Pediatric Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects many areas of functioning. It is defined by difficulties with social communication and interaction skills, and the presence of restricted, repetitive patterns of behavior or interest.

Researchers don’t know what causes ASD. It may be caused by certain genes. A child with ASD may also have differences in brain structure or with certain chemicals in the brain, though many do not. Researchers do know that ASD is not caused by what a parent does to raise a child.

Much less commonly, other things that may cause ASD include:

• Being exposed to toxins in the environment before or after birth
• Problems during delivery
• Infections before birth

Scientific evidence has strongly refuted the theory that the MMR (measles, mumps, rubella) vaccine or preservatives used in vaccines (thimerosal) cause ASD. Vaccines are an important part of maintaining your child’s health and do not lead to any increased risk of developing ASD.

No child will have all of these characteristics, but some common challenges include:

Social Interaction

• Wants to make friends but doesn’t know how
• Often doesn’t “get” social cues or understand unwritten social rules
• Doesn't usually make eye contact
• Doesn't always understand facial expressions and body language
• Makes inappropriate facial expressions
• Shows weaknesses in social responsivity, such as response to name

Communication

• May show delays in speech-language development and problems with grammar and syntax (e.g., pronoun errors) and use and understanding of figurative language
• Uses memorized phrases and quotes
• May not respond when spoken to, or struggle with conversation
• Speaks in an unusual tone of voice

Behavior and Play Skill

• Has over- or under-sensitive senses of smell, taste, sight, sound, pain or touch
• Shows repetitive body movements
• Shows limited imaginative play
• Strongly opposes change; likes routines
• Has intense tantrums
• Has narrow, intense interests
• Can't move off of a single topic of interest
• Is easily overwhelmed, even in small groups
• Notices details but can miss the “big picture”
• Repetitive play tendencies and unusual interest in objects

No child will have all of these characteristics, but some common strengths include: 

Social Interactions

• Has the same emotions as everyone else, but expresses them differently
• Wants to have friends, is loyal and kind to others
• Behaves with honesty and integrity
• Is genuine and open
• Is very willing to follow clear rules and schedules
• Has a charming innocence
• Often has a great sense of humor

Thinking

• Memorizes information, especially visual information, easily
• Has an unusually strong memory
• Pays strong attention to details, especially visual details
• Has an excellent sense of direction
• Works precisely, and is a perfectionist
• Thinks and solves problems logically
• Able to maintain focus on interesting activities
• May have passionate interests
• May have special talents

Autism spectrum disorder is diagnosed after a qualified professional has performed a complete diagnostic evaluation. The evaluation usually includes gathering a developmental history from the child’s parents, along with direct observation and assessment of the child’s behavior, social-communication skills and overall development. The evidence shows that ASD is best evaluated using a multidisciplinary approach, including psychology, psychiatry, developmental pediatrics, speech-language pathology, genetics and related disciplines. Evaluation for ASD should be completed as soon as concerns are evident. Diagnosis can occur in very young children and toddlers, but in some cases ASD may go unrecognized until later childhood or even adolescence or young adulthood.

According to the Centers for Disease Control and Prevention’s (CDC), all children should be screened for developmental delays and disabilities during regular well-child doctor visits at nine, 18, and 24 or 30 months. In addition, all children should be screened specifically for ASD during regular well-child doctor visits at 18 and 24 months. The CDC’s "Learn the Signs. Act Early" program aims to improve early identification of children with autism and other developmental disabilities so children and families can get the services and support they need. To help, the CDC has developed free, easy-to-use milestone trackers and other helpful information about early development. “Learn the Signs. Act Early” materials are available in English, Spanish and some other languages.

The treatment of children with ASD focuses on educational and language and psychological therapies. Even very young children can benefit from the language, cognitive-behavioral and developmental therapies designed specifically for children with social and communication problems and their families. Special teachers and classrooms can help older children improve their academic performance and social skills.

Regardless of their cognitive level, all children with ASD can learn – they simply learn differently than other children. It is important to contact your local school district before your child starts school to discuss how to meet your child’s learning needs. Children with ASD usually require special education supports and services. Infants up to age three and children are often eligible for early intervention services. Contact your local Child Find program to schedule an evaluation. Children over the age of three are often eligible for special education services. Contact your local school district for more information.

A team of professionals from across Children’s National will help evaluate your child and put a treatment plan together. You may also ask your doctor to review the plan. In some cases, medications will be indicated as part of your child’s treatment plan to improve attention and behavior regulation, or anxiety and mood. However, no medication has been found that directly targets core symptoms of ASD.

Don't forget that children with ASD have the same healthcare needs as any other child and benefit from the same healthcare and disease prevention services. Accessing healthcare services can be challenging for children with autism because of communication barriers and sensory sensitivities. Preparation and planning help make medical visits more familiar and comfortable for children and their caregivers. As children with autism learn to cooperate with medical visits, they are better able to participate in healthy living and they build trust with their healthcare providers that impacts their overall health for their lifetime. Children’s National has a variety of visual supports and other resources to help families prepare and plan for medical visits.