Could my child have autism spectrum disorder?

Autism spectrum disorder is a developmental condition that alters a person's ability to communicate and interact. Diagnosing autism spectrum disorder early can improve quality of life and better access to early intervention services. By recognizing the early signs and symptoms, you can get your child the help they need to learn, grow and thrive.

Autism spectrum disorder symptoms

Some children show signs of autism spectrum disorder in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Others develop normally for the first few months or years of life, but then there are signs of decreased emotional responses, aggression or loss of skills previously acquired with motor movement or language. These signs usually appear by age 2.

Each child with autism spectrum disorder has a unique pattern of behavior and severity level — from low-functioning to high-functioning. The child may or may not have a language delay or intellectual disability.

Some children with the disorder have difficulty with learning and language, and others may have signs of lower-than-normal intelligence. Other children have normal-to-high intelligence. They learn quickly, yet have trouble communicating and applying what they know in everyday life, particularly in social situations. Although the symptoms identified may vary, clinical diagnosis is based on autism spectrum disorder diagnostic criteria to differentiate and determine symptom severity.

Social communication, interaction with autism

A child with autism spectrum disorder may have problems with communication skills and social interaction.

These signs may include:

• Appearing to not understand simple questions or directions.
• Failing to respond to their name or appearing not to hear you at times.
• Having difficulty recognizing nonverbal cues, such as interpreting other people's facial expressions, body postures or tone of voice.
• Having poor eye contact and lacking facial expression.
• Inappropriately approaching a social interaction by being passive, aggressive or disruptive.
• Not being able to start a conversation or keep one going.
• Not expressing emotions or feelings and appearing unaware of others' feelings.
• Not pointing at or bringing objects to share an interest and struggling to ask for help with tasks.
• Not speaking, having delayed speech or losing previous ability to say words or sentences.
• Repeating words or phrases verbatim that are out of context or don't make sense to the conversation.
• Speaking with an abnormal tone or rhythm, and using a sing-song voice or robot-like speech.
• Struggling to understand jokes and sarcasm.
• Resists cuddling and holding, and seems to prefer playing alone.

Patterns of behavior

A child with autism spectrum disorder may have limited, repetitive behavior patterns, interests or activities.

These signs may include:

• Being fascinated by details of an object, such as the spinning wheels of a toy car, but not understanding the overall purpose or function of the object.
• Being unusually sensitive to light, sound or touch, yet being indifferent to pain or temperature.
• Developing specific routines or rituals, and becoming upset at the slightest change.
• Fixating on an object or activity with abnormal intensity or focus.
• Having problems with coordination or has odd movement patterns, with odd, stiff or exaggerated body language.
• Not engaging in imitative or make-believe play or cooperative play with other children.
• Performing repetitive movements, such as hand-flapping, rocking or spinning.
• Performing activities that could cause self-harm, such as biting or head-banging.
• Wanting only to eat few, specific foods, or refusing foods with a certain texture.

Some children with the disorder become more engaged with others and show fewer disturbances in behavior as they mature. Even with a diagnosis of autism, higher-functioning individuals may lead normal or near-normal lives. However, people with more significant impairment continue to have difficulty with language or social skills, and the transition to the teen years can bring worse behavioral and emotional problems.

When to seek help

If you're concerned about your child's development or you suspect that your child may have autism spectrum disorder, discuss this with your health care team. The symptoms associated with the disorder also can be linked with other developmental disorders that can be evaluated by a health care professional.

Your health care team may recommend developmental tests if your child doesn't:

• Babble or coo by 12 months.
• Gesture, such as point or wave, by 14 months.
• Loses language skills or social skills at any age.
• Mimic sounds or facial expressions by 9 months.
• Play make-believe or pretend by 18 months.
• Respond with a smile or happy expression by 6 months.
• Say single words by 16 months.
• Speak two-word phrases by 24 months.

Ashley Holland, D.O., sees patients in Psychiatry & Psychology in Eau Claire, Wisconsin.