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What is ASD?
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 2 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:
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Difficulty with communication and interaction with other people
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Restricted interests and repetitive behaviors
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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 / interaction behaviors may include:
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Making little or inconsistent eye contact
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Appearing not to look at or listen to people who are talking
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Infrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others)
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Not responding or being slow to respond to one’s name or to other verbal bids for attention
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Having difficulties with the back and forth of conversation
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Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
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Displaying facial expressions, movements, and gestures that do not match what is being said
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Having an unusual tone of voice that may sound sing-song or flat and robot-like
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Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions
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Difficulties adjusting behaviors to social situations
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Difficulties sharing in imaginative play or in making friends
Restrictive / repetitive behaviors may include:
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Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)
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Having a lasting intense interest in specific topics, such as numbers, details, or facts
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Showing overly focused interests, such as with moving objects or parts of objects
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Becoming upset by slight changes in a routine and having difficulty with transitions
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Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature
People with ASD may also experience sleep problems and irritability.
People on the autism spectrum also may have many strengths, including:
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Being able to learn things in detail and remember information for long periods of time
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Being strong visual and auditory learners
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Excelling in math, science, music, or art
How is ASD diagnosed?
Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by age 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 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 specialize in ASD.
A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. For example, some children may have 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 anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).
Adults who notice signs 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 may be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:
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Social interaction and communication challenges
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Sensory issues
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Repetitive behaviors
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Restricted interests
The evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.
Receiving a correct diagnosis of ASD as an adult can help a person 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.