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2020 Nov

Autism Spectrum Disorder

What are the signs of autism spectrum disorder?

One summer I had a babysitting job caring for my four-year-old autistic nephew. The job was a challenging one for an inexperienced teen. He opposed certain fabrics, so getting him dressed was a challenge. He was picky about what he ate, forcing me to experiment to understand his preferences. He craved routine, so getting a good routine in place helped immensely. Odd things would set him off, like an unexpected change in schedule. Little did I realize what great training that job would be for my current occupation.

Autism spectrum disorder (ASD) is a disability that affects communication (language), behavior (actions), and social skills (interactions). Since this is a communication disorder, it is not usually diagnosed until after the first year of life when children start communicating. These children will sit, crawl, and walk normally.

ASD affects 1 in 54 children. Boys are diagnosed four times more often than girls. Screening tests are done at the 18-month and 24-month check-ups to look for signs of autism. These screening tests include an examination and questionnaire such as the MCHAT: Modified Checklist for Autism in Toddlers. Remember that a positive screening is not a diagnosis.

Researchers are not sure what causes ASD but suggest that it is both genetic and environmental in nature. ASD does tend to run in families. Genetic testing shows that up to 20 percent of children with ASD have some chromosomal abnormality. Research indicates that advanced parental age and birth complications may be factors. Let’s be clear on one point: research clearly indicates that vaccines do not cause autism.

Early signs of autism include little eye contact, lack of responding to a smile, won’t point or bring objects to show a parent. They often lack appropriate facial expressions and won’t show empathy for others. There may be a lack of words by 15 months. Their language may regress between 15 and 24 months. Kids with autism may rock, spin, or flap their hands. They like routine and have trouble transitioning. They may be obsessed with certain activities or topics. If you are concerned about your child’s language or behavior, speak with your pediatric healthcare provider, get an evaluation, and ask for a referral. Keep records of your visits.

The number of children diagnosed with ASD has increased since the 1990s. This is likely due to several factors. Parents and healthcare providers are more aware of autism, routine screenings are completed, schools provide more special education services, and there have been changes in the way ASD is defined. In the past, only the most severe autistics were given the diagnosis. Now, more mild symptoms are picked up and diagnosed due to changes in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorder, 5th edition).

Once a child is suspected of having ASD, a full evaluation is needed. They are often referred to a pediatric developmental specialist or a pediatric neurologist. After a series of examinations and tests (including hearing and language tests) a final diagnosis of ASD may be provided. Early diagnosis and intervention can be fundamental to improving outcomes of children with autism. Learn the signs and act early.

Once diagnosed, early intervention (EI) is essential. EI is a federal program under the Individual with Disabilities Education Act. After EI evaluates the child, if they are found eligible, they will get an individualized family service program (IFSP), which describes current developmental levels and ways to improve with specific outcomes and goals. These services may include speech, occupational, physical, nutrition, and developmental therapy.

If you have a child with ASD, reach out to Family Voices by calling 1-888-835-5669. The goal of these interventions is for every child with ASD to reach his or her personal highest potential.

Learn more:

Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on


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