Autism Spectrum Disorder (ASD) is a developmental disability that can cause social, communication and behavioral challenges. People with ASD may communicate, interact, behave and learn in ways that are different from most other people. The learning, thinking and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives while others need less.
A diagnosis of ASD includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder or ASD.
To learn more, please review the information below.
Diagnosing ASD can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at a person’s developmental history and behavior to make a diagnosis. Although autism can be diagnosed at any age, it is called a “developmental disorder” because symptoms generally appear in the first two years of life. ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and ability to function. The American Academy of Pediatrics recommends that all children be screened for autism. All caregivers should talk to their child’s doctor about ASD screening or evaluation.
People with ASD often experience challenges with social, emotional and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention or reacting to things. Signs of ASD begin in early childhood and typically last throughout a person’s life.
Social impairment and communication difficulties
Social communication and interaction skills can be challenging for people with ASD.
Examples of social communication and social interaction characteristics related to ASD can include:
- Avoids or does not keep eye contact.
- Does not respond to name by 9 months of age.
- Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age.
- Does not play simple interactive games like pat-a-cake by 12 months of age.
- Uses few or no gestures by 12 months of age (e.g., does not wave goodbye).
- Does not share interests with others (e.g., shows you an object that he or she likes by 15 months of age).
- Does not point or look at what you point to by 18 months of age.
- Does not notice when others are hurt or sad by 24 months of age.
- Does not pretend in play (e.g., does not pretend to “feed” a doll by 30 months of age).
- Shows little interest in peers.
- Has trouble understanding other people’s feelings or talking about own feelings at 36 months of age or older.
- Does not play games with turn taking by 60 months of age.
Repetitive and characteristic behaviors
People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by only problems with social communication and interaction.
Examples of restricted or repetitive interests and behaviors related to ASD can include:
- Lines up toys or other objects and gets upset when order is changed.
- Repeats words or phrases or echoes words or phrases (i.e., echolalia).
- Plays with toys the same way every time.
- Is focused on parts of objects (e.g., wheels).
- Gets upset by minor changes.
- Has obsessive interests.
- Must follow certain routines.
- Flaps hands, rocks body, or spins self in circles.
- Has unusual reactions to the way things sound, smell, taste, look, or feel.
Children or Adults with ASD might:
- Have trouble relating to others or not have an interest in other people at all.
- Wants to be alone or tends to isolate or play on their own.
- Have trouble understanding other people’s feelings or talking about their own feelings.
- Prefer not to be held or cuddled or might cuddle only when they want to.
- Appear to be unaware when people talk to them but respond to other sounds.
- Be very interested in people, but not know how to talk, play, or relate to them.
- Have trouble expressing their needs using typical words or motions.
- Repeats actions over and over again.
- Have trouble adapting when a routine changes.
- Have unusual reactions to the way things smell, taste, look, feel, or sound.
- Lose skills they once had (for example, stop saying words they were using).
- Have delayed speech.
Researchers don’t know the exact causes of ASD. There are likely many causes for multiple types of ASD. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors. Although scientists are still trying to understand why some people develop ASD and others don’t, some factors that increase the risk of developing ASD include:
- Having a sibling with ASD.
- Having older parents.
- Having certain genetic conditions (for example, people with conditions such as Down syndrome, fragile X syndrome, and Rett syndrome are more likely than others to have ASD).
- Being born with a very low birth weight.
- Not everyone who has these risk factors develops ASD, please discuss any questions or concerns with your primary care provider.
- Autism now affects 1 in 54 children; over half are classified as having an intellectual disability or borderline intellectual disability.
- Boys are four times more likely to have autism than girls.
- About 40% of children with autism do not speak. About 25%–30% of children with autism have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.
- Autism greatly varies from person to person (no two people with autism are alike).
- The rate of autism has steadily grown over the last twenty years.
- Comorbid conditions often associated with autism include:
- Fragile X
- Bowel disease
- Gastrointestinal/digestive disorders
- Persistent viral infections
- Feeding disorders
- Anxiety disorder
- Bipolar disorder
- Tourette Syndrome
- Sensory integration dysfunction
- Sleeping disorders
- Immune disorders
- Autoimmune disorders
- Autism is the fastest growing developmental disorder, yet most underfunded.
- A 2008 Danish Study found that the mortality risk among those with autism was nearly twice that of the general population.
- Children with autism do progress – early intervention is key.
- Autism is treatable, not a hopeless condition.
ASD affects each person differently. This means that people with ASD may have specific strengths and challenges in social communication, behavior, and cognitive ability. Therefore, treatment plans usually target the individual needs of the person with ASD. Treatments range from therapy, dietary changes and medications.
Therapies and Services:
There are many types of services available to individuals with ASD. These include applied behavior analysis, social skills training, occupational therapy, physical therapy, sensory integration therapy and the use of assistive technology.
Applied Behavior Analysis (ABA)
ABA encourages positive behaviors and discourages negative behaviors to improve a variety of skills. The child’s progress is tracked and measured. This method has become widely accepted among healthcare professionals and used in many schools and treatment clinics.
Assistive technology can help people with ASD communicate and interact with others. For example, the Picture Exchange Communication System (PECS) uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation. Other individuals may use a tablet as a speech-generating or communication device.
Occupational therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people.
Social Skills Training
Social skills training teaches children the skills they need to interact with others, including conversation and problem-solving skills.
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
Some dietary treatments have been developed to address ASD symptoms. However, a 2017 systematic review of 19 randomized control trials found little evidence to support the use of dietary treatments for children with ASD.
If you are thinking about changing your child’s diet, talk to the doctor first or with a registered dietitian to be sure your child’s diet includes the necessary vitamins and minerals for their growth and development.
There are no medications that can cure ASD or treat the core symptoms. However, there are medications that can help some people with ASD function better. For example, medication might help manage high energy levels, inability to focus, anxiety and depression, behavioral reactivity, self-injury, or seizures.
Medications might not affect all children in the same way. It is important to work with a healthcare professional who has experience in treating children with ASD. Parents and healthcare professionals must closely monitor a child’s progress and reactions while he or she is taking a medication to be sure that any negative side effects of the treatment do not outweigh the benefits.
To learn more about medication and ASD, please visit the National Institute of Child Health and Human Development’s website.
Complementary and Alternative Medicine Treatments
To relieve the symptoms of ASD, some parents and healthcare professionals use treatments that are outside of what is typically recommended by pediatricians. These treatments are known as complementary and alternative medicine (CAM) treatments. CAM treatments refer to products or services that are used in addition to or instead of traditional medicine. They might include special diets, supplements, biologicals, or mind-body medicine.
Many of these treatments have not been studied for effectiveness. Current research shows that as many as one-third of parents of children with ASD may have tried CAM treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, talk to your doctor or your child’s doctor.
To learn more about:
- CAM therapies for ASD, visit the National Center for Complementary and Alternative Medicine’s Austim webpage.
- Potentially dangerous treatments, visit the FDA article Potentially Dangerous Products and Therapies that Claim to Treat Autism.
Autism services are a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Medicaid clients who are 20 years of age or younger, and who meet the criteria.
Texas Medicaid offers an array of medically necessary services to support individualized treatment plans for children and youth up through 20 years of age with ASD. These services may be covered benefits when matched with an individualized treatment plan tailored to the specific needs of the child/youth birth through 20 years of age, their caregivers, and documented as medically necessary. Not all services may be clinically appropriate for all people, families, or situations. Services must be evidence based, person-centered, delivered by personnel of appropriate training and credentialing, and oriented to functional, attainable, and measurable goals.
These services may include one or more of the following but are not limited to:
- Applied behavior analysis (ABA) – available after 02/01/2022
- Case management/care coordination (with parent permission)
- Early Childhood Intervention (ECI)
- Nutrition, when provided by a Licensed Dietitian
- Occupational therapy (OT)
- Outpatient behavioral health services
- Physician services, including medication management
- Physical therapy (PT)
- Speech-language pathology (SLP; also called speech therapy, ST)
The Autism Society was the first national autism organization to provide a COVID-19 toolkit to support the autism community. The Autism Society of America promises to remain committed to improving the lives of all affected by autism across the spectrum and throughout the lifespan, and will focus on providing information resources, and advocacy efforts to address these urgent needs.
The autism community has faced extraordinary challenges during the COVID-19 crisis and has launched a comprehensive toolkit on their website, which provides COVID-19 information and resources. This includes topics such as Mental Health & Respite, Modifying Routines, Lifestyle Supports, and much more. To learn more visit, Autism Society - COVID-19.
Autism Spectrum Disorder (ASD):
Autism spectrum disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.
The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders. A diagnosis of ASD includes an assessment of intellectual disability and language impairment.
Pervasive Developmental Disorder (PDD):
The diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Autism (a developmental brain disorder characterized by impaired social interaction and communication skills, and a limited range of activities and interests) is the most characteristic and best studied PDD. Other types of PDD include Asperger's Syndrome, Childhood Disintegrative Disorder, and Rett's Syndrome. Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.
Asperger’s Disorder was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 as a separate disorder from autism. However, there are still many professionals who consider Asperger’s Disorder a less severe form of autism. In 2013, the DSM-5 replaced Autistic Disorder, Asperger’s Disorder and other pervasive developmental disorders with the umbrella diagnosis of autism spectrum disorder.
Diagnosis of Asperger’s Disorder has increased in recent years, although it is unclear whether it is more prevalent or more professionals are detecting it. When Asperger’s and autism were considered separate disorders under the DSM-IV, the symptoms for Asperger’s Disorder were the same as those listed for autism; however, children with Asperger’s do not have delays in the area of communication and language. In fact, to be diagnosed with Asperger’s, a child must have normal language development as well as normal intelligence. The DSM-IV criteria for Asperger’s specified that the individual must have “severe and sustained impairment in social interaction, and the development of restricted, repetitive patterns of behavior, interests and activities that must cause clinically significant impairment in social, occupational or other important areas of functioning.”
Applied behavior analysis (ABA):
Applied behavior analysis (ABA) - the scientific study of the principles of learning and behavior, specifically about how behavior affects, and is affected by, past and current environmental events in conjunction with biological variables. Applied Behavior Analysis (ABA) refers to the application of current, evidence based specialized principles of the applied behavior analysis discipline by a provider, such as a licensed and certified behavior analyst (LBA), trained in this intervention. The intent of ABA therapy is to effect meaningful changes, which are durable and generalizable, in socially significant behaviors in everyday settings. ABA focuses on treating behavior difficulties and shaping behavior patterns through environmental adaptations and consistent reinforcement and consequences across settings and situations.
- Centers for Disease Control and Prevention (CDC) - Autism Spectrum Disorder
- Texas Autism - Resources
- Autism Speaks
- Texas Autism Research & Resource Center
- Autism Society
- National Institute of Mental Health - Autism Spectrum Disorder
- Medicaid Autism Services Draft Policy | TMHP
- Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth With Autism (PDF)