Autism Symptoms in Children and How It Is Diagnosed
Autism spectrum disorders (ASDs) are a group of related brain-based disorders that affect a child’s behavior, social, and communication skills. Other names include autistic disorder, Asperger syndrome, and PDD – not otherwise specified (PDD – NOS). Autistic spectrum disorders affect 1 in 68 children and is more prevalent in males. It is likely that all of us know someone with autism.
Autism is thought to have a multifactorial cause. This means that no one thing is known to cause autism. Research is indicating that there may be genetic and environmental links. Multiple studies indicate that vaccines do not cause autism.
Because most children with ASD will master early motor skills such as sitting, crawling, and walking on time, delays in social and communication skills may not be as obvious to parents until 18 months-3-4 years. Looking back, many parents of children with ASD can think of specific examples that suggest something was different, but nothing indicating a serious problem.
Autism spectrum disorders are lifelong conditions with no known cure. Children may exhibit quite a spectrum of symptoms and that may be very mild or very severe. Children with ASD can progress developmentally and learn new skills. Some children may improve so much that they no longer meet criteria for ASD, although milder symptoms may often persist. Early diagnosis and early intervention are the cornerstone of treatment and make a big positive difference.
It is important to start an intervention program as soon as possible. The sooner autism is identified, the sooner an intervention program can start. Each child with autism has different needs. What works for one child may not work for another.
The amount of information available about ASD can be overwhelming. Below is some basic information with links to helpful resources.
What Are the Symptoms of Autism Spectrum Disorders?
No 2 children with ASD have the exact same symptoms, but the criteria are somewhat standardized. The number of symptoms and how severe they are can vary greatly. The following are examples of how a child with ASD may act.
- Doesn’t snuggle when picked up, but arches back instead
- Doesn’t keep eye contact or makes very little eye contact
- Doesn’t respond to parent’s smile or other facial expressions
- Doesn’t look at objects or events parents are looking at or pointing to
- Doesn’t point to objects or events to get parents to look at them
- Doesn’t bring objects to show to parents just to share his interest
- Doesn’t often have appropriate facial expressions
- Unable to perceive what others might be thinking or feeling by looking at their facial expressions
- Doesn’t show concern (empathy) for others
- Unable to make friends
- Doesn’t say single words by 15 months or 2-word phrases by 24 months
- Repeats exactly what others say without understanding its meaning (parroting or echolalia)
- Doesn’t respond to name being called, but does respond to other sounds (like a car horn or a cat’s meow)
- Refers to self as “you” and others as “I” (pronominal reversal)
- Often doesn’t seem to want to communicate
- Doesn’t start or can’t continue a conversation
- Doesn’t use toys or other objects to represent people or real life in pretend play
- May have a good rote memory, especially for numbers, songs, TV jingles, or a specific topic
- Loses language milestones, usually between the ages of 15 to 24 months in a few children (regression)
(Stereotypic, Repetitive, and Restrictive Patterns)
- Rocks, spins, sways, twirls fingers, or flaps hands (stereotypic behavior)
- Likes routines, order, and rituals
- Obsessed with a few activities, doing them repeatedly during the day
- Plays with parts of toys instead of the whole toy (for example, spinning the wheels of a toy truck)
- May have splinter skills, such as the ability to read at an early age, but often without understanding what it means
- Doesn’t cry if in pain or seem to have any fear
- May be sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
- Unusual use of vision or gaze – looks at objects from unusual angles
- May have unusual or intense but narrow interests
- Other early signs and comparisons to “normal development” are listed in the links below:
There is no specific test for autism. We routinely ask developmental questions at your child’s wellness visits that serve as the first step in problem identification. The 18 and 24 month visit includes questions that specifically target social development. If there is cause for concern, we consider further evaluation of all developmental areas with speech, occupational and physical therapists. Blood tests for lead and genetic analysis are sometimes suggested since 10-20% of autism has a genetic link and some environmental factors affect cognitive development. The following tests do not show sufficient evidence to be ordered specifically for autism:
- Hair analysis
- Multiple vitamin levels
- Intestinal permeability testing
- Stool analysis
- Urinary peptides
- Heavy metal and mercury studies
We then generally refer to a neurologist or developmental pediatrician to confirm a diagnosis of autism.
The diagnosis can be quite overwhelming but there are lots of resources out there to help. The most important member of your child’s treatment team will be you and your family. By making small adjustments day by day and open communication, you will get a wonderful “new normal”. Your child’s treatment team will also include your pediatrician, a developmental pediatrician, occupational therapists and speech therapists.
Some other issues that can present more often with autism include the following:
- Genetic disorders like Fragile X, Angelman Syndrome, Tuberous Sclerosis
- GI disorders like esophagitis, food sensitivities, and constipation
- Pica – eating non-food substances
- Attentional issues or ADHD
- Anxiety disorders
The following link is a great resource for new diagnosis: https://www.autismspeaks.org/family-services/tool-kits/100-day-kit
Week by week plan once a diagnosis is made for the first 100 days: https://www.autismspeaks.org/sites/default/files/docs/week_by_week.pdf
Links to more information: http://www.cdc.gov/ncbddd/autism/links.html