Autism spectrum disorder (ASD) is a neurodevelopmental disorder with symptoms of impaired social communication and restricted, repetitive behaviors or interests.
ASD encompasses a group of related disorders and may present in different forms ranging from limited language ability and intellectual disability to substantially above-average language and intellectual function but difficulty with social communication.
How Common Is ASD and What Are Associated Conditions?
ASD affects approximately 2.3% of 8-year-old children and 2.2% of adults in the US. Compared with people without ASD, those with ASD have higher rates of depression, anxiety, sleep difficulties, and epilepsy.
What Are the Signs and Symptoms of ASD?
Common signs and symptoms of ASD in the first 2 years of life include lack of response when a child is called by name, absent or limited use of gestures when communicating, and lack of imaginative play. Children with ASD may also avoid or not maintain eye contact, have difficulty learning language, use repetitive words and phrases, and/or engage in repetitive movements such as hand flapping, body rocking, or spinning in circles.
ASD is typically diagnosed by a multidisciplinary team of clinicians who use standardized tools to obtain a detailed developmental history and directly observe a child’s behavior. The diagnosis can be made in children who have persistent deficits in 3 areas of social communication and interaction, and at least 2 types of restricted, repetitive behaviors. Severity of ASD is determined by level of social communication impairment and repetitive behavior patterns and required level of support. Additional testing to evaluate speech, language, fine and gross motor skills, and sensory processing may be used to differentiate ASD from other conditions such as intellectual disability or attention-deficit/hyperactivity disorder (ADHD).
Behavioral Therapy for ASD
Intensive behavioral interventions are first-line therapy for ASD and are associated with improvements in language, play, and social communication for children aged 5 years or younger. School-age children with ASD often have access to behavioral, speech, occupational, and physical therapies in educational settings. Inclusion of children with ASD in general classrooms with support strategies can reinforce positive social behaviors. People of any age who have ASD may benefit from behavioral interventions that help them identify situations that prompt specific behaviors and provide a framework to attain behavior changes.
Medications for Certain Symptoms Associated With ASD
There are currently no effective medications for treatment of ASD. However, the US Food and Drug Administration (FDA) has approved 2 medications (risperidone and aripiprazole) for individuals with ASD who have irritability and/or aggression. People with ASD who have ADHD may benefit from a stimulant drug (methylphenidate) or nonstimulant medications (atomoxetine and guanfacine). Melatonin can help relieve sleep difficulties in individuals with ASD.
Box Section Ref ID
Published Online: April 25, 2024. doi:10.1001/jama.2024.3041
Conflict of Interest Disclosures: None reported.
Source: Hirota T, King BH. Autism spectrum disorder: a review. JAMA. 2023;329(2):157-168.