As understanding of autism spectrum disorder (ASD) has grown, so has parents’ anxiety about what is and what isn’t autism.
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ASD reflects a wide range of problems and functional abilities. “Children at the severely affected end tend to have more problems, and more pronounced problems, so the diagnosis is usually more clear,” says Kimberly Giuliano, MD, a pediatrician with a special interest in autism.
Children at the milder end of the autism spectrum are those with Asperger’s syndrome or pervasive development disorder/not otherwise specified (PDD/NOS). “Parents may perceive their problems to be variants of normal and not bring them up with the pediatrician,” says Dr. Giuliano.
Difficulties with verbal communication and social skills, and repetitive behaviors or narrowed interests are hallmarks of autism. But gray areas overlap both normal development and ASD.
What makes autism different?
Delayed speech. “What separates autism from primary speech delay is that children with autism have social problems as well,” says Dr. Giuliano.
Social difficulties. Children with autism find it difficult to interact with peers and with people familiar to them. “Normally developing children may hesitate to interact with strangers, but once they develop a relationship, they interact better. Children with autism struggle with relating to most people,” she says.
Most shy children will eventually warm up to a new situation or will feel OK if someone they know helps them adjust to it. But even a familiar face won’t reassure an autistic child. “Children with autism might be overwhelmed, feel scared or cry in situations that other kids would really enjoy, such as a park or play area where other kids are running around and having a good time,” says Dr. Giuliano.
Narrowed interests. “Children with autism tend to have intense interests that we normally don’t think of as exciting for kids, such as ceiling fans or parts of objects,” she says. A 2-year-old’s obsession with a cartoon character or toy cars is not a sign of autism.
Anger/frustration. A frustrated child with autism can look a lot like a toddler going through the terrible twos. “Yet some parents worry that kids who have temper tantrums, throw themselves on the floor or bang their heads are showing symptoms of autism,” says Dr. Giuliano.
Sleep problems. “Children with autism may wake up in the middle of the night and be ready for their day — and not necessarily tire out or want to nap the next day,” she says. This is far different from kids who settle back to sleep after getting a glass of water or a little TLC from their parents.
Seizures/sensory problems. Children with autism are more likely to develop neurological problems such as seizures and heightened sensitivity to light, sound or touch. “But not every child who has these issues is autistic. For example, some kids with seizures otherwise develop completely normally,” Dr. Giuliano says.
Gastrointestinal problems. Children with autism often experience constipation and diarrhea. “But constipation is a common problem, especially around the toilet-training years,” she says. Frequent diarrhea can be caused by drinking too much juice, lactose intolerance or a medical condition, such as inflammatory bowel disease.
Toe-walking. Toe-walking that persists after age 2 may be a sign of autism — but it may also represent a muscle-related problem. “Once children have been walking for several months, we expect them to become more flat-footed,” says Dr. Giuliano.
When in doubt, talk to your pediatrician
It is always appropriate to share concerns about your child’s development with your pediatrician, she says. Even for an isolated developmental delay, occupational therapy, speech therapy or social skills training will serve your child well.
And if multiple delays point to ASD, then prompt evaluation, appropriate therapies and medications will allow a child to reach his or her full potential — including college, careers and marriage for some.
“We see some children significantly affected by the disorder progress along the spectrum to become very high-functioning,” says Dr. Giuliano. “And some higher-functioning children have what appears to be a normalization of their behaviors or problems.”