Could my child have autism spectrum disorder?

Autism spectrum disorder is a developmental condition that impairs the ability to communicate and interact. Catching autism spectrum disorder early can lead to improved quality of life. By recognizing the early signs and symptoms, you can get your child the help he or she needs to learn, grow and thrive.

Autism spectrum disorder symptoms

Some children show signs of autism spectrum disorder in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Others develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired. Signs usually are seen by age 2.

Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low-functioning to high-functioning.

Some children with the disorder have difficulty learning, and some have signs of lower than normal intelligence. Other children have normal to high intelligence — they learn quickly, yet have trouble communicating and applying what they know in everyday life and adjusting to social situations. Because each child can have a unique mixture of symptoms, severity sometimes can be difficult to determine. It's generally based on the level of impairments and how they affect the ability to function.

Social communication and interaction

A child with autism spectrum disorder may have problems with communication skills and social interaction, including any of these signs:

• Fails to respond to his or her name, or appears not to hear you at times
• Resists cuddling and holding, and seems to prefer playing alone
• Has poor eye contact and lacks facial expression
• Doesn't speak or has delayed speech, or loses previous ability to say words or sentences
• Can't start a conversation or keep one going
• Speaks with an abnormal tone or rhythm, and may use a sing-song voice or robot-like speech
• Repeats words or phrases verbatim, but doesn't understand how to use them
• Doesn't appear to understand simple questions or directions
• Doesn't express emotions or feelings, and appears unaware of others' feelings
• Doesn't point at or bring objects to share interest
• Inappropriately approaches a social interaction by being passive, aggressive or disruptive
• Has difficulty recognizing nonverbal cues, such as interpreting other people's facial expressions, body postures or tone of voice

Patterns of behavior

A child with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these signs:

• Performs repetitive movements, such as hand-flapping, rocking or spinning
• Performs activities that could cause self-harm, such as biting or head-banging
• Develops specific routines or rituals, and becomes upset at the slightest change
• Has problems with coordination or has odd movement patterns, and has odd, stiff or exaggerated body language
• Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the overall purpose or function of the object
• Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
• Doesn't engage in imitative or make-believe play or cooperative play with other children
• Fixates on an object or activity with abnormal intensity or focus
• Only wants to eat few, specific foods, or refusing foods with a certain texture

Some children with the disorder become more engaged with others and show fewer disturbances in behavior as they mature. Those with the least severe problems eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral and emotional problems.

When to seek help

If you're concerned about your child's development or you suspect that your child may have autism spectrum disorder, discuss this with your doctor. The symptoms associated with the disorder also can be linked with other developmental disorders.

Your doctor may recommend developmental tests if your child:

• Doesn't respond with a smile or happy expression by 6 months
• Doesn't mimic sounds or facial expressions by 9 months
• Doesn't babble or coo by 12 months
• Doesn't gesture — such as point or wave — by 14 months
• Doesn't say single words by 16 months
• Doesn't play make-believe or pretend by 18 months
• Doesn't say two-word phrases by 24 months
• Loses language skills or social skills at any age

Tanushree Singhal, M.D., is a pediatrician in Eau Claire, Wisconsin.