What Are the Signs and Symptoms of Autism Spectrum Disorder?

Because ASD refers to a constellation of disorders and behaviors, it is sometimes difficult to understand what constitutes ASD-type behavior. What is important to remember is those with ASD usually exhibit symptoms belonging to two major categories related to communication and repetitive behaviors. These are the two major symptoms as outlined in the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (APA, 2022).

 

Impaired social communication

The DSM-5-TR requires a person with ASD to exhibit all three of the following behaviors (APA, 2022):

1. Difficulty in social-emotional reciprocity: The person has difficulty reading and responding to the emotions of others. This may manifest as them having trouble maintaining a back-and-forth conversation with another person.
2. Difficulty in non-verbal communication: The person has difficulty in understanding or acting on non-verbal gestures. An example could include trouble maintaining eye contact.
3. Difficulty in establishing or maintaining relationships with others: The person may have a hard time playing with or relating to another person. They may not be able to engage in routine, imaginative play.

Restricted, repetitive sensory-motor behaviors

To be diagnosed with ASD, a person must display at least two of the following four behaviors:

1. Repetitive motor movements, speech, or use of objects: An example could be constantly lining up figures/toys in a distinct line.
2. Difficulty adapting to changes: Those with ASD rely on structure. Changes (even small ones) to their routines can result in extreme distress.
3. Highly restricted, focused interests: In our Symptom Media video, the client, Daniel, is fixated on trains. Often, a person with ASD will have a strong attachment to a particular interest.
4. Sensory responses that are hyper- or hypo-reactive: Those with ASD may have difficulty interpreting sensory inputs, such as how a piece of clothing feels against their skin or how a food texture feels when eating.

While not everyone maintains great eye contact or someone may be fixated on a particular activity, the difference for those with ASD is their communication and behaviors impair them in some way. They may keep them from maintaining a job or establishing friendships.

Diagnosis and Risk Factors

Diagnostic tools (usually questionnaires) for ASD start as young as age 12 months and go into adulthood (Lord et al., 2018). However, most clinicians find it difficult to predict that a child may have ASD until they are age 3 or older (Lord et al.). A clinician will often observe and speak with a person to help evaluate them for ASD as well as listen to family reports of the person’s behaviors.

Doctors know that some groups of people are less likely to receive an ASD diagnosis at a younger age in the United States. These include (Lord et al., 2018):

• Children who do not have language delays
• Female children
• Children who are in ethnic minorities
• Children of low socioeconomic status
• Children whose families are not fluent in English

Because researchers have identified a genetic component to ASD, they do know if a person’s family members have the disorder, they themselves or their children are more at-risk.

Treatments

Because ASD symptoms can vary so widely, there is no one specific approach to ASD treatment. Doctors do know those with ASD often have other co-occurring disorders. Examples can include attention deficit hyperactivity disorder, anxiety, and depression as well as developmental disorders (Lord et al., 2018). Treating these underlying disorders can help as well.

Treatments often focus on helping parents understand how to encourage interaction and play with their child. Parents may work with therapists, such as occupational therapists, to help parents identify how to best communicate with their child and establish a routine that aids in their child feeling safe and secure. Other therapy techniques include sensory integration, speech therapy, and music therapy (Lord et al., 2018).

Little evidence exists on medications to specifically treat ASD. Using medications to treat underlying conditions may help with complicating conditions. For example, the medications methylphenidate and atomoxetine may be especially helpful in treating ADHD symptoms in a person with ASD.

Symptom Media provides video vignettes of different ASD manifestations to enhance your clinical practice. Through this presentation, the ASD symptoms outlined in this article come to life.