What is Asperger’s syndrome

Asperger’s syndrome was the name given given to a lifelong developmental disability that affects how people perceive the world and interact with others. Since 2013, the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also known as psychiatrists user manual to diagnose mental illness, remove Asperger’s syndrome as a separate diagnosis and replace it within the term ‘autism spectrum disorder’ ¹⁾. In the terminology of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – Asperger’s syndrome would be seen as being at the ‘upper end’ of the autistic spectrum disorder (ASD) ²⁾. Asperger’s syndrome is an autism spectrum disorder, one of a distinct group of neurological conditions characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Other autism spectrum disorders include: classic autism, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Unlike children with autism, children with Asperger’s syndrome retain their early language skills.

Today people who used to be described as having Asperger’s syndrome is now described as having autism spectrum disorder. There is no separate diagnosis for Asperger’s any more.

The most distinguishing symptom of Asperger’s syndrome is a child’s obsessive interest in a single object or topic to the exclusion of any other. Children with Asperger’s syndrome want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors. Other characteristics of Asperger’s syndrome include repetitive routines or rituals; peculiarities in speech and language; socially and emotionally inappropriate behavior and the inability to interact successfully with peers; problems with non-verbal communication; and clumsy and uncoordinated motor movements.

Children with Asperger’s syndrome are isolated because of their poor social skills and narrow interests. They may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest. Children with Asperger’s syndrome usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

The ideal treatment for Asperger’s syndrome coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with Asperger’s syndrome, but most professionals agree that the earlier the intervention, the better.

Many people with autism spectrum disorder benefit from treatment, no matter how old they are when they are diagnosed. People of all ages, at all levels of ability, can often improve after well-designed interventions.

Research shows that early diagnosis and interventions, such as during preschool or before, are more likely to have major positive effects on symptoms and later skills.

Therapies and services

• Cognitive behavioral therapy can help address anxiety and other personal challenges.
• Social skills training classes can help with conversational skills and understanding social cues.
• Speech therapy can help with voice control.
• Physical and occupational therapy can improve coordination.
• Psychoactive medicines can help manage associated anxiety, depression and attention deficit and hyperactivity disorder (ADHD).

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. It may include social skills training, cognitive behavioral therapy, medication for co-existing conditions, and other measures.

With effective treatment, children with Asperger’s syndrome can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with Asperger’s syndrome are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

Asperger’s syndrome facts

There is often nothing about how people with autism spectrum disorder look that sets them apart from other people, but they may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with autism spectrum disorder can range from gifted to severely challenged. Some people with autism spectrum disorder need a lot of help in their daily lives; others need less.

Autism spectrum disorder begins before the age of 3 and last throughout a person’s life, although symptoms may improve over time. Some children with autism spectrum disorder show hints of future problems within the first few months of life. In others, symptoms may not show up until 24 months or later. Some children with an autism spectrum disorder seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an autism spectrum disorder noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age.

It is important to note that some people without autism spectrum disorder might also have some of these symptoms. But for people with autism spectrum disorder, the impairments make life very challenging.

Autism spectrum disorder occurs in every racial and ethnic group and across all socioeconomic levels. However, boys are significantly more likely to develop autism spectrum disorder than girls. The latest 2018 analysis from the Centers for Disease Control and Prevention estimates that 1 in 59 children has autism spectrum disorder (ASD):

• 1 in 37 boys
• 1 in 151 girls

Boys are four times more likely to be diagnosed with autism than girls.

Most children were still being diagnosed after age 4, though autism can be reliably diagnosed as early as age 2.

31% of children with autism spectrum disorder (ASD) have an intellectual disability (intelligence quotient [IQ] <70), 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to above average range (i.e., IQ >85).

• Autism affects all ethnic and socioeconomic groups.
• Minority groups tend to be diagnosed later and less often.

Early intervention affords the best opportunity to support healthy development and deliver benefits across the lifespan.

• Early intervention can improve learning, communication and social skills, as well as underlying brain development.
• Applied behavior analysis (ABA) and therapies based on its principles are the most researched and commonly used behavioral interventions for autism.
• Many children affected by autism also benefit from other interventions such as speech and occupational therapy.
• Developmental regression, or loss of skills, such as language and social interests, affects around 1 in 5 children who will go on to be diagnosed with autism and typically occurs between ages 1 and 3.

The American Academy of Pediatrics recommends that all children be screened for autism at their 18 and 24-month well-child checkup. If you’re not sure if your child has been screened, you can ask for a screening. You can also complete the online screener, print the results, and bring them to your healthcare provider to discuss your concerns.

If the screener shows that your child may have a greater chance of having autism – it is not a diagnosis. You should speak with your child’s healthcare provider about getting a full evaluation from a qualified medical specialist such as a neurologist, behavior pediatrician, or psychiatrist, who can provide a diagnosis.

In the meantime, you don’t need to wait for a diagnosis of autism to receive services to address related developmental delays and learning challenges. You can access these services free of charge through your state’s Early Intervention program (ages birth – 3) or your school district’s Special Education Office (age 3 – 21). Research shows that early intervention can provide the best outcomes.

Even if your child is receiving services through early intervention or your school district, and their screening indicated an increased risk for autism, you do want to get a full evaluation. That evaluation may result in a diagnosis If you get a diagnosis of autism, you want to contact your early intervention provider or school district and let them know. The diagnosis may help to provide access to autism specific treatments.

It’s important to remember that if your child does receive a diagnosis of autism. He or she is the same child as before the diagnosis. The diagnosis provides access to the services that he needs.

Autism in adulthood

• Over the next decade, an estimated 500,000 teens (50,000 each year) will enter adulthood and age out of school based autism services.
• Teens with autism receive healthcare transition services half as often as those with other special healthcare needs. Young people whose autism is coupled with associated medical problems are even less likely to receive transition support.
• Many young adults with autism do not receive any healthcare for years after they stop seeing a pediatrician.
• More than half of young adults with autism remain unemployed and unenrolled in higher education in the two years after high school. This is a lower rate than that of young adults in other disability categories, including learning disabilities, intellectual disability or speech-language impairment.
• Of the nearly 18,000 people with autism who used state-funded vocational rehabilitation programs in 2014, only 60 percent left the program with a job. Of these, 80 percent worked part-time at a median weekly rate of $160, putting them well below the poverty level.
• Nearly half of 25-year-olds with autism have never held a paying job.

Research demonstrates that job activities that encourage independence reduce autism symptoms and increase daily living skills.

Asperger’s syndrome characteristics

All people with autism spectrum disorder have difficulties with social communication, fixated interests and repetitive behaviors.

Autism is diagnosed depending on how severe it is, with a ranking of 1, 2 or 3. Asperger’s, as it used to be known, describes people with “high-functioning” types of autism. Their symptoms may not be as severe as in some other kinds of autism spectrum disorders.

Table 1: Severity levels for autism spectrum disorder

Severity level	Social communication	Restricted, repetitive behaviors
Level 3 “Requiring very substantial support”	Level 2 “Requiring substantial support”	Level 1 “Requiring support”
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.	Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or  abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited  to narrow special interests, and who has markedly odd nonverbal communication. Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.	Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence

[Source ³⁾ ]

Autism spectrum disorder possible “Red Flags”

A person with autism spectrum disorder might:

• Not respond to their name by 12 months of age
• Not point at objects to show interest (point at an airplane flying over) by 14 months
• Not play “pretend” games (pretend to “feed” a doll) by 18 months
• Avoid eye contact and want to be alone
• Have trouble understanding other people’s feelings or talking about their own feelings
• Have delayed speech and language skills
• Repeat words or phrases over and over (echolalia)
• Give unrelated answers to questions
• Get upset by minor changes
• Have obsessive interests
• Flap their hands, rock their body, or spin in circles
• Have unusual reactions to the way things sound, smell, taste, look, or feel

Asperger syndrome generally involves:

• Difficulty with social interactions
• Restricted interests
• Desire for sameness
• Distinctive strengths

Strengths can include:

• Remarkable focus and persistence
• Aptitude for recognizing patterns
• Attention to detail

Challenges can include:

• Hypersensitivities (to lights, sounds, tastes, etc.)
• Difficulty with the give and take of conversation
• Difficulty with nonverbal conversation skills (distance, loudness, tone, etc.)
• Uncoordinated movements, or clumsiness
• Anxiety and depression

The tendencies described above vary widely among people. Many learn to overcome their challenges by building on strengths.

Though the diagnosis of Asperger syndrome is no longer used, many previously diagnosed people still identify strongly and positively with being an “Aspie.”

People previously diagnosed with Asperger’s disorder have an IQ in the normal range and often good language skills, but despite this had communication difficulties.

What distinguishes Asperger’s syndrome from classic autism are its less severe symptoms and the absence of language delays. Children with Asperger’s syndrome may be only mildly affected, and they frequently have good language and cognitive skills. To the untrained observer, a child with Asperger’s Disorder may just seem like a neurotypical child behaving differently.

Children with autism are frequently viewed as aloof and uninterested in others. This is not the case with Asperger’s Disorder. Individuals with Asperger’s Disorder usually want to fit in and have interaction with others, but often they don’t know how to do it. They may be socially awkward, not understand conventional social rules or show a lack of empathy. They may have limited eye contact, seem unengaged in a conversation and not understand the use of gestures or sarcasm.

Their interests in a particular subject may border on the obsessive. Children with Asperger’s Disorder often like to collect categories of things, such as rocks or bottle caps. They may be proficient in knowledge categories of information, such as baseball statistics or Latin names of flowers. They may have good rote memory skills but struggle with abstract concepts.

One of the major differences between Asperger’s Disorder and autism is that, by definition, there is no speech delay in Asperger’s. In fact, children with Asperger’s syndrome frequently have good language skills; they simply use language in different ways. Speech patterns may be unusual, lack inflection or have a rhythmic nature, or may be formal, but too loud or high-pitched. Children with Asperger’s syndrome may not understand the subtleties of language, such as irony and humor, or they may not understand the give-and-take nature of a conversation.

Another distinction between Asperger’s syndrome and autism concerns cognitive ability. While some individuals with autism have intellectual disabilities, by definition, a person with Asperger’s syndrome cannot have a “clinically significant” cognitive delay, and most possess average to above-average intelligence.

While motor difficulties are not a specific criterion for Asperger’s, children with Asperger’s syndrome frequently have motor skill delays and may appear clumsy or awkward.

Asperger’s syndrome in children

Autism spectrum disorder symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in autism spectrum disorder for additional testing.

Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.

Asperger’s syndrome in adults

Diagnosing autism spectrum disorder in adults is often more difficult than diagnosing autism spectrum disorder in children. In adults, some autism spectrum disorder symptoms can overlap with symptoms of other mental-health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice the signs and symptoms of autism spectrum disorder should talk with a doctor and ask for a referral for an autism spectrum disorder evaluation. While testing for autism spectrum disorder in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with autism spectrum disorder. The expert will ask about concerns, such as:

• Social interaction and communication challenges
• Sensory issues
• Repetitive behaviors
• Restricted interests

Information about the adult’s developmental history will help in making an accurate diagnosis, so an autism spectrum disorder evaluation may include talking with parents or other family members.

Getting a correct diagnosis of autism spectrum disorder as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help. Studies are now underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of transition-age youth and adults with autism spectrum disorder.

Asperger’s syndrome causes

Though autism spectrum disorder research has advanced significantly in the past decade, it is still not known exactly what causes the disorder. Because the autism spectrum disorder (ASD) is so complex and no two people with autism are exactly alike, there are probably many causes for autism. It is also likely that there is not a single cause for autism, but rather that it results from a combination of causes. It’s likely that there are multiple causes, and thus multiple “autisms.” For example, several hundred genes ⁴⁾ have been associated with autism spectrum disorder, and they may interact in a complex manner with each other and with the environment.

Scientists have learned that there are likely many causes for multiple types of autism spectrum disorder. There may be many different factors that make a child more likely to have an autism spectrum disorder, including environmental, biologic and genetic factors.

• Most scientists agree that genes are one of the risk factors that can make a person more likely to develop autism spectrum disorder ⁵⁾.
• Children who have a sibling with autism spectrum disorder are at a higher risk of also having autism spectrum disorder ⁶⁾.
  autism spectrum disorder tends to occur more often in people who have certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis ⁷⁾
• When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of autism spectrum disorder ⁸⁾.
• There is some evidence that the critical period for developing autism spectrum disorder occurs before, during, and immediately after birth ⁹⁾.
• Children born to older parents are at greater risk for having autism spectrum disorder ¹⁰⁾.

Autism spectrum disorder is a developmental disability caused by differences in the brain. Scientists do not know yet exactly what causes these differences for most people with autism spectrum disorder. However, some people with autism spectrum disorder have a known difference, such as a genetic condition. There are multiple causes of autism spectrum disorder, although most are not yet known.

Scientists do know that autism spectrum disorder is not caused by psychological factors, parenting behaviors or practices, or vaccines. Research has helped to identify and diagnose autism spectrum disorder at younger ages, resulting in earlier access to specialized early intervention services for children on the autism spectrum.

Asperger’s syndrome symptoms

Although the symptoms of autism vary in severity, there are two major categories:

Difficulty with social communication

Children with autism spectrum disorder often struggle with nonverbal communication behaviors (for example, making eye contact, reading, and using facial expressions and gestures) that come naturally to other children. Their relationships with peers are often affected because of difficulties understanding and performing reciprocal (back and forth) social interactions. These struggles are often intensified by difficulty reading or responding to other people’s emotions.

Repetitive behaviors and motor movements

Some children with autism spectrum disorder may flap their hands or rock back and forth, repeat lines from books or movies, or have strong or muted reactions to sensory stimuli (for example, smell, sound, or touch). They may have a particular interest or hobby that is unusually intense compared to those of other children their age. Children with autism spectrum disorder may insist on certain routines or patterns in everyday life or want to play with toys in atypical ways (for example, spinning the wheels of a toy car rather than “driving” it).

People with autism spectrum disorder often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with autism spectrum disorder also have different ways of learning, paying attention, or reacting to things. Signs of autism spectrum disorder begin during early childhood and typically last throughout a person’s life.

Social Skills

Social issues are one of the most common symptoms in all of the types of autism spectrum disorder. People with an autism spectrum disorder do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to autism spectrum disorder:

• Does not respond to name by 12 months of age
• Avoids eye-contact
• Prefers to play alone
• Does not share interests with others
• Only interacts to achieve a desired goal
• Has flat or inappropriate facial expressions
• Does not understand personal space boundaries
• Avoids or resists physical contact
• Is not comforted by others during distress
• Has trouble understanding other people’s feelings or talking about own feelings

Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye bye”. Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an autism spectrum disorder might have a very hard time learning to interact with other people.

Some people with an autism spectrum disorder might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an autism spectrum disorder have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.

People with an autism spectrum disorder might have problems with showing or talking about their feelings. They might also have trouble understanding other people’s feelings. Many people with an autism spectrum disorder are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an autism spectrum disorder. Anxiety and depression also affect some people with an autism spectrum disorder. All of these symptoms can make other social problems even harder to manage.

Communication

Each person with autism spectrum disorder has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an autism spectrum disorder do not talk at all. About 25%–30% of children with autism spectrum disorder have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood.

Examples of communication issues related to autism spectrum disorder:

• Delayed speech and language skills
• Repeats words or phrases over and over (echolalia)
• Reverses pronouns (e.g., says “you” instead of “I”)
• Gives unrelated answers to questions
• Does not point or respond to pointing
• Uses few or no gestures (e.g., does not wave goodbye)
• Talks in a flat, robot-like, or sing-song voice
• Does not pretend in play (e.g., does not pretend to “feed” a doll)
• Does not understand jokes, sarcasm, or teasing

People with autism spectrum disorder who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with autism spectrum disorder say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with autism spectrum disorder, “Do you want some juice?” he or she might repeat “Do you want some juice?” instead of answering your question. Although many children without an autism spectrum disorder go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an autism spectrum disorder can speak well but might have a hard time listening to what other people say.

People with autism spectrum disorder might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with autism spectrum disorder might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an autism spectrum disorder might smile while saying something sad.

People with autism spectrum disorder might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an autism spectrum disorder might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.

Unusual Interests and Behaviors

Many people with autism spectrum disorder have unusual interest or behaviors.

Examples of unusual interests and behaviors related to autism spectrum disorder:

• Lines up toys or other objects
• Plays with toys the same way every time
• Likes parts of objects (e.g., wheels)
• Is very organized
• Gets upset by minor changes
• Has obsessive interests
• Has to follow certain routines
• Flaps hands, rocks body, or spins self in circles

Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an autism spectrum disorder might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”

People with autism spectrum disorder often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with autism spectrum disorder. They might “lose control” and have a “melt down” or tantrum, especially if in a strange place.

Some people with autism spectrum disorder also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.

Children or adults with autism spectrum disorder might:

• not point at objects to show interest (for example, not point at an airplane flying over)
• not look at objects when another person points at them
• have trouble relating to others or not have an interest in other people at all
• avoid eye contact and want to be alone
• have trouble understanding other people’s feelings or talking about their own feelings
• prefer not to be held or cuddled, or might cuddle only when they want to
• appear to be unaware when people talk to them, but respond to other sounds
• be very interested in people, but not know how to talk, play, or relate to them
• repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
• have trouble expressing their needs using typical words or motions
• not play “pretend” games (for example, not pretend to “feed” a doll)
• repeat actions over and over again
• have trouble adapting when a routine changes
• have unusual reactions to the way things smell, taste, look, feel, or sound
• lose skills they once had (for example, stop saying words they were using)

Other Symptoms

Some people with autism spectrum disorder have other symptoms. These might include:

• Hyperactivity (very active)
• Impulsivity (acting without thinking)
• Short attention span
• Aggression
• Causing self injury
• Temper tantrums
• Unusual eating and sleeping habits
• Unusual mood or emotional reactions
• Lack of fear or more fear than expected
• Unusual reactions to the way things sound, smell, taste, look, or feel

People with autism spectrum disorder might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an autism spectrum disorder limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.

People with autism spectrum disorder might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.

Development

Children with autism spectrum disorder develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an autism spectrum disorder might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a “b” makes.

Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life.

Autism screening

Your health care provider might use a screening test specifically for autism spectrum disorder (ASD). This test might be the Checklist of Autism in Toddlers (CHAT), the Modified Checklist for Autism in Toddlers Revised (M-CHAT-R), or another test ¹¹⁾. See Autism Screening above.

A more comprehensive list of developmental screening tools is available from the American Academy of Pediatrics (https://medicalhomeinfo.aap.org/about/Pages/September-2017.aspx), including descriptions of the tools, sensitivity and specificity. The list includes general screening tools, as well as those for autism spectrum disorder.

Types of Screening Tools

There are many different developmental screening tools. This list is not exhaustive, and other tests may be available.

Selected examples of screening tools for general development and autism spectrum disorder:

• Ages and Stages Questionnaires (ASQ) (https://agesandstages.com/)
  • This is a general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains.
• Communication and Symbolic Behavior Scales (CSBS) (https://firstwords.fsu.edu/pdf/checklist.pdf)
  • Standardized tool for screening of communication and symbolic abilities up to the 24-month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool.
• Parents’ Evaluation of Developmental Status (PEDS) (https://pedstest.com/)
  • This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool.
• Modified Checklist for Autism in Toddlers (MCHAT) (https://mchatscreen.com/)
  • Parent-completed questionnaire designed to identify children at risk for autism in the general population.
• Screening Tool for Autism in Toddlers and Young Children (STAT) (https://vkc.mc.vanderbilt.edu/vkc/triad/stat/)
  • This is an interactive screening tool designed for children when developmental concerns are suspected. It consists of 12 activities assessing play, communication, and imitation skills and takes 20 minutes to administer.

The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) is a screener that will ask a series of 20 questions about your child’s behavior. The results will let you know if a further evaluation may be needed. You can use the results of the screener to discuss any concerns that you may have with your child’s healthcare provider.

• You can access Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) here: https://www.autismspeaks.org/screen-your-child

Asperger’s syndrome diagnosis

Autism spectrum disorder diagnosis is usually made by a qualified specialist, such as a pediatrician or via a comprehensive assessment performed by a team of specialists. This may include a pediatrician, psychologist or psychiatrist and sometimes a speech pathologist. The specialists will meet and watch the child to assess his or her communication skills, ability to interact socially and general behaviors.

Diagnosing autism spectrum disorder (ASD) can be difficult, since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

Autism spectrum disorder can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable ¹²⁾. However, many children do not receive a final diagnosis until much older. This delay means that children with an autism spectrum disorder might not get the help they need.

Clinicians use a set of standard tests to make a diagnosis. They will see if the child has certain behaviors and social responses.

Children can usually be diagnosed at around two, but sometimes symptoms are subtle and children are not diagnosed until they start school or even until they become adults.

The umbrella term ‘autism spectrum disorder’ (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.

Autism spectrum disorder (ASD) now describes all levels of autism, from those individuals requiring support (level 1), those requiring substantial support (level 2) and those more severely affected and requiring very substantial support (level 3) (see Table 1 above).

The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with autism spectrum disorder. Some children and adults with autism spectrum disorder are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) ¹³⁾ includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified as part of autism spectrum disorder rather than as separate disorders. A diagnosis of autism spectrum disorder includes an assessment of intellectual disability and language impairment.

Diagnosing an autism spectrum disorder takes two steps:

1. Developmental Screening
2. Comprehensive Diagnostic Evaluation

Diagnosis in young children is often a two-stage process

Stage 1: General Developmental Screening During Well-Child Checkups

Developmental screening is a short test to tell if children are learning basic skills when they should, or if they might have delays. During developmental screening the doctor might ask the parent some questions or talk and play with the child during an exam to see how she learns, speaks, behaves, and moves. A delay in any of these areas could be a sign of a problem.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine those answers with information from autism spectrum disorder screening tools, and with his or her observations of the child.

All children should be screened for developmental delays and disabilities during regular well-child doctor visits at:

• 9 months
• 18 months
• 24 or 30 months
• Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons.

Additional screening might be needed if a child is at high risk for autism spectrum disorder or developmental problems. Those at high risk include children who have a family member with autism spectrum disorder, have some autism spectrum disorder behaviors, have older parents, have certain genetic conditions, or who were born at a very low birth weight.

In addition, all children should be screened specifically for autism spectrum disorder (ASD) during regular well-child doctor visits at:

• 18 months
• 24 months
• Additional screening might be needed if a child is at high risk for autism spectrum disorder (ASD) (e.g., having a sister, brother or other family member with an autism spectrum disorder) or if behaviors sometimes associated with autism spectrum disorder (ASD) are present

It is important for doctors to screen all children for developmental delays, but especially to monitor those who are at a higher risk for developmental problems due to preterm birth, low birth weight, or having a brother or sister with an autism spectrum disorder (ASD).

If your child’s doctor does not routinely check your child with this type of developmental screening test, ask that it be done.

If the doctor sees any signs of a problem during this screening process, a comprehensive diagnostic second stage of evaluation is needed.

Stage 2: Comprehensive Diagnostic Evaluation

This second evaluation (Comprehensive Diagnostic Evaluation) is with a team of doctors and other health professionals who are experienced in diagnosing autism spectrum disorder.

This team may include:

• A developmental pediatrician—a doctor who has special training in child development
• A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behavior
• A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
• A speech-language pathologist—a health professional who has special training in communication difficulties

The evaluation may assess:

• Cognitive level or thinking skills
• Language abilities
• Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because autism spectrum disorder is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

• Blood tests
• Hearing test

The outcome of the evaluation will result in a formal diagnosis and recommendations for treatment.

Autism Spectrum Disorder Diagnostic Criteria

There are many tools to assess autism spectrum disorder in young children, but no single tool should be used as the basis for diagnosis. Diagnostic tools usually rely on two main sources of information—parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior.

In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis. Such specialists include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists, and early intervention programs that provide assessment services.

Selected examples of diagnostic tools for autism spectrum disorder (ASD) ¹⁴⁾:

• Autism Diagnosis Interview – Revised (ADI-R) ¹⁵⁾
  • A clinical diagnostic instrument for assessing autism in children and adults. The instrument focuses on behavior in three main areas: reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults with mental ages about 18 months and above.
• Autism Diagnostic Observation Schedule – Generic (ADOS-G) ¹⁶⁾
  • A semi-structured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorder. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language.
• Childhood Autism Rating Scale (CARS) ¹⁷⁾
  • Brief assessment suitable for use with any child over 2 years of age. CARS includes items drawn from five prominent systems for diagnosing autism; each item covers a particular characteristic, ability, or behavior.
• Gilliam Autism Rating Scale – Second Edition (GARS-2) (https://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildAutisticSpectrumDisorders/GilliamAutismRatingScale-SecondEdition(GARS-2)/GilliamAutismRatingScale-SecondEdition(GARS-2).aspx)
  • Assists teachers, parents, and clinicians in identifying and diagnosing autism in individuals ages 3 through 22. It also helps estimate the severity of the child’s disorder.

In addition to the tools above, the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides standardized criteria to help diagnose autism spectrum disorder ¹⁸⁾. See American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) diagnostic criteria below.

In addition, your health care provider may also recommend that your child have a blood test to help rule out some other conditions and problems ¹⁹⁾.

Depending on the results of the blood test and the developmental and other screenings, your child’s health care provider will either:

• Rule out autism or
• Refer your child to a specialist in child development or another specialized field to diagnose the child with autism. The specialist will then do a number of tests to figure out whether your child has autism or another condition. These will include tests of your child’s communication abilities and observation of the child’s behaviors.

American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Autism Diagnostic Criteria

Because the diagnostic criteria for autism spectrum disorder (ASD) changed in 2013, ongoing research will help ensure that these screening tests are accurately identifying children who meet the new criteria for autism spectrum disorder (ASD).

The American Psychiatric Association, a professional society of psychiatrists, updated the criteria for an autism diagnosis in May 2013. The criteria are published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ²⁰⁾.

Diagnostic Criteria for Autism Spectrum Disorder

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. (See table below.)

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.)

• C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).
• D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
• E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with a known medical or genetic condition or environmental factor
• (Coding note: Use additional code to identify the associated medical or genetic condition.)
• Associated with another neurodevelopmental, mental, or behavioral disorder
• (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
• With catatonia

Social (Pragmatic) Communication Disorder

Diagnostic Criteria

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.

C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).

D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

According to the DSM-5 criteria ²¹⁾, a person has autism spectrum disorder if he or she:

• Has problems with communication and social interactions, namely:
  • Doesn’t respond appropriately to social and emotional cues
  • Has deficits in nonverbal communication during social interactions
  • Has trouble developing friendships, keeping friends, and understanding relationships
• Has at least two types of repetitive behavioral patterns. These might include repetitive movements, inflexible routines, very restricted interests, or unusual responses to certain sensory inputs, such as the way a particular object feels.

There are various tools that specialists commonly use to diagnose autism. The only tool that currently fits the revised DSM-5 criteria is the Autism Diagnostic Observation Schedule (ADOS-2). However, it alone is not enough to make a diagnosis of autism spectrum disorder. Existing diagnostic tools are being modified to better fit the DSM-5 criteria.

During an Autism Diagnostic Observation Schedule (ADOS-2) assessment, the specialist interacts directly with your child in social and play activities. For example, the specialist will see whether your child responds to his or her name and how he or she performs in pretend play, such as with dolls. The specialist is looking for specific characteristics that are hallmarks of autism spectrum disorder. To be diagnosed with autism spectrum disorder, a child must have had symptoms since an early age ²²⁾.

As part of the diagnosis, the specialist will also note whether your child has ²³⁾:

• Any genetic disorder that is known to cause autism spectrum disorder or its symptoms, including Fragile X syndrome or Rett syndrome; your child might receive a genetic test to detect these types of disorders.
• A language disability and the level of disability
• Intellectual disability and the level of disability
• Any medical conditions common among those with autism spectrum disorder, such as seizures, anxiety, depression, or problems with the digestive system

Depending on your child’s unique symptoms and needs, the team of specialists may also want to give your child a range of other tests. If your child shows symptoms of seizures, a brain specialist, or neurologist, might use electrical sensors to observe your child’s brain activity.

Your child may need other tests to determine how best to treat the symptoms of autism spectrum disorder. A hearing specialist, or audiologist, might test your child’s hearing, which can sometimes seem poor in children with autism spectrum disorder. Other tests might include tests of muscle strength and tests of your child’s ability to control movement.

Asperger’s syndrome treatment

There are no medications that can cure autism spectrum disorder or treat the core symptoms. However, there are medications that can help some people with autism spectrum disorder function better. For example, medication might help manage high energy levels, inability to focus, depression, or seizures.

Medications might not affect all children in the same way. It is important to work with a health care professional who has experience in treating children with autism spectrum disorder. Parents and health care professionals must closely monitor a child’s progress and reactions while he or she is taking a medication to be sure that any negative side effects of the treatment do not outweigh the benefits.

It is also important to remember that children with autism spectrum disorder can get sick or injured just like children without autism spectrum disorder. Regular medical and dental exams should be part of a child’s treatment plan. Often it is hard to tell if a child’s behavior is related to the autism spectrum disorder or is caused by a separate health condition. For instance, head banging could be a symptom of the autism spectrum disorder, or it could be a sign that the child is having headaches. In those cases, a thorough physical exam is needed. Monitoring healthy development means not only paying attention to symptoms related to autism spectrum disorder, but also to the child’s physical and mental health, as well.

Early Intervention Services

Research shows that early intervention treatment services can greatly improve a child’s development ²⁴⁾. Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an autism spectrum disorder or other developmental problem.

Even if your child has not been diagnosed with an autism spectrum disorder, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (https://sites.ed.gov/idea/) says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal autism spectrum disorder diagnosis. While early intervention is extremely important, intervention at any age can be helpful.

Types of Treatments

There are many different types of treatments available. For example, auditory training, discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy, and sensory integration.

The different types of treatments can generally be broken down into the following categories:

• Behavior and Communication Approaches
• Dietary Approaches
• Medication
• Complementary and Alternative Medicine

Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with autism spectrum disorder are those that provide structure, direction, and organization for the child in addition to family participation.

Applied Behavior Analysis (ABA)

A notable treatment approach for people with an autism spectrum disorder is called applied behavior analysis (ABA). Applied behavior analysis has become widely accepted among health care professionals and used in many schools and treatment clinics. Applied behavior analysis encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The child’s progress is tracked and measured.

There are different types of applied behavior analysis. Following are some examples:

• Discrete Trial Training (DTT): Discrete Trial Training is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.
• Early Intensive Behavioral Intervention (EIBI): This is a type of applied behavior analysis for very young children with an autism spectrum disorder, usually younger than five, and often younger than three.
• Pivotal Response Training (PRT): Pivotal Response Training aims to increase a child’s motivation to learn, monitor his own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.
• Verbal Behavior Intervention (VBI): Verbal Behavior Intervention is a type of ABA that focuses on teaching verbal skills.

Other therapies that can be part of a complete treatment program for a child with an autism spectrum disorder include:

• Developmental, Individual Differences, Relationship-Based Approach (also called “Floortime”): Floortime focuses on emotional and relational development (feelings, relationships with caregivers). It also focuses on how the child deals with sights, sounds, and smells.
• Treatment and Education of Autistic and related Communication-handicapped CHildren (TEACCH) (https://teacch.com/): TEAACH uses visual cues to teach skills. For example, picture cards can help teach a child how to get dressed by breaking information down into small steps.
• Occupational Therapy: Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.
• Sensory Integration Therapy: Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.
• Speech Therapy: Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
• The Picture Exchange Communication System (PECS): The Picture Exchange Communication System uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation.

Dietary Approaches

Some dietary treatments have been developed by reliable therapists. But many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of autism spectrum disorder. Some parents feel that dietary changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to the doctor first. Or talk with a nutritionist to be sure your child is getting important vitamins and minerals.

Medication

Currently, there is no medication that can cure autism spectrum disorder (autism spectrum disorder) or all of its symptoms. But some medications can help treat certain symptoms associated with autism spectrum disorder, especially certain behaviors.

Health care providers often use medications to deal with a specific behavior, such as to reduce self-injury or aggression. Minimizing a symptom so that it is no longer a problem allows the person with autism to focus on other things, including learning and communication. Research shows that medication is most effective when used in combination with behavioral therapies ²⁵⁾.

Health care providers usually prescribe a medication on a trial basis to see if it helps. Some medications may make symptoms worse at first or take several weeks to work. Your child’s health care provider may have to try different dosages or different combinations of medications to find the most effective plan.

Families, caregivers, and health care providers need to work together to make sure that the medication plan is safe and that all medications have some benefit.

In 2006, the U.S. Food and Drug Administration (FDA) approved the drug risperidone for treating irritability in children with autism who are between 5 years and 16 years of age ²⁶⁾. Risperidone is currently the only FDA-approved drug for the treatment of specific autism symptoms.

Other drugs are often used to help improve symptoms of autism, but they are not approved by the FDA for this specific purpose. Some medications on this list are not approved for those younger than 18 years of age. Please consult the FDA for complete information on the medications listed below.

All medications carry risks, some of them serious. Families should work closely with their children’s health care providers to ensure safe use of any medication ²⁷⁾.

• Selective serotonin re-uptake inhibitors (SSRIs): This group of antidepressants treats some problems that result from imbalances in the body’s chemical systems. Selective serotonin re-uptake inhibitors (SSRIs) might reduce the frequency and intensity of repetitive behaviors; decrease anxiety, irritability, tantrums, and aggressive behavior; and improve eye contact.
• Tricyclics: These medications are another type of antidepressant used to treat depression and obsessive-compulsive behaviors. These drugs seem to cause more minor side effects than do SSRIs. They are sometimes more effective than SSRIs for treating certain people and certain symptoms.
• Psychoactive or anti-psychotic medications: These types of medications affect the brain of the person taking them. The anti-psychotic drug risperidone is approved for reducing irritability in 5-to-16-year-olds with autism. These medications can decrease hyperactivity, reduce stereotyped behaviors, and minimize withdrawal and aggression among people with autism.
• Stimulants: This group of medications can help to increase focus and decrease hyperactivity in people with autism. They are particularly helpful for those with mild autism spectrum disorder symptoms.
• Anti-anxiety medications: This group of medications can help relieve anxiety and panic disorders, which are often associated with autism spectrum disorder.
• Anticonvulsants: These medications treat seizures and seizure disorders, such as epilepsy. (Seizures are attacks of jerking or staring and seeming frozen.)
  Almost one-third of people with autism symptoms have seizures or seizure disorders.

Autism Speaks, one of the leading autism science and family support organizations in the United States, offers a tool to help parents and caregivers make informed decisions about medication (https://www.autismspeaks.org/tool-kit/atnair-p-medication-decision-aid).

Complementary and Alternative Treatments

To relieve the symptoms of autism spectrum disorder, some parents and health care professionals use treatments that are outside of what is typically recommended by the pediatrician. These types of treatments are known as complementary and alternative treatments. They might include special diets, chelation (a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (like deep pressure) ²⁸⁾.

These types of treatments are very controversial. Current research shows that as many as one third of parents of children with an autism spectrum disorder may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment ²⁹⁾. Before starting such a treatment, check it out carefully, and talk to your child’s doctor.