Autism

Spectrum
Disorder
What is autism spectrum disorder?
Autism spectrum disorder (ASD) is a neurological and developmental disorder
that affects how people interact with others, communicate, learn, and behave.
Although autism can be diagnosed at any age, it is described as a “developmental
disorder” because symptoms generally appear in the first two years of life.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a
guide created by the American Psychiatric Association that health care providers
use to diagnose mental disorders, people with ASD often have:
● Difficulty with communication and interaction with other people
● Restricted interests and repetitive behaviors
● Symptoms that affect their ability to function in school, work, and other
areas of life
Autism is known as a “spectrum” disorder because there is wide variation in the
type and severity of symptoms people experience.
People of all genders, races, ethnicities, and economic backgrounds can be
diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and
services can improve a person’s symptoms and daily functioning. The American
Academy of Pediatrics recommends that all children receive screening for autism.
Caregivers should talk to their child’s health care provider about ASD screening
or evaluation.

What are the signs and symptoms of ASD?

The list below gives some examples of common types of behaviors in people
diagnosed with ASD. Not all people with ASD will have all behaviors, but most
will have several of the behaviors listed below.
Social communication and social interaction behaviors may include:
● Making little or inconsistent eye contact
● Appearing not to look at or listen to people who are talking
● Infrequently sharing interest, emotion, or enjoyment of objects or activities
(including infrequently pointing at or showing things to others)
● Not responding or being slow to respond to one’s name or to other verbal
bids for attention
● Having difficulties with the back and forth of conversation
● Often talking at length about a favorite subject without noticing that others
are not interested or without giving others a chance to respond
● Displaying facial expressions, movements, and gestures that do not match
what is being said
● Having an unusual tone of voice that may sound sing-song or flat and robot-like
● Having trouble understanding another person’s point of view or being unable
to predict or understand other people’s actions
● Difficulties adjusting behavior to different social situations
● Difficulties sharing in imaginative play or in making friends
Restrictive/repetitive behaviors may include:
● Repeating certain behaviors or having unusual behaviors, such as repeating
words or phrases (a behavior called echolalia)
● Having a lasting intense interest in specific topics, such as numbers,
details, or facts
● Showing overly focused interests, such as with moving objects or with
parts of objects
● Becoming upset by slight changes in a routine and having difficulty with transitions
● Being more sensitive or less sensitive than other people to sensory input,
such as light, sound, clothing, or temperature
People with ASD also may experience sleep problems and irritability.
People on the autism spectrum also may have many strengths, including:
● Being able to learn things in detail and remember information for long
periods of time
● Being strong visual and auditory learners
● Excelling in math, science, music, or art

What are the causes and risk factors for ASD?

Researchers don’t know the primary causes of ASD, but studies suggest that a
person’s genes can act together with aspects of their environment to affect
development in ways that lead to ASD. Some factors that are associated with an
increased likelihood of developing ASD include:
● Having a sibling with ASD
● Having older parents
● Having certain genetic conditions (such as Down syndrome or Fragile X syndrome)
● Having a very low birth weight
Not everyone who has these risk factors develops ASD.

How is ASD diagnosed?

Health care providers diagnose ASD by evaluating a person’s behavior and
development. ASD can usually be reliably diagnosed by the age of 2. It is
important to seek an evaluation as soon as possible. The earlier ASD is
diagnosed, the sooner treatments and services can begin.
Diagnosis in Young Children
Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child checkups with a pediatrician or an early
childhood health care provider. The American Academy of Pediatrics recommends
that all children receive screening for developmental delays at their 9-, 18-, and
24- or 30-month well-child visits, with specific autism screenings at the 18- and
24-month well-child visits. A child may receive additional screenings if they are at
high risk for ASD or developmental problems.
Considering caregivers’ experiences and concerns is an important part of the
screening process for young children. The health care provider may ask questions
about the child’s behaviors and evaluate those answers in combination with
information from ASD screening tools and clinical observations of the child. To
learn more about ASD screening tools, visit the Centers for Disease Control and
Prevention (CDC) website at www.cdc.gov/ncbddd/autism/hcp-screening.html.
If a child shows developmental differences in behavior or functioning during
this screening process, the health care provider may refer the child for
additional evaluation.

Stage 2: Additional Diagnostic Evaluation

It is important to accurately detect and diagnose children with ASD as early as
possible, as this will shed light on their unique strengths and challenges. Early
detection also can help caregivers determine which services, educational
programs, and behavioral therapies are most likely to be helpful for their child.
A team of health care providers who have experience diagnosing ASD will conduct
the diagnostic evaluation. This team may include child neurologists, developmental
behavioral pediatricians, speech-language pathologists, child psychologists and
psychiatrists, educational specialists, and occupational therapists.
The diagnostic evaluation is likely to include:
● Medical and neurological examinations
● Assessment of the child’s cognitive abilities
● Assessment of the child’s speech and language abilities
● Observation of the child’s behavior
● An in-depth conversation with the child’s caregivers about the child’s behavior
and development
● Assessment of age-appropriate skills needed to complete daily activities
independently, such as eating, dressing, and toileting
● Questions about the child’s family history
Because ASD is a complex disorder that sometimes occurs with other illnesses or
learning disorders, the comprehensive evaluation may include blood tests and a
hearing test.
The outcome of this evaluation may result in a formal diagnosis and
recommendations for treatment.

Diagnosis in Older Children and Adolescents

Caregivers and teachers are often the first to recognize ASD symptoms in older
children and adolescents who attend school. The school’s special education team
may perform an initial evaluation and then recommend that a child undergo
additional evaluation with their primary health care provider or a health care
provider who specializes in ASD.
A child’s caregivers may talk with these health care providers about the child’s
social difficulties, including problems with subtle communication. These subtle
communication differences may include problems understanding tone of voice,
facial expressions, or body language. Older children and adolescents may have
trouble understanding figures of speech, humor, or sarcasm. They also may have
trouble forming friendships with peers.

Diagnosis in Adults
Diagnosing ASD in adults is often more difficult than diagnosing ASD in children.
In adults, some ASD symptoms can overlap with symptoms of other mental
health disorders, such as an anxiety disorder or attention-deficit/hyperactivity
disorder (ADHD).
Adults who notice signs and symptoms of ASD should talk with a health care provider
and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults
is still being refined, adults can be referred to a neuropsychologist, psychologist,
or psychiatrist who has experience with ASD. The expert will ask about:
● Social interaction and ● Repetitive behaviors
communication challenges ● Restricted interests
● Sensory issues
The evaluation also may include a conversation with caregivers and other family
members to learn about the person’s early developmental history, which can help
ensure an accurate diagnosis.
Obtaining a correct diagnosis of ASD as an adult can help people understand past
challenges, identify personal strengths, and find the right kind of help. Studies are
underway to determine the types of services and supports that are most helpful
for improving the functioning and community integration of autistic transition-age
youth and adults.
What treatment options are available for ASD?
Treatment for ASD should begin as soon as possible after diagnosis. Early treatment
for ASD is important because proper care and services can reduce individuals’
difficulties while helping them learn new skills and build on their strengths.
People with ASD may face a wide range of issues, which means there is no single
best treatment for ASD. Working closely with a health care provider is an
important part of finding the right combination of treatments and services.

Medication
A health care provider may prescribe medication to treat specific symptoms. With
medication, a person with ASD may have fewer problems with:
● Irritability
● Aggression
● Repetitive behavior
● Hyperactivity
● Attention
● Anxiety and depression
Read more about the latest medication warnings, patient medication guides, and
information on newly approved medications at the Food and Drug Administration
(FDA) website at www.fda.gov/drugsatfda.

Behavioral, Psychological, and Educational Interventions

People with ASD may be referred to health care providers who specialize in
providing behavioral, psychological, educational, or skill-building interventions.
These programs are typically highly structured and intensive, and they may
involve caregivers, siblings, and other family members. These programs may help
people with ASD:
● Learn social, communication, and language skills
● Reduce behaviors that interfere with daily functioning
● Increase or build on strengths
● Learn life skills for living independently

Other Resources
Many services, programs, and other resources are available to help people with
ASD. Here are some tips for finding these additional resources:
● Contact a health care provider, local health department, school, or autism
advocacy group to learn about special programs or local resources.
● Find an autism support group. Sharing information and experiences can help
people with ASD and their caregivers learn about treatment options and
ASD-related programs.
● Record conversations and meetings with health care providers and teachers.
This information helps when it’s time to decide which programs and services
are appropriate.
● Keep copies of health care reports and evaluations. This information may help
people with ASD qualify for special programs.

Where can I find resources about ASD?

For more information about ASD, visit:
● Eunice Kennedy Shriver National Institute of Child Health and Human Development
www.nichd.nih.gov/health/topics/autism
● National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov/Disorders/All-Disorders/Autism-Spectrum-Disorder-
Information-Page
● National Institute on Deafness and Other Communication Disorders
www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-
problems-children
● Centers for Disease Control and Prevention
www.cdc.gov/autism
● Interagency Autism Coordinating Committee
https://iacc.hhs.gov

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or
treat diseases and conditions. Although individuals may benefit from being part
of a clinical trial, participants should be aware that the primary purpose of a
clinical trial is to gain new scientific knowledge so that others may be better
helped in the future.
Talk to a health care provider about clinical trials, their benefits and risks,
and whether one is right for you or a loved one. For more information, visit
www.nimh.nih.gov/clinicaltrials.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
NIH Publication No. 22-MH-8084
Revised 2022