This is a challenging and compelling question, and one that researchers have been working hard to answer! Scientists now believe that autism is the common end result of both genetic (hereditary) and environmental factors. It is clear that there is no single cause of autism for all children. More than likely, we will come to find that there are different combinations of factors that cause autism for different children – perhaps explaining why the symptoms differ so much from one child to the next.

We know that autism is hereditary from numerous twin and family studies that have been conducted over the years.  In families who have one child with autism, the risk of having a second child with the disorder ranges from 5%-19%, which is higher than the risk for the general population. The more similar siblings are genetically, the more likely it is that if one has autism, the other will also have autism (which is referred to as being “concordant” for autism). So, identical twins are more likely to be concordant for autism than are fraternal twins. But even in identical twins, who share the same genetic material, concordance is not 100%, which means that autism cannot be caused only by genetic factors.

Several environmental factors have also been linked to autism. The strongest links have been found for: maternal infections (such as German measles, or rubella) during pregnancy; birth complications that disrupt the flow of oxygen to the baby; the mother’s exposure to air pollution, certain drugs, or certain chemicals during pregnancy; and older ages of parents at the time of conception. It appears that these environmental factors do not cause autism in and of themselves, but instead increase the risk of autism in children who are already genetically vulnerable.

A great deal of research is being conducted to identify potential genetic and environmental factors that interact to cause autism. Follow us on Facebook to read about some of the latest findings.

Have a question or comment? Feel free to send us a note.

“My child was just diagnosed with ASD – what do I do now?”

This is a frequent question we hear from parents of young children. Children with ASD have a unique learning style that often requires a comprehensive, multidisciplinary approach. Sorting through the many treatment options can be quite difficult for families new to the diagnosis.

Below are some elements of a treatment plan that address different aspects of children’s learning, development, and behavior. But remember − no two children or families are alike (whether or not they have ASD!), and intervention plans need to be individualized to the specific needs of child as well as their families. For all interventions, look for therapists who have experience with children with ASD and who involve parents by providing training and/or coaching.

Early Intervention (EI) System

What is it?

Early intervention programs are part of a statewide system of services designed to promote children’s age-appropriate growth and development, as well as support families, during the critical birth to three years. EI staff work with families to develop an Individualized Family Service Plan (IFSP), which identifies goals and the support services needed to meet them. EI services are often provided in the family’s home, though some may be center-based or take place elsewhere in the child’s natural environment.

Who provides it? In Washington, this system is called Early Support for Infant and Toddlers (ESIT). EI providers include Family Resource Coordinators (FRCs), early childhood  specialists, speech-language pathologists (SLPs) and occupational therapists (OTs).

Speech and language therapy

What is it?

Speech and language therapy helps children learn to communicate, both verbally and nonverbally. Goals can focus on helping children use speech sounds or language, or communicate via augmentative and alternative communication (AAC) systems such as picture boards or electronic devices.

Who provides it?

Speech-language pathologists (SLPs)

Occupational therapy (OT)

What is it?

Occupational therapy helps increase children’s participation in everyday activities. Goals may target motor skills, self-care activities, and play skills, as well as sensory and feeding issues.

Who provides it?

Occupational therapists (OTs).

Behavioral intervention (ABA)

What is it?

Applied Behavioral Analysis (ABA) is a behavioral intervention that employs the principles of learning to increase desired behaviors, decrease undesired behaviors, and teach new skills. ABA therapists address a range of different skill areas, including communication, play, social skills, daily living skills, and challenging behaviors.

Who provides it?

Board Certified Behavior Analysts (BCBA) oversee treatment programs and may also provide direct services. In-home services are often provided by therapy assistants, supervised by BCBAs.

Could my child have autism?

The frequent press coverage that autism has received over the past several years has led many parents of young children to wonder whether their child might be showing signs of autism. Here is some information to consider as you observe and interact with your child.

The diagnosis of autism is based on a pattern of behavioral symptoms in two areas: (1) social interaction and communication, and (2) restricted and repetitive interests or activities. Symptoms in both areas must be present for a child to receive a formal diagnosis of autism.  However, these two behavioral symptoms can be expressed very differently from one child to another. In fact, there is a common expression that “if you know one child with autism…..you know one child with autism.”

Social Interaction and Communication

Almost from the moment of birth, infants are very social beings. They enjoy close physical contact with caregivers, like looking at faces, turn toward voices, and smile at family members. As toddlers, they show interest in other children, and they learn how to interact by watching and imitating how others talk, play, and behave. Even before they learn to talk, they communicate nonverbally, using eye contact, facial expressions, gestures, and body language. They enjoy the give-and-take of social engagement and seek it out. In contrast, children with autism may not show the expected development of early social interactions. They may be less interested in playing social games (such as pat-a-cake) with caregivers, or may prefer to play alone with favorite toys rather than having others join in their play. Some parents find that the best way to engage their child with autism is through physical activities, such as rough-and-tumble play. Children with autism may have difficulty communicating their needs or desires by using eye contact, facial expressions, or gestures. They may initiate interactions with caregivers only “on their own terms,” to get something they want, instead of communicating to share their interests or enjoyment with others.  They may be less interested in watching, playing with, or imitating the actions of other children.

Restricted, Repetitive Interests or Activities

Children with autism may become preoccupied with certain activities, toys, or interests in a way that is unusual in its intensity. For example, they may spend hours opening and closing objects with hinges, or lining up puzzle pieces over and over, without actually putting them in the puzzle. They may also find comfort in predictable routines, such as always drinking out of the same cup or going through the same exact sequence of activities before bedtime every single night. Sometimes if their activities are interrupted, or their routine changes, they can become very upset or distressed. They may have very focused interests that differ from those of their peers, such as learning about different types of vacuum cleaners or ceiling fans. They may also show unusual body movements, such as body tensing, toe-walking, or arm flapping. Unusual reactions to sensory stimuli can also be seen in children with autism. Some children may be very interested in visually examining objects by holding them close to their eyes, others may seek out certain textures to touch, and still others may find certain sounds disturbing or be hypersensitive to the feel of new clothes.

Keeping Perspective

Many of the individual behaviors described above also occur in some form among children with typical development.  But if these social and behavioral symptoms occur in combination, persist over time, and occur across a variety of different contexts, then a conversation with your primary care provider may be warranted. The Caregiver Observation Checklist (see below) may be helpful in observing your child’s behavior and communicating your concerns to your doctor or other service provider. Please note that some of the items on this checklist are not meaningful for children less 14-15 months old, so we recommend that it be used only for children who are at least 14-15 months old. Also, please note that this checklist is not designed as a screening tool; rather, it is designed as a tool for observing and communicating about your child with others.

Have a question? Feel free to send us a note.

Caregiver Observation Checklist

Download Caregiver Observation Checklist

1. When you smile at your child, does s/he smile back?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

2. When your child is playing by him/herself and you call his/her name, does s/he look at you?
   • □ Rarely          □ Sometimes          □ Often
   • Most likely times:
   • Least likely times:

3. When you point to show your child something, does s/he follow your point?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

4. When you try to join in your child’s play activities, does s/he share his/her toys and play interactively with you?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

5. When you show your child a different way to play with a toy, does s/he watch you and then try it?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

6. When a familiar adult greets your child, does s/he respond by looking at the person?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

7. When your child is enjoying an activity, does s/he look at you and smile to indicate his/her pleasure?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

8. When you laugh at something your child does, will s/he repeat the action to see if you will laugh again?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

9. Does your child point to things or show you things just to share his/her interest or excitement with you?
   • □ Rarely         □ Sometimes           □ Often
   • Most likely times:
   • Least likely times:

10. Does your child try to get you to play with him/her, such as handing you toys while looking at you?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

11. Does your child approach other children and try to play with them?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

12. Does your child look at you when you are talking to or playing with her/him?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

13. Does your child play with toys or other objects in unusual ways?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

14. Does your child move his/her hands or body in unusual ways?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

15. Does your child seem to be unusually interested in seeking out certain types of sensory stimulation?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

16. Does your child seem to be unusually sensitive to, or disturbed by, certain types of sensory stimulation?
    • □ Rarely         □ Sometimes           □ Often
    • Most likely times:
    • Least likely times:

© 2006 Wendy L. Stone and Theresa Foy DiGeronimo