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Autism spectrum disorder (ASD)


Expert reviewer, Dr Rahul Bhattacharya, Consultant Psychiatrist
Next review due April 2018

Autism spectrum disorder (ASD) is a condition that affects how a person develops. This can include their behaviour and how they communicate with others.

Doctors have started using the term ASD to include both autism and Asperger’s syndrome, because both conditions are now seen as parts of one spectrum. Even so, you'll often still hear the older terms used to help describe particular difficulties someone faces. On this page, we’ve used ASD throughout.

Children playing

About autism spectrum disorder

People with ASD may see the world, and respond to it, in a different way to people around them. They may:

  • have difficulties with social situations
  • find it hard to understand and relate to other people
  • find change difficult to manage, and prefer daily routines and sometimes strict rules
  • have intense interests in certain things which they like to focus on

However, ASD is a spectrum – which means how people are affected by it varies. Some people may have subtle problems with understanding, while others may be severely disabled.

The signs of ASD often start being noticed when a child is young, perhaps before they go to school. But sometimes people aren’t diagnosed with ASD until they become adults, often during times of stress or life change.

ASD is lifelong, which means that if your child has ASD, they’ll grow up to be an adult with it. There is no ‘cure’ for ASD, but there are many things you can do to support yourself or your child. Some children with ASD grow up into adults who live independently and have jobs and families, whereas others may need specialist support throughout their lives.

It’s worth knowing that many people with ASD also have other health conditions and difficulties. These include:

  • epilepsy – around two or three out of every 10 people with ASD will have it
  • mental health conditions – around seven out of 10 people with ASD will have a condition such as attention deficit hyperactivity disorder (ADHD) or anxiety
  • learning difficulties
  • physical difficulties, such as sleeping and eating problems, and sensory issues

The number of people being diagnosed with ASD has increased over the last 10 years. Around one in every 100 children has it. ASD often runs in families and boys are four times more likely to be diagnosed with ASD than girls. This is thought to be partly because girls with ASD may have different behaviours than boys, which can make the signs less obvious.

Features of autism spectrum disorder

People with ASD vary enormously in how it affects them, but there are some common features which everyone shares. How ASD affects you can change as you get older and mature. It can also change as you change your behaviour or have to adapt to the world around you. The common features of ASD can make home, school and work difficult, and make taking part in family life, relationships and friendships hard.

Social communication

People with ASD have problems communicating with others. This can affect how they speak as well as how they communicate without words; for example, using eye contact and body language. Here are some potential examples in children.

  • If your child is less than a year old, they may not play social games like peek-a-boo with you.
  • Your child may not make eye contact with you.
  • Your child may not have the same facial expressions for different emotions as other children.
  • Your child may be slow to talk, not talk at all, or they may have unusually ‘adult’ language at an early age.
  • If your child is older, they may either be very quiet, or talk at other people rather than having a conversation.
  • Older children and adults sometimes talk a lot about the things that they find interesting.

Social skills and understanding others

People with ASD often find it hard to recognise or understand what other people are feeling and may have trouble expressing their own feelings. This can make friendships hard and make it difficult to fit in socially. Here are some examples for both adults and children.

  • Your child may not share well with other children or take turns, or be able to play with another child using their imagination.
  • You or your child might feel overwhelmed in social situations.
  • You may have little awareness of personal space – you might not like it when someone comes into your personal space, or make others feel uncomfortable by getting too close.
  • Your child may prefer to spend time on their own.

Behaviour, interests and activities

If you’re an adult with ASD, you’re likely to have some rigid and repetitive behaviour. This means you may have behaviours like flapping your hands or flipping an object, which you do often. You probably have difficulty managing change too, and you may have strict routines for certain things that must be done a certain way. This can help you to feel less anxious.

If you have a child with ASD, they may develop a special and overwhelming interest in something. This can be anything from trains to rocks, to dinosaurs. Your child may collect lots of the same thing, number them or list them, and their interest in whatever it is can last a lifetime.

People with ASD can also develop inflexible thinking. This means they find it hard to plan or find things like creative writing difficult. Unstructured times and situations can be particularly difficult. If you have ASD, you may take what other people do and say literally, which makes things like sarcasm and jokes hard to understand.

Diagnosis of autism spectrum disorder

Some people have reservations about getting a diagnosis of ASD for their child. If you’re an adult and you think you may have ASD, then you may be happy to stick with a ‘self-diagnosis’ and not want to take it any further. Whatever your situation, it’s a personal choice whether to ask for a referral for diagnosis. But, it is important to know the facts before you make a decision. So, ask your GP for information and advice or contact the National Autistic Society to find out more.

As a parent, you may find that having your child assessed for ASD and getting a diagnosis can be helpful. Many parents find it a relief as it helps explain some of the difficulties your child has been having and helps them to get support at home and school.

ASD can be diagnosed at any age. But, for at least half of children with ASD, their parents have noticed unusual behaviour before they’re 18 months old. One sign of possible ASD is if your child is under three and develops language or social skills, and then seems to lose them or goes backwards in their development.

If you notice your child might be showing signs of ASD, or you think you may have it, see your GP or your child’s health visitor. Your child’s nursery or school may also notice unusual behaviour or learning difficulties and talk to you about a possible assessment for ASD. You may find it helpful to keep a behaviour diary for a few days to gather useful information and show any behaviour you’re concerned about.

ASD is diagnosed after an assessment by a specialist team, which could include doctors, psychologists and other health professionals.

Once you or your child has been referred, you may have to wait a while for the assessment. For a child, the guidelines say this should happen within three months. In the meantime, you can ask your GP, health visitor or school to arrange other support or assessments that may be helpful.

As part of the assessment, the ASD team will do some, or all, of the following:

  • talk to you about any family history of ASD and your behaviour and development (or your child’s)
  • do some assessments or questionnaires to find out more about any learning, thinking, communication, behaviour and mental health issues
  • give you or your child a full physical examination
  • do tests and assessments for other health conditions
  • look at reports from your child’s school or nursery
  • visit and watch your child at home and at nursery or school

After the assessment you might be told straightaway whether you or your child has ASD. You should also get a written report which should say clearly what the diagnosis is. If you or your child has a condition that overlaps with ASD, such as attention deficit hyperactivity disorder (ADHD), that should also be in the report.

Treatment of autistic spectrum disorder

There isn’t a cure for ASD. But, there are lots of ways to manage the symptoms and behaviours of ASD. What works best for you, or your child, will depend on how you or they are affected by ASD and the impact it has on day-to-day life.

If your child has ASD, their age, their behaviour and how they learn will influence the kind of support they need at home and at school. If you have ASD, then how severely you’re affected and how well you manage in day-to-day life and social situations will guide the kind of support you’ll need.

You or your child will usually be supported by a team of specialists in your local area. If you have a child with ASD, the support you have usually involves the whole family, including any brothers and sisters. If you’re a partner of someone with ASD, or if you’re caring for an adult with it, you should be offered support too.

If your child has ASD, you may be offered the following:

  • a parent course or programme which helps you to understand ASD, manage your child’s behaviour and give them the right support
  • play activities which help your child with their communication and social skills
  • making physical changes to your home and school to make it more manageable for your child, such as changing the lighting or reducing the amount of noise
  • developing ways to prevent or manage challenging behaviour, including having structure and routines and managing times of change
  • treatments to manage other health problems and to help with any difficulties with sleeping and eating
  • making ‘reasonable adjustments’ to school activities and timetables, and giving your child extra support to help them manage
  • behaviour therapies – there is a wide range of these programmes which help children to develop positive behaviour or adapt their behaviour
  • therapies that help with specific problems. For example, speech and language therapy, physiotherapy to improve movement and coordination, and occupational therapy to help develop daily living skills
  • if your child also has anxiety, then they may be offered a cognitive behaviour therapy (CBT) programme

If you have ASD, you may be offered the following:

  • a course to help with social skills – you can do this alone or in a group with other people with ASD
  • training programmes to help with life skills – these might be based around leisure activities
  • help to manage your anger if this is an issue for you – this might include relaxation activities and developing problem solving or coping skills
  • help to get a job or volunteer role

Making a choice about what’s best for you or your child can be difficult as there are so many options. Talk to your ASD team for more information about the different approaches to managing ASD. You can also find out more from The National Autistic Society and Research Autism. See our Other helpful websites section for contact details.

Medicines

Medicines can sometimes help to ease the more severe symptoms of ASD. For example, if your child has challenging behaviour or severe sleep problems, their specialist may prescribe medicines. Always ask your specialist or pharmacist for advice and read the patient information leaflet that comes with any medicine.

Causes of autistic spectrum disorder

No one knows exactly what causes ASD. But, doctors and scientists think that it’s a mix of factors rather than one single thing.

ASD runs in families, so the cause is partly due to your genes. If you have ASD, then there is about a one in 10 chance that your brother or sister will have it too. But, other factors may also play a part, including:

  • whether you’re born early and underweight
  • whether you get certain infections while in your mother’s womb or soon after birth
  • how healthy a woman is when she is pregnant

Lots of research studies have now shown that there is no link between ASD and the MMR (measles, mumps and rubella) vaccine.

Frequently asked questions

  • Living with ASD, or looking after a child with it, can sometimes be challenging and hard work. ASD can affect every part of life and all your relationships with other people. You’re likely to need support from teachers and education professionals, health professionals, social services and national and community organisations and groups.

    Some adults and families can get financial help from benefits. These can help to cover some of the extra costs involved in living with ASD. Check the Gov.uk website to find out more. Families and carers may also be able to get respite care and short breaks for themselves and a child with ASD.

    If your child has ASD and has special educational needs, then they have the right to support at school and college to help them learn. What kind of support they get will vary, depending on their individual needs and how your child is affected by ASD. See our frequently asked questions below for more information about education and ASD.

    The National Autistic Society has a helpline and offers various types of support.

  • Children with autism spectrum disorder (ASD) like life to be predictable and feel safer with routines, so any change can be very stressful. When your child is stressed, it can affect their behaviour and their ability to do day-to-day things like shopping, travelling on public transport and going to the doctor or dentist. Your child may not understand why they’re being asked to do these things or know what’s going to happen, and this can make them anxious and worried. Some children with ASD also have sensory difficulties, which can make some places very challenging to be in.

    Here are some things that you can do to help your child manage new things.

    • Take time to prepare your child beforehand so that they know what to expect. If you’re planning a trip, you can put it on the calendar and help them to countdown to it.
    • Describe what’s going to be happening clearly and carefully.
    • Use things like photos, websites and films to show what a new place or activity looks like. If your child is changing school, you can take them to visit the new one, gradually building up their time there.
    • Use a timetable to explain what will happen during a trip. This might include how you’ll get there, when you’ll eat and when you’ll return home.
    • If your child is changing school, or the people supporting them will be changing, then involve new people as well as your child in planning the changes.
    • Have a box or bag of familiar and comforting things to touch or smell in the new place.

    The National Autistic Society website has useful tips for planning new activities, including going to the doctor, going shopping and visiting the hairdresser. See our Other helpful websites section for contact details.

  • If your child has autism spectrum disorder (ASD) and special educational needs, then their school or college should provide extra help and support. The kind of support they need will depend on how they’re affected by their ASD, and how severely it affects their learning and day-to-day life.

    Each part of the UK has a different way of giving children the support they need. However, there are some general areas of support for every child with ASD.

    • Children with ASD should have a written plan at school or college. The plan should include information about their needs, their support and how teachers, parents and children will know if the support is making a difference.
    • Your child may need to have specialist assessment to see how well they are learning and managing in school and what support they may need.
    • Any support should cover the whole school or college day, including break times and lunch and any transport to and from school.
    • Support might be given by people, such as a teaching assistant in class, as well as by aids and adaptations, such as ear defenders or sensory equipment.

    Many children with ASD go to a mainstream school with support provided by the school itself. However, some children need more support or more specialised help. If your child is severely affected, and needs a lot of support, they may go to a special school. If you think your child needs more help, talk to the person who supports children with special educational needs such as the special educational needs coordinator (SENCO) at their school or college.

    The National Autistic Society has an education and an exclusion service, as well as a service that supports young people making the transition from education to adulthood. Contact them for advice and support in getting the best education for your child. See our Other helpful websites section for contact details.

  • There’s no good evidence that giving your child a specific diet, such as a gluten-free or casein-free diet, can help ASD. But, if your child has eating problems, such as eating a small number of foods or behaviour which stops them eating healthily, then get specialist advice. Ask your GP to refer you to a dietitian.

    Your child is growing and developing, so it’s important that they have a healthy and balanced diet with a range of foods. Excluding certain things from the foods they eat can be harmful, so always get advice if you’re worried about what they’re eating or want to try changing their diet.


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Related information

    • Autism spectrum disorder in under 19s: support and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, 2013
    • What is autism? National Autistic Society. www.autism.org.uk, last reviewed June 2016
    • Assessment, diagnosis and interventions for autism spectrum disorders. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, 2016
    • Autism spectrum disorders. BMJ Best Practice. bestpractice.bmj.com, last reviewed December 2017
    • Autism in children. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2014
    • Autism Spectrum Disorder. PatientPlus. patient.info, last checked August 2017
    • Diagnosis for children. National Autistic Society. www.autism.org.uk, last reviewed September 2016
    • Autism diagnosis for adults. National Autistic Society. www.autism.org.uk, last reviewed August 2016
    • Autism spectrum disorder in under 19s: recognition, referral and diagnosis. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, 2017
    • Autism spectrum disorder in adults: diagnosis and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, 2016
    • Extra help in school in England. National Autistic Society. www.autism.org.uk, last reviewed December 2016
    • Family life. National Autistic Society. www.autism.org.uk, accessed January 2018
    • Benefits and care. National Autistic Society. www.autism.org.uk, accessed January 2018
    • Assessment and support for carers. National Autistic Society www.autism.org.uk, last reviewed September 2016
    • SEND Code of Practice. Department for Education and Department of Health. www.gov.uk, 2015
    • Shopping strategies. National Autistic Society. www.autism.org.uk, last reviewed May 2017
    • Sensory differences. National Autistic Society. www.autism.org.uk, last reviewed March 2016
    • Preparing for change. National Autistic Society. www.autism.org.uk, last reviewed August 2017
    • In education. National Autistic Society. www.autism.org.ukx, accessed January 2018
  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, April 2018
    Expert reviewer, Dr Rahul Bhattacharya, Consultant Psychiatrist
    Next review due April 2018



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