends to look away instead of making eye contact.
- Might use your hand like a tool to get something they want.
- Often prefers to play alone (this can be typical for a bit, but with Autism, it might continue past age 2).
You might notice your older child (around 4-10 years old):
- Talks a lot about a few specific topics.
- Conversations can feel a bit one-sided, without much back-and-forth.
- Doesn’t seem very interested in starting conversations.
- Has a hard time talking about their own feelings or understanding how others feel.
- Struggles with using or reading body language (like facing away from someone while talking).
- Might speak in a voice that’s flat or a bit sing-songy.
- Has trouble picking up on social cues from others.
You might notice your adolescent (pre-teen and teen years):
- Has trouble understanding things like sarcasm or figures of speech.
- Doesn’t often start up social interactions.
- Makes very little or no eye contact.
- Finds it tricky to match their words with their body language.
- Has a tough time making and keeping friends their own age.
- Might get along better with younger kids or adults.
- Has difficulty seeing things from someone else’s perspective.
- Doesn’t always grasp unwritten social rules, like how to greet someone or personal space.
- Can sometimes seem a bit aloof or distant around others.
How Your Child Acts
You might notice your toddler:
- Repeats words or phrases they hear – this is called echolalia.
- Does the same movements over and over, like flapping their hands, rocking, or spinning.
- Plays with a toy or part of a toy in the same way repeatedly, like just spinning a car’s wheels.
- Gets very upset by small changes in their routine.
- Likes to line up toys or objects in a specific order and doesn’t like it if they’re moved.
- Is a very picky eater, especially with certain food textures.
- Reacts strongly to how certain clothes feel, or other sensations on their skin.
- Shows an intense interest in an unusual object, like a specific spoon or a ceiling fan.
You might notice your older child or adolescent:
- Repeats phrases from books, movies, or TV shows.
- Finds it hard to switch from one task to another.
- Strongly prefers familiar routines and patterns.
- Has very intense and focused interests, like a particular subject or a collection of items.
It’s tricky, right? Lots of these things are just… kids being kids at certain stages. With Autism, these patterns of behavior might create challenges for your child in places like school, or later on, at work.
What Strengths Do Autistic People Have?
It’s so important to remember that being autistic also comes with many wonderful strengths! Every person is unique, of course, but research shows some common strengths:
- A real ability to speak their mind and go against the grain, even if it’s not popular.
- A strong sense of what’s right and wrong; they often stick to their morals.
- They tend to be direct and honest in how they express themselves.
- A knack for connecting with people of all different ages.
- The ability to focus deeply on something for a long time, becoming quite the expert!
- Often, strong skills in nonverbal reasoning – like solving puzzles.
What Causes Autism?
This is a big question, and the truth is, we don’t have one single answer. It seems to be a mix of genetic factors and certain things that can happen during pregnancy or birth. These things can interact and lead to the brain differences we see in Autism.
Some things that might make Autism a bit more likely include:
- Pregnancy over the age of 35.
- Getting pregnant again very soon (within 12 months) after a previous baby.
- Having gestational diabetes during pregnancy.
- Experiencing bleeding during pregnancy.
- Using certain medications (like valproate, an epilepsy drug) while pregnant.
- The baby being smaller than expected during pregnancy (intrauterine growth restriction).
- Reduced oxygen to the baby during pregnancy or delivery.
- The baby being born prematurely.
These factors might directly influence how a baby’s brain develops, or they could affect how certain genes work, which then leads to these brain differences.
Is Autism Genetic?
Yes, there’s a strong genetic component to Autism, but it’s complex. It’s not like some other genetic conditions where we can point to one specific gene and say, “That’s it!”
Instead, many different gene variations are linked to Autism. An autistic person might have one or more of these. Sometimes, genetic testing might not show any known Autism-linked gene variations for your child. That doesn’t change their diagnosis, and it doesn’t mean genes aren’t involved. It just means there’s still more for us to learn!
Is Autism Inherited?
It can be. “Genetic” means it relates to genes, but “inherited” means it’s passed down from parents. Those gene variations we talked about can sometimes appear for the first time in a baby (not inherited). But, they can also be passed down. We see patterns in families, like siblings both being autistic, which suggests it can be inherited.
Sometimes, Autism is part of a broader genetic syndrome, like Fragile X syndrome, Down syndrome, or tuberous sclerosis. In these cases, a child is autistic and also has other developmental differences due to the syndrome, which itself has specific inheritance patterns.
Getting an Autism Diagnosis: What’s Involved?
Getting a diagnosis for Autism is usually a team effort, and you and your child are the most important members of that team! It starts with us doctors talking with you about what you’ve noticed and then interacting with your child.
The first step is often a screening. Your pediatrician will likely do this at your child’s 18-month and 24-month check-ups. It’s usually a questionnaire for you, followed by a chat.
If the screening suggests possible signs of Autism, your pediatrician will likely refer you to a specialist, like a developmental pediatrician, a child psychologist, or a neurologist. This specialist will talk more with you and spend time observing and playing with your child. They’ll be looking for the specific characteristics of Autism.
Criteria for an Autism Diagnosis
To make a diagnosis of Autism Spectrum Disorder, specialists use criteria from the DSM-5-TR. Your child would need to show ongoing difficulties in three specific social areas:
- Social-emotional reciprocity: This is the give-and-take of social interaction. Think of a conversation – one person talks, the other responds. Autistic children might not engage in this back-and-forth as much as expected.
- Nonverbal communication: This includes things like eye contact, facial expressions, and body language. Autistic children might use these cues differently or have trouble understanding them in others.
- Developing and maintaining relationships: This is about seeking out others, sharing interests, and understanding social situations. Autistic children might approach friendships differently than their peers.
AND, your child must show at least two of the following restricted or repetitive behaviors:
- Repetitive movements, use of objects, or speech: This could be hand-flapping, lining up toys, or repeating phrases (echolalia).
- Insistence on sameness, routines, or ritualized patterns: This means a strong preference for things to be predictable and a difficulty with change.
- Highly restricted, fixated interests that are abnormal in intensity or focus: This is an interest in a topic or object that’s much stronger or more consuming than typical.
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment: This means being either very sensitive (overwhelmed) by sights, sounds, textures, or, conversely, seeking out intense sensory experiences (like sniffing or touching things a lot).
Is There an Autism Test?
There isn’t a blood test or a brain scan that can diagnose Autism. Sometimes, doctors might recommend genetic testing to look for gene variations associated with Autism or related syndromes. This isn’t a test for Autism itself, but it can sometimes help understand underlying causes and tailor support.
A specialist, often a developmental pediatrician, might use standardized assessment tools like the Autism Diagnostic Observation Schedule (ADOS). This involves structured activities and observations to help clarify the diagnosis.
What About Autism “Treatment”?
This is a really important point: because Autism isn’t a disease, we don’t “treat” it in the way we treat an infection. It’s not something that “goes away” or needs to be “cured.” It’s a fundamental part of how your child’s brain works and who they are.
Instead, we focus on managing any aspects of Autism that might be challenging for your child and supporting them to use their strengths. This usually involves different kinds of therapies to help your child build skills they’ll use throughout life, like social communication or daily living skills. Many therapies also teach you and your family strategies to best support your child. The earlier this support starts – ideally before age 3 – the more beneficial it can be.
Some common therapies include:
- Behavioral therapies, like Applied Behavior Analysis (ABA).
- Family therapy.
- Speech therapy.
- Occupational therapy.
Support for Co-occurring Conditions
It’s quite common for autistic children to also have other conditions that need support. Some of these include:
- Attention-Deficit/Hyperactivity Disorder (ADHD)
- Anxiety disorders
- Avoidant/Restrictive Food Intake Disorder (ARFID) (a type of eating disorder)
- Conduct disorder or oppositional defiant disorder
- Bipolar disorders
- Depressive disorders
- Digestive issues, like constipation
- Epilepsy
- Intellectual disabilities
- Obsessive-Compulsive Disorder (OCD)
- Schizophrenia spectrum disorder (rare in children, but possible)
- Sleep disorders
If your child has any of these, we’ll work on managing them too, often with:
- Cognitive Behavioral Therapy (CBT)
- Medications, if appropriate.
- Help with educational support, like creating an Individualized Education Plan (IEP) for school.
A Bit More on Terms
Is ASD a Neurodevelopmental Disorder?
Yes, it is. Autism Spectrum Disorder (ASD) is considered a neurodevelopmental disorder. This is a broad category for conditions that affect how a child’s brain develops and functions, and they usually become noticeable early in life, often before or around the time they start school.
Some children with ASD also have other neurodevelopmental disorders, like ADHD or an intellectual disability.
You might have heard older terms like Asperger’s disorder, autistic disorder, or PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified). We now understand Autism as a spectrum. So, instead of these different labels, doctors use ASD as the diagnosis and then describe the specific characteristics and support needs for each individual child. It’s all about understanding your unique child.
Take-Home Message for Parents Navigating Autism
This is a lot to take in, I know. If you’re on this journey of understanding Autism for your child, here are a few key things I hope you’ll remember:
- Autism is a different way of being, not a flaw. Your child’s brain is wired uniquely, and that comes with both strengths and challenges.
- You are not alone. Many families are navigating this, and there’s a wonderful community of support out there.
- Early support makes a difference. Identifying your child’s needs early and starting therapies can help them build crucial skills.
- Focus on strengths and support needs. The goal isn’t to “cure” Autism, but to help your child thrive as their authentic self.
- Trust your instincts. You know your child best. If you have concerns, please talk to us. We’re here to listen and help.
You’re doing a great job. This journey of understanding Autism is one of learning and love. We’ll figure out the next steps together.