What is autism?

Autism is a complex deve­lo­p­mental disorder with a wide spec­trum that occurs in the first three years of life. Often, however, it is not diagnosed until much later, on average at 5 1/2 years of age. Autism has an impact on the brain in terms of social and commu­ni­ca­tive skills.

Signs of autism

Accor­ding to the ICD-10 clas­si­fi­ca­tion system (Inter­na­tional Clas­si­fi­ca­tion of Dise­ases, WHO, 1992), signs of the autistic spec­trum include mild to severe impairm­ents in social inter­ac­tions and in verbal and non-verbal commu­ni­ca­tion, but also percep­tual disor­ders, as well as rest­ricted and repe­ti­tive beha­vi­oral patterns.

  • Changed sensory perception
  • Deve­lo­p­ment of rituals and stereotypes
  • Disrup­tion of all communication
  • Disrup­tion in social beha­vior and understanding
  • Disrup­tion in play skills and directed attention

The mani­fes­ta­tions of the autistic spec­trum vary widely. Some indi­vi­duals expe­ri­ence autistic symptoms as less limi­ting and others as more limi­ting, which in turn may result in a higher need for support.

The diagnosis of autism has been around since …

In 1943, autism was first reco­gnized by Dr. Leo Kanner of John Hopkins Hospital. At the same time, the German scien­tist Dr. Hans Asperger has described a milder form of the autistic state, now known as asperger syndrome. The diagnosis of “autistic spec­trum” includes:

  • Symptoms of the autistic spec­trum range from very mild to very severe
  • Infan­tile autism, asperger syndrome
  • Rett Syndrome
  • PDD NOS (perva­sive deve­lo­p­mental disorder, without further specification)

In the recent diagno­stic there is a summary term: autism spec­trum disorder (ASD) which includes all former diagnoses of autism

How many autistic people are there?

Every autistic person is diffe­rent and so is the appearance of “their” autism. An ever-incre­asing percen­tage of the popu­la­tion is affected (1 in 59, accor­ding to esti­mates from CDC’s Autism and Deve­lo­p­mental Disa­bi­li­ties Moni­to­ring (ADDM) Network, Surveil­lance Summa­ries / April 27, 2018 / 67(6); 1–23).

The exact number of children with autism is unknown. A report from the U.S. Centers for Disease Control and Preven­tion indi­cates that autism and related disa­bi­li­ties are more common than previously suspected. It is unclear whether this is due to an incre­asing rate of autism or an increased ability to diagnose autism.

Autism is difficult to diagnose

Unlike other limi­ta­tions and condi­tions, the symptoms of autism are usually not appa­rent at birth. The autistic signs usually become appa­rent in the first three years of life. There is curr­ently no blood or DNA test to diagnose autism.

Autism is a series of symptoms. After these, the doctor usually don’t look until certain deve­lo­p­mental delays and limi­ta­tions cannot be explained in any other way.

Symptoms of autism

Children with autism usually have diffi­cul­ties in verbal and non-verbal commu­ni­ca­tion, social inter­ac­tion and imagi­nary play. Some also show aggres­sion towards other people or themselves.

Indi­vi­duals with autism can display repe­ti­tive body move­ments, unusual prefe­rences to items and conspi­cuous diffi­culty chan­ging routines. Some indi­vi­duals with autism are sensi­tive in the sensory percep­tion (vision, hearing, touch/feeling, smell and taste). For example, some children refuse to wear “scratchy” clothes and become very stressed when forced to do so, as their skin is so sensitive.

Some combi­na­tions of the follo­wing charac­te­ristics can occur in diffe­rent propor­tions in people with autism.


  • Fails to point to draw others’ atten­tion to objects (around 14 months of age)
  • Does not direct gaze to things others are looking at
  • Is unable to initiate or sustain a conversation
  • Slow or no language development
  • Repeats words or memo­rized phrases, for example, from adver­ti­se­ments or movies
  • Does not talk about self in the first person (for example, says “You want water” when it means “I want water”)
  • Uses rhymes that are incom­pre­hen­sible to others or out of context
  • Commu­ni­cates with gestures instead of verbal language.

Reaction to sensory information

  • Has an increased or low percep­tion in sight, hearing, touching, feeling, smell or taste
  • Seems to have increased or low pain sensation
  • May with­draw physical contact because it is perceived as over-stimu­la­ting or overwhelming
  • Doesn’t wince to loud noises
  • Could find ever­yday sounds painful and cover own ears with their hands
  • Rubs surfaces, takes objects in their mouth or licks them
  • Shows little or no imagi­nary play
  • Does not imitate the acti­vi­ties and move­ments of other people

Prefers to play alone or ritualized

Social Interaction

  • There seems to be a lack of empathy
  • Making friends is absent or seems to be more difficult
  • Seems with­drawn
  • With­draws and seems to prefer being alone
  • May not respond to eye contact or smiles
  • Avoids eye contact
  • Treats others as if they were objects
  • Does not play inter­ac­tive games


  • Has very strong emotional reac­tions and states

Signs and tests

All children should have a pedia­tric consul­ta­tion for routine deve­lo­p­mental evalua­tions. Further inves­ti­ga­tion may be neces­sary if there are concerns on the part of the parents or the doctor. This is espe­ci­ally important if the child has not reached any of the follo­wing mile­stones in language development:

Making sounds at 12 months

Gestures (pointing, waving) at 12 months

Single words at 16 months

Spontaneous two-word sentences at 24 months (not just repeating)

Loss of language or social ability at any age level

Children may then be given a hearing test, blood test (lead poiso­ning), and a test to rule out autism.

The actual diagnosis should be made by a doctor who has expe­ri­ence in diagno­sing and trea­ting autism. Because there is no biolo­gical test for autism, the diagnosis is often based on very specific criteria (set out in ICD 10).

Autism involves a wide range of symptoms. Ther­e­fore, a single, short assess­ment cannot foresee the true abili­ties of the child. ideally, a team of diffe­rent specia­lists should evaluate the child. Language, commu­ni­ca­tion, thin­king ability, motor skills, success in school or preschool and other factors should be looked at.

Some are reluc­tant to diagnose a child with autism because of concerns about labe­ling the child. However, failure to diagnose means that, unfort­u­na­tely, the child does not receive the neces­sary instruc­tion and support.

Questions to clarify whether diagnostic clarification might be useful.

There are 5 domains of early child­hood beha­viors in which devia­tions from the deve­lo­p­ment of non-autistic children are noted in children with autism.
Beha­viors are listed in each of the 5 areas. If these beha­viors are not observed in your child, or are only observed in very small ways, this is a reason to seek diagno­stic clari­fi­ca­tion. Then consider clari­fi­ca­tion with physi­cians and child and youth psychiatrist.

1. Does the child respond to own name when called by his caregiver(s)?

Within the first few months of life, infants respond to their own name by orien­ting them­selves accor­ding to the person who called them. Typi­cally deve­lo­ping infants usually react to the voice of well-known people with eye-contact and also with a smile.

By contrast, todd­lers who are later diagnosed with autism mostly don’t respond to their name. They also often react only to a limited extent. It also happens that they comple­tely ignore some sounds, but react to others very directly. For example, they may not show a reac­tion when they are called by their name by their parents. But they hear imme­dia­tely, when the TV is turned on. It is not uncommon for parents to suspect that their child is hard of hearing or deaf.

2. Does the toddler have joint attention? 

Towards the end of the first year of life, most todd­lers start by looking at the same items or acti­vi­ties as their care­giver. In order to create a common atten­tion with the care­giver, typi­cally deve­lo­ping children begin to turn their gaze from toys to the person. They follow the poin­ting of others with the gaze and observe the direc­tion in which others are looking. They point to things and acti­vi­ties to share inte­rest or to show other toys.

This beha­vior has a certain quality of commu­ni­ca­ting. For example, the toddler might point to a plane flying over his head, looking at his mother or father as if to say, “Look there!”

In contrast, todd­lers with autism have great diffi­culty sharing atten­tion with others. They rarely turn their gaze to showing others. They don’t often switch their gaze from items to people. And they don’t really seem to be present when the care­giver watches things, people or acti­vi­ties and talks about them. They rarely turn their gaze to show some­thing to others.

3. Does the child imitate others? 

Typi­cally deve­lo­ping todd­lers are imita­tors. Even babies can mimic facial move­ments (for example sticking out tongue or opening their mouths). Already at the age of 8 to 10 months, the mother and toddler mimic each other’s sounds and move­ments. Imita­tion also plays a very big role in well-known finger games, such as “pat-a-cake” or “how big?” (“how big is …? This big!” while the child stret­ches her arms up).

Todd­lers with autism mimic other people less often. They demons­trate fewer imita­tions with the body or face (waving, making faces, playing toddler games) and also mimic less with objects.

4. Does the child respond emotionally to others?

Typi­cally deve­lo­ping children react soci­ally to others. They smile when they are smiled, they also initiate smiles and laugh when playing with toys or others. When typi­cally deve­lo­ping children watch other children cry, they may start to cry them­selves or look distressed. Slightly older todd­lers then perhaps crawl close to the crying person, caressing or trying to offer comfort in other ways. These some­what later beha­viors indi­cate compas­sion and can be observed espe­ci­ally in children in the second year of life.

In contrast, children with autism seem not to perceive the feelings of others. They don’t notice the smiles of others and ther­e­fore they don’t look. They might not smile back in response to each other’s smiles, either. They may ignore the sadness of other people.

Several scien­tists have shown that children with autism are more likely to be distressed than compas­sio­nate when another injures them­selves. For example, if an adult pretends to get their knee injured, young children with autism look less at the adult or show concern in the facial expression.

5. Does the child play imaginary games? 

Someone once said, “playing is the child’s work.” Todd­lers love role play in which they pretend to be a mother, a father, a baby, a fire­fighter or a horse. Although the children play with toys at about 6 months old, it does not come to the pretend play until the end of the first year of life. This way of playing, for example, could start by feeding the mother or a doll. Or the child combs the doll or puts the bear to bed. Around the second birthday, children play imagi­nary games. Dolls then take on human quali­ties such as spea­king or house­hold routines are re-enacted. The children may then imagine that a sponge is some­thing to eat, a buil­ding block a hat or a plastic bowl a swim­ming pool with water.

In contrast, the play of children with autism high­lights many defi­cits. The toddler may not be inte­rested in objects at all, or the inte­rest is more focused on the move­ment of her own hand or on a piece of string. If they are inte­rested in toys, it is often only very specific toys that elicit inte­rest. These are used in a repe­ti­tive way, which doesn’t align with the way most other kids would play with the toy. One may be more inte­rested in flip­ping a toy car and spin­ning the wheels instead of pushing the car back and forth. Summing up, the quali­ties of pretend play are comple­tely absent from children with autism under the age of two.

Autism in infancy

Accor­ding to a study by Gill­berg, it is possible to detect signs of autism or autistic symptoms even in infants. The symptoms mostly reported are in the areas of eye-contact, hearing and playing.


Avoi­ding eye-contact Is often referred to as a charac­te­ristic for children with autism. Here, however, it is above all the quality of the eye-contact that matters. Many children don’t seem to see people at all and ther­e­fore don’t look them in the eye. In an infant with autism, the viewing takes place briefly and out of the corner of the eye.


Speci­fics of hearing are of great importance, but diffi­cult to clas­sify. Many children with autism are initi­ally presumed to be deaf. Only a few have deaf­ness. But they do not respond to their name and seem unaf­fected by noisy changes in the envi­ron­ment. Children with autism even seem to ignore very loud noises that would make most other children flinch. The recep­tion and proces­sing of audi­tory stimuli may be diffe­rent in autistic indi­vi­duals. These diffe­rences can cause them to appear deaf or even disin­te­rested to others. This need not be the case, however, and the reason for lack of response should rather be seen in percep­tual and proces­sing differences.

Social development and play 

In infants, play and social inter­ac­tion are so directly linked that it is precisely at this stage of deve­lo­p­ment that the beha­vior of the child is conspi­cuous. Infants with autism often show no inte­rest in the games that require social inter­ac­tion with parents.

The absence of this joint acti­vity seems to be very signi­fi­cant. The study by Frith and Soares shows that state­ments by parents with children with autism show an absence of common inte­rests and acti­vi­ties within the first year of life. The children do not point to things that inte­rest them, do not take an active part of finger games and do not want to carry out acti­vi­ties together.

Transfer (referral) to specialist:

Early concerns of parents about progress in the infant’s deve­lo­p­ment should be taken into account. When a mother expresses fears about the social and emotional responses, as well as the skills in percep­tion, profes­sio­nals should be on alert regar­ding autism.

Adequate refer­rals to specia­lists for children with and without deve­lo­p­mental disa­bi­li­ties could mean that the diagnosis can be made faster than in the past. While infants can show autistic traits, only a compre­hen­sive diagno­stic approach can reveal whether they have autism or have beha­vi­oral charac­te­ristics of other difficulties.

A professional assessment is necessary

This is best clari­fied in a child deve­lo­p­ment unit. Several experts are needed for this, because good team colla­bo­ra­tion yields better results for an accu­rate diagnosis. The assess­ment includes an over­view of family history, pregnancy, child beha­vior and progress in deve­lo­p­ment. A physical exami­na­tion is neces­sary to detect hidden medical condi­tions that contri­bute to devia­tions or delays in expected development.

The deve­lo­p­ment inves­ti­ga­tion includes:

  • Fine and gross motor skills
  • Language (language compre­hen­sion, expres­sive language and sound production)
  • Sensory percep­tion
  • Social and emotional development
  • Play

The quality of deve­lo­p­ment is an important factor in the assess­ment. It’s a big diffe­rence, for example, whether skills are only present, or whether they are also used for social beha­vior. A child with autism may have the ability to repeat words, but not yet an under­stan­ding of their meaning. Or a toddler with autism can point to things, but doesn’t use that ability to draw another person’s atten­tion to it.

Ideally, children should be observed in their ever­yday envi­ron­ment, for example at home or in daycare.

Diagnosis of autism is unli­kely to occur within just one exami­na­tion date, espe­ci­ally if the child is still very small.

Close moni­to­ring of deve­lo­p­ment and regular assess­ments are neces­sary to get a full over­view. But regard­less of a defi­ni­tive diagnosis of autism or autistic spec­trum, help can be offered to the children and their parents. Infants suspected of a deve­lo­p­mental disorder (autism autistic spec­trum) may receive services tail­ored to each needs. Parents can be instructed on how to support their child in the respec­tive stages of development.


A child is diagnosed with autism when he or she exhi­bits various beha­viors in three areas of deficit. These three areas are:

  • Social inter­ac­tion
  • Commu­ni­ca­tion
  • Behavior/Interaction.

Autism spec­trum defi­cits include the following:

  • lack of eye contact
  • lack of rela­ti­onship buil­ding with peers
  • diffi­culty putting oneself in the shoes of others
  • lack of imagi­na­tive play

Autistic Spec­trum can usually be reliably diagnosed by age 3. Mean­while, recent rese­arch supports the diagnosis of autism as early as 6 months of age.


Parents are the first to notice their child’s extra­or­di­nary beha­vior and, compared to other children, see that their child is not reaching the usual stages of deve­lo­p­ment. Some parents describe that their child’s beha­vior seemed diffe­rent from birth. While other parents describe their child deve­lo­ping age appro­pria­tely but then losing skills.

Pedia­tri­cians often over­look the first signs of autism and advise parents to wait and see, with the expl­ana­tion that the child is a late bloomer. New rese­arch shows that parents’ first assump­tions that some­thing is discer­nible with the child’s beha­vior are often confirmed. If you have concerns about the deve­lo­p­ment of your child (or a child you work with), don’t hesi­tate. Talk to a doctor (or parents) to clarify autism. That’s the best thing you can do for the child.

The earlier support begins, the better.…

Diagnosis (early) can help provide an expl­ana­tion for deve­lo­p­mental diffe­rences, an under­stan­ding of the resul­ting needs, and a claim for appro­priate support.

Studies suggest that early ABA/VB (applied beha­vior analysis and verbal beha­vior) support for at least 2 years in kinder­garten age, can bring outstan­ding impro­ve­ments in a wide range of skills for many children on the autistic spectrum.

After the diagnosis is completed, appro­priate support can be started. ABA/VB programs can have a variety of objec­tives. Common areas of support include commu­ni­ca­tion, self-care, cogni­tive skills, and social inter­ac­tion skills.


Autism is a physical condi­tion asso­ciated with a change in brain biology and chemistry. The exact causes of these changes are still unknown, but rese­arch is very active in this area. Presu­mably, there is a combi­na­tion of factors that lead to autism.

Genetic predis­po­si­tion seems to play an important role in autism. Iden­tical twins seem to be more likely to have autism than fraternal twins or other siblings. Language problems are also more common among rela­tives of children with autism. Changes in chro­mo­somes and other neuro­lo­gical problems are also more common in fami­lies with autism.

A whole number of possible causes for autism are suspected but not proven. Genetic as well as neuro­phy­sio­lo­gical causes are considered likely. Inter­ac­tions between envi­ron­mental factors and genes also seem to play a role.

Many sources state that with an autism ratio of 4:1, signi­fi­cantly more males are affected. These figures should be judged cautiously. Females with Asperger syndrome, for example, are diagnosed less often. Possible reasons for this may be that diagnosis tends to be more boy- or male-specific. Other sources suggest that girls/women are better able to adapt and compen­sate for their envi­ron­ment and are ther­e­fore less likely to stand out.

Family income, parenting/education, life­style, race or reli­gious affi­lia­tion do not appear to affect the deve­lo­p­ment of autism.

Studies on autism

Infor­ma­tion on autism and current research