Autism Spectrum Disorder

Autism is called a spectrum disorder because symptoms and behaviors are different for every child.

The wide range of characteristics or symptoms of ASD fall into two main categories.

The first category is deficits in communications and social interactions. This includes:

• Deficits in social-emotional reciprocity. This means a child does not respond to his or her name, does not share emotions with others (such as smiling back when someone smiles at him or her) and seems to be in his or her own world.
• Deficits in nonverbal communicative behaviors used for social interaction. This is when a child does not make eye contact and does not respond to body language. He or she may have limited facial expressions and a voice that sounds different.
• Deficits in developing, maintaining and understanding relationships. This is when a child struggles to make friends and often does not know how to fit in. Pretend play can be difficult. He or she may prefer playing alone.

The second category is restricted, repetitive patterns of behavior, interests or activities. This includes:

• Stereotyped or repetitive motor movements, use of objects or speech. Children with ASD may make a repeated motion such as rocking back and forth, or they may repeat specific phrases at inappropriate times. Instead of playing with their toys, children with ASD tend to line them up. Some children may use formal adult speech while others may make unexpected noises.
• Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior. Children with ASD prefer things to stay the same. They may want the same foods for every meal or continuously repeat the same play routines. Changes in routine or transition from one activity to another are difficult, often leading to a meltdown.
• Highly restricted, fixated interests. In some cases, children zero in on one interest. For example, they may learn everything there is to know about dinosaurs and play with and talk about dinosaurs all the time.
• Reactivity to sensory input. Children with ASD can experience sensory information (sounds, smells, touch, tastes, sights and balance) differently.

• Hyper-reactivity. Children react to things that do not bother others such as loud noises or certain lights.
• Hypo-reactivity. Children may show no reaction to pain or other stimuli, or they may crave sensory input such as being wrapped tightly in a blanket or spinning on swings.

Children with ASD may experience all of the symptoms from both categories, or they may show many characteristics from one category and just a few from another.

Autism spectrum disorder may occur with other conditions such as:

• Language impairment (how children understand and speak)
• Intellectual and cognitive disability
• Attention-deficit/hyperactivity disorder
• Anxiety
• Depression
• Learning disabilities

Many parents are caught by surprise when they learn their child has autism. Families often seek help from their child’s doctor because their child has behavior problems, has trouble in school or is not responding to normal cues.

An autism diagnosis can seem overwhelming at first. With regular therapy and treatment and the right supports, many children perform well in school and participate in childhood activities.

Diagnosis of Autism Spectrum Disorder

Doctors at Riley at IU Health will study your child's behavior to make a diagnosis of autism spectrum disorder. This condition cannot be diagnosed with a blood test or brain scan. Doctors from the following specialty departments at Riley at IU Health may be involved in making the diagnosis:

• Child Development
• Psychiatry
• Developmental Pediatrics
• Medical & Molecular Genetics
• Neurology

Doctors generally use the following to evaluate a child for autism spectrum disorder:

• Medical history. The specialists will obtain a thorough family medical history as well as a complete medical history for your child. The doctor will talk with you about your child’s behavior, including how it compares to the behavior of his or her siblings and/or peers.
• Clinical evaluation. The specialists will examine your child’s body and basic sensory functions to check for any abnormalities. During the exam, the specialists will pay attention to how your child interacts with you and others and how he or she responds to questions or the chance to look at a new toy.
• Psychological testing. In some cases, a child’s behaviors make diagnosis of autism spectrum disorder obvious. In other cases, more formalized testing is needed to make a diagnosis or determine if other factors are contributing to a child’s actions. These tests may seem like the doctor or psychologist is playing with your child, but the interactions are designed to put certain demands on your child to see how he or she responds.