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What is Autism Spectrum Disorder (ASD)? | Symptoms of Autism & Next Steps

Dr. Mary Barbera

In this week’s video blog, I’d like to go back to the basics and cover what autism is and how to tell if a young child has autism. I’ve been doing weekly video blogs for over two and a half years now and I just realized that I didn’t have a video called “What is autism?” or some of the most basic content that I should have. So today I’m covering what autism spectrum disorder is, and what next steps you can take if you think your child or client has autism.

Each week I provide you with some of my ideas about turning autism around. So, if you haven’t subscribed to my YouTube channel, you can do that now.

Previously I have done video blogs on this topic. I’ve done a video blog called “Can you prevent autism?” I’ve also done one titled, “Is it autism or a speech delay?“, as well as “Autism or ADHD“. I also highly recommend a blog I did a few months ago on using the MCHAT, The Modified Checklist for Autism in Toddlers that would really be helpful as a supplement to this blog. You might be new to the autism world and you’re worried about a young child or you might be with me for a long time and like me, my son was diagnosed 20 years ago and your child may be older. Things have changed since 1999 when Lucas was diagnosed when we used to use the DSM 4 for diagnosis purposes and now we use the DSM 5. There have been changes and even just the rate increase is a lot more than in the past. So if you want to get more up to date on the latest diagnostic information, I hope to be able to provide some basics right here.

What is autism spectrum disorder (ASD)?

Autism is a spectrum known as Autism Spectrum Disorders, but the DSM 4 back when Lucas was diagnosed included things like PDD-NOS, Pervasive Developmental Disorder, Not Otherwise Specified. It also included Asperger Syndrome and Autistic Disorder, which were part of the autism spectrum. Now with the DSM 5, that’s all eliminated. So now everyone is known or thought to be having Autism Spectrum Disorder. If you have a child that was previously diagnosed with Asperger syndrome or PDD-NOS, no one’s going to make you stop using that term. It’s just not a diagnostic category anymore.
Autism Spectrum Disorder is a developmental disorder with symptoms appearing usually by the age of 3, although diagnoses can come much later. When kids are diagnosed or even adults are diagnosed, a lot of times you have to look back earlier in their lives. Ask yourself was there a speech delay? Were there repetitive interests from the early on phase? But we’re going to just assume that you’re worried about your child or some child in your life. These are some of the signs in young children that might indicate that they have autism spectrum disorder.

Signs of autism in children

The big area of deficit is social language deficits. That is language that you need for social engagement. Even before expressive language starts, when a young child is even a baby or a toddler, they should still have joint attention skills that start even as a baby. Early on they should be smiling at an adult and kind of babbling and cooing back and forth. When they get to over a year, they should be pointing with their index finger.  They should be pointing to show you things and pointing to indicate interest. Pointing is a big red flag; failure to point to show you things and to want things. It was a red flag for Lucas, but I didn’t know that was a problem. I did do a video blog on the importance of pointing, so you may want to check that out. Also in addition to failure to point, it could be low or lack of eye contact and lack of bringing you things to share or show you. It doesn’t have to be zero. It could just be very rare that a child does point or very rarely do they share and show you things. Usually, a lack of following directions and expressive language almost always is delayed or abnormal too.

They might, like Lucas, take an adult’s hand and put that adult’s hand on the item they want. That’s called hand leading and that could be a red flag for autism spectrum disorder as well. Also, non-verbal reaction could be a sign of autism.  So say they spilled water, a typically developing toddler will kind of like look at the adult, look at the mess, and figure out what are we supposed to do about it? Where a child with autism may just smash in the liquids and just play with it. I also have done videos where I’ve used a screening tool for autism in 2-year-olds where I’ve handed little kids bubbles with the lid tightly closed. I hand it to them and they’re handing it back to my hand but they’re not looking at me like, could you help me out? Could you open these bubbles? They’re not babbling. They’re not engaging in any eye contact. Social language, even without expressive language, the lack of pointing and nonverbal communication skills is usually the first sign.

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There are also impairments, usually in imitation and play. Pretend play is usually very delayed. An interest in peers is very delayed. Other kids of 3 and 4-years-old are pretend playing and negotiating language back and forth where a child with autism is often severely delayed with their ability to navigate the whole system and to share and to play with other children. In addition to the language and social deficits, children with Autism Spectrum Disorder also have restricted or repetitive behaviors. This could mean flapping their hands in front of their faces. It could be lining things up, spinning of toys, spinning their whole body, or obsession with certain items. I’ve had clients who wanted all of these little figurines and they wanted to carry them around and hoard them.
Insistence on sameness, like going the same way to the store or when you’re in the mall going in the exact same order is a red flag because they like the sameness. They don’t like all the changes that come every day. Children with autism can also be over or under reactive to sensory input like covering their ears, causing tantrums with change or when different foods are presented. They just don’t like different foods.
Now I’m saying all of these can be signs that can be red flags, but it doesn’t mean that if your child has delays in any of these areas that it’s definitely autism. But they are red flags and it’s always a good idea to be on top of it so that you’re not like me, who was sticking my head in the sand and being in denial because that’s really not going to help the situation.

The DSM 5 categorizes autism also has 3 levels of diagnosis of autism with level 1 needing just a little support and level 3 being severe autism with very significant needs. These 3 levels are pretty subjective and they definitely can change over time. I’ve done some video blogs in the past on high functioning versus low functioning autism. I also did a video blog on “Can you predict how a 2-year-old will do when he’s older?” And the truth is that you can’t, so I know plenty of kids who started out looking very low functioning, very severely affected and they are doing really well now. Some of my previous clients are learning to drive and go to college and all those great things. So we can’t really predict how they’re going to do. We want every child to reach his or her fullest potential and that’s really the goal.

Steps to start early intervention for autism spectrum disorder

So what can you do if you think your child, grandchild, client, neighbor, or friend, might have autism? One of the things you can do is download my free, 3 step guide, which is called, “Is it autism, ADHD, or typical toddler tantrums?” You can get that at marybarbera.com/toddler. I’ll give you the 3 steps right now though.
The first one is knowing your developmental milestones. Know when your child’s supposed to sit up when they’re supposed to point, and when they’re supposed to be putting two words together.
Secondly, if there are any discrepancies, I would encourage you to make an appointment with your child’s pediatrician and get a free or very low-cost early intervention evaluation. If you’re in the United States, you can Google your area for early intervention evaluations and you probably can find the number to call. You’ll also want to get on a waitlist for an evaluation by a developmental pediatrician or other physician or healthcare provider who can diagnose or evaluate autism.
The third thing I’d recommend is learning all you can about ABA. So while you wait for a diagnosis or more intensive therapy, you could join my online courses and community. If you download the free guide at marybarbera.com/toddler you’ll also have the opportunity to watch a free online workshop.
If you liked this video/article, I hope that you’ll let me know by commenting, give me a thumbs up, and share it with others who might benefit and I’ll see you right here next week.

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