Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by a wide range of challenges in social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities. Because it’s a spectrum, ASD affects each person differently, leading to varying levels of severity and support needs.
ASD is a lifelong condition that typically begins in early childhood, though sometimes it’s not diagnosed until adolescence or adulthood. While there’s no cure for autism, evidence-based treatments can help people with ASD manage challenges and develop essential life skills, especially if treatment starts early in life.
In its 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association (APA) changed its description of how autism is understood and diagnosed. Formerly separate diagnoses, autistic disorder, Asperger’s syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified were consolidated under the single umbrella term autistic spectrum disorder, or ASD.
While ASD is now a single diagnosis, the DSM-5 acknowledges individual differences in symptoms and severity. It also outlines three distinct levels of support needs, to better describe how much assistance a person may need because of challenges in social interaction, communication, and behavior.
Level 1: Requiring Support
People with level 1 ASD require support because of:
Noticeable difficulties in social communication and interaction
Difficulty in initiating social interactions and maintaining a back-and-forth conversation, and a tendency to offer responses that others find unusual or unexpected when others try to engage
Inflexibility in behavior or difficulty coping with change
Frustration or distress when asked to switch between activities
Many people with level 1 ASD have developed age-typical language and cognitive skills; however, their social and behavioral differences require some support to navigate daily life and build relationships.
Level 2: Requiring Substantial Support
People with level 2 ASD require substantial support because of:
Noticeable challenges in both verbal and nonverbal communication
Limited interest in or ability to initiate social interactions; responses that are minimal, unusual, or unexpected
Inflexibility in behavior or difficulty coping with change
Intense focus on a restricted set of interests
Repetitive behaviors that are frequent enough to be noticeable to casual observers and often interfere with their ability to manage daily activities in various settings
Level 3: Requiring Very Substantial Support
People with level 3 ASD require very substantial, often round-the-clock, support to help them navigate daily life and ensure their safety and well-being because of:
Severe difficulties in verbal and nonverbal communication skills that cause significant challenges with daily life or major problems in daily functioning
Very limited initiation of social interactions and minimal response to others; nonverbal or have very few words that others can easily understand
Extreme inflexibility of behavior and intense difficulty coping with change
A restricted set of interests or repetitive behaviors that significantly interfere with their ability to function
The signs and symptoms of ASD can vary widely from one person to another, but they generally involve ongoing challenges in several areas, including communication and interaction, as well as patterns of repetitive behavior and a restricted set of interests or activities.
While these signs often begin in early childhood (typically before age 3), they might not always be recognized until later in life. Early indicators that a young child may have ASD include:
Making limited eye contact or none at all
Not responding to their name or making facial expressions to show different emotions by 9 months old
Uses few to no gestures, such as waving hello or goodbye, by age 1
Doesn’t share interests, such as showing you an object they like, by 15 months
Doesn’t point to things that interest them by 18 months
Doesn’t pick up on others’ upset or hurt feelings by age 2
Doesn’t play “pretend” (such as imagining they’re a superhero) by age 4
Doesn’t act, dance, or sing for you by age 5
Other potential signs and symptoms of ASD in children or adults include:
Delayed, limited, or no speech
Seemingly limited awareness of their surroundings; for example, doesn’t respond when their name is called
Speaks in an accent others find unusual, speaks very quickly or slowly, or has differences in intonation (such as sounding monotone)
Difficulty judging pauses or turn-taking in conversations
Talks extensively about their own interests, but doesn’t ask much about others’ interests
Is more honest or direct in conversation than others expect (rather than telling a “polite lie,” for example)
Has challenges in recognizing or interpreting the emotions and perspectives of others, or finds it hard to express their own feelings in conventional ways
Difficulty judging whether someone is joking in a friendly way or trying to bully them
Repeats words or phrases they’ve heard (echolalia), sometimes without immediate relevance to the conversation
Engages in repetitive physical movements, like hand-flapping, rocking, or spinning (also known as stimming)
Has sensory processing issues; is either more or less sensitive than others to particular sounds, lights, textures, smells, or tastes
Loses skills they once had, such as previously acquired speech or social skills (known as regression)
The medical community doesn’t yet know the cause of ASD. But research suggests that ASD is likely caused by a combination of genetic and environmental factors. People with at least one of the following risk factors have increased odds of developing ASD.
A sibling with ASD
Older parents
Certain genetic conditions, including fragile X syndrome, Down syndrome, or Rett syndrome
A very low birth weight
Premature birth (before 26 weeks of pregnancy)
Male sex (ASD is diagnosed more often in boys than girls)
One factor that has been proved not to increase the risk of ASD is vaccination. False information that came out in the late 1990s linking vaccination to autism (subsequently disproven in myriad studies) garnered a lot of public attention. Since that time, ample research has found no connection between childhood vaccines (or their ingredients) and ASD.
There isn’t a specific medical test that can diagnose ASD on its own. While genetic testing might be done as a part of a broader evaluation to look for related conditions or contributing genetic factors, the diagnosis of ASD itself is based on observations of a person’s behavior and developmental history.
The American Academy of Pediatrics recommends general developmental and behavioral screenings for all children during regular well-child visits at 9, 18, and 30 months, with specific screenings for autism at the 18- and 24-month well-child visits.
If an initial screening indicates the possibility of autism, a comprehensive diagnostic evaluation is the next step. This evaluation is usually done by a specialist, such as a developmental pediatrician, child neurologist, child psychologist, or child psychiatrist. They’ll compare the the diagnostic criteria for ASD outlined in the DSM-5 with the child’s symptoms. The evaluation often includes detailed interviews with parents or caregivers about the child’s developmental history and current behaviors, as well as direct interaction with the child.
ASD begins in early childhood, so it doesn’t suddenly develop in adulthood. But it’s increasingly common for teens and adults to be diagnosed if their ASD wasn’t recognized when they were younger, if they were misdiagnosed with something else, or if they were able to hide their symptoms and blend in as a young kid to avoid being detected (known as masking).The process for adult diagnosis also involves a thorough evaluation, often including a detailed personal history, and, if possible, input from family members about early development.
Treatment for autism typically includes a combination of behavioral therapies, dietary approaches, medications, and complementary and alternative medicine approaches that best meet the needs of the individual.
There are no medications that cure autism — or make all its symptoms disappear. In some instances, however, medications can help someone manage the disorder and improve symptoms that can co-occur with autism.
While there’s no cure for ASD, a range of treatments and therapies can help people with ASD manage symptoms, develop essential skills, and have a better quality of life. Generally, early intervention leads to better outcomes. Treatment approaches often require the person with ASD and their family to work closely with a team of professionals.
Behavioral and Developmental Therapies
A big part of support for people with ASD is therapy to help them learn new skills and manage challenges in their daily lives. Some of the most common and well-researched approaches include:
Applied behavior analysis (ABA): ABA uses positive reinforcement to teach important skills and reduce challenging behaviors. The goal is to improve social, communication, and learning skills.
Speech and language therapy: Many people with ASD struggle with communication, whether that involves understanding others or expressing themselves. Speech therapists can help your child build and improve communication skills, whether through speech, gestures, signs, pictures, or electronic communication devices.
Occupational therapy: This form of therapy helps people with ASD learn skills so they can live as independently as possible, such as how to eat, bathe, dress, and interact with others. It may involve sensory integration therapy, which helps people with sensory processing issues, as well as physical therapy, which helps improve physical skills some people with ASD may struggle with, like movements of the body, torso, or fingers.
Educational Therapies
Children with ASD tend to do well with educational programs and therapies that are highly structured. One common educational approach is called Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH). TEACCH is an educational approach that focuses on providing students with daily routines, clear boundaries, and verbal and visual instructions, as well as physical demonstrations. It’s based on the idea that people with ASD thrive in environments that emphasize consistency and visual learning.
Educational Support and Services
In the United States, children with ASD have a legal right to get the support they need to learn and participate in school. Federal laws are in place to make sure this happens.
Individuals With Disabilities Education Act (IDEA) This law ensures that eligible children with disabilities receive a Free Appropriate Public Education (FAPE). This means public schools must provide special education and related services to meet a child’s unique needs at no cost to the parents.
Individual Family Services Plan (IFSP) For eligible children with disabilities under age 3, IDEA requires early intervention services through an IFSP, which outlines the services a child will receive. It focuses on the infant or toddler’s needs, as well as the needs and concerns of other family members regarding the child.
Individualized Education Program (IEP) If a school-age child is found eligible for special education services under IDEA, a team including the parents, teachers, specialists, and sometimes the student develops an IEP. This is a legally binding document that outlines the child’s learning goals and the services the school will provide.
Medication Options
While no medications can cure ASD, they can help manage certain symptoms of ASD or co-occurring conditions that can make life with the condition more challenging. For example, a doctor may prescribe one or more of the following.
Antipsychotics Antipsychotic medications may help reduce irritability, aggression, hyperactivity, or withdrawal among people with ASD. Risperidone and aripiprazole are approved by the U.S. Food and Drug Administration (FDA) for these symptoms in people with ASD.
Antidepressants Some doctors may recommend antidepressants called selective serotonin reuptake inhibitors (SSRIs) for managing anxiety, repetitive behaviors, aggression, irritability, or tantrums, as well as improving eye contact. Another type of antidepressant, called tricyclic antidepressants, may be helpful for managing depressive symptoms or obsessive-compulsive tendencies.
Anti-Anxiety Medication These medications may help manage anxiety or panic disorders, a common co-occurring condition in people with ASD.
Stimulants Doctors may prescribe stimulant medication to help reduce symptoms of hyperactivity, improve focus, or manage executive function issues, especially among people with mild symptoms of ASD.
Anticonvulsants If the person with ASD also has seizures, their doctor may prescribe anticonvulsant (or anti-seizure) medications to manage them. About one-third of people with ASD have seizures, epilepsy, or another seizure disorder.
Complementary and Integrative Therapies
When considering treatments for ASD, some people may supplement standard treatments with complementary and integrative therapies. It’s very important to talk with a doctor before trying any of these therapies. This helps make sure that they’re safe and appropriate for you or your child. Some common examples include:
Melatonin: Some research suggests that melatonin may help with insomnia, a common issue for people with ASD, but more research is needed to confirm this.
Music or art therapy: Some people with ASD may find therapies like music or art therapy beneficial. These approaches can offer ways to express feelings, improve social interaction in a therapeutic setting, boost self-esteem, or alleviate anxiety.
Other complementary and integrative therapies such as vitamin supplements, probiotics, or acupuncture have been studied, and while these therapies aren’t necessarily harmful, there’s no evidence that they’re helpful for ASD symptoms.
Additionally, some therapies, such as special diets that limit nutrients, chelation therapy (a treatment said to remove mercury or other heavy metals from the body), or hyperbaric oxygen therapy (a treatment involving breathing inside a pressurized oxygen chamber) not only have no evidence of benefit for ASD symptoms, but they could be harmful or even dangerous. For that reason, they’re not recommended for people with ASD.
There’s no known way to prevent ASD. But identifying it early through strategies including, but not limited to, regular developmental screenings and starting interventions as soon as possible can make a big difference as a child learns and grows.
Certain lifestyle habits can support the overall well-being of people with ASD and help them manage related challenges, potentially improving daily functioning and quality of life. These include:
Exercise: Physical activity can help support overall health, as well as improve self-esteem and social interaction, which in turn helps boost language development.
Setting a sleep schedule and sticking to it: Sleep disturbances are very common in people with ASD. Healthy sleep habits and naps when necessary can help.
Maintaining a balanced diet: While no specific diet “treats” ASD, maintaining a balanced diet with a wide variety of nutritious foods can help support overall health.
ASD is a lifelong condition. Because ASD is a spectrum, the long-term outlook varies greatly from one person to another. Early diagnosis and intervention does a lot to improve the outlook for people with ASD.
The core differences in social interaction, communication, and behavior associated with ASD can sometimes lead to challenges in daily life, such as:
Difficulties with school and learning
Challenges in finding and maintaining employment
Social isolation
Increased stress within the family
Higher risk of being bullied or victimized
ASD is a common neurodevelopmental condition. The Centers for Disease Control and Prevention reported that, as of 2022, approximately 1 in 31 (3.2 percent) 8-year-old children have been diagnosed with ASD in the United States. This reflects an increase from previous years, likely because of improved awareness, widened diagnostic criteria, and improved access to diagnostic services.
ASD occurs in people of all racial, ethnic, and socioeconomic groups and is more than three times more common among boys than girls.
For adults, earlier estimates suggest about 1 in 45 U.S. adults have ASD, though many adults may still be undiagnosed if their condition went unrecognized or misdiagnosed during childhood.
Certain co-occurring medical and mental health conditions and issues are more common in people with ASD than in the general population. These can include:
Disruptive, aggressive, or self-injurious behaviors
The Takeaway
ASD is a lifelong neurodevelopmental condition, and its symptoms and severity vary from person to person.
If you think you or your child has symptoms of autism, reach out to a professional such as a psychiatrist or neurologist for an evaluation.
There’s no cure for ASD, but many evidence-based treatments can help people manage symptoms, develop essential life skills, and have a better quality of life.
Early diagnosis and intervention can make a significant difference in the outlook of ASD.
