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)

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a condition that can affect people of any age — including kids and teens. It causes people to have obsessions, which are fears, doubts, and worries that take over and interrupt a person's normal thoughts and routines. 

To get relief from obsessive thoughts, people with OCD develop behaviors called rituals or compulsions. To a person with OCD, the rituals have the power to make things seem "right" or prevent the bad things they worry about.

Obsessive thoughts can be upsetting and scary. But kids and teens feel powerless to stop focusing on these thoughts, even though they want to. This can make life very stressful.

Fortunately, kids and teens with OCD can get better with the right attention and care.

Recognizing OCD

OCD can be recognized through obsessions and compulsive rituals.

Obsessions
Obsessive thoughts can cause kids and teens to feel and act irritable, upset, sad, or anxious. Kids with OCD often get obsessed with: 

  • whether something is dirty or germy
  • things being symmetrical or even 
  • things being done in set order or a specific way
  • whether they might have sinned, broken a rule, or offended someone
  • numbers, words, sounds, or colors that seem "lucky" or  "unlucky"
  • having sexual or aggressive thoughts
  • body wastes
  • illness or harm coming to them or their relatives

Kids with OCD become afraid of what might happen if something is dirty or uneven, or if they see an "unlucky" number or color. They worry that the bad things they're afraid of will come true. They may think that having bad thoughts means they are bad. Obsessions make it hard to concentrate on schoolwork or enjoy activities.

Compulsive Rituals

Kids with OCD feel compelled to do specific rituals to get relief from their obsessive thoughts. They do these rituals to "make sure" things are clean, in order, or "just right." Rituals include things like: 

  • washing and cleaning
  • repeating specific behaviors — like saying a word or phrase over and over
  • going in and out of doorways several times in a row
  • checking — like making sure an appliance is off, a door is locked, or repeatedly checking homework
  • touching or tapping a certain number of times or a set way
  • ordering or arranging objects "just so"
  • counting — like counting to a certain number, or counting over and over

Doing a ritual gives kids with OCD temporary relief from fear, worry, or bad thoughts. But the more kids do a ritual, the more they feel the urge to do it again. Eventually, the ritual doesn't bring as much relief as it once did. So a kid may do it over, then over again. This is called "getting stuck."   

A kid with OCD may get stuck hand washing for so long he can't get to bed on time. Or a kid may get stuck packing and re-packing a backpack so many times that she misses the bus. Getting stuck in a ritual can make kids (and parents) feel frustrated, upset, and exhausted. 

Kids and teens with OCD often feel embarrassed. They might be afraid they'll be teased about their rituals. They often hide rituals or do them in a way that others don't notice. Because rituals can be upsetting, kids start to avoid situations that trigger the need to do them.

OCD affects students at school. A need to erase, rewrite, or re-do work slows kids down. Some kids won't write the correct answer on a test if it uses a "bad" number or word. They would rather get a poor grade than "risk" the bad thing they imagine might happen if they break OCD's "rules."  

Some kids tell a parent what's bothering or scaring them. But other kids may keep the worries and rituals to themselves. Parents may not realize what's causing their child's difficulties.

Why Do Kids Get OCD?

Scientists don't yet know why some people get OCD. Kids may get OCD because it's in their genes or they had an infection. And, there may be differences in certain brain structures and brain activity in people with OCD. But whatever caused OCD to happen in the first place, it's not the child's fault.

People with OCD can't control their condition or get better on their own. But the right diagnosis and therapy can help them get better and get on with life.

Diagnosing OCD

OCD can get better with the right attention and care. But problems also can continue or get worse if they're not treated. If you think your child might have OCD, here's what to do.

Talk with your child about what's going on. Talk supportively, listen, and show love. Tell your child what you've noticed and that you know it's stressful for him. Say that something called OCD might be causing your child to be worrying and "fixing" things in these ways. Say that a check-up with the doctor can find out if this is what's going on. Reassure your child that this can get better and that you want to help.

Kids with OCD sometimes feel ashamed or embarrassed at first. They may try to hide a ritual or deny doing it. But it can be a relief to a kid if someone understands what's going on.

Schedule a visit to your child's pediatrician. Tell the doctor what you have noticed. Encourage your child to speak up, too. The doctor will probably examine your child and ask questions. That helps the doctor decide if the symptoms could be OCD or another health condition. The doctor may refer you to a mental health professional for more evaluation and treatment, and can help you find a therapist who specializes in treating OCD.

Getting Help

When OCD is diagnosed, it can be a relief to kids and parents. Now they can focus on getting better. 

Therapists treat OCD with cognitive behavioral therapy. During this type of talk-and-do therapy, kids and teens learn helpful new ways to think about OCD. They learn that doing rituals keeps OCD going strong, and that not doing rituals helps to weaken OCD. 

As they go through the therapy, kids and teens learn ways to face fears and resist doing rituals. Learning these skills helps reset the brain's activity to a healthier way of working. That can stop the cycle of obsessive-compulsive messages and urges. Sometimes, doctors also prescribe medicines to treat OCD. But most kids don't need medicine to get well.  

During treatment, parents will learn what they can do to help kids get better. It's not easy at first — and the treatment takes time, practice, and patience. There can be successes and setbacks along the way. But it works well for most people who stick with it. 

Many resources and support are available for parents and families dealing with OCD. Knowing that you're not alone can help you cope and give you hope and confidence.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: April 28, 2017