Learn About Autism in Children: A Comprehensive Guide for Parents

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that affects how a child’s brain develops. The term “spectrum” is crucial because autism presents itself in a wide variety of ways. Children with autism may exhibit a broad range of symptoms, cognitive abilities, language skills, and behaviors. This guide provides parents with a detailed understanding of autism in children, from the diverse nature of the condition that can make diagnosis challenging, to common issues faced by autistic children such as sensory sensitivities and rigid eating habits, and an overview of evidence-based interventions.

Understanding Autism Spectrum Disorder (ASD)

Autism spectrum disorder is categorized as a neurodevelopmental disorder, meaning it impacts a child’s developmental trajectory. While autism is believed to begin before birth, diagnoses are often not made until preschool or school age, sometimes even later, when the characteristic signs and symptoms become more noticeable.

The core features of ASD involve a combination of challenges in two primary areas: difficulties in social communication and interaction, and the presence of restricted, repetitive behaviors or interests. The spectrum nature of ASD highlights that each individual with autism is unique, displaying a different combination and intensity of these characteristics.

Diagnostic Criteria for Autism Spectrum Disorder

Identifying autism involves recognizing patterns of behavior that fall into these two core categories. It’s important to note that these signs can vary significantly from child to child.

Social Communication and Interaction Deficits:

In younger children (under 3 years), these deficits may manifest as:

Lack of response to their name: A child may not turn their head or acknowledge when their name is called.
Reduced interest in sharing or showing objects: They may not point out interesting things to others or engage in joint attention.
Limited displays of affection: They might not cuddle, reach out to be held, or show typical affectionate behaviors.
Preference for solitary play: They often prefer to play alone and may not engage in interactive play with peers or adults.

In older children, social communication and interaction challenges can include:

Difficulty with reciprocal conversations: Struggling to maintain back-and-forth exchanges, often talking at someone rather than with them.
Reduced eye contact: Avoiding or making minimal eye contact during interactions.
Challenges with nonverbal communication: Difficulty understanding and using body language, facial expressions, and gestures.
Difficulty understanding emotions and social cues: Struggling to recognize how others are feeling, responding inappropriately in social situations, and understanding social norms and relationships.
Aversion to physical affection: Discomfort or resistance to being hugged or touched.
Preference for playing alone: Continuing preference for solitary activities over social interaction.

Restricted, Repetitive Behaviors, Interests, or Activities:

Children with autism often exhibit repetitive behaviors or rituals and may develop intense fixations on specific details or topics. These behaviors can include:

Distress over changes in routine: Becoming significantly upset by even minor alterations to their daily schedule.
Repetitive play patterns: Lining up toys, sorting objects, or organizing items instead of engaging in imaginative play.
Intense, narrow interests: Developing an all-consuming interest in a particular subject or object, sometimes to the exclusion of other activities.
Unusual sensory sensitivities: Showing heightened or lessened sensitivity to sensory input like sounds, lights, textures, tastes, or smells.

For a diagnosis of ASD, these symptoms must be present in early childhood, although they may not become fully apparent until later when social demands increase or when learned strategies mask some of the core difficulties. Crucially, these symptoms must cause significant impairment in social, occupational, academic, or other important areas of functioning.

Beyond these core diagnostic criteria, many children with autism also experience sensory processing issues and have varying cognitive and language abilities.

Sensory Sensitivities:

A significant number of autistic children have sensory processing differences. They may be hypersensitive, reacting strongly to everyday sensory input, or hyposensitive, seeking out more sensory stimulation.

Hypersensitivity: Overwhelmed by bright lights, loud noises, strong smells, certain textures, or tastes. This can lead to avoidance behaviors, distress, or meltdowns in response to sensory overload.
Hyposensitivity: Seeking out sensory experiences by bumping into things, touching objects excessively, smelling things intensely, or engaging in repetitive movements to gain sensory input.

Verbal and Nonverbal Communication:

Language abilities in children with autism are highly variable.

Nonverbal autism: Some children may have very limited or no spoken language.
Atypical speech patterns: Others may speak with an unusual tone, such as monotone, sing-song, or overly formal.
Monopolizing conversations: Highly verbal children may dominate conversations without recognizing or responding to the other person’s cues or interests.
Echolalia and non-functional knowledge: Some children may repeat phrases or sentences (echolalia) without demonstrating understanding of their meaning or possess “non-functional knowledge,” where they can recite facts but cannot apply them to problem-solving or conversation.

It is also important to recognize that autistic children are at a higher risk for co-occurring conditions, including medical problems and other mental health disorders like anxiety, ADHD, and depression. Symptoms of these conditions can sometimes overlap with or be mistaken for autism traits, making accurate diagnosis crucial.

Terminology: Identity-First vs. Person-First Language (“Autistic” vs. “With Autism”)

When discussing autism, language preferences vary. “Person-first” language, such as “child with autism,” emphasizes the individual’s identity beyond their diagnosis. This approach is often promoted as respectful when discussing disabilities or health conditions.

However, many autistic individuals and advocates prefer “identity-first” language, using terms like “autistic person” or “autistic child.” They argue that being autistic is an integral part of their identity, similar to other identity categories. Identity-first language reframes autism as a core aspect of who they are, rather than a condition separate from themselves.

In this guide, we use both “autistic children” and “children with autism” to reflect the diverse preferences within the autism community and promote inclusivity.

Historically, “Asperger’s disorder” was a separate diagnosis. However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) consolidated Asperger’s into autism spectrum disorder. While technically outdated, some people still use “Asperger’s” to describe autistic individuals who typically do not have significant language or intellectual impairments.

The Diagnostic Process for Autism in Children

Diagnosing autism spectrum disorder can be complex due to its diverse presentation. Misdiagnosis is possible; children with ASD might be mistakenly diagnosed with ADHD, oppositional defiant disorder (ODD), or simply told there is “nothing wrong.” Conversely, some children may be incorrectly diagnosed with autism.

Initial Screening: Pediatricians and other healthcare providers often use screening tools as a first step to identify children who may be at risk for autism and require further evaluation. These screenings can involve parent questionnaires or brief assessments conducted by clinicians.

If a screening suggests the possibility of ASD, a comprehensive diagnostic evaluation by a trained autism specialist is essential. This evaluation should include:

Observation across settings: Assessing the child’s behavior in different environments to understand how they interact and communicate in various contexts.
Developmental history: Gathering information about the child’s developmental milestones and patterns from parents or caregivers through detailed interviews.
Autism-Specific Diagnostic Tools: Utilizing standardized assessments designed to identify autism characteristics, such as:
- Autism Diagnostic Observation Schedule, Second Edition (ADOS-2): A direct observation assessment with different modules tailored to various ages and developmental levels. It assesses social communication and repetitive behaviors during structured and semi-structured tasks.
- Autism Diagnostic Interview-Revised (ADI-R): A comprehensive parent interview that gathers detailed information about the child’s current and past behaviors relevant to autism diagnostic criteria.

Comprehensive evaluations should also assess other developmental domains to provide a complete picture of the child’s strengths and challenges. This includes evaluating:

Cognitive Abilities: Assessing intellectual functioning using tools like the Differential Ability Scales, Second Edition (DAS-II) or Mullen Scales of Early Learning (MSEL).
Adaptive Behavior: Evaluating daily living skills, communication, and socialization using instruments like the Vineland Adaptive Behavior Scales, Third Edition (VABS-3).
Language and Motor Skills: Assessing both receptive and expressive language skills, as well as fine and gross motor skills, using tools like the DAS-II or MSEL.

It is vital to seek evaluation from mental health professionals with specific expertise in diagnosing autism spectrum disorder. Their experience and knowledge are crucial for accurate assessment and diagnosis.

Learn more about autism diagnosis here.

Reasons for Delayed Autism Diagnoses

Early intervention is critical for children with autism, as it significantly improves long-term outcomes. Ideally, intervention should begin in toddlerhood. However, delays in diagnosis are common, preventing children from accessing timely support.

Often, initial diagnoses may focus on related but distinct conditions, such as speech-language impairments, ADHD, or sensory processing issues. It may not be until the increased social and academic demands of school, around age 5 or 6, that autism is recognized.

It’s important to note that co-occurrence is common. It’s estimated that a significant percentage of autistic children also have ADHD, and sensory sensitivities are so prevalent in autism that they are considered a core feature of the disorder.

The problem arises when clinicians and parents stop investigating once an initial diagnosis is made, overlooking symptoms that point towards autism. This diagnostic overshadowing can lead to children receiving treatment for ADHD or sensory issues while missing out on autism-specific interventions that could have a more profound impact on their development and quality of life.

Read more about the reasons behind delayed autism diagnoses.

Why Autism is Often Missed in Girls

Girls are diagnosed with autism significantly less often than boys, with boys receiving diagnoses at over four times the rate of girls. While autism may be inherently more prevalent in males, underdiagnosis in girls is a serious concern. This disparity is often attributed to how autism can present differently in girls, leading to them being overlooked. Reasons for missed or delayed diagnosis in girls include:

Subtle symptom presentation: Girls with autism may exhibit less outwardly disruptive behaviors than boys. They are often socialized to be compliant and cooperative, which may mask their struggles and reduce referrals for evaluation.
Social interests that appear “typical”: While boys with autism may have intense interests in subjects like trains or technology, girls’ special interests might align more with perceived “girlish” interests, such as animals or popular culture, making them seem less unusual.
Social masking: Girls are often more adept at social mimicry and may learn to imitate neurotypical social behaviors, including making eye contact and engaging in basic social interactions. This “masking” can make their social communication difficulties less obvious, leading them to “pass” as neurotypical, sometimes until adolescence or adulthood.
Misdiagnosis of mental health conditions: Girls struggling with undiagnosed autism are at increased risk for developing anxiety, depression, and low self-esteem. Clinicians may focus on these mental health symptoms without exploring underlying autism.

Learn more about why autism is often undiagnosed in girls.

Communicating Your Child’s Autism Diagnosis to Family and Friends

Sharing an autism diagnosis with family and friends can be challenging. While autism awareness has increased, misinformation persists. Family members may not fully understand the nature of autism or recognize the challenges your child faces, especially if their difficulties are not immediately apparent. However, building a supportive network is vital for your child’s well-being, making it important to communicate effectively with loved ones.

Focus on Observable Behaviors: Begin by describing specific behaviors they may have already noticed, such as limited eye contact, frequent meltdowns, or difficulties interacting with other children. Grounding the explanation in concrete examples helps others understand the realities of your child’s experience.

Explain the Basics of Autism:

Social Communication Challenges: Emphasize that autism involves difficulties with social skills and communication.
Restricted and Repetitive Behaviors: Explain the presence of repetitive behaviors and focused interests as core features of autism.
Neurodevelopmental Nature: Clarify that autism is a neurodevelopmental condition, affecting brain development.
Lifelong Condition: Acknowledge that autism is a lifelong condition, requiring ongoing understanding and support.
Prenatal Origins: Share the current scientific understanding that autism begins before birth.
Not Caused by Vaccines or Parenting: Debunk common myths by explicitly stating that vaccines and poor parenting do not cause autism.
Spectrum Disorder: Explain that autism is a spectrum, meaning it affects individuals differently with varying levels of support needs.
Access to Support: Highlight that a diagnosis opens doors to therapies and services that can be transformative for your child’s development and well-being.

Read more about talking to family and friends about your child’s autism diagnosis.

Medical Conditions That Can Mimic or Co-Occur with Autism Behaviors

It’s crucial to consider underlying medical conditions when assessing behaviors in children with autism, particularly those who are nonverbal. Medical issues are sometimes overlooked, and certain behaviors may actually be responses to pain or discomfort from treatable medical or dental problems. Children with ASD may struggle to communicate the source of their pain or discomfort effectively.

Common behaviors that might be misinterpreted as autism-related but could have medical causes include:

Gulping or grimacing
Chest or stomach tapping
Abdomen pressing
Sleep refusal
Increased repetitive movements
Self-injurious behaviors like head-banging or self-hitting
Increased meltdowns
Aggression

If you observe these behaviors, consulting your child’s physician is advisable to rule out or identify potential medical conditions, such as:

Painful acid reflux
Constipation
Allergies
Eczema
Tonsillitis
Menstrual cramps
Ear infections
Urinary tract infections
Bone fractures

Learn more about medical causes behind autism-like behaviors.

Sensory Processing Issues in Autism

Sensory processing issues are highly prevalent in autism and often become apparent in toddlerhood. Parents may notice unusual reactions to sensory input, such as:

Aversion to noises, bright lights, certain textures of clothing, or specific smells.
Clumsiness or difficulties with motor skills like climbing stairs or fine motor tasks.
Extreme reactions to sensory experiences, including:
- Screaming when face gets wet
- Tantrums during dressing
- Unusually high or low pain tolerance
- Crashing into objects or people
- Putting non-food items in mouth

These behaviors can indicate sensory processing issues, where the brain has difficulty processing and integrating sensory information. Children may be:

Hypersensitive (over-responsive): Becoming overwhelmed by typical sensory input, leading to avoidance, distress, or meltdowns.
Hyposensitive (under-responsive): Seeking out intense sensory experiences to increase input, resulting in behaviors like bumping, rubbing, or repetitive movements.

Sensory processing issues are now recognized as a common symptom of autism. When sensory input is overwhelming or poorly processed, children can experience distress, anxiety, and meltdowns, or may try to escape to less stimulating environments.

In many cases, sensory sensitivities tend to lessen in severity as children grow older. Occupational therapy and environmental modifications can significantly help manage sensory challenges and reduce their impact over time.

Read more about sensory processing issues in autism.

Rigid Eating Habits and Picky Eating in Autistic Children

Picky eating and rigid eating habits are frequently observed in children with autism. When mealtime challenges arise, it’s important to first consult a pediatric gastroenterologist experienced with autism to rule out underlying medical issues. Other factors contributing to eating problems include:

Sensory Sensitivities: Autistic children often have strong preferences for specific food textures, tastes, or smells. They may favor very soft foods (yogurt, purees) or highly crunchy foods, significantly limiting their food choices.
Oral Motor Skills: Children who primarily eat soft foods may have underdeveloped oral motor muscles needed for chewing tougher textures like meat. Avoidance of these textures can create a cycle of limited muscle development and food refusal.
Mealtime Behavior and Safety: Challenges can extend to behavior at the table, including difficulty sitting for meals, throwing utensils, unsafe behaviors, or anxiety around eating.

For families struggling with rigid eating habits, consulting a feeding specialist is beneficial. This might include a child psychologist, speech-language pathologist, or occupational therapist who can address sensory, behavioral, and motor aspects of eating.

Learn more about autism and picky eating.

Wandering and Elopement in Children with Autism

Wandering or elopement—impulsively leaving a safe space without warning—is a significant safety concern for children with autism. This behavior can have serious consequences, including accidental injury or drowning, as children may be drawn to water or other dangers without a fully developed sense of risk.

Wandering is sometimes attributed to an impaired sense of danger. Other explanations include:

Goal-directed wandering: Seeking out a favorite place or object of interest.
Escape-motivated wandering: Attempting to escape a stressful situation or overwhelming sensory stimuli.

Research indicates that approximately half of autistic children between ages 4 and 10 wander, a rate significantly higher than their neurotypical siblings. While it peaks at age 4, wandering remains a concern for older children as well.

Resources like the Autism Wandering Awareness Alerts Response and Education (AWAARE) Collaboration provide valuable advice for families on home safety measures and strategies to prevent wandering.

Repetitive Movements and Stimming in Autism

Repetitive movements, often called stimming (short for self-stimulatory behavior), are common in autism. These movements can include hand flapping, rocking, blinking, pacing, and repeating sounds or words.

“Stereotyped or repetitive motor movements, use of objects, or speech” is a diagnostic criterion for ASD. Stimming may serve various functions:

Sensory regulation: To increase or decrease sensory input.
Emotional regulation: To manage emotions like excitement, frustration, or anxiety.

Stimming becomes problematic if it interferes with a child’s learning, social interaction, or daily activities. Instead of trying to suppress stimming, it’s generally recommended to focus on developing communication skills and engaging activities that can reduce reliance on stimming as a primary coping mechanism.

Learn more about autism and stimming.

Challenges with Transitions in Autism

Transitions, or changes in activity or routine, can be particularly difficult for children with autism. The need for sameness and routine can be a way of creating predictability and managing an often overwhelming world. Unexpected changes can trigger significant distress, refusal to transition, or challenging behaviors like tantrums.

Strategies to support transitions include:

Structured Routines: Establishing predictable daily routines, especially for potentially challenging times like bedtime or school mornings.
Visual Schedules: Using visual aids to represent the sequence of activities and prepare children for upcoming changes.
Transition Warnings: Providing advance notice before transitions, using timers or countdowns to prepare for changes.
Positive Reinforcement: Rewarding successful transitions with praise, stickers, or access to preferred activities or items.

While these strategies are generally helpful, individualized approaches may be necessary for some children with autism.

Read more about why transitions are challenging for children with autism.

Evidence-Based Behavioral Treatments for Autism

Behavioral therapies are designed to help children with autism develop essential skills and reduce challenging behaviors that interfere with learning and social engagement. Several effective treatment approaches are commonly used:

Applied Behavior Analysis (ABA)

Description: ABA is a widely researched and evidence-based therapy that has demonstrated effectiveness in helping autistic children acquire new skills and reduce problematic behaviors across the autism spectrum.

How it Works: ABA principles are based on reinforcement. Behaviors that are reinforced (followed by a reward) are more likely to increase, while behaviors that are not reinforced are likely to decrease. ABA therapy is highly individualized and tailored to each child’s needs and goals.

Types of ABA:

Discrete Trial Training (DTT): A highly structured, one-on-one ABA method, often used with younger children. It involves breaking down skills into small, discrete steps and using prompts and rewards to teach each step.
Pivotal Response Treatment (PRT): A more naturalistic, child-led ABA approach that focuses on “pivotal” developmental areas like motivation, response to multiple cues, self-management, and initiation. PRT uses natural reinforcers directly related to the behavior being taught.
Naturalistic Developmental Behavioral Interventions (NDBIs): These interventions, such as Early Start Denver Model (ESDM) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER), integrate ABA principles within natural, play-based social interactions. They use natural reinforcers and target multiple developmental goals within a single activity.

Learn more about Applied Behavior Analysis (ABA) therapy.

Functional Communication Training (FCT)

Description: FCT teaches individuals with autism effective ways to communicate their wants and needs using language, signs, or visual aids.

How it Works: FCT focuses on teaching “functional” communication skills to replace challenging behaviors that may be used to communicate needs. Positive reinforcement is used to encourage communication. Initially, therapists prompt the child to use the communication method (word, sign, picture) and provide the desired item or activity as a reward. Prompts are gradually faded as the child learns to communicate independently.

Read more about Functional Communication Training (FCT).

Verbal Behavior (VB) Approach

Description: The Verbal Behavior approach, rooted in ABA, emphasizes teaching language and other skills in a child-centered, motivating learning environment.

How it Works: VB therapy teaches language by linking words to their function or purpose. Therapists create a positive learning environment by associating it with enjoyable activities and items. Initially, the focus is on teaching children to request (mand) desired items or activities. Once requesting is established, other language skills like labeling and answering questions are gradually introduced.

Parent Training for Disruptive Behaviors

Description: Parent training programs, such as those from the RUBI Autism Network, are evidence-based interventions that teach parents ABA-based strategies to manage challenging behaviors in children with ASD.

How it Works: Therapists work with parents to teach techniques like prevention strategies, establishing routines, positive reinforcement, compliance training, and functional communication training. Parents learn to implement these strategies at home to reduce challenging behaviors like aggression, tantrums, and noncompliance and promote more adaptive behaviors.

Program for the Education and Enrichment of Relational Skills (PEERS®)

Description: PEERS® is a social skills intervention specifically designed for adolescents and young adults with social challenges, including those with ASD.

How it Works: Delivered in a group format for both youth and parents, PEERS® teaches practical social skills such as initiating and maintaining conversations, choosing appropriate friends, managing conflict, and handling bullying. Parent groups provide support and coaching to reinforce skills learned in the youth groups.

Facing Your Fears (FYF)

Description: Facing Your Fears is a group-based cognitive behavioral therapy (CBT) program designed to address anxiety in children and adolescents with ASD.

How it Works: FYF helps children identify their anxieties and develop coping strategies. Children learn to recognize anxious thoughts, challenge them, and practice coping mechanisms in a supportive group setting. Separate parent groups provide education and strategies for supporting their child’s anxiety management.

Occupational Therapy (OT)

Description: Occupational therapy helps children develop skills needed for daily living activities or “occupations.”

How it Works: Occupational therapists work with children to improve a range of skills, including fine and gross motor skills, feeding skills, sensory processing, and self-help skills like dressing, hygiene, and toileting. OT interventions are tailored to address individual needs and improve participation in everyday activities.

Learn more about Occupational Therapy (OT).

Medication for Children with Autism Spectrum Disorder

There is no medication that directly treats the core symptoms of autism itself. However, medication may be used to manage co-occurring conditions or specific symptoms like aggression, irritability, anxiety, depression, or ADHD that can significantly impact functioning. Careful monitoring by a physician is crucial, especially when children have multiple diagnoses or are taking multiple medications.

Medication for Behavior Problems:

Risperidone (Risperdal): An antipsychotic medication approved by the FDA to treat irritability, aggression, and self-injurious behaviors in autistic children. While effective in reducing severe behavior problems, Risperdal has potential side effects including weight gain, metabolic changes, and neurological issues. It’s essential to consider behavioral therapies as primary interventions and use medication judiciously when necessary and with close medical supervision.

Read more about Risperdal and its use in autism.

Medication for Co-occurring ADHD:

Stimulant Medications: Commonly prescribed for ADHD, stimulants can help improve attention and reduce hyperactivity and impulsivity in autistic children who also have ADHD. Finding the right stimulant type and dosage may require careful titration and monitoring due to individual differences in medication response.
Non-Stimulant Medications: May be considered if stimulants are ineffective or cause intolerable side effects.

Medication for Co-occurring Depression:

Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants commonly used to treat depression in individuals with and without autism.
Atypical Antidepressants: Other types of antidepressants may also be prescribed.
Therapy for Depression: Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness-based therapies are evidence-based treatments for depression that can be used alongside or instead of medication.

Medication for Co-occurring Anxiety:

Selective Serotonin Reuptake Inhibitors (SSRIs): Often the first-line medication for anxiety disorders in autistic individuals.
Benzodiazepines: May be used in some cases for severe anxiety, but are typically prescribed cautiously due to the risk of tolerance and dependence.
Cognitive Behavioral Therapy (CBT): Considered the gold standard treatment for anxiety disorders. CBT techniques help individuals identify and manage anxiety symptoms. Facing Your Fears (FYF) is a CBT program specifically adapted for children with autism and anxiety. Medication may be used to reduce anxiety to a level where therapy becomes more effective.