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.
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.
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.
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:
- 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)
- 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)
From Nemours' KidsHealth
- Speech-Language Therapy
- Sending Your Child With Special Needs to Camp
- Sleep Problems in Teens
- What Is ADHD?
- Camps for Kids With Special Needs
- Giving Teens a Voice in Health Care Decisions
- Anxiety, Fears, and Phobias
- Relaxation Techniques for Children With Serious Illness
- Raising a Child With Autism: Paige and Iain's Story
- Autism Special Needs Factsheet
- Is There a Connection Between Vaccines and Autism?
- Delayed Speech or Language Development
- Brain and Nervous System
- Obsessive-Compulsive Disorder
- Occupational Therapy
- Disciplining Your Child With Special Needs
- A to Z: Autism
- Individualized Education Programs (IEPs)
- Does My Toddler Have a Language Delay?
- Asperger Syndrome
- Auditory Processing Disorder
Trusted External Resources
- The Power of Positive Parenting: A Wonderful Way to Raise Children, by Dr. Glenn I. Latham
- Educate Toward Recovery: Turning the Tables on Autism, by MA BCBA Robert Schramm
- Autism’s False Prophets: Bad Science, Risky Medicine, and the Search For A Cure, by Paul A. Offit, MD
All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.
OCD is a type of anxiety disorder. Kids with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty — or with thoughts that bad stuff could happen.
With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person's mind and are hard to shake. Kids with OCD also might worry about things not being "in order" or "just right." They may worry about losing things, sometimes feeling the need to collect these items, even though they may seem useless to other people.
Someone with OCD feels strong urges to do certain things repeatedly — called rituals or compulsions — in order to banish the scary thoughts, ward off something dreaded, or make extra sure that things are safe, clean, or right in some way.
Children may have a difficult time explaining a reason for their rituals and say they do them "just because." But in general, by doing a ritual, someone with OCD is trying to relieve anxiety. They may want to feel absolutely certain that something bad won't happen or to feel "just right."
Think of OCD as an "overactive alarm system." The rise in anxiety or worry is so strong that a child feels like he or she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life.
Most kids with OCD realize that they really don't have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is "required" to neutralize the uncomfortable feeling. And often the behavior does decrease the anxiety — but only temporarily. In the long run, the rituals may worsen OCD severity and prompt the obsessions to return.
Doctors and scientists don't know exactly what causes OCD, although recent research has led to a better understanding of it and its potential causes. Experts believe OCD is related to levels of a neurotransmitter called serotonin. Neurotransmitters are chemicals that carry signals in the brain.
When the flow of serotonin is blocked, the brain's "alarm system" overreacts and misinterprets information. These "false alarms" mistakenly trigger danger messages. Instead of the brain filtering out these messages, the mind dwells on them — and the person experiences unrealistic fear and doubt.
Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain's serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop a serotonin imbalance that causes OCD can be inherited.
Having the genetic tendency for OCD doesn't mean that someone will develop OCD, but it does mean there's a stronger chance that he or she might. Sometimes an illness or some other stress-causing event may trigger the symptoms of OCD in a person who is genetically prone to develop it.
It's important to understand that the obsessive-compulsive behavior is not something that a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, and is not something kids can control or have caused themselves.
OCD is also not something that parents have caused, although life events (such as starting school or the death of a loved one) might worsen or trigger the onset of OCD in kids who are prone to develop it.
Common OCD Behaviors in Kids
OCD can make daily life difficult for the kids that it affects and their families. The behaviors often take up a great deal of time and energy, making it more difficult to complete tasks, such as homework or chores, or to enjoy life.
In addition to feeling frustrated or guilty for not being able to control their own thoughts or actions, kids with OCD also may suffer from low self-esteem or from shame or embarrassment about what they're thinking or feeling (since they often realize that their fears are unrealistic, or that their rituals are not realistically going to prevent their feared events).
They also may feel pressured because they don't have enough time to do everything. A child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete the compulsive rituals. Kids might have difficulties with attention or concentration because of the intrusive thoughts.
Among kids and teens with OCD, the most common obsessions include:
- fear of dirt or germs
- fear of contamination
- a need for symmetry, order, and precision
- religious obsessions
- preoccupation with body wastes
- lucky and unlucky numbers
- sexual or aggressive thoughts
- fear of illness or harm coming to oneself or relatives
- preoccupation with household items
- intrusive sounds or words
These compulsions are the most common among kids and teens:
- grooming rituals, including hand washing, showering, and teeth brushing
- repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or rereading, erasing, and rewriting
- checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework
- rituals to undo contact with a "contaminated" person or object
- touching rituals
- rituals to prevent harming self or others
- ordering or arranging objects
- counting rituals
- hoarding and collecting things of no apparent value
- cleaning rituals related to the house or other items
Signs and Symptoms of OCD
Recognizing OCD is often difficult because kids can become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, a child may not engage in the ritual at school, so parents might think it's just a phase.
When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. Kids who feel embarrassed or as if they're "going crazy" may try to blend the OCD into the normal daily routine until they can't control it anymore.
It's common for kids to ask a parent to join in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, "I didn't touch something with germs, did I?" the parent might have to respond, "No, you're OK," and the ritual will begin again for a certain number of times. Initially, the parent might not notice what is happening.
Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, which brings families into treatment.
Parents can look for the following possible signs of OCD:
- raw, chapped hands from constant washing
- unusually high rate of soap or paper towel usage
- high, unexplained utility bills
- a sudden drop in test grades
- unproductive hours spent doing homework
- holes erased through test papers and homework
- requests for family members to repeat strange phrases or keep answering the same question
- a persistent fear of illness
- a dramatic increase in laundry
- an exceptionally long amount of time spent getting ready for bed
- a continual fear that something terrible will happen to someone
- constant checks of the health of family members
- reluctance to leave the house at the same time as other family members
OCD is more common than many other childhood disorders or illnesses, but it often remains undiagnosed. Kids might keep the symptoms hidden from their families, friends, and teachers because they're embarrassed.
Even when symptoms are present, a parent or health care provider might not recognize that they are part of a mental health disorder and may attribute them to a child's quirkiness or even bad behavior.
Doctors consider OCD to be a pattern of obsessive thinking and rituals that does one or more of the following:
- takes up more than an hour each day
- causes distress
- interferes with daily activities
OCD in kids is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone.
If your child shows signs of OCD, talk to your doctor. In screening for OCD, the doctor or a mental health professional will ask your child about obsessions and compulsions in language that kids will understand, such as:
- Do you have worries, thoughts, images, feelings, or ideas that bother you?
- Do you have to check things over and over again?
- Do you have to wash your hands a lot, more than most kids?
- Do you count to a certain number or do things a certain number of times?
- Do you collect things that others might throw away (like hair or fingernail clippings)?
- Do things have to be "just so"?
- Are there things you have to do before you go to bed?
Because it might be normal for a child who doesn't have OCD to answer yes to any of these questions, the doctor also will ask about how often and how severe the behaviors are, about your family's history of OCD, Tourette syndrome and other motor or vocal tic disorders, or other problems that sometimes occur with OCD. OCD is common in people with Tourette syndrome.
Other disorders that often occur with OCD include other anxiety disorders, depression, disruptive behavior disorders, attention deficit hyperactivity disorder (ADHD), learning disorders, and trichotillomania (compulsive hair pulling). PANS, a rare condition that stands for Pediatric Acute-onset Neuropsychiatric Syndrome, also has been associated with having OCD.
The most successful treatments for kids with OCD are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps kids learn to change thoughts and feelings by first changing behavior.
Behavioral therapy involves gradually exposing kids to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur. For example, kids who are afraid of dirt might be exposed to something dirty, starting with something mildly bothersome and ending with something that might be really dirty.
For exposure to be successful, it must be combined with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, a child who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly.
Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something he or she can control. Over time, the anxiety provoked by dirt and the urge to perform washing rituals gradually disappear. The child also gains confidence that he or she can "fight" OCD.
OCD can sometimes worsen if it's not treated in a consistent, logical, and supportive manner. So it's important to find a therapist who has training and experience in treating OCD.
Just talking about the rituals and fears have not been shown to help OCD, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a child cope with OCD.
Many kids can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to perform rituals.
Helping Kids With OCD
It's important to understand that OCD is never a child's fault. Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive.
Kids with OCD get better at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better.
It can be helpful to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD. It's also important to not let OCD be the "boss" of the house and regular family activities. Giving in to OCD worries does not make them go away.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: August 11, 2016