Key points to remember about autism spectrum disorder

• 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?

"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) or social skills
• behaviour

Communication and social skills develop in children at different rates. Communication involves many different skills. Children learn to understand what people say to them; speak clearly and use words and sentences to talk and get their message across; understand and use gestures, signs and body language; look, listen and take turns in a conversation.

Children with ASD interpret the world and what is happening around them differently than other children.

Behaviours associated with ASD include restricted, stereotyped or repetitive interests, and experiencing more difficulty with change than other children of a similar age.

ASD is different for every child who has it. The word 'spectrum' refers to the wide range of differences children with ASD can have. These differences can vary with age and can also vary over time in a child. ASD related differences are sometimes seen in the toddler years but they may not be as obvious until social demands exceed a child's abilities.

How common is autism spectrum disorder?

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 autism spectrum disorder?

We don't know exactly what causes ASD but it is likely to be a combination of factors. Children with ASD are more likely to have a family member with ASD than those who don't. This suggests genetic factors play a part. Some children will have a rare medical condition that may be associated with ASD.

Extensive research shows there is no evidence that the measles, mumps and rubella (MMR) vaccine causes autism. For more information about this, see the external links and downloads below.

What are the signs of possible autism spectrum disorder in a young child (1-3 years)?

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

Social interaction or play

In social interaction or play, a young child may:

• prefer to play or be alone
• not smile when smiled at
• have difficulty starting or continuing eye contact
• not recognise or respond to another person's happiness or distress
• not want to be picked up or cuddled
• seem disinterested in, or too friendly with, other people
• appear to be in their own world
• prefer to play alone
• not copy others (clapping, waving)
• ignore greetings and farewells (such as waving hello or goodbye)
• not respond when you play peek-a-boo or other games
• not do much pretend play or 'make believe' (talking on the phone or looking after a doll)
• not involve other people in what they're doing (such as not bringing toys or objects to share)
• not invite other people to look at what they're doing

Communication

In communication, a young 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 respond to their name 
• refer to themselves as 'you' or 'she/he' rather than 'I'
• not point to things or not show interest when others point to things
• sometimes appear not to hear
• lead by the hand to show what they want
• may not seek help when they need it
• have difficulty following directions

Impairment of interests, activities and other behaviours

A young child may:

• have very set and/or unusual rituals or routines and get very upset at changes in routine
• play with toys in a repetitive way (might 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)
• struggle with flexible, cooperative, imaginative play
• 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

Other factors that may support a diagnosis of autism spectrum disorder

A young child may have over- or under-sensitivity to sound, touch, movement, visual stimuli or smells.

What are the signs of possible autism spectrum disorder in a child (4-8 years)?

A child in this age group might have some or all of the following difficulties, as well as the features described for younger children.

Social interaction or play

In social interaction or play they might:

• prefer to spend time alone
• not join in with other children's play – or try to join in, but inappropriately
• have difficulty knowing if someone is joking
• not understand the usual social rules for behaviour
• have difficulty taking part in a two-way conversation
• show extreme reactions to invasions of personal space
• not readily engage in role play or joking around
• not be able to develop and maintain friendships in the same way as other children
• sometimes say or do things that are tactless or socially inappropriate
• be easily overwhelmed by social and other stimulation

Communication

In communication they might:

• find it hard to communicate what they want
• use an unusual tone or pitch or accent (a monotone or an unusual accent)
• use unusual words (can be very adult in their language)
• not use language so much for social interaction – instead, talk freely on topics that interest them without an awareness of whether the listener is interested
• show a tendency to talk freely only about specific topics
• appear to not understand what people want or say
• refer to themselves as 'you' or 'she/he' rather than 'I'
• be unaware of nonverbal communication like eye contact, facial expression, body language or gesture
• take information or instructions 'literally'
• have difficulty with new instructions or settings

Impairment of interests, activities and other behaviours

A child in this age group might:

• have very set and/or unusual rituals or routines and can get very upset at changes in routine
• struggle with flexible, cooperative, imaginative play
• have a particular interest which they like to talk about and takes up a lot of time – these fixed interests can be very intense
• struggle to cope with change or unstructured situations (such as school trips, relieving teachers)
• recite facts about their particular interest without consideration for the listener
• have poor coordination

Other factors that may support a diagnosis of autism spectrum disorder

A child in this age group may have over- or under-sensitivity to sound, touch, movement, visual stimuli, pain or smells. The may also have unusual movements. 

What are the signs of autism spectrum disorder in an older child or teen (9-18 years)?

Signs of ASD are usually more subtle in this age group. Older children and teens with ASD have difficulty thinking in an abstract manner and often develop a growing awareness of their social difficulties as peer relationships become more complex. Without appropriate support and understanding, they may become the victims of bullying or develop anxiety or depression, particularly at times of stress (social or academic) or change (for example, leaving school).

What are the definite signs that my child needs assessment for autism spectrum disorder?

• no babbling or pointing or other gesture by 12 months
• no single words by 16 months
• no 2-word phrases by 24 months
• any loss of ANY language or social skills at ANY age

How is autism spectrum disorder diagnosed?

Initial concerns

You may be 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. A developmental coordinator may also be a member of the team looking after your child.

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

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.

Children with ASD have difficulties in all settings of their lives (such as home, and daycare or school) but their difficulties may be more obvious in one setting. It is the extent and impact the difficulties are having on day to day functioning that is important. Your health professional will check that your child's symptoms are not caused by other problems such as hearing or learning problems, developmental delay, or another rare condition.

How is autism spectrum disorder managed?

"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. You might find the disability support section [1] of this website helpful.

Exploring Autism
Exploring Autism is a programme for parents, caregivers, families and whānau of children with a recent diagnosis of autism. It's for children from 0-9 years (up to their 10th birthday). It's free and available throughout New Zealand. Families can self-refer into this programme through the HealthCare New Zealand website [2] or by calling 0800 605 001 and asking one of the team to complete the referral for them. See:

• Exploring Autism - for children aged 0-5 years with a recent diagnosis of autism (PDF, 117KB) [3]
• Exploring Autism - for children aged 6-9 years with a recent diagnosis of autism (PDF, 131KB) [4]
• Exploring Autism - referral form [5]

Developmental coordinators
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.

Medicines

There are no medicines to cure ASD.

Children with ASD can develop psychological problems such as anxiety, ADHD, depression or psychosis or medical problems such as epilepsy. These problems may benefit from treatment with medicine. A paediatrician or child psychiatrist usually prescribes this medicine to begin with, but your family doctor can often continue prescribing it later on.

Complementary and alternative medicine

All parents want to provide the best opportunities for their child with ASD. There is a lot of information on the internet about a range of treatments for children with ASD. Much of this information is based on individual stories (anecdotes). If you are considering this kind of treatment for your child, talk to your child's paediatrician or psychiatrist first. You could also check Complementary and alternative medicine: General advice for parents [6].