Autism: First, What Is Autism?

Do you KNOW your child is a child with autism? Do you SUSPECT your child is a child with autism? Are you AFRAID your child is a child with autism? If you fit into any of these categories, you’re not alone. As parents struggle to deal with the prospect or reality of a child with autism, they often ask, “What can I do for my child?” The signs and symptoms of autism appear differently in every child, so before that question can be answered, the best thing you can do for your child is learn. As a speech-language pathologist, I am very involved in both autism diagnosis and autism therapy. This is the first in a series of blog posts intended to help parents learn about autism and discover meaningful things they can do to help their children.

The first question to ask is, what is autism? Autism is a social-communication disorder. Delays in the development of social skills, as well as language and communication difficulties, are the diagnostic hallmarks of autism. The definition of autism changed in 2013 when the American Psychiatric Association published new classification and diagnostic criteria. Essentially, all of the previous autism-related diagnoses were consolidated into one diagnosis: autism spectrum disorder. Previously, the autism spectrum disorders were grouped into autism, Asperger’s syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS). Now, only autism spectrum disorder remains. Autism spectrum disorder is commonly referred to as autism or ASD.

Combining the earlier autism spectrum disorders into one diagnosis does not alter what autism is. The range of defining characteristics and severity are within one category, so autism is autism, and instead of worrying about other labels, both parents and professionals can now focus on planning and implementing the best autism therapy possible for our children.

Early signs and symptoms of ASD in young children are often first identified by parents or physicians; concerning behaviors in older children are often identified by teachers. It’s important to remember that not all children with ASD will exhibit all of the ASD behaviors, but most children with autism will display some, or several, of the typical behaviors. It’s equally important to remember that many autism-like symptoms are caused by treatable medical conditions. Autism-like symptoms can also be signs or symptoms of another developmental disability. Speech and language disorders, intellectual disability, hearing loss, or other disorders can share symptoms with autism and may be mistaken for signs of autistic behavior. For all of these reasons, it is important to assemble a diagnostic team and to consider your whole child.

The two main types of ASD behaviors are described as “restricted/repetitive behaviors” and “social communication/interaction behaviors.” Remember, all children with ASD probably won’t display all of these behaviors, but most children with ASD will display at least some of these behaviors.

Restricted or repetitive behaviors are sometimes called stereotyped behaviors because they generally refer to persistent and mechanical repetition of speech and/or movements or unusual focus on objects. Examples may include:

Repeating certain behaviors, as though “stuck” doing the same thing over and over, unable to move on
Demonstrating unusual behaviors, including physical behaviors like hand flapping
Intense interest or attachment to toys, objects, or routines, such as dressing or eating
Putting objects in a certain order, lining up objects, or categorizing objects according to size, color, etc.
Ongoing, intense interest in a certain topic or topics, such as numbers or facts; may overly focus on detail
Echolalia, the repetition of others’ words or phrases; may be immediate or delayed

Communication/interaction behaviors are grouped together because interactions, or lack thereof, do communicate something. Examples include:

Not responding to name or other attempts to gain child’s attention
Little or no eye contact
Inability to express what (s)he wants or needs
Refusal/inability to follow directions
Appearing to sometimes hear, sometimes not
Not babbling or saying words, or stopping those activities
Preferring to be alone even at play; not sharing objects or activities with others
“Tuning out” other people and being in his or her “own world”
Use of words that may seem odd or inappropriate to the situation
Facial expressions and gestures that don’t match what is being said
An unusual voice quality; tone and inflection are lacking and the voice may sound flat and robotic
Little or no knowledge or awareness of conversation or the rules of conversation, such as turn-taking

These are some examples of developmental red flags that may signal ASD. There may be other difficulties, such as sensitivity to things in the environment (e.g., noise, light, etc.), sleep problems, etc. You are encouraged to discuss signs and symptoms with your child’s pediatrician and to seek other credible sources of information, such as Autism Speaks, an autism advocacy organization.

Developing a clearer understanding of what autism is can lead to the next step, diagnosing autism spectrum disorder. Diagnosing ASD will be the topic of the next blog post. I hope to see you there!