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Autism spectrum disorder

  • Autism is a neurodevelopmental disability that affects the way people communicate, process information and interact with the world.

    Autism Spectrum Disorder (ASD) is a term that describes a condition that presents in a wide range of ways, according to age and a child’s other abilities.

    The term has replaced terms such as Autistic Disorder, Asperger Syndrome and Pervasive Developmental Disorder that were once considered to be separate conditions. There are a number of adults with this condition who prefer to be referred to as “autistic people” whereas some families prefer the use of “child with autism” instead of the term “ASD”.

    Around 1-2 in 100 Australians are autistic and many people will have a connection with an autistic person. Often autism runs in families and family members may have similar traits or have already been diagnosed with ASD.

    Signs and symptoms - How does ASD present? 

    Children with ASD have difficulties in two main areas: social communication and repetitive behaviour. These present differently at different ages.  

    In infants and pre-schoolers, the first indicators of ASD may be an unusual or delayed pattern of communication and limited ability to interact or engage in play with others. Children may be slow to learn to speak or use words in an unusual way. They may rely less on nonverbal ways of communicating, such as eye contact, pointing and gestures. Carers may notice particular habits in play such as repeating the same action or body movement or exploring unusual aspects of toys.  Some children need a strict routine in order to feel comfortable. Others develop a special interest that dominates their play. A child can also start to show unusual sensitivity or lack of sensitivity to sounds, textures, pain or light. They may start to become fussy about food.

    Some children present with difficulties in primary school. They may be good at communicating their needs and ideas, but struggle to share information or join in conversations. Similarly, they may prefer to follow their own ideas in play rather than take up the ideas of others. Many children have an intense special interest or series of special interests. Changing from one activity to another and dealing with unexpected changes can be harder for children with ASD. Heightened sensory sensitivity can lead to discomfort in classrooms or noisy environments. Children may fall behind academically and find it difficult to be part of social groups such as sports or clubs.

    ASD may not be considered until adolescence or adulthood in some people. These people may have a history of difficulty making lasting friendships, experience high anxiety and have a very strong focus on particular ideas or interests. In others, a different diagnosis has been considered first but the person appears to have extra support needs. Common diagnoses that can overlap with ASD are Attention Deficit Disorder, language delay, Intellectual Disability, eating and anxiety disorders. Girls with ASD are more likely to present later.

    Each child with ASD is different, with a different pattern of strengths and difficulties. The most important next step is to try to develop a comprehensive understanding of a child’s needs and abilities.

    What other problems can arise for children with ASD?

    There are a range of conditions that may occur alongside ASD. They include:

    • Attention Deficit Hyperactivity Disorder (ADHD)
    • Global Developmental Delay
    • Intellectual Disability
    • Anxiety and mood disorders
    • Challenging behaviour
    • Learning difficulties
    • Motor co-ordination difficulties
    • Eating and sleeping difficulties.
    • Medical and genetic disorders such as Fragile X Syndrome

    These conditions require separate consideration and management strategies. They have an impact on the overall progress for the child with ASD 

    Support for children with ASD 

    Following assessment, the next step is to develop a plan for supporting a child’s development, so as to enhance their existing skills and help them develop strategies to overcome difficulties.  Regular reviews by a paediatrician can help carers determine what is working and what else can be offered to their child.

    The choice of support services is guided by the child and their carers but should be informed by existing evidence of what works. Therapies work best when the family can help the child to practise their skills in everyday life. The following supports are commonly suggested or considered:
    • Psychology: to help manage emotions and challenging behaviours and develop social understanding
    • Speech Pathology: to develop good communication skills and explore how language can be used for social engagement
    • Occupational Therapy: to help determine the pattern of sensory responses for a child and how the environment should be changed to help a child. They also work with children to develop joint play skills.

    Medication is not recommended for the core features of ASD, but may be useful if a child had one of the co-occurring conditions listed above. In children under 7 years of age, an application to the National Disability Insurance Scheme (NDIS) can be made as soon as a child is found to have difficulties in two or more areas of development. A child can receive services with this funding before having a formal diagnosis. In children over 7 years, there is a need to meet access requirements to obtain NDIS funding. A diagnostic report can help with eligibility. There are also private services and community-based services that may be appropriate. 

    When to see a doctor

    If there are concerns about a child’s behaviour or abilities, consult your family doctor and ask for a referral to a paediatrician, speech pathologist or specialist psychologist. Paediatricians and psychologists can investigate further and confirm a diagnosis of ASD or ask for further assessments to be performed. This often involves talking to people who know the child in the community such as teachers or preschool educators.  Some children need a multi-disciplinary team to finally decide on a diagnosis or to complete an assessment.  

    An important part of the assessment process involves developing a comprehensive understanding of the child’s strengths and difficulties. This will often involve formal testing of language and thinking skills. The paediatrician or psychologist involved in the assessment can guide this process. Having a clear plan and a good support network helps parents through this difficult and often confusing time. 

    Key points to remember

    • A child with ASD usually has difficulties in two main areas: social communication and repetitive behaviour. 
    • If you are concerned about your child, see your GP and ask for a referral to a specialist psychologist or pediatrician. Do not try to make a diagnosis yourself.
    • No two children with ASD show exactly the same signs and symptoms. Because the symptoms can vary so much, there is no single test for ASD.
    • Treatment varies for each child and family and usually changes over time.

    For more information

    Common questions our doctors are asked

    What will be my child’s future?
    It is impossible to predict how any particular child with ASD will develop. All children will learn and improve their skills as they get older. Much progress has been made in understanding the condition and tailoring services to meet the needs of children with ASD. 

    When do I talk to my child about their condition?
    Evidence suggests that children who learn about their autism early have better long term outcomes. The diagnosis can give a child a better understanding of why they face difficulties and give them a reason to be involved in supportive therapies. The decision is ultimately one for parents, as they need to feel comfortable before talking with their child. It can be useful to get the help of a therapist or doctor who knows you and your child. 

    Developed by The Royal Children's Hospital Specialist Autism Team. We acknowledge the input of RCH consumers and carers.

    Reviewed December 2021. 

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


Disclaimer  

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.