It’s estimated that 1.5 million people in the United States have autism spectrum disorder (ASD), while a recent CDC report indicates a rise in autism rates. It’s more imperative than ever to increase our understanding and awareness of this disorder.

One way to do this is to understand the obstacles autism presents — not just for those who receive a diagnosis, but for the entire family. We looked to three doctors who shared and answered some of the more common questions they get asked about autism.

From how a child is diagnosed, to how autism can affect the family dynamic, read on to find out what they had to say.

Dr. Geraldine Dawson

Duke Autism Center

How is autism diagnosed in young children?

The diagnosis of autism is based on an expert clinician’s careful observations of a child’s behavior. The clinician engages the child in a set of play activities that are designed to probe for autism symptoms, and the diagnosis is based on how many symptoms are present.

A certain number of symptoms in two categories are required: difficulties in socially interacting and communicating with others, and the presence of restricted and repetitive behaviors. In addition to observing behaviors, other medical information is also typically obtained, such as genetic testing.

What are early signs of autism?

Symptoms of autism can be observed as early as 12-18 months of age. Symptoms include:

  • reduced interest in people
  • lack of gestures such as pointing and showing
  • lack of engagement in social play, such as “patty cake”
  • failure to consistently orient when the child’s name is called

For some children, symptoms are not apparent until they’re in more demanding social situations, such as at preschool. Some children may engage more easily with familiar adults such as their parents, but have difficulty when engaging with peers.

Bio: Geraldine Dawson is a practicing clinical psychologist and researcher in the area of autism. She’s a professor of psychiatry and behavioral sciences and director of the Duke Center for Autism and Brain Development at Duke University. She’s published extensively on the early detection and treatment of autism.

Dr. Sam Berne

Behavioral optometrist

Why do people diagnosed with autism spectrum disorder (ASD) sometimes have a difficult time making eye contact?

Researchers recently have found that people diagnosed with ASD have a hard time making eye contact. In one study, the subcortical system of the brain was shown to exhibit a high activation, which researchers believe may be the basis of people with autism avoiding eye contact in daily life. This pathway is involved in facial recognition and detection.

In infants, the more this pathway is used, the better the visual cortex develops. This can help give the person diagnosed with autism and their loved ones an improved ability to recognize social cues and communicate with one another.

How does visual processing impact someone with ASD?

Researchers have found that learning is more effective when our vision is linked to the information coming into the brain. Because vision is our dominant sense, improving our visual information processing can help us with movement, orientation, and understanding the relationship between our eyes, brain, and body.

People with ASD, especially children, may or may not be able to communicate their visual difficulties. Some, however, may [display certain] behaviors, which can be indicative of wider vision problems. These behaviors include, but aren’t limited to:

  • eye tics or blinking
  • dilated pupils
  • erratic eye movements
  • poor eye contact or avoiding eye contact
  • avoiding visual attention, especially reading and near work
  • frequent loss of place when reading
  • rereading letters or words
  • closing or blocking one eye when reading
  • looking out of the corner of the eye
  • difficulty copying from far away
  • holding a book too close to the eyes
  • overly interested in shadows, patterns, or lights
  • bumping or running into objects
  • confusion going up or down stairs
  • rocking

Bio: Dr. Sam Berne is a behavioral optometrist. He uses holistic protocols and vision therapy to improve behavioral conditions, like ADHD and autism, and address the root causes of eye conditions like cataracts, macular degeneration, and glaucoma.

Dr. Raun Melmed

Future Horizons, Inc.

How can siblings be included in the care of children with autism and related disabilities?

Siblings of a child with a disability or illness often feel neglected, embarrassed, angry, and might even have behavioral challenges of their own. So what can be done? Invite the sibling to office visits together with their brother or sister. Let them know how glad you are that they’re able to attend the visit, and empower them with the sense that they, too, have a voice in the care of their sibling.

Let them know that negative and confusing thoughts about their sibling with autism are common. Ask them if they would like to hear what some of those might be. If they agree, tell them that some siblings are resentful of the time parents spend with the child with a disability or illness. Some feel embarrassed by the behavior of their brothers or sisters, while others might even be scared that one day they’ll have to care for their sibling.

Underline that some of these “confusing” feelings are normal. Ask them if they’ve ever had these types of feelings, and be prepared for them to acknowledge that they do. Parents [should communicate] to their children that they [understand] what they’re going through is tough, and that negative feelings are normal. Set aside time for open communication and ventilation of those feelings.

What can I do because my child never listens and I seem to be always nagging?

This is a very common concern for parents of children with autism — and indeed for all children. “Secret signals” are a favorite intervention tool that can be used for many situations. The child is taught a signal as a prompt for a desired behavior. After two or three times of combining a verbal prompt with the “signal,” the verbal stimulus is withdrawn, and the signal is used alone.

These signals operate in much the same way that a catcher alerts the pitcher in a game of baseball — with a little training, a secret vocabulary can be built. These signals relieve both the parent and the child of nagging, cajoling, and admonishing. Instead of repeating those same requests, parents signal to a child, alerting them to a concern. The child has to stop and think “What is it now that I need to do?” This allows the child to become a more active participant in their behavioral learning process.

For children who speak too loudly indoors or in public, a “V” sign standing for “voice” can be made. For sucking thumbs, nail-biting, or even hair pulling, a child can be shown “three fingers,” as a sign to count to three and take three breaths. And for children who touch themselves inappropriately in public, showing them a “P” for “private” can be used to encourage the child to stop and think about what they’re doing.

These secret signals not only encourage independence of thought and self-control, but also are far less embarrassing or intrusive for children who would otherwise shrink from having verbal attention focused on them.

Bio: Dr. Raun Melmed is a developmental pediatrician, the director of the Melmed Center, and co-founder and medical director of the Southwest Autism Research and Resource center. He’s the author of “Autism and the Extended Family” and a series of books addressing mindfulness in children. These include “Marvin’s Monster Diary — ADHD Attacks” and “Timmy’s Monster Diary: Screen Time Attacks!”