Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a developmental disorder that affects communication, social skills and behaviour. If your child does have ASD, there are services available to support you and your child.

Key points to remember

  • autism spectrum disorder (ASD) is a developmental disorder that affects communication (verbal and nonverbal), social skills and behaviour
  • children with ASD can have a wide range of challenges and these can vary with age and over time in an individual
  • if your child does have ASD, there are services available to support you and your child

What is autism spectrum disorder (ASD)?

"It is common for me and other people with autism to be unable to say the words to describe what is bothering us. It's also hard for us to figure out that other people don't experience the world the same way we do".

ASD is a developmental disorder that affects communication (verbal and nonverbal), social skills and behaviour. Children with ASD interpret the world and what is happening around them differently than other children.

ASD is different for everyone who has it. The word 'spectrum' refers to the wide range of differences children with ASD can have. Signs and symptoms vary with age and can also vary over time in an individual.

ASD can be mild, moderate or severe.

How common is it?

International figures suggest that about 1 in 100 children have ASD.  It is about 4 times more common in boys than girls.

It might seem like there are more children with ASD now than in the past. This is probably because of better recognition of ASD than in the past. It could also be because of changes in how ASD is diagnosed.

ASD occurs in children and adults. ASD is usually diagnosed in childhood, but sometimes a diagnosis is not made until the teenage years or adulthood.

What causes it?

We don't know exactly what causes ASD but it is likely to be a combination of factors. These include genetics – children with ASD are more likely to have a family member with ASD.

Extensive research shows there is no evidence that the measles, mumps and rubella (MMR) vaccine causes autism.

For more information, see the following:

What are the symptoms?

Communication and social skills develop in children at different rates. Communication involves many different skills. Children learn to:

  • understand what people say to them

  • use words and sentences to talk to get their message across

  • speak clearly

  • understand and use gestures, signs and body language

  • look, listen and take turns in a conversation


When problems with communication and behaviour are severe enough to interfere with their learning and social relationships, in more than one setting, it can be a sign of ASD.

Children with ASD all have some degree of:

  • difficulties with communication and social interaction
  • restricted, stereotyped and repetitive interests and/or behaviour

What are the signs of possible autism spectrum disorder (ASD) in a preschool child?

A preschool child with ASD might have some or all of the following difficulties.

Communication

In communication, a preschool child might:

  • find it hard to communicate what they want
  • have language skills that are behind other children of their age
  • appear to not understand what people want or say
  • use language in an unusual way (such as repeating words or songs)
  • not point to things or show interest when others point to things
  • sometimes appear not to hear
  • use objects, such as a cup or DVD, or leads by the hand to show what they want
  • seem very independent for their age (will not seek help from others)
  • have difficulty following directions

Social interaction or play

In social interaction or play, a preschool child may:

  • prefer to play or be alone  
  • not smile when smiled at
  • have difficulty initiating or sustaining eye contact
  • not copy others (clapping, waving)
  • ignore greetings and farewells (such as waving hello or goodbye)
  • appear disinterested in other children or people
  • not respond when you play peek-a-boo or hide and seek games
  • not do much pretend play or 'make believe' (talking on the phone or looking after a doll)
  • rarely bring toys and objects to share or show adults or other children
  • rarely attract other people's attention to what they are doing

Restricted or repetitive beviour

In restricted or repetitive behaviour, a preschool child may:

  • have very set and/or unusual rituals or routines and get very upset at changes in routine
  • like to line things up or put things in a certain order
  • seem to get stuck doing the same thing over and over
  • have unusual movement patterns (such as hand flapping or walking on toes)
  • play with toys in unusual ways (such as spinning the wheels on a car)
  • make unusual movements near their face
  • show attachments to unusual objects (such as a key ring or piece of string)
  • over react to loud noises (put hands over ears) or be very sensitive to particular smells, tastes or textures

What are the signs of possible autism spectrum disorder (ASD) in a school aged child?

A school aged child with ASD might have some or all of the following difficulties, as well as the features described for preschool children. In communication:

  • finds it hard to communicate what they want
  • uses an unusual tone or pitch or accent (a monotone or an unusual accent)
  • uses unusual words (can be very pedantic)
  • doesn't use language so much for social interaction – instead, talks freely on topics that interest them without an awareness of whether the listener is interested
  • may appear to not understand what people want or say
  • might refer to themselves as  'you' or 'she/he' rather than 'I'
  • is unaware of nonverbal communication like eye contact, facial expression, body language or gesture
  • takes information or instructions 'literally'
  • has difficulty with new instructions or settings

In social interaction or play:

  • prefers to spend time alone
  • doesn't join in with other children's play – or tries to join in, but inappropriately
  • has difficulty knowing if someone is joking
  • does not understand the usual social rules for  behaviour
  • has difficulty taking part in a two way conversation
  • does not readily engage in role play or joking around
  • sometimes has acquaintances, but very few friends
  • can't develop and maintain friendships in the same way as other children
  • sometimes says or does things that are tactless or socially inappropriate
  • is easily overwhelmed by social and other stimulation

In restricted or repetitive behaviour:

  • has very set and/or unusual rituals or routines and can get very upset at changes in routine
  • has a particular interest which they like to talk about and takes up a lot of time – these fixed interests can be very intense
  • will recite facts about their particular interest without consideration for the listener
  • has poor coordination
  • has unusual movement patterns
  • over reacts to loud noises or is very sensitive to particular smells, tastes,  textures or pain

How is it diagnosed?

Initial concerns

You may one of the first to notice signs of ASD in your child. Your child's teachers, Well Child nurse or family doctor may also raise concerns about your child's development. Your Well Child nurse checks your child's growth and development at all Well Child visits. You and your Well Child nurse can discuss any concerns you have about your child's development and behaviour.

You know your child best. Get a second opinion if you remain concerned. 

If you have concerns about your child's development or behaviour, you could talk to:

  • your Well Child nurse
  • your family doctor
  • an early childhood teacher at your child's child care centre or kindergarten
  • someone at the Ministry of Education, Special Education (phone 0800 622 222)

You know your child best. Get a second opinion if you remain concerned.

If autism spectrum disorder is suspected

If there are concerns that your child might have ASD, one of the professionals listed in the section above may suggest an appointment with a health professional with training and experience in ASD. The health professional could be a paediatrician, child and adolescent psychiatrist, or a psychologist. To accurately identify whether or not your child has ASD, the health professional will usually:

  • meet with you and your child to explore symptoms of ASD and associated conditions, to identify any family history of ASD, and to understand the impact of symptoms on your child and family
  • communicate with your child's preschool or school in order to understand how your child's symptoms may be affecting their learning
  • order other tests (including blood tests) if needed
  • involve your hospital's developmental coordinator

There is no single test to diagnose ASD. The diagnosis is best made after your health professional has collected a range of information and this process may take more than one appointment.

For a diagnosis of ASD, the symptoms are usually present in more than one setting of a child's life (for example, home and school or day care). It is the extent and impact the symptoms are having on day to day functioning that is important. It will be important to make sure that the symptoms are not caused by other problems such as hearing difficulties, learning difficulties or developmental delay.

For more information, see the following:

Management of autism spectrum disorder

"People who know the details about my autism are usually more comfortable dealing with me. Also, the more information my teachers have, the more ideas they have to help me learn".

There is no cure for ASD but providing the right support can significantly change your child's learning and their relationships.

What support is available?

If your child has ASD, there are services and financial support available for you and your child.

See the disability support section.

Each district health board (DHB) has a developmental coordinator who is involved with children having an assessment for ASD. Your developmental coordinator may be able to give you information about support available for children and families with ASD in your area.

Ministries of Health and Education. 2016. New Zealand Autism Spectrum Disorder Guideline (2nd edn). Wellington: Ministry of Health. http://www.health.govt.nz/publication/new-zealand-autism-spectrum-disorder-guideline [Accessed 29/11/16]

This page last reviewed 16 December 2016.
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