Signs of Autism Spectrum Disorder

Autism symptoms can look different for every child

A child’s growth isn’t just measured in height and weight. Young kids also reach milestones in how they play, learn, speak, act and move. Becoming familiar with both markers — physical size and milestones — gives you a complete picture of your child’s overall development.

Reaching milestones at the typical ages shows a child is developing as expected. Not reaching milestones or hitting them much later than kids the same age can be a sign of a developmental problem like autism spectrum disorder, or ASD.

The number of children diagnosed with ASD continues to rise, largely due to better detection, and identifying early signs is crucial to improving long-term outcomes.

“Early intervention can help kids develop vital skills to reduce the impact of the disorder on their daily lives, schooling and relationships,” says Thomas Challman, MD, medical director and neurodevelopmental pediatrician in Geisinger’s Department of Developmental Medicine. “The sooner children get support, the greater their chances for progressing in communication skills and social interactions — and the best chance of developing to their full potential.”

What is autism spectrum disorder?

ASD is a type of neurological disorder that affects the way a child behaves, communicates and socializes. It’s associated with repetitive behaviors and highly focused interests. In severe instances, autism can prevent children from learning to speak at all.

Every person with ASD is different, and the term “spectrum” in the condition name refers to the range of symptoms and severity. For example, some kids with autism have learning problems, while others do well in school. Some have trouble speaking, but other kids have better speech and language skills. Some kids prefer to play alone, yet others want to make friends.

“People with autism share certain traits, but at different degrees,” says Dr. Challman. “We diagnose kids with autism spectrum disorder so we can offer the best treatment. Those who have milder symptoms can often maintain a greater degree of independence, but some people with autism have more severe symptoms and need more help with daily tasks.”

Higher-functioning people with autism may develop certain areas of intense interest like mathematics or art and become quite knowledgeable about these topics. These areas of interest might even create job opportunities for them in adulthood.

Types of autism

Today, all autism diagnoses are viewed within the single diagnostic category of “autism spectrum disorder.” However, several other names have been used over the years to describe these types of social and communication differences. While these diagnoses are no longer widely used in clinical practice, some people still use them to describe types of autism.

“Autistic disorder, pervasive developmental disorder and Asperger syndrome are diagnoses previously used to describe varying degrees of symptoms within the autism spectrum,” says Dr. Challman. “People given diagnoses of Asperger syndrome generally had better language and cognitive skills, but exhibited difficulty with social communication as well as patterns of repetitive behavior and intense interests.”

Those diagnosed with pervasive developmental disorder or autistic disorder typically had more severe symptoms. But as noted, these terms have largely been put aside in favor of simply “autism spectrum disorder.”

Signs of autism

People commonly first notice signs of autism in a child at or before the age of 2. Some children show symptoms during their first year of life, while others may have more typical development for the first 18 to 30 months of age, but then regress in language and social skills.

“A diagnosis is made based on core autism symptoms: challenges with social communication and interactions skills, and restricted and repetitive behaviors,” says Dr. Challman. “We also rate the severity of these symptoms based on the level of daily support a child requires with a scale ranging from 1 to 3 — with level 3 needing the most support.”

Here are signs to look for if you think your child might have autism:

Social communication and interaction skills

Makes little to no eye contact or facial expressions
Delays in or lack of speech development
Struggles to engage in back-and-forth conversations
Frequently repeats words or phrases and speaks in an abnormal tone
Has trouble understanding others’ body language, gestures or facial expressions
Doesn’t express emotion and appears unaware of others’ feelings
Struggles to make friends and play with peers, prefers to play alone
Lacks interest in making friends or in interacting socially with family
Feels overwhelmed in social situations

Restricted and repetitive behaviors

Makes unusual repetitive body movements to regulate emotions, such as rocking, hand flapping or spinning in circles
Has rituals like lining up toys in a row or sorting objects
Gets extremely upset by changes in routine or rituals
Has a fixation or obsessive interest in specific topics, objects or activities
Shows unusual sensitivity to light, sound or touch
Has specific food preferences, such as refusing foods with a certain texture

Autism causes

Scientists have identified many genetic and environmental factors as contributors in developing ASD. These factors are thought to cause changes in the brain very early in development, before a baby is even born.

“There are now hundreds of different genetic changes that have been shown to cause autism,” says Dr. Challman. “These genetic differences may be a new change that occurs spontaneously at the time of conception or might be inherited from a parent. Geisinger is a leader in research into the genetic factors that are important in autism and other developmental conditions. We are only beginning to understand how changes in genes affect brain development and function and lead to the symptoms of autism.”

The American Academy of Pediatrics recommends that all children with ASD undergo certain genetic tests to try to identify these causes.

Several other factors also appear to be risk factors for ASD, including extreme prematurity or complications at birth, certain viral infections during pregnancy and advanced parental age.

But the research is clear: Vaccines do not cause autism. Multiple well-designed studies have not shown any evidence connecting the onset of autism with immunizations.

When to contact a pediatrician for an evaluation

If you’re concerned about the way your child acts, plays, learns or speaks, start by talking with your child’s primary care provider. They may recommend developmental tests to identify delays in cognitive, language or social skills — and if necessary, can help guide the next steps for further evaluation.

Healthcare professionals including developmental pediatricians, psychologists and neurologists can diagnose ASD and determine the best treatment plan. Evidence shows early intervention like behavioral therapies and other support can make a significant difference in your child's development and quality of life.

“While intervention early in childhood is effective in improving behavior, social skills and language development, intervention at any age is helpful,” says Dr. Challman. “Though children typically don’t ‘outgrow’ autism, they can learn to function well in school, in relationships and at work later in life.”