Autism in children

Facing a possible diagnosis of autism can be overwhelming for parents and caregivers. But rest assured, help is out there. Let's look at what's known about the causes of autism, early signs to look for, how it's diagnosed and treatment options.

Autism is one of many conditions grouped under the broad term autism spectrum disorder (ASD). These conditions are most often characterized by difficulties with social interaction, repetitive behaviors and communication. While some children with autism may need lifelong support, others can live independently as adults.

There is no single known cause for ASD. There may be contributing factors, but they are not necessarily the cause. These include: 

• A genetic tendency toward autism
• A mix of genetic and environmental influences, such as advanced paternal age or birth complications
• Problems in the early development of several areas of the brain

Note that these two factors do not play a role in increasing the risk for autism:

• Parenting styles
• Vaccines

There are some common signs of ASD to look out for in babies, toddlers and infants. Children who do not have autism may also show one or more of these signs. However, in children with autism, these symptoms affect their daily functioning.

Babies and toddlers

Signs of ASD most often appear before the age of 2 years and can sometimes be seen as early as 6 months. They may include: 

• Limited or no eye contact by 6 months
• Not smiling very often by 6 months or showing few happy expressions
• Not responding to facial expressions (like smiles or sounds by 9 months)
• Little or no babbling by 12 months
• Not responding to their name, although possibly to other sounds, by 12 months
• Exhibiting few or no gestures by 12 months (like pointing, waving or showing objects)
• Saying only a few or no single words by 16 months
• Saying very few or no meaningful two-word phrases by 24 months

Children

Some children with ASD develop normally until 18 to 24 months, then stop developing or even lose some function. However, common signs that can appear at any age include: 

• Communication issues, such as delayed speech, repeating words and mixing up pronouns (perhaps referring to others as "I" and to themselves as "you")
• Not understanding other people's feelings or having trouble talking about their own feelings
• Liking routine and repetition and having trouble with change
• Not playing imaginary games (like pretending to feed dolls)
• Repeating the same motions (like rocking, spinning, flapping their hands and swaying)
• Overreacting or underreacting to pain
• Being either very sensitive or not at all sensitive to smells, sounds, lights, textures and touch
• Avoiding eye contact and wanting to be alone

Diagnosing autism can be challenging, as there is no blood test or X-ray that can lead to a diagnosis. Typically, a pediatrician can help children by monitoring for delays in their development. After that, they may recommend a visit to a specialist, who will assist further. These specialists might be developmental pediatricians, child psychologists, speech pathologists or occupational therapists. The specialist may do a formal, thorough developmental evaluation to diagnose autism.

No treatments have been shown to cure autism, but many interventions have been developed and studied to lessen autism symptoms in children, improve communication and thinking skills, and maximize the child's ability to function in society. Because every child has their own unique strengths and weaknesses, each therapy plan should be made specific to that child. Common interventions include:

• Speech and occupational therapy
• Training in social skills
• Applied behavioral analysis (therapy that encourages positive behaviors and discourages negative ones)
• Assistive technology, such as communication boards and tablets
• Developmental, Individual Difference, Relationship-based approach (also called "Floortime"). This focuses on emotional and relationship development, as well as how the child deals with sights, sounds and smells.
• Medications

It may be daunting for parents or caregivers to learn that their child has autism spectrum disorder, but there is help available. Remember to seek advice from a pediatrician to learn how to best support a child with autism. Finally, reach out to friends and relatives for emotional support, as it's just as important to talk through how you're feeling.

Published April 2021.