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Introduction

 

Autism spectrum disorder (ASD) is a neurodevelopmental disability that is characterized by impairments in social communication and interaction as well as repetitive behaviors, interests, or activities (sometimes including unusual sensory sensitivities or interests in sensory aspects of an individual’s environment).

ASD is considered to be a pervasive disorder that can present challenges that affect many areas of an individual’s life, beginning in the early years and impacting ongoing development.  Though individuals with ASD typically share common characteristics and challenges, ASD is considered a spectrum disorder because these characteristics affect each individual in different ways and to varying degrees of intensity.

Criteria for diagnosing ASD is outlined in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Under previous diagnostic criteria, five disorders of autism were recognized:

  • Autism disorder
  • Asperger’s Disorder
  • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
  • Childhood Disintegrative Disorder, and
  • Rett’s Disorder.

However, since the adoption of the DSM-5 in 2013, autism spectrum disorder (ASD) is now a single diagnosis that recognizes and encompasses the characteristics previously associated across the first four diagnoses with the fifth diagnosis (Rett’s Disorder) being dropped from the DSM all together. Additionally, the DSM-5 includes a new and related diagnosis of social communication disorder (SCD).

There is no cure for ASD, but the use of various strategies and interventions can help manage and correct certain challenges, behaviors, and symptoms.

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What Causes ASD?

Currently, no singular cause for ASD has been identified; several studies have found patterns that can explain some of the occurrences though not all (e.g., irregular levels of neurotransmitters and differences in several areas of the brain have been noted among individuals with ASD). Most researchers believe that there are likely many causes and variations of ASD, with one’s genetics (including 10 or more genes on different chromosomes) and environment playing a role in the prevalence of the disorder. In some families there may be a pattern of autism but no one gene has been acknowledged to cause autism. Further research is necessary in determining the relationship between genetics and ASD.

Environmental factors may include such factors as certain viruses or particular drugs (such as thalidomide and valproic acid) being taken during pregnancy. Additionally, research continues to investigate possible neurological, infectious, metabolic, and immunologic factors that may lead to ASD, though the disorder is likely the result of many interrelated and interacting factors given the complexity and the uniqueness of each individual with ASD. ASD is not caused by bad parenting or parental practices.

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How Common is ASD?

According to the Centers for Disease Control and Prevention (CDC, 2014), current estimates suggest that 1 in 68 children in the United States (1-2% of the population) have ASD, with ASD occurring approximately five times more commonly in males than females (Blumberg, Bramlett, & Kogan et al., 2013). ASD occurs in individuals of all races, ethnicities, social classes, and educational backgrounds.

What are the Symptoms of ASD?

As specified within the current diagnostic criteria (DSM-5), ASD is characterized as affecting individuals across the lifespan in two functional areas: (1) challenges related to social communication and social interactions and (2) restricted repetitive behaviors, interests, or activities.

Communication challenges vary among individuals with ASD, as some individuals may be completely nonverbal while others may speak but struggle to use language to communicate their needs, desires and interests effectively with others.

Similarly, social challenges among individuals with ASD can vary greatly, but individuals frequently experience difficulty in using and/or recognizing nonverbal cues such as eye contact, facial expressions, body posture, and gestures. Many individuals also have trouble understanding social cues and rules, which can make social situations uncomfortable and lead to anxiety and challenging behaviors.

Individuals with ASD may also demonstrate a range of unusual interests and repetitive behaviors.

For instance, an individual may be intensely focused on a particular cartoon character, historical event, toy, or animal to the extent that the interest interferes with his or her ability to socialize or engage in other activities.

In addition, some individuals with ASD engage in repetitive motor movements, use of objects, or speech (repeating certain words or phrases). They also tend to prefer routine and sameness as a means of lending predictability and stability to their environment and may experience challenging behaviors when typical routines or their environment are changed.

Additionally, individuals with ASD may be overly or under reactive to certain sensory experiences (such as the way things feel, taste, look, smell, or sound) within their environment and, as a result, they may seek out certain sensory experiences or withdraw from them altogether as a means to calm and self-regulate.

For more information on common characteristics of ASD, visit About the Diagnosis page.

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What Should I Do if I Suspect That Someone in My Family Has ASD?

An evaluation of ASD can be conducted at any age.  However, the American Academy of Pediatrics (AAP) recommends that pediatricians screen children at 9, 18, and 24 or 30 months for ASD utilizing a standardized screening tool. In addition, screening instruments may also be utilized by other professionals such as in the context of an educational or medical evaluation to determine if a more formal evaluation is warranted.

For the purpose of establishing an eligibility ASD within the school system, a request for evaluation must be submitted to the school system for an educational evaluation to be conducted by the multidisciplinary team.  For the purpose of establishing a medical diagnosis that will impact funding and resources, the individual will need to be referred to a medical professional (e.g., psychiatrist or clinical psychologist) and/or team specializing in the disorder.

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How is ASD Diagnosed?

There is no medical or biological test to diagnose ASD.  Rather, diagnoses are made through the process of observation, interviews of caregivers, review of historical records and products, as well as rating scales.  Screenings are typically completed in young children to detect the earliest indicators of ASD. If screenings or other symptoms suggest the occurrence of ASD, a comprehensive evaluation by a multidisciplinary team is recommended to review and observe the child’s:

  • development
  • behavior
  • hearing
  • vision,
  • speech/language
  • motor abilities
  • sensory abilities, and
  • cognitive ability.

While pediatricians, family physicians and other medical professionals (e.g., therapists, social workers) may complete screenings and recommend further evaluation, specialists such as psychiatrists, developmental pediatricians, pediatric neurologists, and psychologists typically provide the more formal medical diagnosis of ASD.

It is important to note that while the DSM-5 diagnostic criteria is considered by both medical professionals and school personnel when evaluating the presence of ASD in a child, a medical diagnosis of ASD is not equivalent to a determination of special education eligibility within a school setting (and vice versa). For more information about the differences between a medical diagnosis and educational classification of ASD, visit the Screening & Diagnosis page.

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What Additional Challenges/Symptoms May Be Observed with ASD?

Sometimes, individuals with ASD demonstrate additional symptoms that are not formally associated with the diagnostic criteria of the disorder, but which may impact the individual over and above the diagnosis of ASD alone, may interfere with learning, interactions, and success, and may warrant some added focus and interventions. Such common added difficulties might include but not be limited to the following:

  • distractibility,
  • sleep challenges,
  • feeding challenges,
  • slower learning, and/or
  • irritability symptoms from intense anxiety and frustration.

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What Unique Abilities May Individuals with ASD Have?

While ASD can present a number of challenges, individuals with ASD may also demonstrate unique skills or abilities.

For instance, many individuals with ASD exhibit the ability to follow concrete rules and sequences, demonstrate excellent long-term memory, show high levels of creativity and/or artistic ability, possess large vocabularies, and demonstrate honesty, focus, loyalty, and strong work ethics.

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Additional Resources

 

References

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