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Autism Spectrum Disorder

AMBULATORY CARE:

Autism spectrum disorder (ASD)

is a range of developmental conditions that can make social interaction and communication challenging. Spectrum means signs and symptoms can vary from one child to another and range from mild to severe. ASD includes autism disorder, Asperger syndrome, and pervasive developmental disorder, not otherwise specified. These terms are sometimes used interchangeably with ASD.

Call your local emergency number (911 in the US) if:

  • Your child has a seizure for the first time.

Seek care immediately if:

  • Your child is taking seizure medicine but still has a seizure.
  • Your child swallows something that is not food.

Call your child's doctor if:

  • Your child becomes depressed, or has new problems eating or sleeping.
  • Your child is eating poorly and is losing weight.
  • You have questions or concerns about your child's condition or care.

Signs and symptoms of ASD

The main signs and symptoms are social interaction problems and repeated behaviors. These prevent your child from functioning easily in social settings, such as school. Signs and symptoms are usually noticed during the early developmental period, often by 3 years. Your child may not reach expected milestones. He or she may reach milestones but then lose skills that were gained. ASD sometimes becomes noticeable later, when children need to interact with others at school. You may notice any of the following about your child, depending on the kind of ASD:

  • He or she does not interact with others. You may first notice your child does not respond to his or her name by 12 months. Your child may not point at objects or play pretend games such as dressing up. He or she may not want to make eye contact or play with other children. He or she may have trouble interpreting body language, gestures, or facial expressions.
  • Speech and language skills are different from children his or her age. Your child may have started speaking later or earlier than others his or her age. Language skills can range from no speech to highly developed speech. Your child may use large vocabulary words or complex sentences but speak in a halting, robotic tone. Your child may repeat words or phrases over and over. He or she may not know how to hold a conversation. For example, your child may say something not related to the topic discussed, or not respond at all.
  • Behavior is different from children his or her age. Your child may become upset by a change in routine or where an object is stored. He or she may have repeated motions, such as hand flapping, body rocking, or spinning in circles. He or she may have tantrums (crying or screaming without control). He or she may try to harm himself or herself. Your child may focus on parts of an object, such as wheels on a toy car. He or she may focus heavily on certain topics and show no interest in others. Your child may also have problems tolerating light, sound, textures, or tastes.

How ASD is diagnosed:

Tell your child's healthcare provider if your child has a family history of ASD. Your child will be checked for other conditions that may look like ASD or occur with it. Some examples are anxiety, depression, and ADHD. If tests rule out other causes, the following can help diagnose ASD:

  • Screening is part of a well child visit. Screening for ASD usually happens at 18 to 24 months. Your child's provider may recommend more screening if your child's risk for ASD is higher. Examples include having a brother or sister with ASD or showing signs that make ASD likely. Screening includes tests to check your child's ability to solve problems. Your child's coordination, vision, and hearing will be checked. His or her ability to tolerate sound, light, smells, tastes, and textures will be checked.
  • Your child's healthcare provider will ask if he or she reached developmental milestones. The following are examples of possible missed milestones:
    • By 12 months, your child may not respond to his or her name.
    • By 14 months, your child may not seem interested in people or objects. He or she may not point at objects or people.
    • By 18 months, your child may not want to be around other people. He or she may start spending time alone or not giving eye contact. He or she may not speak or may repeat words over and over. Answers may not relate to questions he or she is asked.
  • Healthcare providers may ask you and your child's teachers about your child's behavior at home and at school. They may watch while your child plays or talks with other children.

How ASD is managed:

Your child's healthcare provider may talk to you about levels of support for your child. This is based on challenges your child has with social skills, communication, and repeated behaviors. The level of support ranges from 1 to 3. Level 3 is the most support needed.

  • Early intervention may help your child learn and keep new skills. Early intervention begins before your child is 3 years old. Intervention may need to change many times during your child's life to help fit his or her needs. Providers will work with you and everyone who takes care of your child. This will help make sure everyone knows how to support your child.
  • Therapy may be recommended. The goal of therapy is to help your child feel confident and supported. Support may include social skill, behavior, speech, or physical therapy. Therapy may also help your child tolerate certain sounds and smells more easily. A therapist may also help your child with sleep problems. The therapist can help your child create a relaxing bedtime routine and find ways to make his or her room comfortable.
  • Medicines may be needed or changed. Medicines may be given to help decrease anxiety, decrease repeated behaviors, or decrease anger. Some children with ASD also have seizures. Your child may need medicine to control or prevent seizures. Medicine such as melatonin may be recommended to help your child sleep better. Some medicines used to manage ASD can also cause sleep problems. Examples include stimulant medicines and seizure medicines. Your child's healthcare provider may change your child's current medicine schedule if his or her sleep is affected.

Help support your child:

Your child may have trouble sleeping. He or she may not want to eat healthy foods. This can lead to weight control problems, such as obesity. Your child may feel anxious or often have stomach pain or diarrhea. He or she may have attention problems such as ADD or ADHD. Your child may wander and leave the house without being noticed. The following can help you support your child and keep him or her safe and healthy:

  • Keep a schedule. Your child may be comforted by routines. Introduce changes slowly. Make activity a part of your child's daily schedule. Regular exercise can help reduce your child's stress and anxiety.
  • Show your child how you interact with others. For example, introduce yourself to other people while your child is with you. Tell your child the steps before you do them, such as saying hello and exchanging names. After you and the new person meet, go over the steps again with your child. Give him or her opportunities to practice social interaction. Do not force it. He or she will not get better at interaction if you force it. Your child may be open to being introduced to a new person you are meeting, but ask first.
  • Be patient. Your child will have an easier time calming down and communicating if you stay calm. You may feel frustrated if your child becomes upset often. It may help to take a short break. Make sure your child is safe and with a responsible adult before you step away.
  • Build on and celebrate your child's strengths. Help your child find activities he or she enjoys and does well. Your child may have amazing strengths, such as advanced abilities with music or math. Encourage your child to try new things, but do not force him or her. Encourage your child as he or she tries something new or gains new skills.
  • Talk to officials at your child's school. Your child may need support at school. He or she may need help feeling more comfortable in class. An individualized education program (IEP) may be used through high school graduation. The IEP identifies your child's learning needs and helps teachers understand how to help him or her learn. The IEP may help your child build skills he or she will need after high school.
  • Work with healthcare providers to create a meal plan for your child. If your child will eat only specific foods, work with healthcare providers to plan meals and snacks. Healthcare providers may suggest blending foods your child will eat with others he or she refuses. This may help your child get the nutrients he or she needs.
  • Have a bedtime routine. Sleep problems are common in children with ASD. A routine that calms your child before bedtime may help him or her fall asleep or stay asleep more easily. Have your child go to sleep and wake up at the same times each day. This may help decrease sleep problems. You may want to install motion alarms in your house. These alarms will wake you if your child gets out of bed at night. Talk to your child's healthcare provider about other ways to help keep your child safe.

Follow up with your child's doctor as directed:

Write down your questions so you remember to ask them during your visits.

For support and more information:

  • Autism Speaks
    1 East 33rd Street, 4th Floor
    New York , NY 10016
    1 East 33rd Street, 4th Floor
    New York , NY 10016
    Phone: 1- 888 - 288-4762
    Web Address: https://www.autismspeaks.org/
  • Autism Society of America
    4340 East-West Highway
    Bethesda , MD 20814-3067
    Phone: 1- 800 - 328-8476
    Web Address: http://www.autism-society.org

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Autism Spectrum Disorder (Ambulatory Care)

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