More Information About Autism

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The age at which autism is diagnosed and the indicators present vary widely. Some infants show hints in their first months. In others, behaviours become apparent around age 2 or 3. Not all children with autism show all the signs. Many children who aren’t on the spectrum show a few. The following list may indicate the need for diagnostic evaluation. If your child exhibits the following, ask your pediatrician or family doctor for an assessment.

By 6 months: 

• Few or no big smiles or other warm, joyful and engaging expressions 
• Limited or no eye contact 

By 9 months: 

• There is little or no back-and-forth sharing of sounds, smiles or other facial expressions 

By 12 months: 

• Little or no babbling 
• Little or no back-and-forth gestures, such as pointing, showing, reaching or waving 
• Little or no response to their name 

By 16 months: 

• Very few or no words 

By 24 months: 

• Very few or no meaningful, two-word phrases (not including imitating or repeating) 

At any age: 

• Loss of previously acquired speech, babbling or social skills 

There is a range of both physical and mental health conditions that commonly occur in autistic people. The following list is not exhaustive but is meant to give an overview of some of the most common co-occurring needs. 

Since autistic people may have difficulty communicating their experiences or sensations, it can make identifying co-occurring needs challenging. Understood.org shares how it can be helpful to take note to know when something might be an area to further explore. 

Notice if something is going on that is out of the ordinary. 

Observe and keep track of patterns. 

Talk with other people who can help support you, like pediatricians, teachers, and other caregivers. 

Engage your loved one to get information and explore options for what to do next. 

"Health care workers sometimes try to fit you in a category but we have complex comorbid conditions so I wish they would show more compassion and less trying to categorize and 'fix'. I have been told several times by health care professionals that I don't look like someone with autism. not sure what that means."

Physical Health

Children and youth on the spectrum are three times more likely to have another long-term health condition compared to those without autism. Autistic adults also commonly experience a range of co-occurring physical health needs. 

"I wish people would understand how interconnected their physical health is with all the other aspects of their health (e.g. mental health). For instance, feeling physically well can immediately result in feeling lighter mentally."

Courtney, Self Advocate, ON

"I also would like health care workers to know that many of us not only struggle with this condition but sometimes it's difficult to communicate ailments we feel. Also, that any ailments or health issues exacerbate our condition, sometimes a minor ache or pain might be impossible to ignore or tune out and other pains might not be felt at all."

Adult Self Advocate, ON

Sleep Challenges 

Sleep can be a lifelong challenge. Many autistic people experience difficulty falling asleep and/or staying asleep through the night. Sleep issues can extend from other physical and mental health conditions like anxiety, depression, GI disorders, ADHD, or as a side effect of a medication. Some traits like hypersensitivity to sights and sounds, and disruptions in routines also increase sleep disturbances. More research is needed, but early studies have determined that some individuals on the spectrum have different circadian rhythms. Sleep issues can have negative impacts on behaviour, interfere with learning and decrease overall quality of life. 

Eating & Feeding Challenges

Eating challenges occur in as many as 80% of children on the spectrum, with up to 10% of those becoming lifelong conditions.

Many autistic adults likewise describe food aversions and restricted eating patterns. Sensory sensitivities in taste, texture, and smell, as well as a strong preference for sameness, can all impact an individual’s diet and create issues with food selectivity and restricted eating.

Epilepsy and Seizures

Epilepsy is a neurological disorder characterized by repeated seizures that can vary in type and severity. The association between autism and epilepsy has been well-established, but more information about why they often co-occur is needed. Research into the prevalence of autism and epilepsy has varied results. However, all studies suggest a higher prevalence of seizure disorder in the autistic population compared with the general population. 

Seizures can significantly impact an autistic person’s day-to-day abilities. Signs include: 

• Unexplained staring spells
• Involuntary movements
• Unexplained confusion
• Severe headaches
• Sleepiness
• Disrupted sleep
• Unexplained changes in abilities or emotions
• 
  

Gastrointestinal Disorders (GI)

GI issues may be common in the autistic population due to nutritional deficiencies related to feeding challenges and/or food selectivity. Prevalence reports vary; more research is needed to determine accurate prevalence and causes. Indicators of GI issues are flatulence, restrictive routines or irritability around mealtimes, stomach pain, constipation, and diarrhea. However, GI issues can sometimes be challenging to identify or commonly overlooked in autistic people, mainly if there are barriers to communicating pain and discomfort. 

Mental Health

Like non-autistic people, autistic people can experience a range of mental health challenges throughout their lives, although they may experience these challenges differently. For example, an autistic person may have more exposure to traumatic events or negative experiences due to communication and social differences. 

Those on the spectrum may also experience additional distress due to the pressures of fitting into a world that struggles to understand and accept their needs. Mental health exists on a spectrum, spanning from experiencing no distress to diagnosable mental health conditions. 

"Many of us with autism also have other mental health disorders. I have Tourette Syndrome, Obsessive Compulsive Disorder, ADHD and learning disabilities. But I am Andrew, not just someone with mental health disorders and autism."

Adult Self Advocate, ON

Anxiety

Anxiety disorders affect 22% of autistic children aged 5-17 years in Canada. 

More information is needed regarding anxiety and the autistic adult population. Identifying anxiety in an autistic person can be complicated by communication issues. Social anxiety – or extreme fear of new people, crowds, and social situations – is especially common among autistic people. In addition, many autistic people have difficulty controlling or managing symptoms of anxiety once they are experienced. Signs someone may be feeling anxious can include: 

• Increases or changes in repetitive behaviours
• General moodiness
• Avoidance
• Sleep disturbances
• Complaints of headaches or stomachaches

Depression

Mood disorders affect 6% of autistic children compared to 2% of non-autistic children in Canada. 42% of autistic adults experience life-long depression. 

Depression can be caused by several factors, including genetic risk, individual brain chemistry, and environmental circumstances. Contributing factors that are common in the autistic population are lack of meaningful employment, financial stressors, burnout and overwhelm, low self-esteem, difficulty building and maintaining healthy relationships, and isolation. Depression rates for people with autism rise with age and intellectual ability. Autism-related communication challenges can mask signs of depression. Signs someone may be feeling depressed can include: 

• Loss of interest in favourite activities
• A noticeable worsening in hygiene
• Chronic feelings of sadness, hopelessness, worthlessness and irritability
• At its most profound, frequent thoughts about death and/or suicide

Obsessive Compulsive Disorder (OCD)

OCD and autism have overlapping traits that can complicate a diagnosis, such as repetitive behaviours and perseverative thinking (a repetitive thought that feels “stuck” in the mind). It is believed that 17% percent of autistic people also have a diagnosis of OCD, although that number is believed to be higher due to the challenges of differentiating autism and OCD diagnoses. 

Trauma & Post-Traumatic Stress Disorder (PTSD)

There are many overlapping traits between autism and those experiencing trauma. PTSD occurs in approximately 4% of people in the general population versus 40% to 60% in the autistic community.

Research has shown that autistic children have a more reactive nervous system and can be more sensitive to traumatic events. Autistic people also encounter victimization across their lifespan at higher rates than the general population, increasing their exposure to traumatic events.

More research is significantly needed to understand better how autistic people experience trauma and to inform therapeutic best practices for this population. 

For adults, an assessment is usually done by a psychologist or Psychiatrist.

There is no federal or provincial funding for adults to receive a diagnostic assessment for autism; as such, assessments are commonly accessed through a private provider.

Due to these financial barriers, as well as a movement away from viewing autism as a “disorder,” it is becoming more common for adults to choose to self-identify as autistic instead of receiving a formal diagnosis.

What can I expect from a diagnostic assessment?

• There is no standardized autism assessment for adults. Professionals will use modified children’s assessment tools or an unstructured interview format.
• Before booking your assessment, ask the professional about their experience and knowledge of adults on the spectrum (see questions to ask professionals) 
• An assessment can be one or multiple sessions with a professional.
• Be prepared to answer questions regarding your childhood, educational experiences, and current mental health and day-to-day functioning.

Some services and supports are relevant to autistic people of all ages and across multiple life stages.

Recreation

Inclusion in recreational activities provides opportunities to express creativity and achieve and master new skills. This is particularly important for autistic people as it provides opportunities to practice social skills, enhance physical aptitude, and increase motivation, all potentially influencing self-confidence. Some autistic people will be able to participate in community activities with minimal support and accommodation, while others may benefit from access to a dedicated support person or require programs to be adapted or modified to meet their needs. Inclusion Training for organizations is essential to increase the capacity and understanding to support people on the spectrum with a wide range of needs and abilities in recreational programming.

Skill Development

Caregiver education is essential to maximize opportunities for growth and development in the home and community. It is strongly recommended that any program targeting children and youth also include a caregiver component, to ensure opportunities for skill generalization outside of the therapeutic setting. Caregiver educational programs may include group training and/or individual coaching. One example is the Caregiver Skills Training program, which uses scientifically proven strategies for promoting child development, reducing disruptive behaviors, and strengthening caregiver coping skills.