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What is Autism Spectrum Disorder?

Autism Spectrum Disorder (ASD) is a developmental disability that affects how a person thinks, learns, and interacts with others. Individuals with ASD may have differences in communication, social behavior, and how they perceive the world. The term “spectrum” means that the condition can vary greatly from person to person, with some people having mild challenges, while others face more significant difficulties.

Previously, ASD was diagnosed using several different diagnoses (autistic disorder, Asperger’s disorder, and pervasive developmental disorder-not otherwise specified, PDD-NOS). However, starting around 2013, these separate diagnoses were consolidated into one category: autism spectrum disorder (ASD). This change was made to reflect the understanding that these conditions share common features and exist on a spectrum, varying in severity and specific characteristics.

Signs and Symptoms of Autism Spectrum Disorder

In general, a diagnosis of ASD is based on the following signs and symptoms:

  • Difficulties in social communication and interactions, which can include difficulties with verbal and nonverbal communication, as well as developing and maintaining relationships.
  • Restricted and repetitive behaviors and interests, which can include stereotyped motor movements, use of objects, or speech, difficulties with changes in routines (even small ones), highly fixated interests, and sensory difficulties.

How these symptoms present vary widely based on the individual’s age, level of functioning, and the severity of the symptoms. The next sections will look further into how these symptoms present throughout the lifespan of the affected individual.

Autism Spectrum Disorder Symptoms in Infants

While ASD is not typically diagnosed under 2 years of age, symptoms of ASD can present in infants but may be subtle and vary widely and may include:

  • Delayed or absent social responses such as limited eye contact (typically develops around 2-3 months), lack of social smiling (typically develops around 6 weeks), and limited or no response to their name being called (typically develops around 6-12 months).
  • Lack of joint attention, where the infant looks at or points to something and then looks back at the caregiver to share the experience (typically develops around 9 months).
  • Delayed or unusual communication such as limited or lack of babbling (typically develops around 6 months), limited or lack of gestures such as pointing or waving (typically develops around 12 months), and limited or lack of use of words (typically develops around 12-18 months).
  • Repetitive behaviors such as repetitive body movements like hand-flapping, rocking, or spinning objects, and showing intense focus in particular objects or parts of objects (e.g., the spinning wheels on a toy car instead of the entire toy car).
  • Sensory sensitivities of overreacting or underreacting to sensory input, such as being overly or underly sensitive to sounds, textures, smells, or lights.
  • Unusual sleeping or eating patterns such as needing less sleep than others their age and difficulties with foods like extreme pickiness with food textures or smells.

Autism Spectrum Disorder Symptoms in Toddlers

Symptoms of ASD often become more noticeable as children reach the age of 2 or 3. Some common symptoms during early childhood include:

  • Limited or absent eye contact.
  • Difficulty engaging with others, such as not responding to others or showing little or no interest in interacting with peers or adults.
  • Lack of joint attention, such as not pointing or showing others something, or not showing interest in what others are doing.
  • Limited or lack of speech or non-verbal communication including words (simple words typically develop around 18 months), gestures, and other attempts to communicate. In a toddler with ASD who does have speech, they may have difficulties such as understanding how to ask or answer questions.
  • Echolalia, which is repeating words or phrases, often repetitively, out of context, and without the communicative intent.
  • Engaging in repetitive motions such as hand-flapping, rocking, or spinning, and intense focus on objects and non-functional play, such as lining up cars instead of playing with them on a track.
  • Narrow range of interests, becoming intensely focused on a specific object, activity, or topic and not engaging with other toys or activities.
  • Overreacting or underreacting to sensory stimuli: Toddlers with ASD may become distressed (or conversely appear unphased) by loud noises, bright lights, or certain textures or clothes. They also might not respond to pain or temperature in a typical manner.
  • Difficulties with changes in routine (even small changes) and difficulties with being interrupted.
  • Intense meltdowns due to difficulties processing their environment, and frustrations due to difficulties in being able to communicate their needs.

Autism Spectrum Disorder Symptoms in Children and Teenagers

ASD symptoms in children and teenagers vary as the individual progresses through their different developmental milestones, but generally include:

  • Difficulties in conversations, such as starting and sustaining a conversation and answering and asking questions.
  • Challenges with understanding social cues, such as understanding whether someone does or does not want to be their friend.
  • Limited interest in friendships or interest in making friends but difficulties in doing so.
  • Difficulties with empathy, understanding others’ emotions and feelings, and how to react to these feelings in others.
  • Unusual body language such as too much or lack of eye contact, facial expressions, or gestures.
  • Repetitive movements such as hand-flapping, rocking, or spinning in circles when excited, anxious, or bored.
  • Ritualistic behaviors such as lining up toys or objects in a specific order and having to form every letter correctly when writing.
  • Strong preference for sameness such as insisting on eating the same food at every meal or taking the same route to school.
  • Intense, narrow interests, often at the exclusion of other topics, such as only wanting to talk and learn about one topic, like dinosaurs.
  • Hypersensitivity or hyposensitivity to sensory input, such as being overly sensitive to lights, sounds, textures, or smells, or conversely, little to no response to pain or other sensory stimuli.
  • Executive functioning difficulties such as planning and organizing and poor time management skills.
  • Emotional regulation difficulties such as frequent emotional outbursts and challenges with developing appropriate coping skills.

Autism Spectrum Disorder Symptoms in Adults

While ASD symptoms might be less obvious in adulthood due to the individual having developed their own coping strategies, adults with ASD still face challenges related to social communication, restrictive interests, and sensory processing. Symptoms may include:

  • Difficulties with social interactions such as finding it hard to initiate or maintain conversations, understand social cues, navigate social norms, or interpret body language, tone of voice, or facial expressions, which can lead to misunderstandings in both personal and professional relationships.
  • Continued challenges with empathy such as struggling to express or recognize empathy, making it difficult to respond to others’ emotions appropriately.
  • Limited social engagement such as preferring solitary activities or having difficulties forming close friendships or romantic relationships due to a lack of understanding of social rules or hesitancy in social situations.
  • Literal thinking, such as finding sarcasm, humor, or idiomatic expressions difficult to understand.
  • Difficulties with intense, focused interests, being routine-driven, and repetitive movements or behaviors which interfere with their daily life, relationships, and abilities to become and remain employed.
  • Difficulties with being oversensitive or undersensitive to sensory stimulation such as finding busy or loud environments like stores and workplaces overwhelming.
  • Executive functioning difficulties such as planning and difficulties with organization, as well as difficulties coping with change or unpredictability.
  • Emotion regulation difficulties such as challenges in managing their emotions, meltdowns, emotional outbursts, and difficulties coping with stress.
  • Co-occurring mental health conditions such as anxiety and depression as well as attention-related difficulties.

Many adults with undiagnosed ASD have struggled throughout their lives. Receiving a formal diagnosis can help them better understand themselves, their challenges, and the support they need.

Lifestance Health specializes in Autism Spectrum Disorder treatment with multiple locations in 33 states. Services and available treatments vary by location.

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Assessment and Diagnosis of Autism Spectrum Disorder

Obtaining an ASD diagnosis is a process that typically involves a combination of behavioral assessments and clinical evaluations by a trained professional. Diagnosis is based on a thorough evaluation of the individual’s developmental history, social and communication behavior, and patterns of restrictive or repetitive behaviors. There are no medical or blood tests to diagnose ASD.

Early developmental screenings are used to identify whether infants, toddlers, and young children are meeting their developmental milestones. Those who are not meeting these milestones may be showing early signs of ASD and can then be referred for further evaluation.

Regardless of the individual’s age, a clinical diagnosis is made following a comprehensive evaluation including a detailed developmental history, direct observations of the individual’s social communication and behaviors, parent and caregiver interviews, questionnaires, and standardized testing such as the Autism Diagnostic Observation Schedule (ADOS). Other often included evaluations include cognitive testing, speech and language assessments, and behavioral assessments. Hearing and genetic testing may also be completed to rule out other conditions or explore possible comorbidities.

Diagnostic testing in adults can be more challenging because, by the time they reach adulthood, the individuals may have developed coping mechanisms or adaptive behaviors that mask their symptoms. For adults, clinicians may rely on self-reported questionnaires, retrospective assessments of early development, and interviews to assess their social, communication, and behavior patterns.

Causes of Autism Spectrum Disorder

The exact cause of ASD is not fully understood, but research suggests a combination of genetic, neurobiological, and environmental factors contribute to the development of ASD. Some main factors include:

  • Genetic factors.
    There is strong evidence that genetics contribute to the development of ASD. Studies show that ASD tends to run in families, indicating a genetic predisposition. Certain genetic mutations or variations may increase the risk of developing ASD (e.g., Fragile X Syndrome). Genetic factors likely also make an individual more susceptible to environmental influences, which together increase the risk of developing ASD.
  • Neurobiological differences.
    Research has shown differences in the brain structure and function of people with ASD, along with how these different regions of the brain communicate with each other. These differences may affect communication, social interaction, and sensory processing.
  • Environmental factors.
    Certain factors during pregnancy, such as maternal infections, advanced parental age, or exposure to environmental toxins (e.g., certain chemicals or drugs), may increase the risk of ASD in the child. However, these factors are not deterministic and typically interact with genetic susceptibility. Also, complications during birth (such as lack of oxygen) may play a role, though this is still being researched.
  • Other factors.
    There is some evidence that abnormalities in the immune system might contribute to the development of ASD, although this is not fully understood. Also, in some cases, metabolic or mitochondrial disorders (which affect energy production in cells) have been linked to ASD.

What is clear is that vaccines do not cause ASD. Research has conclusively shown that vaccines do not cause ASD. The idea that vaccines, particularly the MMR (measles, mumps, rubella) vaccine, could cause ASD was based on a fraudulent study published in 1998, which has since been retracted. Extensive studies have failed to find any link between vaccines and ASD.

Treatments for Autism Spectrum Disorder

ASD is not “curable,” but early and individualized treatment can help improve symptoms and enhance functioning. Treatment for ASD typically involves a combination of behavioral interventions, educational and workplace supports, speech and language therapy, physical and occupational therapy, and sometimes medications to manage co-occurring symptoms like anxiety or hyperactivity. As no two individuals with ASD are the same, treatments are individualized and tailored to the individual’s (and their family’s) needs. Some treatment examples include:

  • Behavioral therapies, such as applied behavior analysis (ABA), behavioral social skills training, feeding therapy, focus on reinforcing positive behaviors and reducing undesirable ones through evidence-based structured interventions, aiming to improve social, communication, and adaptive skills and decrease maladaptive behaviors.
  • Cognitive behavioral therapy (CBT) can help individuals with ASD manage anxiety, depression, and other emotional challenges by teaching them to identify and change negative thought patterns and behaviors and develop effective coping strategies.
  • Early Intensive Behavioral Intervention (EIBI) focuses on providing intensive intervention during the early years of development and has been shown to improve cognitive and social outcomes in some cases.
  • Medications may be prescribed to help manage symptoms such as anxiety, irritability, hyperactivity, or difficulty sleeping.
  • Specialized education plans, such as Individualized Education Programs (IEPs) in schools, are tailored to meet the specific needs of children with ASD. These plans provide individualized learning goals, support, and accommodations.
  • Many individuals with ASD benefit from speech and language therapy to improve their communication skills, such as understanding language, forming sentences, and using social language effectively.
  • Physical and occupational therapy can help individuals with ASD improve their ability to perform daily tasks and cope with sensory sensitivities, which can make everyday activities difficult.

Finding Help for Autism Spectrum Disorder at LifeStance

LifeStance Health providers offer a wide variety of treatment options for individuals with ASD. We offer both online and in-person visits to help make it easier to find an appointment that works for you. Our offices employ a wide variety of Mental Health care providers who can work together to implement a care plan that is uniquely suited to your (or your child’s) needs.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Coury, D. L., et al. (2012). Management of children with autism spectrum disorders. Pediatrics, 130(5), 1005-1016.

Lai, M.-C., Baron-Cohen, S., & Gledhill, J. (2019). Autism: A social and communication disorder in adults. Journal of Developmental & Behavioral Pediatrics, 40(1), 1-10.

Lord, C., & Jones, R. M. (2012). Autism Spectrum Disorders: Diagnosis, Prevalence, and Services for Children and Families. Springer.

Lord, C., Rutter, M., & Le Couteur, A. (2000). Autism Diagnostic Observation Schedule (ADOS): A standardized diagnostic tool for autism spectrum disorders. Journal of Autism and Developmental Disorders, 30(5), 205-223.

Matson, J. L. (Ed.). (2007). Handbook of assessment and diagnosis of autism spectrum disorders. Springer.

O’Neill, M., & Alston, L. (2017). Autism Spectrum Disorder in Children and Adolescents: A Guide to Understanding and Managing Behavior. Springer.

Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(36), 3623-3629.

Volkmar, F. R., et al. (2014). “Autism and Pervasive Developmental Disorders.” In The Handbook of Autism and Pervasive Developmental Disorders (4th ed.), Wiley.

Wood, J. J., & McLeod, B. D. (2008). Cognitive-behavioral therapy for children and adolescents with autism spectrum disorders: A review of the literature. In J. L. Matson (Ed.), Handbook of Assessment and Diagnosis of Autism Spectrum Disorders (pp. 491-508).