Understanding Autism Spectrum Disorder in Children

Autism spectrum disorder (ASD) in children is a lifelong developmental difference in how a child communicates, relates to others, learns, and experiences the world. Every autistic child shares differences in two core areas, social communication and restricted or repetitive behaviors, but how those differences show up varies a great deal from one child to the next. That range is why it is called a spectrum.

Key takeaways

• ASD is defined by differences in social communication and by restricted or repetitive behaviors, interests, or sensory responses.
• “Spectrum” means autistic children have very different profiles of strengths and support needs, not that autism runs from “mild” to “severe” in a straight line.
• The DSM-5 describes three support levels. They describe support needs at one point in time and can change.
• Many autistic children also have co-occurring conditions, such as anxiety, sleep differences, or gastrointestinal issues.
• Support works best when it is built around your child’s strengths, interests, and your family’s goals.

What is autism spectrum disorder?

The National Institute of Mental Health describes ASD as a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. The CDC puts it simply: ASD is a developmental disability caused by differences in the brain.

Autism is not caused by parenting, and it is not something a child grows out of. It is a different way of developing. Signs are often visible in early childhood, though some children are not identified until they are older, when social or school demands increase.

If you are just starting to wonder about your child’s development, our guide to the early signs of autism walks through what to watch for by age.

The two core areas of autism

Clinicians use the American Psychiatric Association’s DSM-5 criteria to diagnose autism. The CDC summarizes these DSM-5 diagnostic criteria for health care providers. A diagnosis requires differences in both of the areas below.

1. Social communication and social interaction

This area covers how a child connects and communicates with other people. It can include:

• Back-and-forth interaction. Your child may not respond to their name, may rarely start conversations, or may talk at length about a favorite topic without noticing whether the listener is interested.
• Nonverbal communication. Eye contact, gestures like pointing or waving, and facial expressions may be used less often or in different ways.
• Relationships. Your child may prefer playing alone, find pretend play with other children confusing, or want friends but not know how to join in.

The CDC’s list of signs includes examples such as not pointing to show you something interesting by 18 months and using few or no gestures by 12 months.

2. Restricted or repetitive behaviors, interests, or activities

This area covers patterns in how a child moves, plays, and responds to the world. It can include:

• Repetitive movements or speech. Hand flapping, rocking, spinning, lining up toys, or repeating words and phrases (called echolalia).
• Strong need for sameness. Distress when routines change, or a need to take the same route or eat from the same plate.
• Intense, focused interests. Deep interest in a topic, such as trains, numbers, or one TV show, or attention to parts of objects, like spinning wheels.
• Sensory differences. The DSM-5 includes “hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment” in this area. A child might cover their ears at the sound of a blender, seem not to notice pain, or love watching lights.

Many of these behaviors serve a purpose for your child. Repetitive movement can be calming. A focused interest can be a source of joy and real expertise. Good support does not try to remove these behaviors for their own sake. It looks at whether something is getting in the way of your child’s safety, learning, or well-being. We cover sensory differences in more depth in our article on sensory processing and autism.

What “spectrum” really means

People often picture the autism spectrum as a line from “mild” to “severe.” That picture is misleading.

A more useful way to think about it is a set of different skills and needs, each of which can look different for each child. One autistic child may speak in full sentences, read early, and struggle a lot with changes in routine and loud places. Another may not use spoken words, communicate well with pictures or a device, and enjoy busy playgrounds. Both children are autistic. Their profiles are simply different.

A child’s profile can also be uneven. It is common for an autistic child to be ahead of peers in one area, such as memorizing facts or solving puzzles, and to need a lot of support in another, such as getting dressed or asking for help.

What happened to the “types” of autism?

Parents searching for types of autism often find older terms, such as Asperger’s syndrome or pervasive developmental disorder–not otherwise specified (PDD-NOS). The current DSM-5 framework uses one diagnosis, autism spectrum disorder, and describes each person’s needs with support levels and “specifiers” instead of separate types.

Autism levels: what levels 1, 2, and 3 mean

When a clinician diagnoses ASD under the DSM-5, they also describe how much support the child needs in each of the two core areas. The CDC lists the three DSM-5 severity levels this way:

Level	DSM-5 wording	What it may look like in daily life
Level 1	“Requires support”	Your child may talk and learn alongside peers, but find it hard to start or keep up conversations, make friends, or handle changes in plans without support.
Level 2	“Requires substantial support”	Differences are more noticeable to others. Your child may speak in short phrases or use limited speech, and changes in routine may cause significant distress.
Level 3	“Requires very substantial support”	Your child may use very little spoken language and need a high level of support with communication, daily routines, and managing change.

The right-hand column gives general examples only. Every child is different, and a child can have different levels for social communication and for restricted or repetitive behaviors.

A few points help keep these levels in perspective:

• Levels describe support needs, not worth or potential. They say nothing about how much your child understands, feels, or can learn.
• Levels can change. They reflect a point in time. As your child builds skills or faces new demands, their support needs may shift.
• Levels are descriptive. The American Speech-Language-Hearing Association (ASHA) notes that severity ratings “are used for descriptive purposes only and not to diagnose or determine eligibility for services”.

Specifiers you may see on a report

A diagnostic report may also note whether a child’s autism occurs with or without accompanying intellectual impairment, and with or without accompanying language impairment. It may also list any known medical or genetic condition. These notes help the team plan support. They are not extra labels meant to limit your child.

Co-occurring conditions

Many autistic children have other conditions or differences alongside autism. The CDC lists other characteristics that may be present, including:

• Delayed language, movement, or learning skills
• Hyperactive, impulsive, or inattentive behavior
• Epilepsy or seizure disorder
• Unusual eating and sleeping habits
• Gastrointestinal issues, such as constipation
• Unusual mood or emotional reactions
• Anxiety, stress, or excessive worry
• Lack of fear, or more fear than expected

(CDC, Signs and Symptoms of ASD)

These matter because they can affect how your child feels and behaves. A child who is not sleeping well or has stomach pain may have a harder time at therapy, at school, and at home. If you notice any of these, bring them up with your child’s pediatrician. Your pediatrician or a qualified specialist is the right person to talk with about your child’s specific medical needs.

Strengths and differences

Autism is not only a list of challenges. Many autistic children have real strengths, such as:

• Excellent memory for facts, routes, or schedules
• Deep focus and persistence on topics they love
• Strong visual thinking and pattern recognition
• Honesty and directness
• Close attention to detail

Strengths look different in every child, and no child should be expected to have a “special talent.” What matters is noticing what your child enjoys and does well, then using it. A child who loves trains might practice counting train cars, taking turns with a train set, or asking for “more train” with words, signs, or a picture.

Talking about autism: identity-first or person-first language

You will see two common ways of talking about autism:

• Identity-first: “autistic child,” “autistic person”
• Person-first: “child with autism,” “person with autism”

Many autistic adults prefer identity-first language because they see autism as part of who they are. Many parents and professionals were taught person-first language to put the child before the diagnosis. Both come from a place of respect.

In this article we use both, and our team follows your family’s preference. As your child grows, their own preference matters most. Ask them, and let them decide how they want to describe themselves.

What support can look like

There is no single treatment that works for every autistic child. The CDC describes several types of approaches, including behavioral approaches like applied behavior analysis (ABA), developmental approaches like speech and language therapy and occupational therapy, educational approaches, and social-relational approaches. The CDC also notes that there are no medications that treat the core features of autism, though a doctor may treat co-occurring conditions.

For many families, support includes some mix of:

• ABA therapy to build communication, daily living, social, and play skills, led by a Board Certified Behavior Analyst (BCBA). If you are new to it, start with what ABA therapy is.
• Speech therapy for autism to support understanding, expression, and social communication, whether your child uses spoken words, signs, pictures, or a device.
• Occupational therapy for fine motor skills, self-care, and sensory regulation.
• Parent training so you have practical strategies for daily routines at home.
• School supports through your child’s school district.

Good support is individualized. It respects your child’s dignity and assent, which means paying attention to whether your child is comfortable and willing to take part. It focuses on goals that matter in your child’s real life, like asking for help, getting through a haircut, or playing with a sibling. It does not aim to make your child look less autistic.

Starting early can help. Our article on early intervention for autism explains why, and what services are available before age 3.

If your child does not have a diagnosis yet

If you have concerns, you do not need to wait. Talk with your pediatrician about developmental screening and a referral for an evaluation. Our guide on when to get an autism evaluation explains who can diagnose autism and what to expect. United Autism Therapy does not diagnose autism, but we can help you think through next steps and support your child once a diagnosis is in place.

Talk with our team

Learning about autism spectrum disorder can bring up many questions, and you do not need to have them all answered at once. If you would like to talk about support for your child, United Autism Therapy offers a free consultation for families in Westminster and across Orange County.

Call us at (714) 709-7819 or contact our team to set up a time that works for you.