What to do if you think your child is on the autism spectrum

If you’re concerned that your child may have autism spectrum disorder (ASD), one of the most important things you can do is to learn the early signs of autism and the typical developmental milestones that your child should be reaching.

Nearly 1 in 36 children are identified with ASD by the time they turn 8 years old.1 Boys are 4 times more likely to be identified with ASD than girls, according to the Centers for Disease Control and Prevention (CDC).2

The age of symptom onset and the intensity of those symptoms vary widely from child to child. For some, there are signs within infancy. For others, it doesn’t develop until they’re toddlers. It’s also important to note that signs may present differently depending on the child. Some children with autism won’t tick off every symptom, and many kids who don’t have ASD may display symptoms. This is why it’s important to see a health care provider.3

With the increased awareness of autism, it’s normal for parents to wonder if their child might have ASD. Let’s take a closer look at ASD, its symptoms and how it’s diagnosed.

What exactly is ASD?

In simple terms, Autism Spectrum Disorder (ASD) is a developmental disability. People with autism tend to have issues with social communication and interaction. They may also have restricted, repetitive behaviors or interests.4

If your child has ASD, they may have “difficulty navigating some part of the social world,” says pediatric neuropsychologist David Black, Ph.D., director of the Center for Assessment and Treatment in Chevy Chase, Maryland. “That could be reading social cues or understanding why people are doing what they’re doing, like interpreting someone’s reaction.”

“This difficulty in reading, understanding and interpreting social interactions can be significant. It may interfere with daily life. And it cannot be explained by something else, such as a language disorder,” Black says.

What are the symptoms of ASD?

ASD is a “spectrum” disorder, meaning that the symptoms may range from mild to severe. The disorder will present itself differently in different people, through a wide range of symptoms. As a starting point, the CDC offers a list of ASD signs and symptoms.5

Examples of social communication and social interaction issues related to ASD, according to the CDC, may include:5

  • Avoids or does not keep eye contact
  • Uses few or no gestures by 12 months (for example, does not wave goodbye)
  • Does not notice when others are hurt or upset by age 2
  • Does not notice other children or join them in play by age 3
  • Does not pretend to be something else, such as a teacher or superhero, during play by age 4
  • Does not sing, dance or act for you by age 5

Examples of restricted or repetitive behaviors/interests related to ASD, according to the CDC, may include:5

  • Lines up toys or other objects and gets upset when the order is changed
  • Repeats words or phrases over and over (called echolalia)
  • Plays with toys the same way every time
  • Gets upset by minor changes
  • Has obsessive interests
  • Must follow certain routines

Other symptoms related to ASD cited by the CDC may include:5

  • Delayed language skills
  • Delayed movement skills
  • Delayed cognitive or learning skills
  • Hyperactive, impulsive and/or inattentive behavior

Where should I start if I think my child has autism?

Your first point of contact should be your child’s doctor. As your child ages, their pediatrician monitors developmental milestones at well-child appointments. These are standard benchmarks that most children reach by a certain age, with some normal variability. “Development differs widely from child to child,” Black says. “Your pediatrician’s job is to help you anchor your child into what’s broadly normal.”

The pediatrician will also assess whether your child has any medical issues. “They’ll look for any neurological conditions, such as seizures, that could negatively affect their behavior or temperament,” adds Black.

The American Academy of Pediatrics recommends that all children be formally screened for ASD at their 18- and 24-month well-child checkups, or whenever a parent has a concern.6 A screening is not the same as a diagnosis.

A positive screening result shows that further assessment is needed. The pediatrician may recommend an evaluation by a specialist, such as a developmental pediatrician or psychologist.6 Developmental specialists often work as part of a team that includes other health care professionals, such as a speech language pathologist and an occupational therapist.

If your child is 3-years-old or younger, it may be recommended that you start with your state’s early intervention program for infants and toddlers with disabilities. These programs offer early childhood evaluations as required by the federal Individuals with Disabilities Education Act.7

How will my child be assessed for ASD?

With a formal evaluation, the assessment team will interact with your child in a systematic, age-appropriate way, using a variety of tools.9 For young children, part of the team’s evaluation will include playing with your child in a way that allows them to assess your child’s development.6, 9 They will also ask you to join your child and observe your interactions. Depending on the child’s age, they may also meet with your child alone.7, 9

The team will do a thorough developmental assessment, paying close attention to language and social development. “Within a play-based assessment, the evaluators would watch how your child plays both independently and with others, how they initiate and respond to social interactions with others in the room. They would also watch how the child communicates their needs both verbally and nonverbally,” Black says.

For example, with a 2-year-old, Black notes that he would look for developmental milestones such as imitating others or showing interest in other children. Curiosity for their surrounding environment and engaging in simple back-and-forth play are indicators he would look for.

Expect to be interviewed by the team on how your child behaves in other environments and interacts with different people. They will also want information about your child’s temperament and any concerns you may have.

What are my next steps if my child is diagnosed with ASD?

The best next step is to talk to the developmental specialist about an individualized plan that addresses your child’s specific strengths and weaknesses. “There are a range of treatments that vary widely depending on the child’s needs,” Black says.

If your child has difficulty with communication, for example, speech language therapy may be recommended. Other types of therapy may be used based on your child’s behavioral issues. For example, Applied Behavior Analysis (ABA) focuses on identifying the circumstances in the environment that are triggering a behavior and coming up with a strategy to change the behavior.9 This approach may work well for a child with ASD who acts out when they’re unable to communicate. ABA helps the child express what they want in a different, more successful way.

“With early intervention, the challenges that many children with autism have can be significantly improved,” Black says. “Some of the social, communication and sensory challenges can be well managed in a way that that makes it easier to navigate.”

The bottom line: If you suspect that your child has autism, take comfort in knowing there is a lot of available support and resources for you. The first step is talking to your child’s pediatrician so they can help you and your child better understand and manage this condition.

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