Autism

KidsHealth from Nemours

Patient and family education is important to us. Here you can learn more about autism spectrum disorders in children, and view trusted insights from KidsHealth.org, the No. 1 most viewed health site for children, created by the experts at Nemours. We've also provided information from the most respected nonprofit organizations.

About Autism in Children

Autism — whether mild or severe — is a lifelong condition and your child may need medication, therapy or support throughout his or her life. Thankfully today, unlike only a few decades ago, autism specialists can offer many interventions and therapies that can remarkably increase your child’s skills and abilities. The next few decades (and even the next few years) show great promise of more to come.

 
What Is Autism Spectrum Disorder?

Autism is a neurodevelopmental disorder, which means it’s a condition related to the improper development of the neurons in the brain.

Children with an autism spectrum disorder develop “unevenly” and have difficulties in communication and social interactions and exhibit repetitive or restrictive behaviors. Very often, these children have exceptional strengths in other areas, such as math, visual processing and musical and artistic abilities (to name a few). Autism spectrum disorder is an active area of research — every day we’re uncovering important information about the disorder.

Traditional Types of Autism

Autism has had many names, including:
  • autistic disorder (or autism) — refers to the more severe cases in which children have difficulty communicating and interacting with others (or they may be unable to communicate), and also exhibit unique repetitive/restrictive behaviors such as hand flapping, spinning or rocking.
  • Asperger syndrome (AS, also called Asperger’s) — a milder form of autism in which children have average or above-average intelligence, impaired language skills only in some areas (like language pragmatics, or understanding the meaning of words in certain situations), impaired social skills (problems with reciprocity, or the natural “give and take” that occurs in a conversation) and repetitive/restrictive behaviors, sometimes related to a special interest.
  • pervasive developmental disorder-not otherwise specified (PDD-NOS) — Because there are many variations within the autism spectrum — with no two children experiencing the same symptoms or patterns of behavior — today we refer to all types of autism as “autism spectrum disorder” regardless of how mild or severe symptoms may be.
 
Prevalence and Cause of Autism Spectrum Disorders in Children

The Centers for Disease Control (CDC) estimates that 1 in 88 children has an autism spectrum disorder. And while there are many theories about the causes of autism spectrum disorder in children, large research studies show vaccinations do not increase the risk for the disorder. Other studies show that genes may play a role, and possibly prenatal illness or infections, but it is not caused by anything a mother did, or did not do, during pregnancy. What’s more, autism is not a result of a child’s upbringing, amount of nurturing or environment at home. The cause of autism development disorder continues to be a very active area of study.

 
Symptoms of Autism Spectrum Disorder in Children

Children with an autism spectrum disorder exhibit behavioral symptoms in specific areas, with different degrees of severity, and at different ages or life stages. Some symptoms include:

Communication Difficulties
  • delayed babbling or speaking
  • does not speak, or is “nonverbal” (but may be able to communicate using pictures or assistive technologies)
  • problems understanding the meaning of words
  • difficulty starting and sustaining (continuing) conversation
  • can only talk about a special interest (no “small talk”)
  • does not understand tone, body language or facial expressions
  • interprets words literally (may not understand statements like “it’s raining cats and dogs”)
  • may speak in a different tone (monotone or high-pitched)
Impaired Social Interaction
  • does not engage in interactions or imitation (smiling back or responding to name)
  • reduced interest in people
  • lack of eye contact
  • difficulty making and keeping friends
  • difficulty playing games or working in groups (has own rules or way of playing)
  • responds to things differently (laughs when it’s serious or cries when it’s not)
  • hard time understanding how people think or feel (difficulty with or lack of empathy)
  • difficulty seeing other people’s perspective
  • difficulty regulating emotions (tantrums when overloaded)
Repetitive/Restrictive Behaviors
  • repeats words over and over
  • upset when a routine is disrupted or changed
  • hand-flapping, rocking or spinning
  • uses toys differently (repeatedly lines items up, spins wheels on vehicles, opens and shuts/turns things on and off)
  • intense fixation with details, particularly related to a special interest
Sensory Processing Difficulties

Some children may be easily overloaded by too much — or too little — sensory input. For example, children with an autism spectrum disorder may:

  • react adversely to itchy clothing (tags or seams)
  • dislike loud noises (vacuum cleaner, school bell, etc.)
  • avoid bright lights (particularly flickering of fluorescent lighting)
  • avoid being touched or hugged (or conversely, need more touch)

Disciplining Your Child With Special Needs

From the moment you heard the diagnosis, you knew life would be more challenging for your child than for most. So when you ask him to do something and it's not done, you let it go. Does he really need you to point out his limitations? Or maybe you fear that what you'd like him to do, or not do, is impossible for him to achieve.

But here's the truth: If you feel that your son or daughter doesn't deserve discipline, it's like telling your child, "I don't believe you can learn." And if you don't believe it, how will your child?

What experts call "behavior management" is not about punishing or demoralizing your child. Instead, it's a way to set boundaries and communicate expectations in a nurturing, loving way. Discipline — correcting kids' actions, showing them what's right and wrong, what's acceptable and what's not — is one of the most important ways that all parents can show their kids that they love and care about them.

Here are some strategies to help parents discipline a child who has special needs.

Be Consistent

The benefits of discipline are the same whether kids have special needs or not. In fact, kids who have trouble learning respond very well to discipline and structure. But for this to work, parents have to make discipline a priority and be consistent.

Correcting kids is about establishing standards — whether that's setting a morning routine or dinnertime manners — and then teaching them how to meet those expectations. All kids, regardless of their needs and abilities, crave this consistency. When they can predict what will happen next in their day, they feel confident and safe.

Yes, they will test these boundaries — all kids do. But it's up to you to affirm that these standards are important and let your child know that you believe he or she can meet them.

Learn About Your Child's Condition

To understand your child's behavior, you have to understand the things that affect it — including his or her condition. So no matter what challenge your child faces, try to learn as much about the unique medical, behavioral, and psychological factors that affect his or her development.

Read up on the condition and ask the doctor about anything you don't understand. Also talk to members of your child's care team and other parents (especially those with kids who have similar issues) to help determine if your child's challenging behavior is typical or related to his or her individual challenges. For example, can another parent relate to the trouble you have getting your 5-year-old dressed each morning? Sharing experiences will give you a way to measure your expectations and learn which behaviors are related to your child's diagnosis and which are purely developmental. You also might pick up some helpful tips about how to handle the behavior you are noticing.

If you have trouble finding parents of kids with similar challenges, consider joining an online support or advocacy group for families of kids with special needs. Once you know what is typical behavior for your child's age and health challenges, you can set realistic behavioral expectations.

Defining Expectations

Establishing rules and discipline are a challenge for any parent. So keep your behavior plan simple and work on one challenge at a time. And as your child meets one behavioral goal, he or she can strive for the next one.

Here are some pointers.

Use Rewards and Consequences

Work within a system that includes rewards (positive reinforcement) for good behavior and natural consequences for bad behavior. Natural consequences are punishments that are directly related to the behavior. For example, if your child is throwing food, you would take away the plate.

But not every kid responds to natural consequences, so you might have to match the consequence to your child's values. For instance, a child with autism who likes to be alone might consider a traditional "time out" rewarding — instead, take away a favorite toy or video game for a period of time.

After correcting your child for doing something wrong, offer a substitute behavior. So if your child is talking too loudly or hitting you to get your attention, work on replacing that with an appropriate behavior such as saying or signaling "help me" or getting your attention in appropriate ways, such as tapping your shoulder. Active ignoring is a good consequence for misbehavior meant to get your attention. This means not rewarding bad behavior with your attention (even if it's negative attention, like scolding or yelling).

Use Clear and Simple Messages

Communicate your expectations to your child in a simple way. For kids with special needs, this may require more than just telling them. You may need to use pictures, role playing, or gestures to be sure your child knows what he or she is working toward.

Keep verbal and visual language simple, clear, and consistent. Explain as simply as possible what behaviors you want to see. Consistency is key, so make sure that grandparents, babysitters, siblings, and teachers are all on board with your messages.

Offer Praise

Encourage accomplishment by reminding your child about what he or she can earn for meeting the goals you've set, whether it's getting stickers, screen time, or listening to a favorite song. And be sure to praise and reward your child for effort as well as success. So a child who refuses to poop in the toilet may be rewarded for using a potty near the toilet.

Another strategy: practice "time-in" — when you catch your child doing something right, praise him or her for it. In certain cases, time-in can be more effective than punishment, because kids naturally want to please their parents. By getting credit for doing something right, they'll likely want to do it again.

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Establish a Routine

Children with certain conditions, like autism and ADHD (attention deficit hyperactivity disorder), respond particularly well to discipline that's based on knowing exactly what will happen next. So try to stick to the same routine every day. For example: If your child tends to melt down in the afternoon after school, set a schedule for free time. Maybe he or she needs to have a snack first and then do homework before playtime.

Charts can be helpful. If your child is non-verbal or pre-verbal, draw pictures or use stickers to indicate what comes next. Set a schedule that's realistic and encourage input from your child where appropriate.

Believe in Your Child

If, after taking his first few steps, your little one kept falling down, would you get him some crutches or a wheelchair? No. So don't do the same with a child with special needs. Maybe your child can't put on his or her shoes the first time, or 10th time, but keeps trying. Encourage that!

When you believe your child can do something, you empower him or her to reach that goal. The same is true for behavior. For example, if your child is too aggressive when playing with other kids, don't stop the play altogether. Instead, work with your child to limit the physicality of the play. You may want to plan for non-physical activities during play dates, like arts and crafts projects. Use discipline where necessary in the form of time-outs, enforced turn-taking, and rules like "no touching" — and provide rewards when your wishes are met.

Whatever you do, don't give up on your child when the going gets tough. Bad behavior that's ignored in the early years can become unbearable, even dangerous, in the teen years and adulthood. Be patient and take the time to work with your child to help reach his or her best potential. Your vote of confidence is sometimes all your child needs to succeed.

Have Confidence in Your Abilities

Discipline is an exhausting undertaking. There will be good days when you're amazed by your child's progress, bad days when it seems like all your hard work was forgotten, and plateaus where it seems like further progress is impossible. But remember this: Behavior management is a challenge for all parents, even those of kids who are typically developing. So don't give up!

If you set an expectation in line with your child's abilities, and you believe he or she can accomplish it, odds are it will happen. If your efforts don't result in changes, talk to your child’s doctor, therapist, or behavior specialist to help reach your goals. He or she can work with you to develop a behavior plan that's tailored to your child's special needs.

Reviewed by: Larissa Hirsch, MD
Date reviewed: September 26, 2016