Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication and interaction, and restricted or repetitive behaviors and interests. Autism symptoms are usually noticed in early childhood; difficulties with eye contact and reciprocal communication, lack of response to name, delay in language development, repetitive movements, and sensory sensitivities may be observed. Symptoms and support needs vary from person to person.
Diagnosis of autism is made through developmental history, clinical observation, and expert evaluation. There is no single blood test or imaging method that can diagnose autism on its own. Individualized education, speech and language therapy, and appropriate developmental support applications started at an early age can help the individual improve their communication and daily living skills.
What Are the Symptoms of Autism?
Symptoms of autism may present as differences in social communication, repetitive behaviors, restricted interests, and sensory sensitivities. While speech development is delayed in some children, language skills may be developed in others, yet difficulties in reciprocal communication may still be experienced. The manifestation, intensity, and impact of symptoms on daily life vary from individual to individual.
The main symptoms that can be observed in autism are as follows:
- Difficulty in Social Communication: Struggling to maintain reciprocal conversation, understand social cues, or share mutual interests.
- Differences in Eye Contact: Eye contact being limited, brief, or differing from the usual.
- Delay in Language and Speech Development: Words not appearing at the expected period or experiencing difficulty in using them for communication purposes.
- Repetitive Movements: Repetition of hand-flapping, rocking, or similar movements.
- Restricted Areas of Interest: Showing intense interest in specific objects or topics.
- Adherence to Routines: Experiencing marked distress in the event of changes in the daily routine.
- Sensory Sensitivities: Reacting differently to sound, light, touch, smell, or the texture of certain foods.
- Differences in Play and Social Interaction: Struggling with initiating reciprocal play, imitating, or interacting with peers.
The presence of one or a few of these features does not mean a diagnosis of autism on its own. Symptoms must be evaluated together with the developmental process.
Symptoms of Autism in Infants
Symptoms of autism in infants can be noticed through differences in social communication and developmental skills within the first two years of life. Lack of response to name, limited reciprocal smiling, failure to develop pointing behavior, and delay in language development are among the signs that require attention.
Developmental signs that can be monitored between 0–2 years of age are as follows:
- 0–6 Months: Social smiling, interest in faces, and reciprocal interaction being more limited than expected.
- 6–9 Months: Observation of differences in reciprocal vocalization, responding to facial expressions, and social interaction.
- 9–12 Months: Not responding consistently to name, limited gestures such as waving goodbye, or failure to develop joint attention behaviors.
- 12–18 Months: Limited behaviors of showing interesting objects to others and pointing, delay in speech development.
- 18–24 Months: Words and communication skills not developing as expected, difficulty in symbolic play, or prominence of repetitive behaviors.
- Loss of Developmental Skills: Loss of previously used words, gestures, or social skills.
These developmental signs are not seen at the same age or in the same way in every child. Especially in the case of loss of acquired skills, an expert evaluation should be sought without waiting.
Symptoms of Autism in Children
Autism in children can manifest itself through differences in communicating with peers, playing games, adapting to daily changes, and responses given to sensory stimuli. While some children have difficulty speaking, others may experience difficulty in maintaining a reciprocal conversation despite speaking fluently.
Symptoms that may attract attention during childhood are as follows:
- Difficulty in Peer Relationships: Struggling to initiate or maintain joint play with other children.
- Difference in Reciprocal Communication: Struggling to understand the other party's reactions during a conversation.
- Repetitive Speech: Repeating heard words or sentences.
- Differences in Play Habits: Engaging with specific parts of toys for a long time or repeating the same play pattern.
- Difficulty Adapting to Changes: Being noticeably affected by changes in daily habits or plans.
- Sensory Responses: Experiencing intense discomfort in the face of noisy environments, clothing textures, or certain foods.
Symptoms of Autism in Adults
Symptoms of autism in adults can emerge through difficulties experienced in social relationships, communication differences, intense areas of interest, and sensory sensitivities. Some individuals do not receive a diagnosis during childhood and may try to manage their symptoms for many years using different methods. Support needs may become more prominent, especially during periods when social expectations increase.
Features that can be observed in adults are as follows:
- Difficulty Interpreting Social Cues: Struggling to understand innuendo, facial expressions, body language, and indirect expressions.
- Struggling in Reciprocal Conversation: Experiencing difficulty maintaining the flow of conversation or transitioning between topics.
- Need for Routine: Needing more time to adapt to unexpected changes.
- Intense Areas of Interest: Focusing on specific topics for a long time and in detail.
- Sensory Sensitivities: Struggling due to crowds, noise, intense light, or physical contact.
- Social Fatigue: Feeling the need to rest after making an intense effort to comply with expectations in social environments.
In the evaluation of autism in adulthood, not only current behaviors but also developmental features observed since childhood are taken into account.
When and at What Age is Autism First Noticed?
Symptoms of autism mostly begin to be noticed within the first two years of life. While differences related to social communication can be seen in some infants within the first 12 months, symptoms become prominent in some children between 18–24 months. Routine screening for autism is recommended at 18 and 24 months. However, a diagnosis of autism can also be made at older ages.
The prominent periods in developmental monitoring are as follows:
- First 12 Months: Social smiling, reciprocal vocalization, response to name, and the development of gestures are monitored.
- 12–18 Months: Pointing, joint attention, and communication skills with first words are evaluated.
- 18–24 Months: Social communication, language development, play behaviors, and repetitive features can be examined in more detail.
- 2–3 Years: Social communication and behavioral differences become more prominent in some children.
- School Age and Beyond: Features that were not noticed before may become visible with increased social and academic expectations.
It is not necessary to wait for a specific age in case of suspected autism. If the family has concerns about development, the evaluation can be initiated earlier.
What Causes Autism?
There is no single cause of autism. Research shows that genetic traits and certain pregnancy and perinatal factors that can affect brain development are associated with autism. However, the presence of a risk factor does not mean that the child will definitely have autism. It is thought that different biological factors play a role together in the development of autism.
The main factors associated with autism are as follows:
- Genetic Predisposition: A large number of genetic changes associated with autism have been found. Having a family history of autism may increase the probability.
- Family History: The probability of autism occurring in children who have a sibling with autism may be higher compared to the general population.
- Differences in Brain Development: Biological processes affecting the development of the nervous system may play a role in the emergence of autism.
- Parental Age: Advanced maternal or paternal age has been associated with an increased probability of autism in some studies.
- Pregnancy and Birth-Related Factors: Premature birth, low birth weight, and certain pregnancy complications may be associated with the risk.
- Certain Genetic and Medical Conditions: Specific genetic syndromes or neurodevelopmental conditions may be seen together with autism.
Not all of these associations imply a direct cause-and-effect relationship. Autism does not stem from parents' rearing style or from not showing enough interest in the child. There is also no scientific evidence that vaccines cause autism.
How is Autism Diagnosed?
Diagnosis of autism is made by evaluating the individual's developmental history, social communication features, behaviors, and clinical observation performed by an expert together. Family interviews, developmental evaluations, and appropriate standardized tools can be utilized during the diagnostic process. Blood tests, EEG, or brain imaging methods cannot be used alone to confirm or rule out an autism diagnosis.
The following stages are generally followed during the diagnostic process:
- Taking the Developmental History: Information is obtained about the development of the child's language, communication, play, movement, and social skills.
- Family Interview: Behaviors observed at home, school, or other environments are evaluated.
- Clinical Observation: Social interaction, communication, and repetitive behavior features are examined.
- Developmental Evaluation: Language, cognitive skills, daily living skills, and, when necessary, motor development are addressed.
- Investigation of Co-occurring Conditions: Hearing problems, language disorders, intellectual development differences, or other medical conditions are evaluated.
- Diagnosis and Support Planning: Findings are addressed together to create support recommendations suitable for the individual's needs.
Autism Screening and Evaluation Tests
Autism screening and evaluation tools help in the early identification of developmental differences and structuring clinical observations. While screening tests investigate the probability of autism, more comprehensive tools support the diagnostic evaluation.
The main tools are as follows:
- M-CHAT-R/F: A screening tool based on parent responses used to identify developmental risks associated with autism, especially in children aged 16–30 months. Depending on the result, a follow-up interview and detailed evaluation may be required.
- ADOS-2: An evaluation tool based on structured observation of social communication, interaction, play, and behavioral patterns. It is administered by trained experts and supports the clinical diagnosis.
- ADI-R: Enables the examination of the individual's early development and behavioral features through a structured interview conducted with parents or caregivers.
- CARS-2: Helps evaluate behavioral features associated with autism through observation and developmental information.
- Developmental Evaluation Scales: Can be used to examine the development level of language, movement, cognitive, and social skills.
M-CHAT-R/F is not a diagnostic test. ADOS-2 alone does not provide a definitive diagnosis either. Results are interpreted together with the developmental history and expert evaluation. It is not necessary to administer all tools to every patient.
Related content: Autism Test and Autism Screening Scale.
Expert Evaluation in Autism Diagnosis
Expert evaluation in autism diagnosis addresses the individual's development and daily life in a holistic manner beyond screening results. Relevant specialty areas, primarily child and adolescent psychiatry for children and adult psychiatry for adults, may take part in the evaluation process.
Depending on clinical needs, support can be obtained from child neurology, speech and language therapy, clinical psychology, and other developmental evaluation fields.
In expert evaluation, along with autism symptoms, the individual's strengths, communication style, learning characteristics, and requirements are also determined.
How is Autism Spectrum Disorder Classified?
Autism spectrum disorder is evaluated within a single diagnostic scope rather than being divided into separate subtypes in the current DSM-5-TR classification. However, the level of support individuals need in social communication and restricted, repetitive behaviors may vary. The three defined support levels are used to explain the individual's functionality and support requirement.
Support Need Levels in Autism
There are three support levels for autism in the DSM-5-TR classification. These levels are determined by taking into consideration the areas of social communication and restricted and repetitive behaviors.
- Level 1 – Requiring Support: There may be difficulties noticed when there is no support in social communication. Difficulty in initiating or maintaining social interaction, adapting to changes, and planning skills may be observed.
- Level 2 – Requiring Substantial Support: Marked difficulties may be experienced in verbal and non-verbal communication. Differences in social interaction can be seen even when support is provided. Repetitive behaviors and difficulty in adapting to changes can affect daily functionality in various environments.
- Level 3 – Requiring Very Substantial Support: Severe difficulties in social communication and restricted interaction may be observed. Marked difficulty in adapting to changes and repetitive behaviors can affect many areas of daily life. Comprehensive and continuous support may be needed.
Things to know about support levels:
- Support requirement is evaluated separately for social communication and repetitive behaviors.
- The support level does not define the individual's intelligence level or speech skill on its own.
- The individual's needs may change depending on age, environmental conditions, and the support provided.
- Intellectual development, language skills, and co-occurring medical or genetic conditions are specified separately.
Therefore, support levels should not be used as unchangeable labels that determine all of a person's abilities or future level of independence.
How Are Asperger's Syndrome and Atypical Autism Evaluated Today?
Asperger's syndrome and atypical autism are diagnostic names used in the past. With DSM-5 and DSM-5-TR, these categories are not used as separate autism subtypes. Today, relevant features are evaluated within the scope of autism spectrum disorder if diagnostic criteria are met.
The main differences between the old and current classification are as follows:
- Asperger's Syndrome: It was included as a separate category in previous diagnostic systems. Today, if the symptoms and developmental history are appropriate, it is evaluated within the scope of autism spectrum disorder.
- Atypical Autism: It was a name used in the past for conditions that showed some features of autism but did not fully meet previous diagnostic criteria. Today, the individual's current symptoms are re-evaluated according to current ASD criteria.
- Classic Autism (Autistic Disorder): It was a separate diagnostic category in the old classification. In the current classification, it is evaluated under the umbrella of autism spectrum disorder.
- Childhood Disintegrative Disorder: It was used as a separate category in previous diagnostic systems. Children exhibiting a loss of developmental skills are evaluated in terms of current diagnostic criteria and other possible causes.
Rett Syndrome is not a current subtype of autism. In most classic cases, it is a separate neurodevelopmental/genetic condition associated with changes in the MECP2 gene. Some of its symptoms may resemble autism. An autism diagnosis, however, is only evaluated in a person with Rett syndrome if ASD diagnostic criteria are also met.
What Are Education and Support Methods in Autism?
Education and support applications in autism aim to improve the individual's communication, social interaction, learning, and daily living skills. Early intervention, special education, speech and language therapy, developmental and behavioral approaches can be planned according to needs. Applications should be arranged in accordance with the individual's age, strengths, sensory features, and support requirements.
Early Intervention and Special Education
Early intervention aims to plan the support the child needs without delay after developmental differences are noticed. Individualized special education programs can ensure that communication, play, social participation, learning, and daily living skills are worked on.
- Individualized Education: Determining goals according to the child's development level and learning characteristics.
- Play-Based Learning: Supporting reciprocal play, joint attention, and interaction skills.
- Social Skill Studies: Developing communication with peers and participation in social environments.
- Daily Living Skills: Supporting independence in areas such as dressing, feeding, and self-care.
Related content: Autism Special Education Program.
Speech and Language Therapy
Speech and language therapy supports individuals with autism in communicating, understanding language, expressing themselves, and reciprocal interaction skills. Therapy does not focus solely on developing speech sounds. When necessary, gestures, visuals, or alternative communication methods can also be utilized.
- Receptive Language Skills: Supporting the skills of understanding what is said and following instructions.
- Expressive Language Skills: Developing ways to express requests, emotions, and thoughts.
- Social Communication: Working on turn-taking, joint attention, and reciprocal interaction skills.
- Alternative and Augmentative Communication: Using visual cards, symbols, or communication devices when necessary.
Behavioral and Developmental Interventions
Behavioral and developmental interventions are structured approaches aimed at supporting the communication, learning, and daily living skills of individuals with autism. The application format is chosen in line with the individual's needs and goals determined together with the family.
- Developmental Approaches: Supporting the child's play, social interaction, and communication skills within natural interactions.
- Behavioral Learning Methods: Conducting structured studies aimed at teaching functional skills in daily life.
- Sensory Arrangements: Adapting environmental conditions by taking sensory sensitivities into account.
- Functional Behavior Assessment: Investigating communication, environment, or health-related needs underlying behaviors that cause difficulty.
The impact of support programs should be monitored regularly; applications that are inappropriate or cause intense distress to the individual should be re-evaluated.
Family Education and Daily Life Support
Family education supports understanding the needs of the child with autism and using appropriate communication methods in daily life. Adopting consistent approaches in the home and school environment that are sensitive to the child's characteristics can help transfer developmental goals into daily life.
- Communication Support: Communicating in a way that suits the child's self-expression style.
- Daily Routines: Organizing daily activities in a predictable and understandable way.
- Visual Supports: Utilizing picture schedules or visual instructions when necessary.
- Sensory Needs: Taking into account the sound, light, or tactile stimuli that cause discomfort to the child.
- Family and School Cooperation: Maintaining communication regarding educational goals and daily life arrangements.
Is Pharmacotherapy Used in Autism?
There is no drug treatment that eliminates the core social communication and repetitive behavior features of autism. However, pharmacotherapy can be evaluated for co-occurring attention problems, anxiety, sleep difficulties, or severe behavioral problems affecting the individual's safety in individuals with autism. Drug use is not necessary for every individual and should be planned by a specialist physician.
The main issues taken into consideration in drug treatment are as follows:
- Co-occurring Mental Health Problems: The presence of anxiety, ADHD, or other psychiatric conditions is evaluated.
- Sleep Problems: The causes of sleep difficulties are investigated, and appropriate environmental and behavioral arrangements are addressed first.
- Severe Behavioral Difficulties: In situations where there is a risk of the individual harming themselves or their environment, causes are investigated and necessary treatment options are evaluated.
- Monitoring Response to Treatment: In the event of drug use, expected benefits, side effects, and the necessity of continuing treatment are tracked.
Pharmacotherapy in individuals with autism does not replace individualized education and developmental support practices. The decision to start any medication, change the dose, or discontinue the medication must be made together with a specialist physician.
What Should Families of Children with Autism Pay Attention To?
Families of children with autism should focus on understanding their child's communication style, sensory features, and daily life needs. It is important for families to observe developmental differences, reach out to appropriate expert support, and support the child's strengths. Establishing a predictable order in daily life and maintaining communication between the school and health experts can be useful.
Recommendations for families are as follows:
- Recognizing the Child's Communication Style: Paying attention to gestures, facial expressions, behavior, and other ways of communication alongside words.
- Monitoring Developmental Changes: Observing newly acquired or lost skills and sharing them with the expert.
- Taking Sensory Sensitivities into Account: Regulating stimuli that cause discomfort as much as possible.
- Structuring Daily Life: Creating routines and transitions that the child can understand.
- Supporting Strengths: Using activities the child is interested in for learning and participation.
- Cooperating with School and Experts: Ensuring that educational and developmental support goals are addressed consistently in different environments.
- Considering the Needs of Family Members: Also taking into account the psychological and social support requirements of parents and siblings.
Instead of constantly comparing the child's skills with other children, tracking progress in their own development may be more useful.
Which Doctor to Visit for Autism?
When there is a suspicion of autism in children, a child and adolescent psychiatry specialist can be consulted. When necessary, support can be obtained from child health and diseases, child neurology, clinical psychology, and speech and language therapy fields. Evaluation of autism in adults, on the other hand, can be performed within the scope of adult psychiatry. The specialty area to consult is determined according to the individual's age and symptoms.
Specialty areas that can take part in autism evaluation are as follows:
- Child and Adolescent Psychiatry: Evaluates autism symptoms, developmental history, and co-occurring mental health problems during childhood and adolescence.
- Adult Psychiatry: Evaluates autism features and co-occurring mental states in adults.
- Child Neurology: Can participate in the evaluation in cases with suspected seizures, developmental regression, or neurological diseases.
- Clinical Psychology: Can contribute to the diagnosis and support plan with developmental, cognitive, and psychological evaluations.
- Speech and Language Therapy: Evaluates communication and language skills and plans studies suitable for needs.
For the relevant department information of NPİSTANBUL Hospital, the Child Adolescent Psychiatry page can be reviewed.
For appointment procedures: NPİSTANBUL Online Appointment.
