Autism Symptoms and Diagnosis
Autism Spectrum Disorder (ASD) is a developmental disorder that involves impairments to social and communication abilities, restricted interests or repetitive behaviors, and challenges with sensory processing. The term "spectrum" reflects the fact that symptoms vary across different individuals, ranging in type and severity.
The condition appears and is able to be diagnosed by about age two. Some children do not reach developmental milestones, while others appear to develop typically until the onset of the disorder. While the severity of symptoms varies greatly, there are invariably impairments to social and communication skills. Parents may notice that their infant avoids eye contact or doesn't respond, and it may be difficult for them to form emotional bonds and parental attachment. Some children will experience awkwardness trying to maintain eye contact or sustain a conversation, while those on the severe end of the spectrum could have aggressive outbursts or remain nonverbal.
Children with autism exhibit many kinds of repetitive behaviors early in life, such as hand flapping, body rocking, and making sounds. They may arrange or stack objects over and over again. Some children inflict injury to themselves by repeated actions such as hand biting and head banging. They show an early preference for unvarying routines of everyday life.
Restricted interests are another feature of autism, so children may develop a fascination with train schedules or comic books, for example. They may devote tremendous time to those interests and become experts on the topic. Kids with autism may also be distressed by sensory experiences such as a buzzing lightbulb or an uncomfortable shirt.
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The symptoms of autism spectrum disorder, according to the DSM-5, involve challenges with social skills, communication, sensory processing, and restrictive or repetitive behaviors. Like many mental health conditions, autism can’t yet be diagnosed from a biological marker such as a blood test or brain scan, so clinicians rely on children’s behavior for screening and diagnostic assessments.
The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool for children with autism that relies on a parent or caregiver’s response to 23 questions. The Autism Diagnostic Observation Schedule (ADOS) allows a clinician to diagnose the condition by observing the child for about an hour, and the Autism Diagnostic Interview-Revised (ADI-R) tests for the condition based on a 93-question survey for parents or caregivers.
Most children can be reliably diagnosed with autism at age 2. Some kids may be diagnosed earlier if they have more severe symptoms, but most children in the U.S are diagnosed at age 4 or later.
The American Academy of Pediatrics recommends that all children are screened for autism during check-ups with their doctor at 18 months and 24 months old. Doctors may encourage additional screening if babies are at higher risk of developing the condition, such as if they have a sibling with autism.
Early diagnosis is key because it can allow parents and children to access therapies and services that will support healthy development, such as behavioral therapy. People are increasingly being evaluated as adults as well, and a late diagnosis of autism can be life-changing for those who have navigated the experiences of autism without a formal label.
Early signs of autism include avoiding eye contact, not showing interest in other children or parents, talking less than other children, and feeling distressed by small changes to the daily routine, according to the CDC.
It can also be valuable to monitor whether a child is reaching developmental milestones. But it’s important to keep in mind that autism presents differently in different children. Some may not reach those milestones, while about a quarter may pass each milestone but regress later.
Signs of autism in adulthood may include difficulties maintaining eye contact, keeping up conversation, making friends, interpreting sarcasm or idioms, and reading others’ emotions.
People with autism may have repetitive behaviors, such as certain hand movements, and prize routine and structure. They may be passionate about a particular topic, such as math, and discuss or practice it extensively. They may also be distressed by particular sounds, sights, or textures.
Autism occurs 4 times more often in boys than in girls. But many women still struggle with the condition—and they’re often overlooked or misdiagnosed. Women with autism can devote tremendous effort to teaching themselves how to behave socially to blend into the neurotypical world. They adopt compensatory strategies and ultimately camouflage the condition. Additionally, current diagnostic measures have been created by assessing male behavior.
Symptoms of autism can present differently in men and women. Women may develop an obsession with a celebrity or brand, rather than with an object or system. Women may struggle with uncomfortable clothes and choose to opt for comfort over style. They may avoid naturally making eye contact, even if they’ve trained themselves to do so. The inability to fit in can also erode self-esteem and lead to anxiety or depression, both of which may be more likely to be identified in women.
Yes. Autism is a developmental disorder and developmental disability. Children with any disability, autism included, are eligible to receive educational support. This may include establishing an Individualized Education Plan or a 504 plan, which protect children from discrimination and help them fully engage with their education.
The current edition of the diagnostic manual for mental health conditions, the DSM-5, created the diagnosis of autism spectrum disorder. This overarching label encompassed three discrete conditions contained in the previous iteration, the DSM-IV. Those conditions were autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified.
Asperger’s disorder referred to those with impaired social skills and restrictive or repetitive behaviors. Today, people with milder symptoms of autism may still refer to having Asperger's syndrome, although it’s no longer a formal diagnostic category.