Five-year-old Eli is quiet and serious. Bright lights and loud noises can overwhelm him, but he loves color and expresses himself through vivid drawings. He tends to play on his own, focusing intently on the intricate patterns he creates with his toy blocks.

At eight, Leah is non-verbal but has a strong sense of her surroundings. Using an assistive communication device, she selects images to convey her feelings and needs. She thrives on routines, finding comfort in predictability, and often rocks back and forth when trying to soothe herself.

Ten-year-old Shmueli finds comfort in routines. Transitions, especially unexpected ones, are unsettling for him. He asks lots of questions, seeking clarity and stability. He thrives on clear expectations and needs gentle reassurance throughout the day. He rarely initiates conversations but listens intently, often repeating phrases or sounds he finds intriguing. 

All three of these children have autism spectrum disorder (ASD, or autism in short). 

What Exactly is Autism?

Autism is a complex neurological disorder. At its core, autism is a neurodevelopmental disability shaped by various brain differences, and it impacts how the brain processes information, interprets experiences, and engages with the world. According to the Centers for Disease Control, ASD affects approximately 1 in 36 children in the United States today. It’s four times as common among boys than girls. 

ASD has been termed a spectrum disorder because there’s a vast range of experiences and abilities among individuals with autism. Some individuals face challenges in social interactions, while others have heightened sensitivities to sensory stimuli. Conversely, many show remarkable talents in areas like art, music, mathematics, or memory. All of these may be symbols of autism.

Every individual with autism experiences the world in a unique way, and behind each of these experiences lies a rich tapestry of thoughts, feelings, and potential.

The neurological underpinnings of autism are multifaceted. Variances in brain structure and function contribute to the unique challenges and strengths of those with ASD. Imagine the brain as a complex highway system; in autism, the “routes” for social cues, sensory input, and other skills might be mapped differently. 

These alternative pathways can lead to sensory sensitivities and can also come along  with medical or mental health conditions like gastrointestinal disorders, seizures, or anxiety. 

While autism brings challenges, it’s also filled with opportunities for discovery and growth. With the right guidance, those alternative pathways can lead to extraordinary destinations.

Understanding Autism Spectrum Disorder

Signs of ASD can manifest early on in a child’s life. While signs of autism in newborns aren’t pronounced, they become more apparent at 24 months or later. 

Early diagnosis offers the benefit of timely intervention, increasing the potential for a positive long-term impact. However, it’s essential to note that even if a diagnosis was made later, there’s still great potential for growth and progress. 

Keeping an eye on a child’s developmental progress is essential. Signs of autism in newborns to look out for during the first year of life, include things like limited eye contact, not responding to their names, or a lack of bodily communication like pointing or waving by 12 months. 

As they grow into toddlers, between the ages of 1 and 3, you might notice more pronounced symptoms such as delayed speech, repetitive behaviors, or inconsistent reactions to sensory stimuli.

When children reach preschool age, from 3 to 5 years, their social interactions offer more cues. They may show difficulty in understanding how to play with toys appropriately, exhibit distress at even minor changes in routine, and may struggle with understanding and expressing emotions. 

For a more complete list of symptoms, see our article on signs of autism. 

Realize that occasional signs don’t confirm autism; it’s their persistence and intensity that matter. Consult a health care professional for an evaluation and possible early interventions if you’re concerned.

Diagnosis: Screening and Testing

Identifying autism is a multi-step process that integrates observations, screenings, and comprehensive assessments. 

Pediatricians often serve as the first line of identification through routine well-child checkups, at which they monitor growth, behavior, and learning. These regular visits can help detect potential developmental delays and serve as a foundation for further evaluation.

Additionally, a specific screening tool, the Modified Checklist for Autism in Toddlers (M-CHAT), is used for children aged 16-30 months to help parents and professionals identify early signs of autism. 

Parents and caregivers, who are often the first to notice signs of developmental differences, play an invaluable role by providing observations and concerns that lay the foundation for more thorough evaluations.

If preliminary screenings raise flags, the next step involves a more comprehensive diagnostic evaluation by a team of specialists. These professionals may include developmental pediatricians, who specialize in child development and behavior; child neurologists, who rule out other neurological disorders; child psychologists or psychiatrists, who conduct detailed behavioral assessments; and speech and language pathologists focusing on the common speech and language challenges in autism.

The guidelines for diagnosing autism come from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). They look at challenges in social communication and interaction, like difficulties with social-emotional connections and non-verbal communication, as well as repetitive behaviors and fixations.

There isn’t a specific medical test to diagnose autism; instead, specialists will use a combination of structured observations and tests covering social interactions, communication skills, and behavior to assess whether an individual meets these criteria. 

Additional specialists may be included in the diagnostic process, and in some cases, genetic testing may be recommended to identify conditions like Rett syndrome or Fragile X syndrome.

The results of these formal evaluations are crucial for determining whether the individual meets the criteria for an autism spectrum disorder, which now encompasses conditions previously diagnosed separately, like autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. 

Ultimately, the objective is to ensure that individuals receive the targeted autism supports, resources, and interventions they require, which, depending on the findings, might also include early intervention services.

What Help Is Available? 

Navigating the realm of autism treatments and medication options can be overwhelming. With the vast array of choices available, it’s important to ensure that interventions are an appropriate fit with the person’s unique needs. 

These are some of the interventions which you might find helpful in assisting your child with autism:

1. Behavioral and communication therapies:
   1. Applied Behavior Analysis (ABA): A widely recognized treatment for autism, ABA involves understanding and modifying behaviors. Using positive reinforcement strategies, it helps improve a range of skills and minimize undesired behaviors.
   2. Speech therapy: This addresses challenges with communication and language, aiding individuals in improving verbal, non-verbal, and social communication skills.
   3. Occupational therapy: Tailored to the individual, this therapy focuses on improving daily living skills, motor skills, and sensory processing issues.
2. Educational therapies: Children with autism often benefit from tailored educational programs and therapies. These can include:
   1. Individualized education plans (IEPs): Customized learning plans targeting the student’s unique needs.
   2. Structured teaching and autism visual supports: Emphasizing visual aids, this approach helps organize the individual’s environment to align with their learning style.‍
3. ‍Family therapies: Parents and siblings are integral to the support system. Family therapies and autism support groups can:
   1. equip families with strategies to better understand and interact with their loved ones with autism.
   2. offer counseling to help families address the emotional and physical challenges they may face.

See this article “Living and Thriving with Autism” for additional ideas. 

4. Medication options: While no medication can cure autism, certain drugs can alleviate some symptoms associated with the condition. Commonly prescribed medications might address the following:
   1. Attention challenges: Medication like Methylphenidate can help improve focus in some individuals with autism.
   2. Anxiety and depression: Selective serotonin reuptake inhibitors (SSRIs) can be beneficial.
   3. Behavioral issues: Medications such as Risperidone or Aripiprazole can help manage irritability and aggressive behaviors.
   4. Sleep disturbances: Melatonin supplements or other sleep aids may be considered under a physician’s guidance.
5. Alternative and complementary therapies: Many families explore alternative therapies, such as:
   1. Sensory-based therapies: Using items like swings or trampolines may help with sensory integration.
   2. Dietary approaches: Though scientific evidence varies, some families find benefits in gluten- or casein-free diets.
   3. Music or art therapy: Creative outlets can provide therapeutic benefits and self-expression.

While the options for treatment and medication are extensive, it’s paramount to adopt an individualized approach. Staying in touch with health care and therapy professionals, coupled with understanding the individual’s needs and creating a strong support system is the best way forward.

If you’re a parent on  this journey, know that our understanding of autism is ever-evolving, and staying informed is so important. Support is available, both professional guidance, and from autism parent support groups -- communities of parents and caregivers who are walking the same path as you. Seeking and accepting this support will make all the difference.