People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child’s health care provider about ASD screening or evaluation.
Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first two years of life.
People on the autism spectrum also may have many strengths, including:
People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.
Researchers don’t know the primary causes of ASD, but studies suggest that a person’s genes can act together with aspects of their environment to affect development in ways that lead to ASD. Some factors that are associated with an increased likelihood of developing ASD include:
Diagnosing ASD
Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important to seek an evaluation as soon as possible. The earlier ASD is diagnosed, the sooner treatments and services can begin.
Diagnosis in Young Children
Diagnosis in young children is often a two-stage process.
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they are at high risk for ASD or developmental problems. Children at high risk include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.
Considering caregivers’ experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child’s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.
If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.
Stage 2: Additional Diagnostic Evaluation
It is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.
A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.
The diagnostic evaluation is likely to include:
- Medical and neurological examinations
- Assessment of the child’s cognitive abilities
- Assessment of the child’s language abilities
- Observation of the child’s behavior
- An in-depth conversation with the child’s caregivers about the child’s behavior and development
- Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting
Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:
- Blood tests
- Hearing test
The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment.
Diagnosis in older children and adolescents
Caregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.
A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. These subtle communication differences may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.
Diagnosis in adults
Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).
Adults who notice the signs and symptoms of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:
- Social interaction and communication challenges
- Sensory issues
- Repetitive behaviors
- Restricted interests
The evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.
Obtaining a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.
Overview
What is oppositional defiant disorder (ODD)?
Oppositional defiant disorder (ODD) is a behavior condition in which your child displays a continuing pattern of uncooperative, defiant and sometimes hostile behavior toward people in authority. This behavior often disrupts your child’s normal daily functioning, including relationships and activities within their family and at school.
It’s common for children — especially those two to three years old and in their early teens — to be oppositional or defiant of authority once in a while. They might express their defiance by arguing, disobeying or talking back to adults, including their parents or teachers. When this behavior lasts longer than six months and goes beyond what’s usual for your child’s age, it might suggest that they have ODD.
The majority of children and teens who have ODD also have at least one other mental health condition, including:
About 30% of children with ODD develop a more serious behavior condition called conduct disorder. ODD behaviors can continue into adulthood if ODD isn’t properly diagnosed and treated.
What is conduct disorder?
Conduct disorder (CD) is a condition in which your child or adolescent shows an ongoing pattern of aggression toward others. They also show serious violations of rules and social norms at home, in school and with peers.
These rule violations may involve breaking the law. Children with CD are more likely to get injured and may have difficulties getting along with peers.
Signs of conduct disorder include:
- Frequently breaking serious rules, such as running away from home, staying out at night when told not to or skipping school.
- Being aggressive in a way that causes harm, such as bullying, fighting or being cruel to animals.
- Lying, stealing or damaging other people’s property on purpose.
What’s the difference between ODD and ADHD?
Approximately 40% of children with attention-deficit/hyperactivity disorder (ADHD) also have oppositional defiant disorder or a related conduct disorder. While these two conditions commonly occur together, they’re distinct conditions.
ODD is related to a child’s conduct and how they interact with their parents, siblings, teachers and friends. ADHD is a neurodevelopmental disorder that causes a person to be easily distracted, disorganized and excessively restless.
Who does oppositional defiant disorder affect?
ODD most commonly affects children and teenagers, but it can also affect adults. It most commonly begins by age 8.
Some children outgrow ODD or receive proper treatment for it, while others continue to have symptoms through adulthood.
Children assigned male at birth (AMAB) are more likely to have ODD in their younger years than children assigned female at birth (AFAB). But teenagers who were AMAB and AFAB are affected equally.
Your child is more likely to develop ODD if they have the following risk factors:
- A history of child abuse or neglect.
- A parent or caregiver who has a mood disorder or who has substance or alcohol use disorders.
- Exposure to violence.
- Inconsistent discipline and lack of adult supervision.
- Instability in their family, such as divorce, moving to different houses often and changing schools frequently.
- Financial problems in their family.
- Parents who have or have had ODD, attention-deficit/hyperactivity disorder (ADHD) or behavioral problems.
How common is oppositional defiant disorder?
Researchers estimate that oppositional defiant disorder affects 2% to 11% of children. This range is so wide because some children may be misdiagnosed as having conduct disorder, and teenagers, as a population, are often underdiagnosed.
The prevalence of ODD declines with increasing age.
