Autism Spectrum Disorder In Depth

In Depth

Autism spectrum disorder (ASD) is a neurodevelopmental condition, meaning it affects the way your child develops and behaves. The number of children being diagnosed with ASD has been increasing since the 1980s, in part because clinicians and families are better able to recognize it.

Estimates have varied widely, but 2014 statistics from the U.S. Centers for Disease Control and Prevention (CDC) identified 1 in 68 children as having a diagnosis of ASD—1 out of 42 boys and 1 in 189 girls. The true number is hard to know, since different studies were conducted and interpreted in different ways.

ASD affects children differently and to varying degrees. An in-depth evaluation by specialists with expertise in child development and behavior can help identify strengths that can be harnessed to help your child learn, as well as skills she will most need to work on. It’s also important to keep monitoring your child, because the characteristics of her behavior and development may shift as she gets older.

Will my child always have autism?

Parents often ask whether their child will have ASD for the rest of her life. There’s no easy answer. Each child is different, and our understanding of ASD and the therapies available keeps evolving. For many children, ASD is a lifelong condition that may require ongoing support through adulthood. However, symptoms sometimes improve over time, and in a few cases, with time and intensive treatment, a child may no longer be considered to have ASD.

What are the symptoms of autism spectrum disorder?

ASD affects every child differently. It’s not possible to simply say that one child is on the “low” end of the autism spectrum and another at the “high” end. Instead, each child will have different skills and different struggles.

Although the symptoms of autism vary in severity, the core behaviors that describe ASD are:

  • difficulty with social communication and social interaction including: verbal and nonverbal communication, trouble developing and maintaining relationships, and deficits in initiating and responding to social cues
  • unusual, restricted or repetitive behaviors (also called "stereotyped" behaviors or stereotypies), intense interests and/or unusual sensory behaviors

These symptoms typically occur in the first few years of life. You may even notice subtle differences before your child’s first birthday—like not making eye contact, not using gestures or not responding to her name. Sometimes children develop normally at first, but then stop gaining new skills or even begin to lose skills at around 18 to 24 months.

For some children, especially those whose ASD symptoms are less pronounced, symptoms may not be fully appreciated until the middle school years, late adolescence, or young adulthood when social demands increase.

The core symptoms of ASD may show up in different ways. Some children with ASD are nonverbal but can learn to communicate through other means. Others speak easily but aren’t good at using language to communicate with others. Some have unusual-looking behaviors; others do not. Some have severe cognitive impairments; others are very intelligent. Some children are easygoing, while others can get easily frustrated and may behave aggressively or injure themselves.

How do I know that my child might have autism?

These are some things parents of children with ASD have noticed in their child:

  • trouble interacting or communicating with others, including family
  • trouble speaking or not speaking at all
  • difficulty expressing his feelings
  • inability to understand how another person feels
  • disinterest in physical contact with other people
  • being withdrawn or preferring to do things by himself
  • difficulty making friends
  • avoidance of eye contact
  • not using gestures such as pointing
  • saying a word or phrase repeatedly (“echolalia”)
  • trouble understanding subtleties in language, like sarcasm or jokes
  • repetitive motions, such as rocking or flapping hands or spinning in circles
  • unusual rituals or ways of playing with toys
  • a preference for routines, and anxiety when a routine is broken
  • a particular area of interest that consumes a lot of his attention
  • unusual sensory behaviors such as:
    • being preoccupied with lights or moving objects
    • peering at things out of the corner of his eye
    • dislike of certain kinds of sensory stimulation
    • such as loud noises
    • craving other sensory inputs
    • such as deep pressure on his skin

It’s important to note that typically developing children can also show some of the above behaviors—like flapping their arms when they’re excited or having an unusually strong interest. In children who have ASD, however, these behaviors are more pronounced, more frequent and tend to get in the way of doing other things. Sometimes other neurodevelopmental disorders, such as language or cognitive disorders, have symptoms that are similar to ASD.

For more information, visit the Center for Disease Control and Prevention’s ASD website. In addition, the Autism Speaks website has a library of videos showing many of the behaviors of ASD.

What causes autism?

Despite a lot of effort in research, the exact causes of ASD are not known. There are most likely different causes in different children. Researchers have identified certain risk factors, such as having a sibling with ASD or an older father, or having certain genetic conditions, but many children with ASD don’t have these factors.

Many studies are showing that whatever the cause, the result is changes in how the connections in the brain are organized. Most scientists also agree that genetics plays a role. Although many different genes and chromosomal changes have been linked with ASD, most genetic causes are still unknown. Some of these DNA changes may be inherited from parents, while others may occur just in the child. Research at Boston Children’s and elsewhere is exploring how they may contribute to children’s symptoms.

In a small number of cases, a prenatal infection, injury or other medical condition is thought to be involved in ASD. While it has been suggested that some vaccines may be a cause, a large amount of research shows that vaccines are not associated with ASD.

Contact Us

The Autism Spectrum Center at Boston Children’s is best reached through our Call Center.

Boston Children's Hospital
Autism Spectrum Center
Call Center:  617-355-7493
Fax: 617-730-4823

Our coordinator will make the first available appointment based on an intake process that considers your child’s specific needs. For example, children who also have seizures may be directed to a neurologist within the Center, while children with speech, language and communication difficulties may be referred to our Autism Language Program, part of the Center for Communication Enhancement.

Appointments are available in Boston and at many Boston Children’s satellite locations to provide you and your child with care closer to home. The Call Center can help direct you.