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Autism spectrum disorder - Symptoms and causes - Mayo Clinic

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Autism spectrum disorder

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OverviewAutism spectrum disorder is a condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior. The term "spectrum" in autism spectrum disorder refers to the wide range of symptoms and severity.

Autism spectrum disorder includes conditions that were previously considered separate — autism, Asperger's syndrome, childhood disintegrative disorder and an unspecified form of pervasive developmental disorder. Some people still use the term "Asperger's syndrome," which is generally thought to be at the mild end of autism spectrum disorder.

Autism spectrum disorder begins in early childhood and eventually causes problems functioning in society — socially, in school and at work, for example. Often children show symptoms of autism within the first year. A small number of children appear to develop normally in the first year, and then go through a period of regression between 18 and 24 months of age when they develop autism symptoms.

While there is no cure for autism spectrum disorder, intensive, early treatment can make a big difference in the lives of many children.Products & ServicesChildren’s Book: My Life Beyond Autism

SymptomsSome 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. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired. Signs usually are seen by age 2 years.

Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning.

Some children with autism spectrum disorder have difficulty learning, and some have signs of lower than normal intelligence. Other children with the disorder have normal to high intelligence — they learn quickly, yet have trouble communicating and applying what they know in everyday life and adjusting to social situations.

Because of the unique mixture of symptoms in each child, severity can sometimes be difficult to determine. It's generally based on the level of impairments and how they impact the ability to function.

Below are some common signs shown by people who have autism spectrum disorder.

Social communication and interactionA child or adult with autism spectrum disorder may have problems with social interaction and communication skills, including any of these signs:

Fails to respond to his or her name or appears not to hear you at times

Resists cuddling and holding, and seems to prefer playing alone, retreating into his or her own world

Has poor eye contact and lacks facial expression

Doesn't speak or has delayed speech, or loses previous ability to say words or sentences

Can't start a conversation or keep one going, or only starts one to make requests or label items

Speaks with an abnormal tone or rhythm and may use a singsong voice or robot-like speech

Repeats words or phrases verbatim, but doesn't understand how to use them

Doesn't appear to understand simple questions or directions

Doesn't express emotions or feelings and appears unaware of others' feelings

Doesn't point at or bring objects to share interest

Inappropriately approaches a social interaction by being passive, aggressive or disruptive

Has difficulty recognizing nonverbal cues, such as interpreting other people's facial expressions, body postures or tone of voice

Patterns of behaviorA child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these signs:

Performs repetitive movements, such as rocking, spinning or hand flapping

Performs activities that could cause self-harm, such as biting or head-banging

Develops specific routines or rituals and becomes disturbed at the slightest change

Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language

Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the overall purpose or function of the object

Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature

Doesn't engage in imitative or make-believe play

Fixates on an object or activity with abnormal intensity or focus

Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture

As they mature, some children with autism spectrum disorder become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral and emotional problems.

When to see a doctorBabies develop at their own pace, and many don't follow exact timelines found in some parenting books. But children with autism spectrum disorder usually show some signs of delayed development before age 2 years.

If you're concerned about your child's development or you suspect that your child may have autism spectrum disorder, discuss your concerns with your doctor. The symptoms associated with the disorder can also be linked with other developmental disorders.

Signs of autism spectrum disorder often appear early in development when there are obvious delays in language skills and social interactions. Your doctor may recommend developmental tests to identify if your child has delays in cognitive, language and social skills, if your child:

Doesn't respond with a smile or happy expression by 6 months

Doesn't mimic sounds or facial expressions by 9 months

Doesn't babble or coo by 12 months

Doesn't gesture — such as point or wave — by 14 months

Doesn't say single words by 16 months

Doesn't play "make-believe" or pretend by 18 months

Doesn't say two-word phrases by 24 months

Loses language skills or social skills at any age

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CausesAutism spectrum disorder has no single known cause. Given the complexity of the disorder, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.

Genetics. Several different genes appear to be involved in autism spectrum disorder. For some children, autism spectrum disorder can be associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic changes (mutations) may increase the risk of autism spectrum disorder. Still other genes may affect brain development or the way that brain cells communicate, or they may determine the severity of symptoms. Some genetic mutations seem to be inherited, while others occur spontaneously.

Environmental factors. Researchers are currently exploring whether factors such as viral infections, medications or complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.

No link between vaccines and autism spectrum disorderOne of the greatest controversies in autism spectrum disorder centers on whether a link exists between the disorder and childhood vaccines. Despite extensive research, no reliable study has shown a link between autism spectrum disorder and any vaccines. In fact, the original study that ignited the debate years ago has been retracted due to poor design and questionable research methods.

Avoiding childhood vaccinations can place your child and others in danger of catching and spreading serious diseases, including whooping cough (pertussis), measles or mumps.

Risk factorsThe number of children diagnosed with autism spectrum disorder is rising. It's not clear whether this is due to better detection and reporting or a real increase in the number of cases, or both.

Autism spectrum disorder affects children of all races and nationalities, but certain factors increase a child's risk. These may include:

Your child's sex. Boys are about four times more likely to develop autism spectrum disorder than girls are.

Family history. Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It's also not uncommon for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.

Other disorders. Children with certain medical conditions have a higher than normal risk of autism spectrum disorder or autism-like symptoms. Examples include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; and Rett syndrome, a genetic condition occurring almost exclusively in girls, which causes slowing of head growth, intellectual disability and loss of purposeful hand use.

Extremely preterm babies. Babies born before 26 weeks of gestation may have a greater risk of autism spectrum disorder.

Parents' ages. There may be a connection between children born to older parents and autism spectrum disorder, but more research is necessary to establish this link.

ComplicationsProblems with social interactions, communication and behavior can lead to:

Problems in school and with successful learning

Employment problems

Inability to live independently

Social isolation

Stress within the family

Victimization and being bullied

More InformationAutism spectrum disorder and digestive symptoms

PreventionThere's no way to prevent autism spectrum disorder, but there are treatment options. Early diagnosis and intervention is most helpful and can improve behavior, skills and language development. However, intervention is helpful at any age. Though children usually don't outgrow autism spectrum disorder symptoms, they may learn to function well.

By Mayo Clinic Staff

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Show references

Autism spectrum disorder (ASD). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/facts.html. Accessed April 4, 2017.

Uno Y, et al. Early exposure to the combined measles-mumps-rubella vaccine and thimerosal-containing vaccines and risk of autism spectrum disorder. Vaccine. 2015;33:2511.

Taylor LE, et al. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014;32:3623.

Weissman L, et al. Autism spectrum disorder in children and adolescents: Overview of management. https://www.uptodate.com/home. Accessed April 4, 2017.

Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed April 4, 2017.

Weissman L, et al. Autism spectrum disorder in children and adolescents: Complementary and alternative therapies. https://www.uptodate.com/home. Accessed April 4, 2017.

Augustyn M. Autism spectrum disorder: Terminology, epidemiology, and pathogenesis. https://www.uptodate.com/home. Accessed April 4, 2017.

Bridgemohan C. Autism spectrum disorder: Surveillance and screening in primary care. https://www.uptodate.com/home. Accessed April 4, 2017.

Levy SE, et al. Complementary and alternative medicine treatments for children with autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America. 2015;24:117.

Brondino N, et al. Complementary and alternative therapies for autism spectrum disorder. Evidence-Based Complementary and Alternative Medicine. http://dx.doi.org/10.1155/2015/258589. Accessed April 4, 2017.

Volkmar F, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2014;53:237.

Autism spectrum disorder (ASD). Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/autism/Pages/default.aspx. Accessed April 4, 2017.

American Academy of Pediatrics policy statement: Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129:1186.

James S, et al. Chelation for autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010766.pub2/abstract;jsessionid=9467860F2028507DFC5B69615F622F78.f04t02. Accessed April 4, 2017.

Van Schalkwyk GI, et al. Autism spectrum disorders: Challenges and opportunities for transition to adulthood. Child and Adolescent Psychiatric Clinics of North America. 2017;26:329.

Autism. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed April 4, 2017.

Autism: Beware of potentially dangerous therapies and products. U.S. Food and Drug Administration. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm394757.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. Accessed May 19, 2017.

Drutz JE. Autism spectrum disorder and chronic disease: No evidence for vaccines or thimerosal as a contributing factor. https://www.uptodate.com/home. Accessed May 19, 2017.

Weissman L, et al. Autism spectrum disorder in children and adolescents: Behavioral and educational interventions. https://www.uptodate.com/home. Accessed May 19, 2017.

Huebner AR (expert opinion). Mayo Clinic, Rochester, Minn. June 7, 2017.

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Autism

15 November 2023

Key facts

Autism – also referred to as autism spectrum disorder ̶ constitutes a diverse group of conditions related to development of the brain.

About 1 in 100 children has autism.

Characteristics may be detected in early childhood, but autism is often not diagnosed until much later.

The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support.

Evidence-based psychosocial interventions can improve communication and social skills, with a positive impact on the well-being and quality of life of both autistic people and their caregivers.

Care for people with autism needs to be accompanied by actions at community and societal levels for greater accessibility, inclusivity and support.

OverviewAutism spectrum disorders (ASD) are a diverse group of conditions. They are characterized by some degree of difficulty with social interaction and communication. Other characteristics are atypical patterns of activities and behaviours, such as difficulty

with transition from one activity to another, a focus on details and unusual reactions to sensations.The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support. Autism often has an impact on education and employment

opportunities. In addition, the demands on families providing care and support can be significant. Societal attitudes and the level of support provided by local and national authorities are important factors determining the quality of life of

people with autism.Characteristics of autism may be detected in early childhood, but autism is often not diagnosed until much later.People with autism often have co-occurring conditions, including epilepsy, depression, anxiety and attention deficit hyperactivity disorder as well as challenging behaviours such as difficulty sleeping and self-injury. The level of intellectual

functioning among autistic people varies widely, extending from profound impairment to superior levels.EpidemiologyIt is estimated that worldwide about 1 in 100 children has autism (1). This estimate represents an average figure, and reported prevalence varies substantially across studies. Some well-controlled studies have, however, reported figures that are substantially

higher. The prevalence of autism in many low- and middle-income countries is unknown.Causes Available scientific evidence suggests that there are probably many factors that make a child more likely to have autism, including environmental and genetic factors.Extensive research using a variety of different methods and conducted over many years has demonstrated that the measles, mumps and rubella vaccine does not cause autism. Studies that were interpreted as indicating any such link were flawed, and some of the authors had undeclared biases that influenced what they reported about their research (2,3,4).Evidence also shows that other childhood vaccines do not increase the risk of autism. Extensive research into the preservative thiomersal and the additive aluminium that are contained in some inactivated vaccines strongly concluded that these constituents in childhood vaccines do not increase the risk of autism. Assessment and careA broad range of interventions, from early childhood and across the life span, can optimize the development, health, well-being and quality of life of autistic people. Timely access to early evidence-based psychosocial interventions can improve the ability

of autistic children to communicate effectively and interact socially. The monitoring of child development as part of routine maternal and child health care is recommended.It is important that, once autism has been diagnosed, children, adolescents and adults with autism and their carers are offered relevant information, services, referrals, and practical support, in accordance with their individual and evolving needs and

preferences.The health-care needs of people with autism are complex and require a range of integrated services, that include health promotion, care and rehabilitation. Collaboration between the health sector and other sectors, particularly education, employment and

social care, is important.Interventions for people with autism and other developmental disabilities need to be designed and delivered with the participation of people living with these conditions. Care needs to be accompanied by actions at community and societal levels for greater accessibility, inclusivity and support.Human rightsAll people, including people with autism, have the right to the enjoyment of the highest attainable standard of physical and mental health.And yet, autistic people are often subject to stigma and discrimination, including unjust deprivation of health care, education and opportunities to engage and participate in their communities.People with autism have the same health problems as the general population. However, they may, in addition, have specific health-care needs related to autism or other co-occurring conditions. They may be more vulnerable to developing chronic noncommunicable

conditions because of behavioural risk factors such as physical inactivity and poor dietary preferences, and are at greater risk of violence, injury and abuse.People with autism require accessible health services for general health-care needs like the rest of the population, including promotive and preventive services and treatment of acute and chronic illness. Nevertheless, autistic people have higher rates

of unmet health-care needs compared with the general population. They are also more vulnerable during humanitarian emergencies. A common barrier is created by health-care providers’ inadequate knowledge and understanding of autism.WHO resolution on autism spectrum disorders In May 2014, the Sixty-seventh World Health Assembly adopted a resolution entitled Comprehensive and coordinated efforts for the management of autism spectrum disorders,

which was supported by more than 60 countries.The resolution urges WHO to collaborate with Member States and partner agencies to strengthen national capacities to address ASD and other developmental disabilities.WHO responseWHO and partners recognize the need to strengthen countries' abilities to promote the optimal health and well-being of all people with autism.WHO's efforts focus on:increasing the commitment of governments to taking action to improve the quality of life of people with autism;providing guidance on policies and action plans that address autism within the broader framework of health, mental and brain health and disabilities;contributing to strengthening the ability of the health workforce to provide appropriate and effective care and promote optimal standards of health and well-being for people with autism; andpromoting inclusive and enabling environments for people with autism and other developmental disabilities and providing support to their caregivers.WHO Comprehensive mental health action plan 2013–2030 and World Health Assembly Resolution WHA73.10 for “global actions on epilepsy and other neurological disorders” calls on countries to address the current significant

gaps in early detection, care, treatment and rehabilitation for mental and neurodevelopmental conditions, which include autism. It also calls for counties to address the social, economic, educational and inclusion needs of people living with mental

and neurological disorders, and their families, and to improve surveillance and relevant research.References1. Global prevalence of autism: A systematic review update. Zeidan J et al. Autism Research 2022 March.2. Wakefield's affair: 12 years of uncertainty whereas no link between autism and MMR vaccine has been proved. Maisonneuve H, Floret D. Presse Med. 2012 Sep; French (https://www.ncbi.nlm.nih.gov/pubmed/22748860).

3. Lancet retracts Wakefield’s MMR paper. Dyer C. BMJ 2010;340:c696. 2 February 2010 (https://pubmed.ncbi.nlm.nih.gov/20124366/) 4. Kmietowicz Z. Wakefield is struck off for the “serious and wide-ranging findings against him” BMJ 2010; 340 :c2803 doi:10.1136/bmj.c2803 (https://www.bmj.com/content/340/bmj.c2803)

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What is Autism? - Autism Research Institute

at is Autism? - Autism Research Institute About Autism About Autism Is It Autism? Starting Intervention Symptoms Prognosis Prenatal Factors Autism Assessment Tools Autism Assessment Tools Diagnostic Checklist Autism Treatment Evaluation Checklist (ATEC) Understanding and Treating Self-Injurious Behavior Tool Autism Support Autism Support Expert Webinars Newly Diagnosed Studies Seeking Participants Research Research ARI-Funded Research Studies 2023 ARI Think Tanks Participate in Studies ARI-Funded Research By Year About Us About Us Mission Statement ARI Staff Board of Directors Scientific Advisory Board National Autism History Museum Hours Contact Donate ARI's Latest Accomplishments Annual Reports Financials - Audit Reports/990s Donate Cryptocurrency Donate Stock/Mutual Funds Donate Skip to content DonateSubscribe Monthly E-News – SubscribeClinical Research e-News – SubscribeAutism Research Review International – SubscribeARRI EditorialsWebinars Upcoming WebinarsContinuing Medical EducationATEC Take the ATECATEC – HistoryATEC – Interpreting Scores About Autism Is It Autism?Starting InterventionSymptomsPrognosisPrenatal FactorsAutism Assessment Tools Diagnostic ChecklistAutism Treatment Evaluation Checklist (ATEC)ATEC – HistoryATEC – Interpreting ScoresUnderstanding and Treating Self-Injurious Behavior ToolAutism Support Expert WebinarsNewly DiagnosedStudies Seeking ParticipantsResearch ARI-Funded Research Studies 2023ARI Think TanksParticipate in StudiesARI-Funded Research By YearAbout Us Mission StatementARI StaffBoard of DirectorsScientific Advisory BoardNational Autism History Museum HoursContactDonateARI’s Latest AccomplishmentsAnnual ReportsFinancials – Audit Reports/990sDonate CryptocurrencyDonate Stock/Mutual Funds Search for: Search for: What is Autism? What is Autism?firespringInt2022-11-04T09:36:20-05:00 Autism is a developmental disorder with symptoms that appear within the first three years of life. Its formal diagnostic name is autism spectrum disorder. The word “spectrum” indicates that autism appears in different forms with varying levels of severity. That means that each individual with autism experiences their own unique strengths, symptoms, and challenges. Understanding more about ASD can help you better understand the individuals who are living with it. How autism spectrum disorders are described Psychiatrists and other clinicians rely on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to define autism and its symptoms. The DSM-5 definition recognizes two main symptom areas: Deficits in social communication and interaction Restricted, repetitive behaviors, interests, or activities These symptoms appear early in a child’s development—although diagnosis may occur later. Autism is diagnosed when symptoms cause developmental challenges that are not better explained by other conditions. The definition of autism has been refined over the years. Between 1995 and 2011, the DSM-IV grouped Asperger’s Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) with autism. Asperger’s syndrome was an autism spectrum disorder marked by strong verbal language skills and, often, high intellectual ability. PDD-NOS was a more general diagnosis for people who did not fit clearly into the other two categories. However, the DSM-5 no longer recognizes Asperger’s syndrome or PDD-NOS as separate diagnoses. Individuals who would previously have received either of these diagnoses may now receive a diagnosis of autism spectrum disorder instead. Autism symptoms and behaviors Individuals with autism may present a range of symptoms, such as: Reduced eye contact Differences in body language Lack of facial expressions Not engaging in imaginative play Repeating gestures or sounds Closely focused interests Indifference to temperature extremes These are just a few examples of the symptoms an individual with autism may experience. Any individual could have some, all, or none of these symptoms. Keep in mind that having these symptoms does not necessarily mean a person has autism. Only a qualified medical professional can diagnose autism spectrum disorder. Most importantly, an individual with autism is first and foremost an individual. Learning about the symptoms can help you start to understand the behaviors and challenges related to autism, but that’s not the same as getting to know the individual. Each person with autism has their own strengths, likes, dislikes, interests, challenges, and skills, just like you do. How autism is diagnosed There is no known biological marker for autism. That means that no blood or genetic test can diagnose the disorder. Instead, clinicians rely on observation, medical histories, and questionnaires to determine whether an individual has autism. Physicians and specialists may use one or several of the following screening tools: Modified Checklist for Autism in Toddlers, Revised (M-CHAT), a 20-question test designed for toddlers between 16 and 30 months old. The Ages and Stages Questionnaire (ASQ), a general developmental screening tool with sections targeting specific ages used to identify any developmental challenges a child may have. Screening Tool for Autism in Toddlers and Young Children (STAT), an interactive screening tool, comprising 12 activities that assess play, communication, and imitation. Parents’ Evaluation of Developmental Status (PEDS) is a general developmental parent-interview form that identifies areas of concern by asking parents questions. The American Academy of Pediatrics encourages autism screening for all children at their 18 and 24-month well-child checkups. Parents and caregivers can also ask their pediatrician for an autism screening if they have concerns. In rare cases, individuals with autism reach adulthood before receiving a diagnosis. However, most individuals receive an autism diagnosis before the age of 8. Prevalence of autism For many years, a diagnosis of autism was rare, occurring in just one child out of 2,000. One reason for this was the diagnostic criteria. Autism was not clearly defined until 1980 when the disorder was included in the DSM-III. Before that time, some cases of autism spectrum disorder may have been mistaken for other conditions. Since the ’80s, the rate of autism has increased dramatically around the world. In March 2020, the US Federal Centers for Disease Control announced that 1 in every 54 children in the United States is affected by autism. Although autism is more likely to affect boys than girls, children of all genders have been diagnosed with ASD. Several recent studies investigate the impact of race, ethnicity, and socioeconomic disparities on the diagnosis of autism spectrum disorder.1,2,3,4 A short history of autism Researchers have been working on autism and autism-like disorders since the 1940s. At that time, autism studies tended to be small in scale and used varying definitions of the disorder. Autism was also sometimes lumped in with other conditions. Focused research into ASD became more common in the 1980s when the DSM-III established autism as a distinct diagnosis. Since then, researchers have explored the causes, symptoms, comorbidities, efficacy of treatments, and many other issues related to autism. Researchers have yet to discover a cause for autism. Many of the ideas put forth thus far have been disproven. Likely a combination of genetic, neurological, and environmental factors are at work, which is the case with many psychiatric disorders and conditions. Autism Prognosis Autism is a lifelong condition, and a wide variety of treatments can help support people with ASD. The symptoms and comorbidities—conditions occurring in the same individual—are treatable. Early intervention delivers the best results. Parents and caregivers should seek out the advice of a qualified medical professional before starting any autism treatment. Advances in understanding autism, its symptoms, and comorbidities have improved outcomes for individuals with autism. In recent years, more children with autism have attended school in typical classrooms and gone on to live semi-independently. However, the majority remain affected to some degree throughout their lifetime. Co-occurring conditions When a person has more than two or more disorders, these conditions are known as comorbidities. Several comorbidities are common in people with autism. These include: Anxiety Depression Epilepsy Gastrointestinal and immune function disorders Metabolic disorders Sleep disorders Identifying co-occurring conditions can sometimes be a challenge because their symptoms may be mimicked or masked by autism symptoms. However, diagnosing and identifying these conditions can help avoid complications and improve the quality of life for individuals with autism. Autism in pop culture Movies and books featuring characters with autism have helped bring autism spectrum disorder into the public consciousness. Some have ignited controversy; others have increased the public’s general understanding of autism. A few have done both. At ARI, we hope that people will rely on evidence-based research to understand autism spectrum disorder better. Learn more about autism spectrum disorder by watching one of our expert-led webinars. They help you learn about ASD from clinicians, researchers, and therapists who research autism and support individuals with ASD. References Donohue MR, Childs AW, Richards M, Robins DL. Race influences parent report of concerns about symptoms of autism spectrum disorder. Autism. 2019;23(1):100-111. doi:10.1177/1362361317722030 Durkin MS, Maenner MJ, Baio J, et al. Autism Spectrum Disorder Among US Children (2002-2010): Socioeconomic, Racial, and Ethnic Disparities. Am J Public Health. 2017;107(11):1818-1826. doi:10.2105/AJPH.2017.304032 Newschaffer CJ. Trends in Autism Spectrum Disorders: The Interaction of Time, Group-Level Socioeconomic Status, and Individual-Level Race/Ethnicity. Am J Public Health. 2017;107(11):1698-1699. doi:10.2105/AJPH.2017.304085 Yingling ME, Hock RM, Bell BA. Time-Lag Between Diagnosis of Autism Spectrum Disorder and Onset of Publicly-Funded Early Intensive Behavioral Intervention: Do Race-Ethnicity and Neighborhood Matter?. J Autism Dev Disord. 2018;48(2):561-571. doi:10.1007/s10803-017-3354-3 Melanie Glock2023-12-06T14:19:00-05:00Editorial – Addressing delays: proactive parent-led interventions during waiting periodsMelanie Glock2023-12-06T14:19:00-05:00December 6th, 2023|News| The wait for an autism diagnosis and subsequent intervention can be highly stressful for many families, especially when access to needed health and educational services also hinges on the approval ofMelanie Glock2023-08-29T16:53:04-05:00Prenatal exposure to cannabis may increase likelihood of autismMelanie Glock2023-08-29T16:53:04-05:00August 29th, 2023|News| Cannabis use during pregnancy may alter placental and fetal DNA methylation (the process of turning genes “on” and “off”) in ways that increase the likelihood of autism spectrum disorder (ASD) orMelanie Glock2023-08-29T16:27:41-05:00New multi-national study adds to evidence linking alterations of the gut microbiome to autismMelanie Glock2023-08-29T16:27:41-05:00August 29th, 2023|News| Strong new evidence linking alterations of the gut microbiome to autism spectrum disorders (ASD) comes from a new multi-national study by James Morton and colleagues. In the study, researchers in NorthMelanie Glock2023-07-20T18:49:05-05:00Sleep problems in infancy associated with ASD, autism traits, and social attention alterationsMelanie Glock2023-07-20T18:49:05-05:00July 20th, 2023|News| A new study from the United Kingdom indicates that sleep problems in infancy may help to predict later social skills deficits, autism traits, and autism diagnoses in children. Jannath Begum-Ali andMelanie Glock2023-07-17T16:01:07-05:00Preemptive therapy prior to autism diagnosis may be highly cost-effectiveMelanie Glock2023-07-17T16:01:07-05:00July 17th, 2023|News| Preemptive therapy for infants who display early symptoms of autism may be highly cost-effective, according to a new study from Australia. Leonie Segal and colleagues based their economic analysis on a 2021Melanie Glock2023-06-11T00:13:56-05:00Earlier intervention leads to greater benefits for kids with autismMelanie Glock2023-06-11T00:13:56-05:00June 11th, 2023|News| Children with autism spectrum disorders (ASD) who receive intensive early intervention at the age of 18 months fare significantly better than those who begin receiving this type of intervention at 27 Autism Treatment Evaluation Checklist (ATEC)FAQAutism NewsContactPrivacy & Nondiscrimination Policies / Terms of ServiceAutism Research Review InternationalMission StatementAutism Research Institute StaffFinancial InformationAbout Autism Research Institute DONATESUBSCRIBE© 1967-2024 Autism Research Institute. All rights reserved. ARI does not provide medical advice, diagnosis, or treatment. ARI is a non-profit 501(c)(3) organization, Federal ID #95-2548452 Page load link This website uses cookies to improve your experience. 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Autism (ASD): Symptoms, Causes, Tests, Treatment & More

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buy through links on this page, we may earn a small commission. Here’s our process.How we vet brands and productsHealthline only shows you brands and products that we stand behind.Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:Evaluate ingredients and composition: Do they have the potential to cause harm?Fact-check all health claims: Do they align with the current body of scientific evidence?Assess the brand: Does it operate with integrity and adhere to industry best practices? We do the research so you can find trusted products for your health and wellness.Read more about our vetting process.Was this helpful?ASD describes a group of neurodevelopmental conditions that become evident during early childhood. Certain genetic and environmental factors can contribute to its development. What is autism?Autism spectrum disorder (ASD), or autism, is a broad term used to describe a group of neurodevelopmental conditions.These conditions are characterized by differences in communication and social interaction. People with ASD often demonstrate restricted and repetitive interests or patterns of behavior.ASD is found in people around the world, regardless of race and ethnicity, culture, or economic background.According to the Centers for Disease Control and Prevention (CDC), ASD is diagnosed more often in boys than in girls. A study of 8-year-olds in 11 locations throughout the United States found a 4.3-to-1, boy-to-girl ratio in 2016. About 1 in 54 of the study participants had ASD.There are indications that instances of autism are on the rise. Some attribute this increase to environmental factors. However, experts debate whether there’s an actual increase in cases or just more frequent diagnoses. Compare autism rates in different U.S. states.What are the symptoms of autism?Symptoms of ASD typically become clearly evident during early childhood, between ages 12 and 24 months. However, symptoms may also appear earlier or later.Early symptoms may include a marked delay in language or social development.The DSM-5 divides symptoms of ASD into two categories: problems with communication and social interactionrestricted or repetitive patterns of behavior or activitiesTo be diagnosed with autism, a person must experience symptoms in both of these categories.Problems with communication and social interactionASD can involve a range of issues with communication, many of which appear before age 5. Here’s a general timeline of what this might look like:From birth: trouble maintaining eye contactBy 9 months: not responding to their nameBy 9 months: not displaying facial expressions reflective of their emotions (like surprise or anger)By 12 months: not engaging in basic interactive games, like peek-a-boo or pat-a-cakeBy 12 months: not using (or only using a few) hand gestures, like hand-wavingBy 15 months: not sharing their interests with others (by showing someone a favorite toy, for example)By 18 months: not pointing or looking where others pointBy 24 months: not noticing when others appear sad or hurtBy 30 months: not engaging in “pretend play,” like caring for a baby doll or playing with figurinesBy 60 months of age: not playing turn-taking games, like duck-duck gooseAdditionally, autistic children might have trouble expressing their feelings or understanding those of others starting at 36 months.As they age, they might have difficulty talking or very limited speaking skills. Other autistic children might develop language skills at an uneven pace. If there’s a particular topic that’s very interesting to them, for example, they might develop a very strong vocabulary for talking about that one topic. But they might have difficulty communicating about other things. As autistic children begin talking, they might also talk in an unusual tone that can range from high-pitched and “sing-songy” to robotic or flat.They might also show signs of hyperlexia, which involves reading beyond what’s expected of their age. Children on the autism spectrum might learn to read earlier than their neurotypical peers, sometimes as early as age 2. But they tend to not comprehend what they’re reading. While hyperlexia does not always accompany autism, research suggests nearly 84 percent of children with hyperlexia are on the spectrum.As they interact with others, autistic children might have difficulty sharing their emotions and interests with others or find it hard to maintain back-and-forth conversation. Nonverbal communication, like maintaining eye contact or body language, might also remain difficult. These challenges with communication can persist throughout adulthood.Restricted or repetitive patterns of behavior or activitiesIn addition to the communication and social issues mentioned above, autism also includes symptoms related to body movements and behaviors. These can include:repetitive movements, like rocking, flapping their arms, spinning, or running back and forthlining objects, like toys, up in strict order and getting upset when that order is disturbedattachment to strict routines, like those around bedtime or getting to schoolrepeating words or phrases they hear someone say over and over againgetting upset over minor changesfocusing intently on parts of objects, like the wheel of a toy truck or the hair of a dollunusual reactions to sensory input, like sounds, smells, and tastesobsessive interestsexceptional abilities, like musical talent or memory capabilitiesOther characteristicsSome autistic people might experience additional symptoms, including:delayed movement, language, or cognitive skillsseizuresgastrointestinal symptoms, like constipation or diarrheaexcessive worry or stressunusual levels of fear (either higher or lower than expected)hyperactive, inattentive, or impulsive behaviorsunexpected emotional reactionsunusual eating habits or preferencesunusual sleep patternsWhat is stimming?“Stimming” is a term used to describe self-stimulating behaviors, often involving repetitive motions or speech. For example, someone might clap their hands, rub an object, or repeat a phrase. It’s typically associated with autistic people, but nearly everyone does some form of stimming, whether that’s rubbing their hands together or biting their nails.For autistic people, stimming can sometimes get in the way of daily life or cause physical harm. But it can also serve as a helpful coping mechanism for dealing with sensory overload or navigating uncomfortable situations, among other things. Learn more about stimming and how it shows up.What are the different types of autism?The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is published by the American Psychiatric Association (APA). Clinicians use it to diagnose a variety of psychiatric disorders.The most recent fifth edition of the DSM was released in 2013. The DSM-5 currently recognizes five different ASD subtypes, or specifiers. They are:with or without accompanying intellectual impairmentwith or without accompanying language impairmentassociated with a known medical or genetic condition or environmental factorassociated with another neurodevelopmental, mental, or behavioral disorderwith catatoniaSomeone can receive a diagnosis of one or more specifiers.Before the DSM-5, autistic people may have received a diagnosis of:autistic disorderAsperger’s syndromepervasive development disorder-not otherwise specified (PDD-NOS)childhood disintegrative disorderIt’s important to note that a person who received one of these earlier diagnoses has not lost their diagnosis and will not need to be reevaluated.According to the DSM-5, the broader diagnosis of ASD encompasses conditions such as Asperger’s syndrome. Learn more about Asperger’s syndrome and the other older classifications for autism.What causes autism?The exact cause of ASD is unknown. The most current research demonstrates there’s no single cause.Some suspected risk factors for ASD include:having an immediate family member who’s autisticcertain genetic mutationsfragile X syndrome and other genetic disordersbeing born to older parentslow birth weightmetabolic imbalancesexposure to heavy metals and environmental toxinsa maternal history of viral infectionsfetal exposure to the medications valproic acid or thalidomide (Thalomid)According to the National Institute of Neurological Disorders and Stroke (NINDS), both genetics and environment may determine whether a person develops ASD.However, multiple sources, old and new, have concluded that vaccines do not cause ASD.A controversial 1998 study proposed a link between autism and the measles, mumps, and rubella (MMR) vaccine. However, that study has been debunked by other research and was eventually retracted in 2010. Read more about autism and its risk factors.What tests are used to diagnose autism?An ASD diagnosis involves:several screenings genetic tests evaluationsDevelopmental screeningsThe American Academy of Pediatrics (AAP) recommends that all children undergo ASD screening at ages 18 and 24 months.Screening can help identify ASD in children earlier than later. They may benefit from early diagnosis and support.The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool many pediatric offices use. Parents fill out the 23-question survey. Pediatricians can then use the responses to help identify children who may have an increased chance of developing ASD.It’s important to note that screening is not a diagnosis. Children who screen positively for ASD do not necessarily have it. Additionally, screenings do not always identify every child who’s autistic.Other screenings and testsYour child’s physician may recommend a combination of tests for autism, including:DNA testing for genetic diseasesbehavioral evaluationvisual and audio tests to rule out any issues with vision and hearing that aren’t related to ASDoccupational therapy screeningdevelopmental questionnaires, such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)Determining the diagnosisA team of specialists typically makes the diagnosis. This team may include: child psychologistsoccupational therapistsspeech and language pathologistsLearn more about the tests these specialists use to diagnose ASD.What support is available for autistic people?There are no “cures” for ASD. Rather, for some autistic people, supportive therapies and other considerations can help them feel better or alleviate certain symptoms.Many approaches involve therapies such as:behavioral therapyplay therapyoccupational therapyphysical therapyspeech therapyMassages, weighted clothing and blankets, and meditation techniques may also help some autistic people manage symptoms. However, results will vary. Some people may respond well to certain approaches, while others may not.Shop for weighted blankets online.Alternative remediesResearch on alternative remedies is mixed, and some remedies can be dangerous. These alternative remedies include things like:high-dose vitaminschelation therapy, which involves flushing metals from the bodyhyperbaric oxygen therapymelatonin to address sleep issuesBefore investing in any alternative therapy, parents and caregivers should weigh the research and financial costs against any possible benefits.When in doubt, it’s always best to talk with a healthcare professional. Learn more about alternative remedies for autism.Can diet have an impact on autism?There’s no specific diet designed for autistic people. Nevertheless, some autism advocates are exploring dietary changes as a way to help minimize behavioral issues and increase overall quality of life.A foundation of the autism diet is the avoidance of artificial additives. These include:preservatives colorssweetenersAn autism diet may instead focus on whole foods, such as:fresh fruits and vegetableslean poultryfishunsaturated fatslots of waterSome autism advocates also endorse a gluten-free diet. The protein gluten is found in:wheatbarleyother grainsThose advocates believe that gluten creates inflammation and adverse bodily reactions in certain autistic people. However, scientific research is inconclusive on the relationship between autism, gluten, and another protein known as casein.Some studies, and anecdotal evidence, have suggested that diet can help improve symptoms of attention deficit hyperactivity disorder (ADHD), a condition that may be similar to autism. Find out more about the ADHD diet.How does autism affect kids?Autistic children may not reach the same developmental milestones as their peers, or they may demonstrate the loss of previously developed social or language skills.For instance, a 2-year-old without autism may show interest in simple games of make-believe. A 4-year-old without autism may enjoy engaging in activities with other children. An autistic child may have trouble interacting with others or dislike it altogether.Autistic children may also engage in repetitive behaviors, have difficulty sleeping, or compulsively eat nonfood items. They may find it hard to thrive without a structured environment or consistent routine.If your child is autistic, you may have to work closely with their teachers to ensure they succeed in the classroom.Many resources are available to help autistic children as well as their loved ones. Local support groups can be found through the national nonprofit the Autism Society of America.Autism and exerciseAutistic children may find that certain exercises can help in easing frustrations and promoting overall well-being.Any type of exercise that your child enjoys can be beneficial. Walking and simply having fun on the playground are both ideal.Swimming and other in-water activities can serve as both exercise and a sensory play activity. Sensory play activities can help autistic people who may have trouble processing signals from their senses.Sometimes contact sports can be difficult for autistic children. You can instead encourage other forms of challenging yet strengthening exercises. Get started with these tips on arm circles, star jumps, and other autism exercises for kids.How does autism affect girls?Because of its greater rate in boys, ASD is often stereotyped as a “boys’ disease.” According to a 2020 study of 11 regions throughout the United States, ASD is 4.3 times more common in 8-year-old boys than in 8-year-old girls. The research was based on data from 2016.A 2017 literature review concluded that the male-to-female ratio for autistic youth was actually closer to 3 to 1.Either way, this does not mean that ASD doesn’t occur in girls. ASD may simply present differently in girls and in women.In comparison to recent decades, ASD is now being tested earlier and more often. This leads to higher reported rates in both boys and girls.How does autism affect adults?Families who have autistic loved ones may be concerned about what life with ASD looks like for an adult.Some autistic adults go on to live or work independently. Others may require continued aid or support throughout their lives. Each autistic person is different.Sometimes autistic people don’t receive a diagnosis until much later in life. This is due, in part, to a previous lack of awareness among medical practitioners.It’s never too late to receive a diagnosis, though. Read this article if you suspect you have adult autism.Why is autism awareness important?April 2 is World Autism Awareness Day. April has also become known as Autism Awareness Month in the United States. However, many community advocates have rightly called for the need to increase awareness about ASD year-round, not just during 30 select days.The Autism Society of America and other advocates have even proposed that April be designated Autism Acceptance Month instead.Autism acceptance requires empathy and an understanding that ASD is different for everyone.Certain therapies and approaches can work for some people but not others. Parents and caregivers can also have differing opinions on the best way to advocate for an autistic child.Understanding autism and autistic people starts with awareness, but it doesn’t end there. Check out one father’s story on his “frustrations” with autism awareness.What is the difference between autism and ADHD?Autism and ADHD are sometimes confused with one another.Children with an ADHD diagnosis consistently have issues with fidgeting, concentrating, and maintaining eye contact with others. These symptoms are also seen in some autistic people.Despite some similarities, ADHD is not considered a spectrum disorder. One major difference between the two is that people with ADHD do not tend to lack socio-communicative skills.If you think your child may be hyperactive, talk with their doctor about possible ADHD testing. Getting a clear diagnosis is essential to ensure that your child is receiving the right support.It’s also possible for a person to have both autism and ADHD. Explore the relationship between autism and ADHD.What is the outlook for autistic people?The most effective therapies involve early and intensive behavioral support. The earlier a child is enrolled in these programs, the better their outlook will be.Remember, ASD is complex. It takes time for an autistic person — whether a child or adult — to find the support program best suited for them. Last medically reviewed on August 10, 2021How we reviewed this article:SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: 5th edition. Arlington, VA: American Psychiatric Publishing.Autism and vaccines. (2020).https://www.cdc.gov/vaccinesafety/concerns/autism.htmlAutism spectrum disorder information page. (2019).https://www.ninds.nih.gov/Disorders/All-Disorders/Autism-Spectrum-Disorder-Information-PageEggertson L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines.https://doi.org/10.1503/cmaj.109-3179Elder J, et al. (2015). A review of gluten- and casein-free diets for treatment of autism: 2005–2015.https://www.dovepress.com/a-review-of-gluten--and-casein-free-diets-for-treatment-of-autism-2005-peer-reviewed-fulltext-article-NDSLoomes R, et al. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis.https://www.sciencedirect.com/science/article/abs/pii/S0890856717301521Maenner MJ, et al. (2020). Prevalence of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016.https://www.cdc.gov/mmwr/volumes/69/ss/ss6904a1.htmOstrolenk A, et al. (2017). Hyperlexia: Systematic review, neurocognitive modelling, and outcome.https://www.sciencedirect.com/science/article/pii/S014976341630639XPlotkin S, et al. (2009). Vaccines and autism: A tale of shifting hypotheses.https://academic.oup.com/cid/article/48/4/456/284219What is autism spectrum disorder? (2020).https://www.cdc.gov/ncbddd/autism/facts.htmlSigns and symptoms of autism spectrum disorders. (2021).https://www.cdc.gov/ncbddd/autism/signs.htmlZwaigenbaum L, et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research.https://pediatrics.aappublications.org/content/136/Supplement_1/S41Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.Current VersionNov 1, 2021Written ByKristeen Cherney, PhD, Jill Seladi-Schulman, PhDEdited ByKelly MorrellCopy Edited ByDelores Smith-JohnsonAug 21, 2021Written ByKristeen Cherney, PhD, Jill Seladi-Schulman, PhDEdited ByKelly MorrellMedically Reviewed ByLori Lawrenz, PsyDCopy Edited ByCopy EditorsVIEW ALL HISTORY Share this articleMedically reviewed by Marc S. Lener, MD — By Kristeen Cherney and Jill Seladi-Schulman, Ph.D. — Updated on November 1, 2021related storiesSigns of Autism in Babies: A Simple Guide to Developmental DifferencesDoes My 3-Year-Old Have Autism?What Are the Signs of Autism in Teenagers?High-Functioning AutismAsperger’s Treatment: Know Your OptionsRead this nextSigns of Autism in Babies: A Simple Guide to Developmental DifferencesMedically reviewed by Mia Armstrong, MDThere are signs of autism in babies. Recognizing them is important because early intervention is key to helping autistic children succeed. We detail…READ MOREDoes My 3-Year-Old Have Autism?If your 3-year-old exhibits certain behaviors, such as an aversion to touch or eye contact, or if they have delayed speech or motor skills, you should…READ MOREWhat Are the Signs of Autism in Teenagers?Medically reviewed by Karen Gill, M.D.Learn what the common signs of autism spectrum disorder (ASD) look like in teenagers, what you can do if you or your teen has ASD, and what you can do…READ MOREHigh-Functioning AutismHigh-functioning autism isn’t a medical term, but many people still use it. Discover what it means, how different autism levels are treated, and more.READ MOREAsperger’s Treatment: Know Your OptionsMedically reviewed by Karen Gill, M.D.Asperger's treatment can help children make social connections, achieve their potential, and lead a productive life. The earlier a child begins…READ MOREElopement in Autism: What It Is and How to Prevent ItElopement, also known as running or wandering away, can happen regularly for some autistic children. Let's look at why and how to create a safety plan.READ MOREGetting Better Sleep for Autistic Children and AdultsMedically reviewed by Nicole Washington, DO, MPHAutistic people can have difficulty getting a full night's sleep. Let's see why and how to sleep better: READ MOREWhy Autistic Folks Have Trouble with Eye Contact and Tips for Getting More ComfortableMaintaining eye contact can be difficult or even painful for autistic folks. Let's look at why, how to support autistic kids, and tricks to improve…READ MOREAutism and Fixation: Examples and How to Find BalanceFixations are a common experience for autistic people. There are many ways to use these fixations to your advantage and find balance when needed. READ MOREWhy We No Longer Say High or Low Functioning for AutismMedically reviewed by Nicole Washington, DO, MPHFunctioning labels, like high and low autism, are no longer used. Here's why. READ MOREAbout UsContact UsPrivacy PolicyPrivacy SettingsAdvertising PolicyHealth TopicsMedical AffairsContent IntegrityNewsletters© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. See additional information.© 2024 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment. See additional information. See additional information.AboutCareersAdvertise with usOUR BRANDSHealthlineMedical News TodayGreatistPsych CentralBezzy

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Autism Spectrum Disorder (ASD)

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Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Some people with ASD have a known difference, such as a genetic condition. Other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop. We still have much to learn about these causes and how they impact people with ASD.

People with ASD may behave, communicate, interact, and learn in ways that are different from most other people. There is often nothing about how they look that sets them apart from other people. The abilities of people with ASD can vary significantly. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, although symptoms may improve over time. Some children show ASD symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months of age or later. Some children with ASD gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had.

As children with ASD become adolescents and young adults, they may have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may come to the attention of healthcare providers because they also have conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder, which occur more often in people with ASD than in people without ASD.

Signs and Symptoms

People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. These characteristics can make life very challenging. It is important to note that some people without ASD might also have some of these symptoms.

Learn more about signs and symptoms of ASD »

Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s behavior and development to make a diagnosis. ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable.1 However, many children do not receive a final diagnosis until they are much older. Some people are not diagnosed until they are adolescents or adults. This delay means that people with ASD might not get the early help they need.

Learn more about screening and diagnosis of ASD »

Treatment

Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs.2 Treatment plans usually involve multiple professionals and are catered to the individual.

Learn about treating the symptoms of ASD »

Risk Factors

There is not just one cause of ASD. There are many different factors that have been identified that may make a child more likely to have ASD, including environmental, biologic, and genetic factors.

Although we know little about specific causes, the available evidence suggests that the following may put children at greater risk for developing ASD:

Having a sibling with ASD

Having certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis

Experiencing complications at birth

Being born to older parents

CDC is currently working on one of the largest U.S. studies to date on ASD. This study called the Study to Explore Early Development (SEED), was designed to look at the risk factors and behaviors related with ASD. CDC is now conducting a follow-up study of older children who were enrolled in SEED to determine the health, functioning, and needs of people with ASD and other developmental disabilities as they mature.

How Often ASD Occurs

CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network has been estimating the number of 8-year-old children with ASD in the United States since 2000.

ASD occurs in all racial, ethnic, and socioeconomic groups. It is more than 4 times more common among boys than among girls.

Learn more about how CDC estimates the number of children with ASD »

If You’re Concerned

As a parent, you already have what it takes to help your young child learn and grow. CDC has developed materials to help you track your child’s developmental milestones and share that progress, or any concerns, with your child’s doctor at every check-up.

Learn more about CDC milestone checklists and other parent materials »

Contact your child’s doctor if you think your child might have ASD or if you have any other concerns about the way your child plays, learns, speaks, or acts.

If you are still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include

Developmental pediatricians (doctors who have special training in child development and children with special needs)

Child neurologists (doctors who work on the brain, spine, and nerves)

Child psychologists or psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation, sometimes called a Child Find evaluation, to find out if your child qualifies for intervention services. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is not yet 3 years old, contact your local early intervention system.

You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001.

Or visit the ECTA website.

If your child is 3 years old or older, contact your local public school system.

Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

If you’re not sure who to contact, call the ECTA at 919-962-2001.

Or visit the ECTA website.

Research shows that early intervention services can greatly improve a child’s development.3,4 In order to make sure your child reaches their full potential, it is very important to receive services as soon as possible.

References

Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A. Autism from 2 to 9 years of age. Arch Gen Psychiatry. 2006 Jun;63(6):694-701.

Hyman, S.L., Levy, S.E., Myers, S.M., & AAP Council on Children with Disabilities, Section on developmental and behavioral pediatrics. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447.

Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with Autism (2nd ed). Austin, TX: Pro-Ed. 2000.

National Research Council. Educating Children with Autism. Washington, DC: National Academy Press, 2001.

Child Development

Developmental Disabilities

“Learn the Signs. Act Early.” Campaign

CDC’s National Center on Birth Defects and Developmental Disabilities

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(Top)

1Classification

Toggle Classification subsection

1.1Spectrum model

1.2ICD

1.3DSM

2Common characteristics

Toggle Common characteristics subsection

2.1Pre-diagnosis

2.2Broader autism phenotype

2.3Social and communication skills

2.4Restricted and repetitive behaviors

2.4.1Self-injury

2.5Other features

2.5.1Digital media use disorders

3Possible causes

Toggle Possible causes subsection

3.1Biological subgroups

3.1.1Syndromic autism and non-syndromic autism

3.2Genetics

3.3Early life

3.3.1Disproven vaccine hypothesis

3.4Etiological hypotheses

3.5Evolutionary hypotheses

4Pathophysiology

5Diagnosis

6Conditions correlated or comorbid to autism

Toggle Conditions correlated or comorbid to autism subsection

6.1Correlations

6.2Comorbidities

7Management

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7.1Non-pharmacological interventions

7.1.1Education

7.2Pharmacological interventions

7.3Alternative medicine

7.4Prevention

8Prognosis

9Epidemiology

10History

11Society and culture

Toggle Society and culture subsection

11.1Neurodiversity movement

11.2Symbols and flags

11.3Caregivers

11.4LGBT identity and religious beliefs

12See also

13References

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13.1Sources

14Further reading

15External links

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Autism spectrum

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From Wikipedia, the free encyclopedia

Neurodevelopmental disorder

Medical conditionAutism spectrum disorderOther names

Autism spectrum condition (ASC), autism

Formerly: Kanner syndrome/autistic disorder/childhood autism, Asperger syndrome (AS), childhood disintegrative disorder (CDD), pervasive developmental disorder not otherwise specified (PDD-NOS)

Repetitively stacking or lining up objects is a common trait associated with autism.SpecialtyPsychiatry, clinical psychology, pediatrics, occupational medicineSymptomsDifficulties in social interaction, verbal and nonverbal communication, and the presence of repetitive behavior or restricted interestsComplicationsSocial isolation, educational and employment problems,[1] anxiety,[1] stress,[1] bullying, depression,[1][2] self-harmOnsetEarly childhoodDurationLifelongCausesMultifactorial, with many uncertain factorsRisk factorsFamily history, certain genetic conditions, having older parents, certain prescribed drugs, perinatal and neonatal health issuesDiagnostic methodBased on combination of clinical observation of behavior and development and comprehensive diagnostic testing completed by a team of qualified professionals (including psychiatrists, clinical psychologists, neuropsychologists, pediatricians, and speech-language pathologists). For adults, the use of a patient's written and oral history of autistic traits becomes more importantDifferential diagnosisIntellectual disability, anxiety, bipolar disorder, depression, Rett syndrome, attention deficit hyperactivity disorder, schizoid personality disorder, selective mutism, schizophrenia, obsessive–compulsive disorder, social anxiety disorder, Einstein syndrome, PTSD,[3] learning disorders (mainly speech disorders)ManagementApplied behavior analysis, cognitive behavioral therapy, occupational therapy, psychotropic medication,[4] speech–language pathologyFrequency

One in 100 people (1%) worldwide[5]

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC),[6] is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Psychiatry has traditionally classified autism as a mental disorder, but the autism rights movement and an increasing number of researchers see autism as part of neurodiversity, the natural diversity in human thinking and experience, with strengths, differences, and weaknesses.[7] From this point of view, autistic people often still have a disability, but that disability may be rooted in systemic structures rather than in the individual;[8] as such, proponents argue that autistic people need to be accommodated rather than cured.[9] This perspective has led to significant controversy among those who are autistic and advocates, practitioners, and charities.[10][11] As of 2023, consensus is growing among researchers of various empirical and theoretical positions that the established ASD criteria are ineffective to describe autism as a unitary biological entity, and that alternative research approaches should be encouraged.[12]

There are many theories about the causes of autism; it is highly heritable and mainly genetic, but many genes are involved, and environmental factors may also be relevant.[13] The syndrome frequently co-occurs with other conditions, including attention deficit hyperactivity disorder, epilepsy, and intellectual disability. Disagreements persist about what should be included as part of the diagnosis, whether there are meaningful subtypes of autism,[14] and the significance of autism-associated traits in the wider population.[15][16] The combination of broader criteria, increased awareness, and potentially increasing actual prevalence, has led to a trend of steadily increasing estimates of autism prevalence,[17] perpetuating the disproven myth that it is caused by vaccines.[18]

There is no cure for autism. Although early intervention services based on applied behavior analysis (ABA) can help children gain self-care, social, and language skills,[19][20][21][22] independent living is unlikely in more severe cases. But some in the autism rights movement consider ABA therapy unethical and unhelpful.[23] Speech and occupational therapy, as well as implementing alternative modes of communication, are effective adjunctive therapies. Pharmacological treatments also may be useful; the atypical antipsychotics risperidone and aripiprazole are empirically validated for alleviating co-morbid irritability, though these drugs tend to be associated with weight gain and sedation.[24]

Classification

Spectrum model

Before the DSM-5 (2013) and ICD-11 (2022) diagnostic manuals were adopted, what is now called ASD was found under the diagnostic category pervasive developmental disorder. The previous system relied on a set of closely related and overlapping diagnoses such as Asperger syndrome and Kanner syndrome. This created unclear boundaries between the terms, so for the DSM-5 and ICD-11, a spectrum approach was taken. The new system is also more restrictive, meaning fewer people now qualify for diagnosis.[25]

The DSM-5 and ICD-11 use different categorization tools to define this spectrum. DSM-5 uses a "level" system, which ranks how in need of support the patient is,[26] while the ICD-11 system has two axes, intellectual impairment and language impairment,[27] as these are seen as the most crucial factors.

Autism is currently defined as a highly variable neurodevelopmental disorder[28] that is generally thought to cover a broad and deep spectrum, manifesting very differently from one person to another. Some have high support needs, may be non-speaking, and experience developmental delays; this is more likely with other co-existing diagnoses. Others have relatively low support needs; they may have more typical speech-language and intellectual skills but atypical social/conversation skills, narrowly focused interests, and wordy, pedantic communication.[29] They may still require significant support in some areas of their lives. The spectrum model should not be understood as a continuum running from mild to severe, but instead means that autism can present very differently in each person.[30] How a person presents can depend on context, and may vary over time.[31]

While the DSM and ICD greatly influence each other, there are also differences. For example, Rett syndrome was included in ASD in the DSM-5, but in the ICD-11 it was excluded and placed in the chapter on Developmental Anomalies. The ICD and the DSM change over time, and there has been collaborative work toward a convergence of the two since 1980 (when DSM-III was published and ICD-9 was current), including more rigorous biological assessment—in place of historical experience—and a simplification of the classification system.[32][33][34][35]

As of 2023, empirical and theoretical research is leading to a growing consensus among researchers that the established ASD criteria are ineffective to describe autism as a unitary biological entity, and that alternative research approaches must be encouraged, such as going back to autism prototypes, exploring new causal models of autism, or developing transdiagnostic endophenotypes.[12] Proposed alternatives to the current disorder-focused spectrum model deconstruct autism into at least two separate phenomena: (1) a non-pathological spectrum of behavioral traits in the population,[36][37] and (2) the neuropathological burden of rare genetic mutations and environmental risk factors potentially leading to neurodevelopmental and psychological disorders,[36][37] (3) governed by an individual's cognitive ability to compensate.[36]

ICD

The World Health Organization's International Classification of Diseases (11th Revision), ICD-11, was released in June 2018 and came into full effect as of January 2022.[38][32] It describes ASD as follows:[39]

Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual's age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual's functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.— ICD-11, chapter 6, section A02

ICD-11 was produced by professionals from 55 countries out of the 90 involved and is the most widely used reference worldwide.

DSM

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), released in 2022, is the current version of the DSM. It is the predominant mental health diagnostic system used in the United States and Canada, and is often used in Anglophone countries.

Its fifth edition, DSM-5, released in May 2013, was the first to define ASD as a single diagnosis,[40] which is still the case in the DSM-5-TR.[41] ASD encompasses previous diagnoses, including the four traditional diagnoses of autism—classic Kanner syndrome, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS)—and the range of diagnoses that included the word "autism".[42] Rather than distinguishing among these diagnoses, the DSM-5 and DSM-5-TR adopt a dimensional approach with one diagnostic category for disorders that fall under the autism spectrum umbrella. Within that category, the DSM-5 and the DSM include a framework that differentiates each person by dimensions of symptom severity, as well as by associated features (i.e., the presence of other disorders or factors that likely contribute to the symptoms, other neurodevelopmental or mental disorders, intellectual disability, or language impairment).[41] The symptom domains are (a) social communication and (b) restricted, repetitive behaviors, and there is the option of specifying a separate severity—the negative effect of the symptoms on the person—for each domain, rather than just overall severity.[43] Before the DSM-5, the DSM separated social deficits and communication deficits into two domains.[44] Further, the DSM-5 changed to an onset age in the early developmental period, with a note that symptoms may manifest later when social demands exceed capabilities, rather than the previous, more restricted three years of age.[45] These changes remain in the DSM-5-TR.[41]

Common characteristics

Pre-diagnosis

For many autistic people, characteristics first appear during infancy or childhood and follow a steady course without remission (different developmental timelines are described in more detail below).[46] Autistic people may be severely impaired in some respects but average, or even superior, in others.[47][48][49]

Clinicians consider assessment for ASD when a patient shows:

regular difficulties in social interaction or communication

restricted or repetitive behaviors (often called "stimming")

resistance to changes or restricted interests

These features are typically assessed with the following, when appropriate:

problems in obtaining or sustaining employment or education

difficulties in initiating or sustaining social relationships

connections with mental health or learning disability services

a history of neurodevelopmental conditions (including learning disabilities and ADHD) or mental health conditions.[50][51]

There are many signs associated with autism; the presentation varies widely:[52][53]

Common signs for autism spectrum disorder

avoidance of eye-contact

little or no babbling as an infant

not showing interest in indicated objects

delayed language skills (e.g. having a smaller vocabulary than peers or difficulty expressing themselves in words)

reduced interest in other children or caretakers, possibly with more interest in objects

difficulty playing reciprocal games (e.g. peek-a-boo)

hyper- or hypo-sensitivity to or unusual response to the smell, texture, sound, taste, or appearance of things

resistance to changes in routine

repetitive, limited, or otherwise unusual usage of toys (e.g. lining up toys)

repetition of words or phrases (echolalia)

repetitive motions or movements, including stimming

self-harming

Broader autism phenotype

The broader autism phenotype (BAP) describes people who may not have ASD but do have autistic traits, such as avoiding eye contact and stimming.[54]

Social and communication skills

According to the medical model, autistic people experience social communications impairments. Until 2013, deficits in social function and communication were considered two separate symptom domains.[55] The current social communication domain criteria for autism diagnosis require people to have deficits across three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships.[41]

A deficit-based view predicts that autistic–autistic interaction would be less effective than autistic–non-autistic interactions or even non-functional.[56] But recent research has found that autistic–autistic interactions are as effective in information transfer as interactions between non-autistics are, and that communication breaks down only between autistics and non-autistics.[56][57] Also contrary to social cognitive deficit interpretations, recent (2019) research recorded similar social cognitive performances in autistic and non-autistic adults, with both of them rating autistic individuals less favorably than non-autistic individuals; however, autistic individuals showed more interest in engaging with autistic people than non-autistic people did, and learning of a person's ASD diagnosis did not influence their interest level.[58]

Thus, there has been a recent shift to acknowledge that autistic people may simply respond and behave differently than people without ASD.[59] So far, research has identified two unconventional features by which autistic people create shared understanding (intersubjectivity): "a generous assumption of common ground that, when understood, led to rapid rapport, and, when not understood, resulted in potentially disruptive utterances; and a low demand for coordination that ameliorated many challenges associated with disruptive turns."[57] Autistic interests, and thus conversational topics, seem to be largely driven by an intense interest in specific topics (monotropism).[60][61]

Historically, autistic children were said to be delayed in developing a theory of mind, and the empathizing–systemizing theory has argued that while autistic people have compassion (affective empathy) for others with similar presentation of symptoms, they have limited, though not necessarily absent, cognitive empathy.[62] This may present as social naïvety,[63] lower than average intuitive perception of the utility or meaning of body language, social reciprocity,[64] and/or social expectations, including the habitus, social cues, and/or some aspects of sarcasm,[65] which to some degree may also be due to comorbid alexithymia.[66] But recent research has increasingly questioned these findings, as the "double empathy problem" theory (2012) argues that there is a lack of mutual understanding and empathy between both non-autistic persons and autistic individuals.[67][68][69][70][71]

As communication is bidirectional,[72] research on communication difficulties has since also begun to study non-autistic behavior, with researcher Catherine Crompton writing in 2020 that non-autistic people "struggle to identify autistic mental states, identify autistic facial expressions, overestimate autistic egocentricity, and are less willing to socially interact with autistic people. Thus, although non-autistic people are generally characterised as socially skilled, these skills may not be functional, or effectively applied, when interacting with autistic people."[56] Any previously observed communication deficits of autistic people may thus have been constructed through a neurotypical bias in autism research, which has come to be scrutinized for "dehumanization, objectification, and stigmatization".[73] Recent research has proposed that autistics' lack of readability and a neurotypical lack of effort to interpret atypical signals may cause a negative interaction loop, increasingly driving both groups apart into two distinct groups with different social interaction styles.[72]

Differences in verbal communication begin to be noticeable in childhood, as many autistic children develop language skills at an uneven pace. Verbal communication may be delayed or never develop (nonverbal autism), while reading ability may be present before school age (hyperlexia).[74][75] Reduced joint attention seem to distinguish autistic from non-autistic infants.[76] Infants may show delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children may have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences and more likely to simply repeat others' words (echolalia).[77] The CDC estimated in 2015 that around 40% of autistic children do not speak at all.[78] Autistic adults' verbal communication skills largely depend on when and how well speech is acquired during childhood.[74]

Temple Grandin in 2011

Autistic people display atypical nonverbal behaviors or show differences in nonverbal communication. They may make infrequent eye contact, even when called by name, or avoid it altogether. Autistic people often recognize fewer emotions and their meaning from others' facial expressions, and may not respond with facial expressions expected by their non-autistic peers.[79][75] Temple Grandin, an autistic woman involved in autism activism, described her inability to understand neurotypicals' social communication as leaving her feeling "like an anthropologist on Mars".[80] Autistic people struggle to understand the social context and subtext of neurotypical conversational or printed situations, and form different conclusions about the content.[81] Autistic people may not control the volume of their voice in different social settings.[82] At least half of autistic children have atypical prosody.[82]

What may look like self-involvement or indifference to non-autistic people stems from autistic differences in recognizing how other people have their own personalities, perspectives, and interests.[81][83] Most published research focuses on the interpersonal relationship difficulties between autistic people and their non-autistic counterparts and how to solve them through teaching neurotypical social skills, but newer research has also evaluated what autistic people want from friendships, such as a sense of belonging and good mental health.[84][85] Children with ASD are more frequently involved in bullying situations than their non-autistic peers, and predominantly experience bullying as victims rather than perpetrators or victim-perpetrators, especially after controlling for comorbid psychopathology.[86] Prioritizing dependability and intimacy in friendships during adolescence, coupled with lowered friendship quantity and quality, often lead to increased loneliness in autistic people.[87] As they progress through life, autistic people observe and form a model of social patterns, and develop coping mechanisms, referred to as "masking",[88][89] which has recently been found to come with psychological costs and a highly increased risk of suicidality.[72]

Restricted and repetitive behaviors

A young autistic boy who has arranged his toys in a row

ASD includes a wide variety of characteristics. Some of these include behavioral characteristics which widely range from slow development of social and learning skills to difficulties creating connections with other people. Autistic people may experience these challenges with forming connections due to anxiety or depression, which they are more likely to experience, and as a result isolate themselves.[90][91]

Other behavioral characteristics include abnormal responses to sensations (such as sights, sounds, touch, taste and smell) and problems keeping a consistent speech rhythm. The latter problem influences social skills, leading to potential problems in understanding for interlocutors. Autistic people's behavioral characteristics typically influence development, language, and social competence. Their behavioral characteristics can be observed as perceptual disturbances, disturbances of development rate, relating, speech and language, and motility.[92]

The second core symptom of autism spectrum is a pattern of restricted and repetitive behaviors, activities, and interests. In order to be diagnosed with ASD under the DSM-5-TR, a person must have at least two of the following behaviors:[41][93]

An older autistic boy arranging brads on a cork coaster. Repetitive behaviors – Repetitive behaviors such as rocking, hand flapping, finger flicking, head banging, or repeating phrases or sounds.[94] These behaviors may occur constantly or only when the person gets stressed, anxious or upset. These behaviors are also known as stimming.

Resistance to change – A strict adherence to routines such as eating certain foods in a specific order or taking the same path to school every day.[94] The person may become distressed if there is a change or disruption to their routine.

Restricted interests – An excessive interest in a particular activity, topic, or hobby, and devoting all their attention to it. For example, young children might completely focus on things that spin and ignore everything else. Older children might try to learn everything about a single topic, such as the weather or sports, and perseverate or talk about it constantly.[94]

Sensory reactivity – An unusual reaction to certain sensory inputs, such as negative reaction to specific sounds or textures, fascination with lights or movements, or apparent indifference to pain or heat.[95]

Autistic people can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.[96]

Stereotyped behaviors: Repetitive movements, such as hand flapping, head rolling, or body rocking.

Compulsive behaviors: Time-consuming behaviors intended to reduce anxiety, that a person feels compelled to perform repeatedly or according to rigid rules, such as placing objects in a specific order, checking things, or handwashing.

Sameness: Resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.

Ritualistic behavior: Unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.[96]

Restricted interests: Interests or fixations that are abnormal in theme or intensity of focus, such as preoccupation with a single television program, toy, or game.

Self-injury: Behaviors such as eye-poking, skin-picking, hand-biting and head-banging.[76]

Self-injury

Self-injurious behaviors (SIB) are relatively common in autistic people, and can include head-banging, self-cutting, self-biting, and hair-pulling.[97] Some of these can result in serious injury or death.[97] Following are theories about the cause of self-injurious behavior in children with developmental delay, including autistic children:[98]

Frequency and/or continuation of self-injurious behavior can be influenced by environmental factors (e.g. reward in return for halting self-injurious behavior). This theory does not apply to younger children with autism. There is some evidence that frequency of self-injurious behavior can be reduced by removing or modifying environmental factors that reinforce the behavior.[98]: 10–12

Higher rates of self-injury are also noted in socially isolated autistic people. Studies have shown that socialization skills are related factors to self-injurious behavior for autistic people.[99]

Self-injury could be a response to modulate pain perception when chronic pain or other health problems that cause pain are present.[98]: 12–13

An abnormal basal ganglia connectivity may predispose to self-injurious behavior.[98]: 13

The suicide rate for verbal autistics is nine times that of the general population.[100]

Other features

Autistic people may have symptoms that do not contribute to the official diagnosis, but that can affect the person or the family.[101]

Some autistic people show unusual or notable abilities, ranging from splinter skills (such as the memorization of trivia) to rare talents in mathematics, music, or artistic reproduction, which in exceptional cases are considered a part of the savant syndrome.[102][103][104] One study describes how some autistic people show superior skills in perception and attention relative to the general population.[105] Sensory abnormalities are found in over 90% of autistic people, and are considered core features by some.[106]

More generally, autistic people tend to show a "spiky skills profile", with strong abilities in some areas contrasting with much weaker abilities in others.[107]

Differences between the previously recognized disorders under the autism spectrum are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).[108] An estimated 60–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking;[106][109] deficits in motor coordination are pervasive across ASD and are greater in autism proper.[110][111]

Pathological demand avoidance can occur. People with this set of autistic symptoms are more likely to refuse to do what is asked or expected of them, even to activities they enjoy.

Unusual or atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator.[101] Selectivity is the most common problem, although eating rituals and food refusal also occur.[112]

Digital media use disorders

See also: Screen time, Internet addiction disorder, and Video game addiction

This section is an excerpt from Digital media use and mental health § Autism.[edit]

In September 2018, the Review Journal of Autism and Developmental Disorders published a systematic review of 47 studies published from 2005 to 2016 that concluded that concluded that associations between autism spectrum disorder (ASD) and screen time was inconclusive.[113] In May 2019, the Journal of Developmental and Behavioral Pediatrics published a systematic review of 16 studies that found that children and adolescents with ASD are exposed to more screen time than typically developing peers and that the exposure starts at a younger age.[114] In April 2021, Research in Autism Spectrum Disorders published a systematic review of 12 studies of video game addiction in ASD subjects that found that children, adolescents, and adults with ASD are at greater risk of video game addiction than those without ASD, and that the data from the studies suggested that internal and external factors (sex, attention and oppositional behavior problems, social aspects, access and time spent playing video games, parental rules, and game genre) were significant predictors of video game addiction in ASD subjects.[115] In March 2022, the Review Journal of Autism and Developmental Disorders published a systematic review of 21 studies investigating associations between ASD, problematic internet use, and gaming disorder where the majority of the studies found positive associations between the disorders.[116]

In August 2022, the International Journal of Mental Health and Addiction published a review of 15 studies that found that high rates of video game use in boys and young males with ASD was predominantly explained by video game addiction, but also concluded that greater video game use could be a function of ASD restricted interest and that video game addiction and ASD restricted interest could have an interactive relationship.[117] In December 2022, the Review Journal of Autism and Developmental Disorders published a systematic review of 10 studies researching the prevalence of problematic internet use with ASD that found that ASD subjects had more symptoms of problematic internet use than control group subjects, had higher screen time online and an earlier age of first-time use of the internet, and also greater symptoms of depression and ADHD.[118] In July 2023, Cureus published a systematic review of 11 studies that concluded that earlier and longer screen time exposure for children was associated with higher risk of a child developing ASD.[119] In December 2023, JAMA Network Open published a meta-analysis of 46 studies comprising 562,131 subjects that concluded that associations between ASD and screen time were not statistically significant when accounting for publication bias.[120]

Possible causes

Main article: Causes of autism

Exactly what causes autism remains unknown.[121][122][123][124] It was long mostly presumed that there is a common cause at the genetic, cognitive, and neural levels for the social and non-social components of ASD's symptoms, described as a triad in the classic autism criteria.[125] But it is increasingly suspected that autism is instead a complex disorder whose core aspects have distinct causes that often cooccur.[125][126] It is unlikely that ASD has a single cause;[126] many risk factors identified in the research literature may contribute to ASD. These include genetics, prenatal and perinatal factors (meaning factors during pregnancy or very early infancy), neuroanatomical abnormalities, and environmental factors. It is possible to identify general factors, but much more difficult to pinpoint specific ones. Given the current state of knowledge, prediction can only be of a global nature and so requires the use of general markers.[clarification needed][127]

Biological subgroups

Research into causes has been hampered by the inability to identify biologically meaningful subgroups within the autistic population[128] and by the traditional boundaries between the disciplines of psychiatry, psychology, neurology and pediatrics.[129] Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans, to help further neurogenetic studies of autism;[130] one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects.[131] It has been proposed to classify autism using genetics as well as behavior.[132]

Syndromic autism and non-syndromic autism

Main article: Syndromic autism

Autism spectrum disorder (ASD) can be classified into two categories: "syndromic autism" and "non-syndromic autism."

Syndromic autism refers to cases where ASD is one of the characteristics associated with a broader medical condition or syndrome, representing about 25% of ASD cases. The causes of syndromic autism are often known, and monogenic disorders account for approximately 5% of these cases.

Non-syndromic autism, also known as classic or idiopathic autism, represents the majority of cases, and its cause is typically polygenic and unknown.

Genetics

Main article: Heritability of autism

See also

Outline of autism

Animal model of autism

Autism and memory

Autism spectrum disorders in the media

Autistic art

Controversies in autism

Global perceptions of autism

List of autistic fictional characters

List of films about autism

Sex and gender differences in autism

Violence and autism

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What is autism spectrum disorder (ASD)?

What are the characteristics of ASD?

What causes ASD?

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ASD in girls

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What is autism spectrum disorder (ASD)?

Autism spectrum disorder (ASD) is a lifelong developmental disorder. It affects how people behave and interact with the world around them.

In people with ASD, the brain does not grow in the same way it does in most people. ASD presents differently in boys and girls.

ASD is not a mental health problem or an intellectual disability. But some people with ASD will also have those problems.

Children and adults with ASD may be highly intelligent, of normal intelligence, or have an intellectual disability. Along with some challenges, an autistic person will also have a range of strengths.

Doctors used to think that Asperger's syndrome and autism were separate conditions. They now think that they are all part of one condition, called autism spectrum disorder or ASD. People with ASD will all have different experiences.

About 1 in 150 Australians has ASD.

The characteristics of ASD usually start in infancy. But they may not be noticeable until the age of 2 or 3 years. Sometimes ASD is diagnosed much later in life.

Most people with ASD can learn the skills they need to function independently or in a supportive environment. Research shows that early diagnosis and treatment is important.

A late diagnosis of ASD can have consequences. Growing up with ASD without support can have an impact on a person’s mental health, education, development, and social life. They may find themselves at a higher risk of bullying, abuse, and violence.

The earlier your child receives an ASD diagnosis, the earlier they can get support. And the more likely it is they’ll develop:

communication skills

social skills

life skills

These skills are important for a good quality of life.

What are the characteristics of ASD?

The main characteristics related to ASD fall into 2 broad areas:

difficulty with social interactions and communication

restricted and repetitive behaviours and interests

The common signs and traits of ASD in children include the following:

lack of social or emotional exchanges like pointing, smiling, showing you things

lack of non-verbal communication such as nodding and shaking head, using hand gestures

difficulty developing and maintaining relationships appropriate to their age, such as peer play, lack of close friends

delayed expressed speech and understanding of speech

lack of eye contact when speaking

loss of language skills at any age

excessively following routines, patterns or behaviour, and becoming distressed at changes

stereotyped or repetitive speech

using objects in unusual ways, such as rolling wheels before eyes

movements, such as flapping hands, toe walking

strongly reacting to sensory input such as sound, pain or textures

restricted or fixated interests. This might be only playing with certain toys or talking about certain topics

having difficulty managing emotions, such as frequent and long tantrums

In adults, ASD traits may include the following:

struggling with time management

feeling sensitive to the environment

feeling a sense of isolation

difficulty paying attention

struggling to pay attention to detail, or having too strong an attention to detail

feeling anxious in social situations

having difficulty maintaining relationships

becoming overwhelmed easily

What causes ASD?

ASD is caused by differences in how the brain develops. This is caused by genes, which means that if someone in your family has autism, other family members are more likely to also have ASD.

Other factors may increase your chances of having ASD. This may include the age of your parents. Research is also looking at the role of the environment in triggering ASD.

Autism is not caused by:

vaccinations

foods

other lifestyle factors

your cultural or social surroundings

When should I see my doctor?

If you think your child has ASD, see your doctor. Early intervention offers the best outcomes for children with ASD, whether their traits are obvious or subtle.

There may be different signs of autism at different ages.

In the first year, your baby with ASD might not be interested in other people. They may not make eye contact with you. They may not smile or gesture like other babies.

As toddlers, children with ASD might not respond to their name. They might focus on one or 2 activities repetitively, like lining up toys. They may not be interested in playing with other children. They might develop unusual ways of speaking.

Older children with ASD might have difficulties in social situations, following instructions or making friends.

You might receive an autism diagnosis as an adult. You may spend your life feeling like you don’t quite fit in. You may have difficulties with relationships, work and social situations. You may also have mental health conditions like anxiety or depression.

Autism Awareness Australia provides information about signs of autism in people at different ages.

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How is ASD diagnosed?

If your doctor thinks you have ASD, they will refer you to a specialist to confirm the diagnosis. This may be a paediatrician, a psychiatrist or a psychologist.

The specialist uses a set of standard tests to make a diagnosis.

You must have lasting difficulties in social communication and social interaction in multiple situations to be diagnosed with ASD. You must also have restricted interests and activities and repetitive patterns of behaviour. These traits must have been evident from early life, and must significantly affect your life.

A diagnosis of ASD will also include a classification based on the level of support the person requires. The 3 levels are:

level 1: people requiring support

level 2: people requiring substantial support

level 3: people more severely affected and requiring very substantial support

ASD in girls

Boys were previously thought to be 4 times more likely to have autism than girls. This is a misconception. ASD is underdiagnosed in girls and women. This is due to a few different reasons.

Most studies on ASD focus on men and boys. Only a small amount is known about ASD in girls. But studies show that autistic females have different characteristics compared to autistic males. Women with ASD appear to be better at masking, or hiding their autistic characteristic to fit in.

Other factors in females include:

stronger language and communication skills

mimicry of others in social situations

less aggression

shy and passive behaviour

the ability to contain emotions in public, but prone to outbursts at home

Many females find out they have autism in adulthood.

How is ASD managed?

Various treatment options will be explained to you if your child is diagnosed with ASD. A number of organisations offer education programs and support services, such as Autism Spectrum Australia. These services can support children with ASD, and their parents or caregivers.

It’s best to start treatments early after diagnosis. The right support and programs will help manage specific traits and improve social skills.

ASD is a dynamic disorder. Each person with ASD has a unique experience. which is influenced by many different factors. That is why autism is thought of as a spectrum. Treatment programs specifically tailored to individual needs often have the best results.

Intensive educational programs and therapies can teach language and social skills.

Speech pathology focuses on developing communication and social skills.

Occupational therapy can support participation and independence as well as sensory motor development. For example, play skills, fine motor skills and learning how to cope in different environments.

Ensure that the therapies, treatments and supports you choose are informed by evidence. Avoid treatments that offer a ‘cure’ or ‘recovery’. There is no evidence to support these claims.

People with ASD may also have a mental illness. Your doctor can help you to get treatment under the mental health care treatment plan. This provides you with 20 appointments with a mental health professional each year.

Children with ASD can go to either public or private schools. Find out more about schooling options on the Autism Awareness website.

Autism Awareness Australia also offers self-care tips and helpful links and resources.

If you are an adult with ASD, there are different ways to get the help you need. You can get professional support from:

counsellors

occupational therapists

psychiatrists

psychologists

speech therapists

You can also attend an ASD support group.

Misunderstandings about ASD

There are many misunderstandings about ASD that can be harmful. These make it harder for people with ASD to get the support they need.

People with ASD are ‘neurodivergent’. The term neurodivergent also includes those with conditions such as dyslexia, dysgraphia and attention deficit hyperactivity disorder (ADHD).

The word ‘neurotypical’ refers to people who do not have these disorders. The neurotypical perception of autism often involves terms such as mild, moderate, severe, low-functioning and high-functioning.

But autism is a dynamic disorder that affects each person differently. Characterising ASD this way can prevent autistic people from receiving the best treatment.

Here is the truth about autism:

Vaccination does NOT cause autism.

ASD is NOT caused by eating certain foods.

People with ASD DO like to socialise and make friends — they just find this difficult.

People with ASD DO have emotions — they just might show them differently.

Most people with autism ARE able to learn, even if they may progress more slowly than some others.

It IS possible for people with ASD to change their behaviour.

ASD is NOT caused by bad parenting.

Not all people with autism have savant skills, like in the movie Rain Man.

Not all people with ASD have an intellectual disability.

ASD is NOT a mental illness. But people with autism have higher rates of mental illness such as depression and anxiety.

Personal stories — video

Support for carers

Caring for a person with ASD is a lifelong commitment. If you are caring for an autistic person, you can find support through different organisations.

Carer Gateway can give practical information and useful resources. You can also learn more about carers' support and services in your state or territory through Carers Australia.

Resources and support

Having an autistic child or sibling can be a challenging experience at times. There are support services available such as counselling and respite.

For more information about ASD visit:

Amaze

Autism Spectrum Australia

Child Family Community Australia has resources and webinars for parents. These are found through the Australian Institute of Family Studies.

For adults with autism, the Aurora Neurodiversity Program can assist with beginning a career in public service. Services Australia runs this program.

Sources:

Amaze

(About autism),

Amaze

(Women and girls),

Autism Awareness Australia

(Adults),

Autism Awareness Australia

(Understanding autism),

Diversity Council Australia

(Neurodiversity: different not lesser than),

Australian Journal of General Practice

(Recognising, supporting and understanding Autistic adults in general practice setting),

MJA Insight

(Autism: widely known, rarely understood),

The Royal Australian College of General Practitioners

(Autism spectrum disorder – screening, diagnosis and intervention)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2022

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Home > Mental Health Information > Health Topics > Autism Spectrum Disorder

What is ASD?

What are the signs and symptoms of ASD?

What are the causes and risk factors for ASD?

How is ASD diagnosed?

What treatment options are available for ASD?

How can I find a clinical trial for ASD?

Where can I learn more about ASD?

Autism Spectrum Disorder

What is ASD?

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first 2 years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:

Difficulty with communication and interaction with other people

Restricted interests and repetitive behaviors

Symptoms that affect their ability to function in school, work, and other areas of life

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.

People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child’s health care provider about ASD screening or evaluation.

What are the signs and symptoms of ASD?

The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.Social communication / interaction behaviors may include:Making little or inconsistent eye contactAppearing not to look at or listen to people who are talkingInfrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others)Not responding or being slow to respond to one’s name or to other verbal bids for attentionHaving difficulties with the back and forth of conversationOften talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respondDisplaying facial expressions, movements, and gestures that do not match what is being saidHaving an unusual tone of voice that may sound sing-song or flat and robot-likeHaving trouble understanding another person’s point of view or being unable to predict or understand other people’s actionsDifficulties adjusting behaviors to social situationsDifficulties sharing in imaginative play or in making friendsRestrictive / repetitive behaviors may include:Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)Having a lasting intense interest in specific topics, such as numbers, details, or factsShowing overly focused interests, such as with moving objects or parts of objectsBecoming upset by slight changes in a routine and having difficulty with transitionsBeing more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperaturePeople with ASD may also experience sleep problems and irritability.People on the autism spectrum also may have many strengths, including:Being able to learn things in detail and remember information for long periods of timeBeing strong visual and auditory learnersExcelling in math, science, music, or art

What are the causes and risk factors for ASD?

Researchers don’t know the primary causes of ASD, but studies suggest that a person’s genes can act together with aspects of their environment to affect development in ways that lead to ASD. Some factors that are associated with an increased likelihood of developing ASD include:Having a sibling with ASDHaving older parentsHaving certain genetic conditions (such as Down syndrome or Fragile X syndrome)Having a very low birth weight

How is ASD diagnosed?

Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by age 2. It is important to seek an evaluation as soon as possible. The earlier ASD is diagnosed, the sooner treatments and services can begin.Diagnosis in young childrenDiagnosis in young children is often a two-stage process.Stage 1: General developmental screening during well-child checkupsEvery child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they have a higher likelihood of ASD or developmental problems. Children with a higher likelihood of ASD include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.Considering caregivers’ experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child’s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.Stage 2: Additional diagnostic evaluationIt is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.The diagnostic evaluation is likely to include:Medical and neurological examinationsAssessment of the child’s cognitive abilitiesAssessment of the child’s language abilitiesObservation of the child’s behaviorAn in-depth conversation with the child’s caregivers about the child’s behavior and developmentAssessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toiletingBecause ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:Blood testsHearing testThe evaluation may lead to a formal diagnosis and recommendations for treatment.Diagnosis in older children and adolescentsCaregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. For example, some children may have problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.Diagnosis in adultsDiagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).Adults who notice signs of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults may be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:Social interaction and communication challengesSensory issuesRepetitive behaviorsRestricted interestsThe evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.Receiving a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.

What treatment options are available for ASD?

Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care and services can reduce individuals’ difficulties while helping them build on their strengths and learn new skills.People with ASD may face a wide range of issues, which means that there is no single best treatment for ASD. Working closely with a health care provider is an important part of finding the right combination of treatment and services.MedicationA health care provider may prescribe medication to treat specific symptoms. With medication, a person with ASD may have fewer problems with:IrritabilityAggressionRepetitive behaviorHyperactivityAttention problemsAnxiety and depressionRead more about the latest medication warnings, patient medication guides, and information on newly approved medications at the Food and Drug Administration (FDA) website .Behavioral, psychological, and educational interventionsPeople with ASD may be referred to a health care provider who specializes in providing behavioral, psychological, educational, or skill-building interventions. These programs are often highly structured and intensive, and they may involve caregivers, siblings, and other family members. These programs may help people with ASD:Learn social, communication, and language skillsReduce behaviors that interfere with daily functioningIncrease or build upon strengthsLearn life skills for living independentlyOther resourcesMany services, programs, and other resources are available to help people with ASD. Here are some tips for finding these additional services:Contact your health care provider, local health department, school, or autism advocacy group to learn about special programs or local resources.Find an autism support group. Sharing information and experiences can help people with ASD and their caregivers learn about treatment options and ASD-related programs.Record conversations and meetings with health care providers and teachers. This information may help when it’s time to decide which programs and services are appropriate.Keep copies of health care reports and evaluations. This information may help people with ASD qualify for special programs.

How can I find a clinical trial for ASD?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

NIMH’s Clinical Trials webpage: Information about participating in clinical trials

Clinicaltrials.gov: Current Studies on ASD : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country

Where can I learn more about ASD?

Free brochures and shareable resourcesAutism Spectrum Disorder: This brochure provides information about the symptoms, diagnosis, and treatment of ASD. Also available en español.Digital Shareables on Autism Spectrum Disorder: Help support ASD awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about ASD.Federal resourcesEunice Kennedy Shriver National Institute of Child Health and Human Development National Institute of Neurological Disorders and Stroke National Institute on Deafness and Other Communication Disorders Centers for Disease Control and Prevention (CDC)Interagency Autism Coordinating Committee MedlinePlus (also available en español )Research and statisticsScience News About Autism Spectrum Disorder: This NIMH webpage provides press releases and announcements about ASD.Research Program on Autism Spectrum Disorders: This NIMH program supports research focused on the characterization, pathophysiology, treatment, and outcomes of ASD and related disorders.Statistics: Autism Spectrum Disorder: This NIMH webpage provides information on the prevalence of ASD in the U.S.Data & Statistics on Autism Spectrum Disorder : This CDC webpage provides data, statistics, and tools about prevalence and demographic characteristics of ASD.Autism and Developmental Disabilities Monitoring (ADDM) Network : This CDC-funded program collects data to better understand the population of children with ASD.Biomarkers Consortium - The Autism Biomarkers Consortium for Clinical Trials (ABC-CT) : This Foundation for the National Institutes of Health project seeks to establish biomarkers to improve treatments for children with ASD.Last Reviewed: February 2024

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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This brochure presents information about autism spectrum disorder (ASD) including signs and symptoms, causes and risk factors, diagnosis in young children, older children, teens, and adults, and treatments.

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What Is Autism?

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It's a spectrum disorder, which means it affects people in different ways and in varying degrees. It usually appears by age 2 or 3. People with autism have trouble with communication. They have trouble understanding what other people think and feel. This makes it hard for them to express themselves, either with words or through gestures, facial expressions, and touch.People with autism may have problems with learning. Their skills might develop unevenly. For example, they could have trouble communicating but be unusually good at art, music, math, or things that involve memory. Because of this, they might do especially well on tests of analysis or problem-solving.More children are diagnosed with autism now than ever before. But the latest numbers could be higher because of changes in how it’s diagnosed, not because more children have the disorder."Low-functioning" vs. "high-functioning" autism Every person with autism will be affected differently. Some people have a more challenging time with social, learning, or communication abilities. They may need help with everyday tasks and in some cases aren't able to live alone. Many people call this "low-functioning autism."Other people may have autism with less obvious symptoms. They often do well and school and have fewer problems communicating. People usually call this "high-functioning autism."But the terms "high-functioning" and "low-functioning" can be offensive. It's best to avoid them. To talk about how autism affects someone, you can instead use terms like "more significant" or "less significant."Autism SymptomsSymptoms of autism usually appear before a child turns 3. Some people show signs from birth.Common symptoms of autism include:A lack of eye contactA narrow range of interests or intense interest in certain topicsDoing something over and over, like repeating words or phrases, rocking back and forth, or fidgeting with objects (such as flipping a light switch)High sensitivity to sounds, touches, smells, or sights that seem ordinary to other peopleNot looking at or listening to other peopleNot looking at things when another person points at youNot wanting to be held or cuddledProblems understanding or using speech, gestures, facial expressions, or tone of voiceTalking in a sing-song, flat, or robotic voiceTrouble adapting to changes in routine Some children with autism may also have seizures. These might not start until adolescence.Autism symptoms in adultsIn adults, autism may show up in specific ways. Common symptoms can include:Trouble understanding what other people are thinking or feelingChoosing to be on your own or having a hard time making friendsAnxiety about social activitiesKeeping a daily routine and getting upset if it changesHaving a hard time expressing how you feelTaking things literally or not understanding sarcasmComing off as blunt, uninterested, or rude to others without meaning toOther signs of autism in adults could include:Avoiding eye contactNot understanding social queues or "rules"Getting too close to others or getting upset if someone gets too close or touches youBeing very interested in specific thingsPicking up on small details, smells, sounds, or patterns that other people don'tWanting to plan things very carefully before doing them Autism symptoms in childrenChildren may show different signs of autism. They may include:Not responding to their name by 9 months oldNot showing facial expressions by 9 months oldNot wanting to play simple games (like pat-a-cake) by 12 months oldDoesn't use gestures (like waving hello) by 12 months oldDoesn't understand when other people are sad or mad by 24 month oldDoesn't notice or want to join other children to play by 36 months oldDoesn't sing, act, or dance for you by 60 months oldLines up toys in a specific order and gets upset if the order is changed Shows obsessive interestsRocks their body, flaps their hands, or spins in circlesDelayed language, movement, learning, or cognitive skillsOdd sleeping or eating habitsLess or more fear toward things than would ordinarily be expected StimmingStimming is a self-stimulating behavior, such as hand and arm flapping, rocking, spinning, twirling, jumping, head-banging, or other similar body movements. It can also include using an object over and over again, like flicking a rubber band, twirling a string, touching something with a certain texture, and more. People with autism may stim for fun, to ease boredom, or to cope with stress or anxiety. It can also help them adjust the level of sensory input. For example, they may twirl a string so they can watch it or focus on one sound so they can tune out another loud or stressful noise. MeltdownsAt times, a person with autism may become overwhelmed by a situation and be unable to find a way to respond. This can cause them to have a meltdown. They may cry, scream, or act out physically by kicking, punching, or biting. They may shut down completely and stop responding in any way. This isn't a tantrum: They're simply unable to deal with being overwhelmed or to explain their feelings. Autism TypesThese types were once thought to be separate conditions. Now, they fall under the range of autism spectrum disorders including:Asperger's syndrome. Children with Asperger's syndrome tend to score in the average or above-average range on intelligence tests. But they may have challenges with social skills and show a narrow scope of interests.Autistic disorder. This is what most people think of when they hear the word "autism." It affects social interactions, communication, and play in children younger than 3 years.Childhood disintegrative disorder. Children with this disorder have typical development for at least 2 years and then lose some or most of their communication and social skills.Pervasive developmental disorder (PDD or atypical autism). Your doctor might use this term if your child has some autistic behavior, like delays in social and communications skills, but doesn’t fit into another category.Autism CausesExactly why autism happens isn't clear. It could stem from problems in parts of your brain that interpret sensory input and process language.Autism is four times more common in boys than in girls. It can happen in people of any race, ethnicity, or social background. Family income, lifestyle, or educational level doesn’t affect a child’s risk of autism. But there are some risk factors:A child with an older parent has a higher risk of autism.Pregnant women who are exposed to certain drugs or chemicals, like alcohol or anti-seizure medications, are more likely to have autistic children. Other risk factors include maternal metabolic conditions such as diabetes and obesity. Research has also linked autism to untreated phenylketonuria (also called PKU, a metabolic disorder caused by the absence of an enzyme) and rubella (German measles). Is autism genetic?Autism runs in families, so certain combinations of genes may increase a child’s risk. Changes in more than 1,000 genes may be linked to autism. But not all of them are confirmed by experts. Genetic factors can affect someone's risk of autism anywhere from 40 to 80%.Your overall risk depends on the combination of your genes, environment, your parents' age, and any birth complications.A rare gene mutation or chromosome issue is likely to be the sole cause of about 2% to 4% of people with autism. This tends to happen in conditions that also affect other parts of the body, like with mutations in the ADNP gene. With ADNP syndrome, a person will show signs of autism as well as have specific facial features. Many of the genes that are involved in autism are related to brain development. This may be why autism symptoms tend to involve issues with communication, cognitive functioning, or socialization. Vaccines and autismVaccines don't cause autism. Even though some people have concerns that they do, studies have shown that there is no link between the two. Experts have reviewed the safety of eight vaccines for children and adults. They found that they're very safe, despite rare exceptions. Other studies have looked at the ingredients of different vaccines and found no link to autism. The health benefits of vaccines in preventing diseases far outweigh any potential risks. Autism TestingIt can be hard to get a definite diagnosis of autism. Your doctor will focus on behavior and development.For children, diagnosis usually takes two steps.A developmental screening will tell your doctor whether your child is on track with basic skills like learning, speaking, behavior, and moving. Experts suggest that children be screened for these developmental delays during their regular checkups at 9 months, 18 months, and 24 or 30 months of age. Children are routinely checked specifically for autism at their 18-month and 24-month checkups.If your child shows signs of a problem on these screenings, they’ll need a more complete evaluation. This might include hearing and vision tests or genetic tests. Your doctor might want to bring in someone who specializes in autism disorders, like a developmental pediatrician or a child psychologist. Some psychologists can also give a test called the Autism Diagnostic Observation Schedule (ADOS). If you weren’t diagnosed with autism as a child but notice yourself showing symptoms, talk to your doctor.If you've just gotten a diagnosisIf you just got an autism diagnosis, there are a few steps you can take to feel your best:Take the time you need to understand the diagnosis. You might feel a ranged of emotions. Know that you can reach out to your doctor for help. You can continue a normal life even after a diagnosis.Do your research. You can read up on articles (such as this one) about autism. There's a lot of information out there, but a few good sources are all you need to start learning about your diagnosis.Listen to others with autism. There are many blogs, books, or videos that you can use to understand the condition. People with autism can also share their stories to help you learn more about it.Get the help you need. If you feel alone after you or your child got an autism diagnosis, look for support. National advocacy groups, support groups, your doctor, people on social media with autism, or your school, job, or college can help you navigate a diagnosis.Keep an eye out for other health issues. While autism isn't an illness, many people with autism might also have other conditions, including ADHD, dyslexia, and others. If you have questions about you or your child's health, see your doctor and explain your concerns.Living With AutismIf you have autism, you’ll have it your entire life. But early treatment can make a big difference in development for a child with autism. If you think your child shows symptoms of ASD, tell your doctor as soon as possible.Autism treatmentsWhat works for one person might not work for another. Your doctor should tailor treatment for you or your child. The main types of treatments are:Behavioral: Helps a person understand the causes and results of behaviors so they can change unwanted behaviors. Developmental: Speech therapy improves communication skills, physical therapy improves motor ability, occupational therapy works on life skills like dressing and eating. Psychological: Treatments like cognitive-behavioral therapy (CBT) can help people deal with anxiety, depression, or other mental health issues In addition to autism.Educational: Adapts learning processes to the needs of people with autism.Social-relational: Focuses on bettering social skills and building emotional bonds.Medications: Work to ease symptoms of ASD, like attention problems, hyperactivity, or anxiety. Complementary treatments may help boost learning and communication skills in some people with autism. Complementary therapies include music, art, or animal-assisted therapy, such as horseback riding.Applied behavior analysis (ABA) is a type of treatment that aims to promote positive behavior and discourage negative or harmful behavior. Some experts believe that ABA is a form of behavior control. They say that it forces people to conform to a rigid definition of "normal" and stifles behavior that's part of having autism. Advocates say that ABA has evolved from this approach. They claim that it's the best way for a person with autism to adapt in a way that lets them live in society more easily. Fake autism treatmentsThere are certain treatments that are sold or advertised to treat autism but don't actually work. Some of these fake treatments can even be dangerous. Don't try any of the following for autism:Raw camel's milkGcMAF, which is an unlicensed injection made from blood cellsCEASE, which tells people to avoid vaccinations and suggests people take nutritional supplements that could be dangerousChlorine dioxide (CD) or Mineral Miracle Solution (MMS)Some vitamins, minerals, and supplementsSecretin, a hormone found in your bodyChelation, which takes out heavy metal toxins in your bloodTo spot a fake treatment, look for these warning signs:Claims that it's a "cure," "miracle," or that you can "recover from" autism.It's not available on major, reputable health sites.It costs a lot of money.It claims to work in many people "instantly."Personal stories that it's worked instead of medical data.States that anyone can do it, even without medical training.It claims to cure lots of conditions.Autism DisparitiesSome groups of people are affected differently by autism.Autism in womenAutism can sometimes be different for women compared to men. Compared to men, autistic cisgender women might:Hide their feelingsBe quieterCopy people who don't have autism or hide their autism signs in order to "fit in"Seem to deal better with social situationsShow fewer signs of repetitive behaviors Your doctor may not have as much knowledge about diagnosing girls or women with autism. Since many symptoms are focused on male stereotypes of autism, this can make it harder to tell if a female has autism. Because of this, girls and women with autism may be misdiagnosed or missed entirely. As experts become more aware of this, the estimates of how many men have autism compared to women has gotten smaller. Autism and Racial and Ethnic DifferencesMore white children are diagnosed with autism spectrum disorder compared to Black or Hispanic children. Some of the reasons that these groups may not be getting diagnosis or care include: Stigma about the disorder Less access to medical resources because of non-citizenship or incomeNot speaking English as a primary language LGBTQIA+ and AutismResearch shows that people with autism are more likely to identify as a part of the LGBTQIA+ community than people who don't have it. People in this group who also have autism are more likely to face discrimination, issues with getting medical care, violence, and cultural stigmas. This can create greater mental health complications for LGBTQIA+ individuals who are autistic and already at a higher risk for these complications.Be Careful About Changing Your Child’s DietTalk to your doctor before trying something different, like a special diet. There’s no hard evidence that special diets help children with ASD. Autism is a complex brain disorder. Some children with autism might appear to be picky eaters. They may only eat foods of a certain color or texture, not eat enough or eat too much, or eat things that aren't food. They can have constipation, which makes them feel full even if they're not, or have issues with coughing or choking while they eat. While it may seem that cutting out certain foods could relieve your child’s symptoms, it might actually cause more harm.For example, children with autism often have thinner bones. Dairy products have nutrients that can make their bones stronger. Studies on a protein in milk products called casein have found that many children performed the same whether or not they ate foods with this protein. Their autism symptoms didn’t change in any remarkable way. Some evidence shows that people with autism may have low levels of certain vitamins and minerals. This does not cause autism spectrum disorder. But your doctor may suggest supplements to improve nutrition. Vitamin B and magnesium are two of the supplements most often used for people with autism. But people can overdose on these vitamins, so megavitamins should be avoided.However, some diet changes may help with certain symptoms of autism. Food allergies, for example, may make behavior problems worse. Removing the allergen from your child's diet may make some behavior issues better. The important thing is that your child’s diet needs to support their specific nutritional needs and ASD symptoms. The best way to settle on the most useful diet is to work with your doctor and a nutrition specialist like a registered dietitian. They’ll help you design a meal plan tailored for your child.Some children with autism have digestive problems like constipation, belly pain, or nausea and vomiting. Your doctor can suggest a diet that won’t make these issues worse.And remember, nutritional needs change over time. Your child’s dietitian will help you make sure the foods they eat are still meeting their needs as they get older.How to Help your Child With AutismCommunicationYou can help your child communicate better with autism by:Using their name so they know you're speaking to themSpeaking slowly and clearlyKeeping language clear and simpleGive them extra time to understand what you've just saidUse simple gestures, pictures, or eye contact to help them understand what you're saying Avoid:Having a conversation in a noisy or crowded areaSaying things that have more than one meaning like "break a leg"Asking your child a lot of questionsTrouble sleepingMany kids with autism have a hard time falling asleep or staying asleep. You can help them by:Keeping a sleep diary to look for common issuesFollowing the same bedtime routine each nightLetting them use ear plugs to sleep, if they helpKeeping their bedroom dark and quietTalking to a doctor about issues that might affect their sleep SocializingTo help your child make friends and socialize:Ask your child's school if they can help.Ask your autism care team if they can give tips.Look into the National Autism Society directory for local social groups that can help those with autism.Ask for or read information from other parents of children who have autism.Make sure you don't:Force your kid into social settings if they want to be on their own instead.Put pressure on your child. Give them time to learn social skills.RELATED ARTICLES:What is Autism?SymptomsCauses & Risk FactorsPreventionDiagnosisTypesTreatmentDiet & LifestyleHelp for ParentsVisual Guide to Autism Sources Update History ShareSOURCES:American Academy of Pediatrics: Pediatrics 2010.Parker, S., Zuckerman, B., and Augustyn, M. (editors). Developmental and Behavioral Pediatrics: A Handbook for Primary Care, Lippincott, 2005.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5).CDC: “Autism Spectrum Disorder (ASD)," "Spotlight On: Racial and Ethnic Differences in Children Identified with Autism Spectrum Disorder (ASD)," "Treatment and Intervention Services for Autism Spectrum Disorder," "Autism and Vaccines," "Signs and Symptoms of Autism Spectrum Disorder." National Institute of Mental Health: “Autism Spectrum Disorder.”Acta Psychiatrica Scandinavica: “Advanced parental age and autism risk in children: a systematic review and meta-analysis.”Autism Speaks: “What Are the Symptoms of Autism?” “Treatments,” “Pervasive Developmental Disorder -- Not Otherwise Specified (PDD-NOS).”Case Reports in Psychiatry: “Targeted Nutritional and Behavioral Feeding Intervention for a Child with Autism Spectrum Disorder.”National Institute of Child Health and Human Development: “ASD: Nutritional Therapy.”Mayo Clinic: “Autism Spectrum Disorder.”Journal of Autism and Developmental Disorders: “The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with Autism.”Treat Autism & ADHD: “Gut and Probiotics.”PubMed: “How nutritional status, diet and dietary supplements can affect autism.”Health24 News: "Autism Through Ages Baffles Science."Autism and PDD Support Network: "History of Autism."Autism Research Institute: "LGBTQIA+ and Autism."NHS: "How to help your autistic child with day-to-day life," "Treatments that are not recommended for autism," "Newly diagnosed with autism: things to help," "Signs of autism in adults," "Other conditions that affect autistic people."Medline Plus: "Autism spectrum disorder."National Autistic Society: "Meltdowns," "Stimming," "Stimming - a guide for all audiences," "Autistic women and girls."National Center on Disability and Journalism: "Disability Language Style Guide."Science Direct: "Classification of low-functioning and high-functioning autism using task-based EEG signals."National Autism Association: "What is Autism?" Integrity Inc.: "High-Functioning Autism vs. Low-Functioning Autism."Child Mind Institute: "The Controversy Around ABA."How we keep our content up to date:Our medical and editorial staff closely follow the health news cycle, new research, drug approvals, clinical practice guidelines and other developments to ensure our content receives appropriate and timely updates. September 02, 2023Medically Reviewed by: Dan Brennan, MD View privacy policy, copyright and trust info Share View privacy policy, copyright and trust info Next SymptomsMore on AutismWhat Is Autism?Autism Myths and FactsWhich Therapies Can Help with Autism? 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Autism spectrum disorder - Symptoms and causes - Mayo Clinic

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