3/17/2017 NIMH Autism Spectrum Disorder

TheNationalInstituteofMentalHealth:https://www.nimh.nih.gov/health/topics/autismspectrumdisorders
asd/index.shtml

TheNationalInstituteofMentalHealth:www.nimh.nih.gov

AutismSpectrumDisorder
Definition
Autismspectrumdisorder(ASD)isthenameforagroupofdevelopmentaldisorders.ASDincludesa
widerange,aspectrum,ofsymptoms,skills,andlevelsofdisability.

PeoplewithASDoftenhavethesecharacteristics:

Ongoingsocialproblemsthatincludedifficultycommunicatingandinteractingwithothers
Repetitivebehaviorsaswellaslimitedinterestsoractivities
Symptomsthattypicallyarerecognizedinthefirsttwoyearsoflife
Symptomsthathurttheindividualsabilitytofunctionsocially,atschoolorwork,orotherareas
oflife

Somepeoplearemildlyimpairedbytheirsymptoms,whileothersareseverelydisabled.Treatmentsand
servicescanimproveapersonssymptomsandabilitytofunction.Familieswithconcernsshouldtalkto
theirpediatricianaboutwhattheyveobservedandthepossibilityofASDscreening.Accordingtothe
CentersforDiseaseControlandPrevention(CDC)around1in68childrenhasbeenidentifiedwith
someformofASD.

WhatisthedifferencebetweenAspergerssyndromeandASD?

Inthepast,AspergerssyndromeandAutisticDisorderwereseparatedisorders.Theywerelistedas
subcategorieswithinthediagnosisofPervasiveDevelopmentalDisorders.However,thisseparation
haschanged.ThelatesteditionofthemanualfromtheAmericanPsychiatricAssociation,theDiagnostic
andStatisticalManualofMentalDisorders(DSM5),doesnothighlightsubcategoriesofalarger
disorder.Themanualincludestherangeofcharacteristicsandseveritywithinonecategory.People
whosesymptomswerepreviouslydiagnosedasAspergerssyndromeorAutisticDisorderarenow
includedaspartofthecategorycalledAutismSpectrumDisorder(ASD).

SignsandSymptoms
ParentsordoctorsmayfirstidentifyASDbehaviorsininfantsandtoddlers.Schoolstaffmayrecognize
thesebehaviorsinolderchildren.NotallpeoplewithASDwillshowallofthesebehaviors,butmost
willshowseveral.Therearetwomaintypesofbehaviors:restricted/repetitivebehaviorsandsocial
communication/interactionbehaviors.

Restrictive/repetitivebehaviorsmayinclude:
Repeatingcertainbehaviorsorhavingunusualbehaviors
Havingoverlyfocusedinterests,suchaswithmovingobjectsorpartsofobjects
Havingalasting,intenseinterestincertaintopics,suchasnumbers,details,orfacts.

Socialcommunication/interactionbehaviorsmayinclude:

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Gettingupsetbyaslightchangeinaroutineorbeingplacedinaneworoverlystimulatingsetting
Makinglittleorinconsistenteyecontact
Havingatendencytolookatandlistentootherpeoplelessoften
Rarelysharingenjoymentofobjectsoractivitiesbypointingorshowingthingstoothers
Respondinginanunusualwaywhenothersshowanger,distress,oraffection
Failingto,orbeingslowto,respondtosomeonecallingtheirnameorotherverbalattemptsto
gainattention
Havingdifficultieswiththebackandforthofconversations
Oftentalkingatlengthaboutafavoritesubjectwithoutnoticingthatothersarenotinterestedor
withoutgivingothersachancetorespond
Repeatingwordsorphrasesthattheyhear,abehaviorcalledecholalia
Usingwordsthatseemodd,outofplace,orhaveaspecialmeaningknownonlytothosefamiliar
withthatpersonswayofcommunicating
Havingfacialexpressions,movements,andgesturesthatdonotmatchwhatisbeingsaid
Havinganunusualtoneofvoicethatmaysoundsingsongorflatandrobotlike
Havingtroubleunderstandinganotherpersonspointofvieworbeingunabletopredictor
understandotherpeoplesactions.

PeoplewithASDmayhaveotherdifficulties,suchasbeingverysensitivetolight,noise,clothing,or
temperature.Theymayalsoexperiencesleepproblems,digestionproblems,andirritability.

ASDisuniqueinthatitiscommonforpeoplewithASDtohavemanystrengthsandabilitiesinaddition
tochallenges.

Strengthsandabilitiesmayinclude:

HavingaboveaverageintelligencetheCDCreports46%ofASDchildrenhaveaboveaverage
intelligence
Beingabletolearnthingsindetailandrememberinformationforlongperiodsoftime
Beingstrongvisualandauditorylearners
Excelinginmath,science,music,orart.

DiagnosingASD
DoctorsdiagnoseASDbylookingatachildsbehavioranddevelopment.YoungchildrenwithASDcan
usuallybereliablydiagnosedbyagetwo.

OlderchildrenandadolescentsshouldbeevaluatedforASDwhenaparentorteacherraisesconcerns
basedonwatchingthechildsocialize,communicate,andplay.

DiagnosingASDinadultsisnoteasy.Inadults,someASDsymptomscanoverlapwithsymptomsof
othermentalhealthdisorders,suchasschizophreniaorattentiondeficithyperactivitydisorder(ADHD).
However,gettingacorrectdiagnosisofASDasanadultcanhelpapersonunderstandpastdifficulties,
identifyhisorherstrengths,andobtaintherightkindofhelp.

Diagnosisinyoungchildrenisoftenatwostageprocess:

Stage1:GeneralDevelopmentalScreeningDuringWellChildCheckups

Everychildshouldreceivewellchildcheckupswithapediatricianoranearlychildhoodhealthcare
provider.TheCentersforDiseaseControlandPrevention(CDC)recommendsspecificASDscreening
bedoneatthe18and24monthvisits.

EarlierscreeningmightbeneededifachildisathighriskforASDordevelopmentalproblems.Thoseat
highriskincludechildrenwho:
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Haveasister,brother,orotherfamilymemberwithASD
HavesomeASDbehaviors
Werebornpremature,orearly,andatalowbirthweight.

Parentsexperiencesandconcernsareveryimportantinthescreeningprocessforyoungchildren.
Sometimesthedoctorwillaskparentsquestionsaboutthechildsbehaviorsandcombinethis
informationwithhisorherobservationsofthechild.Readmoreaboutscreeninginstrumentsonthe
CDCwebsite.

Childrenwhoshowsomedevelopmentalproblemsduringthisscreeningprocesswillbereferredfor
anotherstageofevaluation.

Stage2:AdditionalEvaluation

Thisevaluationiswithateamofdoctorsandotherhealthprofessionalswithawiderangeofspecialties
whoareexperiencedindiagnosingASD.Thisteammayinclude:

Adevelopmentalpediatricianadoctorwhohasspecialtraininginchilddevelopment
Achildpsychologistand/orchildpsychiatristadoctorwhoknowsaboutbraindevelopmentand
behavior
Aspeechlanguagepathologistahealthprofessionalwhohasspecialtrainingincommunication
difficulties.

Theevaluationmayassess:

Cognitivelevelorthinkingskills
Languageabilities
Ageappropriateskillsneededtocompletedailyactivitiesindependently,suchaseating,dressing,
andtoileting.

BecauseASDisacomplexdisorderthatsometimesoccursalongwithotherillnessesorlearning
disorders,thecomprehensiveevaluationmayinclude:

Bloodtests
Hearingtest

Theoutcomeoftheevaluationwillresultinrecommendationstohelpplanfortreatment.

Diagnosisinolderchildrenandadolescents
OlderchildrenwhoseASDsymptomsarenoticedafterstartingschoolareoftenfirstrecognizedand
evaluatedbytheschoolsspecialeducationteam.Theschoolsteammayreferthesechildrentoahealth
careprofessional.

Parentsmaytalkwithapediatricianabouttheirchildssocialdifficultiesincludingproblemswithsubtle
communication.Thesesubtlecommunicationissuesmayincludeunderstandingtoneofvoice,facial
expressions,orbodylanguage.Olderchildrenmayhavetroubleunderstandingfiguresofspeech,humor,
orsarcasm.Parentsmayalsofindthattheirchildhastroubleformingfriendshipswithpeers.The
pediatriciancanreferthechildforfurtherevaluationandtreatment.

Diagnosisinadults

AdultswhonoticethesignsandsymptomsofASDshouldtalkwithadoctorandaskforareferralforan
ASDevaluation.WhiletestingforASDinadultsisstillbeingrefined,adultscanbereferredtoa
psychologistorpsychiatristwithASDexpertise.Theexpertwillaskaboutconcerns,suchassocial
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interactionandcommunicationchallenges,sensoryissues,repetitivebehaviors,andrestrictedinterests.
Informationabouttheadultsdevelopmentalhistorywillhelpinmakinganaccuratediagnosis,soan
ASDevaluationmayincludetalkingwithparentsorotherfamilymembers.

RiskFactors
ScientistsdontknowtheexactcausesofASD,butresearchsuggeststhatgenesandenvironmentplay
importantroles.

Riskfactorsinclude:

GenderboysaremorelikelytobediagnosedwithASDthangirls
HavingasiblingwithASD
Havingolderparents(amotherwhowas35orolder,and/orafatherwhowas40orolderwhen
thebabywasborn)
Geneticsabout20%ofchildrenwithASDalsohavecertaingeneticconditions.Those
conditionsincludeDownsyndrome,fragileXsyndrome,andtuberoussclerosisamongothers.

Inrecentyears,thenumberofchildrenidentifiedwithASDhasincreased.Expertsdisagreeabout
whetherthisshowsatrueincreaseinASDsincetheguidelinesfordiagnosishavechangedinrecent
yearsaswell.Also,manymoreparentsanddoctorsnowknowaboutthedisorder,soparentsaremore
likelytohavetheirchildrenscreened,andmoredoctorsareabletoproperlydiagnoseASD,evenin
adulthood.

TreatmentsandTherapies
EarlytreatmentforASDandpropercarecanreduceindividualsdifficultieswhilehelpingthemlearn
newskillsandmakethemostoftheirstrengths.Theverywiderangeofissuesfacingthoseonthe
spectrummeansthatthereisnosinglebesttreatmentforASD.Workingcloselywithadoctororhealth
careprofessionalisanimportantpartoffindingtherighttreatmentprogram.Therearemanytreatment
options,socialservices,programs,andotherresourcesthatcanhelp.

Herearesometips.

Keepadetailednotebook.Recordconversationsandmeetingswithhealthcareprovidersand
teachers.Thisinformationhelpswhenitstimetomakedecisions.
Recorddoctors'reportsandevaluationsinthenotebook.Thisinformationmayhelpanindividual
qualifyforspecialprograms.
Contactthelocalhealthdepartment,school,orautismadvocacygroupstolearnabouttheirspecial
programs.
Talkwithapediatrician,schoolofficial,orphysiciantofindalocalautismexpertwhocanhelp
developaninterventionplanandfindotherlocalresources.
Findanautismsupportgroup.Sharinginformationandexperiencescanhelpindividualswith
ASDand/ortheircaregiverslearnaboutoptions,makedecisions,andreducestress.

Medication

AdoctormayusemedicationtotreatsomedifficultiesthatarecommonwithASD.Withmedication,a
personwithASDmayhavefewerproblemswith:

Irritability
Aggression
Repetitivebehavior
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Hyperactivity
Attentionproblems
Anxietyanddepression

JoinaStudy
Clinicaltrialsareresearchstudiesthatlookatnewwaystoprevent,detect,ortreatdiseasesand
conditions.Duringclinicaltrials,treatmentsmightbenewdrugsornewcombinationsofdrugs,new
psychotherapiesordevices,ornewwaystouseexistingtreatments.Thegoalofclinicaltrialsisto
determineifanewtestortreatmentworksandissafe.Althoughindividualparticipantsmaybenefit
frombeingpartofaclinicaltrial,participantsshouldbeawarethattheprimarypurposeofaclinicaltrial
istogainnewscientificknowledgesothatothersmaybebetterhelpedinthefuture.

PleaseNote:Decisionsaboutwhethertoparticipateinaclinicaltrial,andwhichonesarebestsuitedfor
agivenindividual,arebestmadeincollaborationwithyourlicensedhealthprofessional.

ClinicalTrialsatNIMH/NIH
ScientistsattheNIMHcampusconductresearchonnumerousareasofstudy,includingcognition,
genetics,epidemiology,andpsychiatry.ThestudiestakeplaceattheNIHClinicalCenterinBethesda,
Marylandandusuallyrequireregularvisits.Afteraninitialphoneinterviewtoseeifanyoftheclinical
trialsrecruitingsubjectsareagoodmatchforyou,youwillcometoanappointmentattheclinicand
meetwithaclinician.VisittheNIMHClinicalTrialsParticipantsorJoinaStudyformore
information.

HowDoIFindaClinicalTrialNearMe?

Tofindaclinicaltrialnearyou,youcanvisitClinicalTrials.gov.Thisisasearchableregistryandresults
databaseoffederallyandprivatelysupportedclinicaltrialsconductedintheUnitedStatesandaround
theworld.ClinicalTrials.govgivesyouinformationaboutatrial'spurpose,whomayparticipate,
locations,andcontactinformationformoredetails.Thisinformationshouldbeusedinconjunctionwith
advicefromyourhealthprovider.

LearnMore
FreeeBooksandBrochures
AutismSpectrumDisorder:Thisbrochureinformsparentsandadultsontherangeofsymptoms
ofautismspectrumdisorders(ASD),includingsocialimpairment,communicationsissues,and
repetitivebehaviors.

ResearchandStatistics

TheNextStepsforASDResearch

Manyrecentresearchstudieshavefocusedonfindingtheearliestsignsofautismspectrum
disorder(ASD).Thesestudiesaimtohelpdoctorsdiagnosechildrenatayoungeragesotheycan
getneededinterventionsasquicklyaspossible.
NIHJoinsPublicPrivatePartnershiptoFundResearchonAutismBiomarkers
NIMHhasawardedanumberofgrantsforservicesresearch.
NationalDatabaseforAutismResearch(NDAR)isanNIHfundeddatabankthatishelpingto
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speedprogressinASDresearch.NDARisdedicatedtodatasharing,dataharmonizing,and
reportingresearchresults.NDARisaplatformforthescientificcommunityandservesasaportal
tootherresearchrepositories,allowingforthecollectionandsecondaryanalysisofdata.
VisitNIMHsAutismNewspageforthelatestonASD

FederalResources
TheEuniceKennedyShriverNationalInstituteofChildHealthandHumanDevelopment
TheCentersforDiseaseControlandPrevention
MEDLINEplus,theNationalLibraryofMedicine
MEDLINEplus,enEspaol,BibliotecaNacionaldeMedicina
NationalInstituteofNeurologicalDisordersandStroke
NationalInstituteonDeafnessandOtherCommunicationDisorders

JournalArticlesorReports

PubMed.govoffersalistofthemostcurrentjournalarticleson:

AutismSpectrumDisorder
Aspergerssyndrome,whichispartofAutismSpectrumDisorder

LastRevised:October2016

Unlessotherwisespecified,NIMHinformationandpublicationsareinthepublicdomainandavailable
forusefreeofcharge.CitationoftheNIMHisappreciated.PleaseseeourCitingNIMHInformation
andPublicationspageformoreinformation.

https://www.nimh.nih.gov/health/topics/autismspectrumdisordersasd/index.shtml 6/6