Autism Spectrum Disorder

Understanding Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how people communicate, relate to others, and experience the world around them. While it’s often diagnosed in childhood, many adolescents and adults also seek evaluation and support later in life.

At my practice, I aim to create a safe, informed, and compassionate space for individuals and families navigating an autism diagnosis. Whether you’re a parent concerned about your child or an adult exploring lifelong patterns, understanding ASD is the first step toward meaningful support and growth.

What Are the Signs of Autism?

The main way we make a diagnosis of autism is through the Diagnostic and Statistical Manual, Version 5, Text Revision (DSM-5-TR). It outlines two core areas that define ASD:

1. Social communication and interaction differences, such as:
   • Difficulty with back-and-forth conversation
   • Trouble understanding social cues (like tone of voice or facial expressions)
   • Challenges in developing age-appropriate friendships or relationships
2. Restricted and repetitive behaviors or interests, such as:
   • Repeating certain movements or phrases (sometimes called “stimming”)
   • Strong need for routine or sameness
   • Intense interest in specific topics
   • Over- or under-sensitivity to sensory input (e.g., lights, textures, sounds)

To meet criteria, these traits must be present from early development meaning before grade school age, impact daily functioning, and not be better explained by another diagnosis. If these difficulties arose at a later age, then we need to consider alternative diagnoses and ways of understanding your difficulties. Many individuals also have strengths, such as attention to detail, deep focus, or creative thinking, that deserve to be recognized and supported.

How Autism May Present:

The behaviors listed below are possible early clues that a child may benefit from further evaluation for Autism Spectrum Disorder. It’s important to remember that no single behavior on its own means your child has autism. Many children without autism display some of these traits at different stages of development.

However, if you notice several of these behaviors or have ongoing concerns about your child’s development, it’s worth discussing with a professional. Early identification can lead to better support, greater understanding, and more effective interventions.

Variations in Developmental Milestones

• Avoids or does not maintain eye contact.
• Does not respond to name by 9 months of age.
• Does not show facial expressions of emotions by 9 months of age.
• Rarely shares enjoyment with caregivers.
• No simple interactive games (eg, pat-a-cake) by 12 months of age.
• Uses no or few gestures (eg, does not wave goodbye).
• Does not share interests with others.
• Does little or no imitation of other people or does not pretend.
• May not engage in pointing or other shared attention behaviors typical by 18 months.

New Onset of Atypical Behaviors

• Lines up toys in a particular order and gets upset when the order is changed.
• Uses repetitive words and phrases.
• Moves their fingers, hands, or body in an unusual way (finger flicking, hand flapping, body rocking, spinning self in circles, for example).
• Shows excessive interest in particular objects.
• Has intense or focused interests in certain objects and attachment to unusual objects.
• Has unusual reactions to sensory stimuli (e.g., getting upset about a clothing tag, avoiding eating food with certain textures).
• Has strong interest in and seeks unusual sensory experiences (eg, squinting or flapping hands to certain lights, excessively rubbing certain textures, licking or smelling objects.).

Who Is Affected by Autism?

Autism affects people of all ages, genders, and backgrounds. Key facts include:

• Prevalence: About 1 in 31 children in the U.S. is diagnosed with ASD, according to the most recent CDC estimates in 2022.
• Gender differences: Boys are diagnosed more frequently than girls, with boys being nearly 4 times more likely to receive an ASD diagnosis than girls. However, research suggests girls may be underdiagnosed due to different social presentations.
• Age of diagnosis: Signs can be seen as early as 18 months, but many are diagnosed later, sometimes not until adolescence or even adulthood.

ASD can also present alongside other conditions such as ADHD, anxiety, or learning differences. No two individuals on the spectrum are the same.

Understanding the Origins of Autism

There is no single cause of ASD. Current research suggests that autism is the result of complex interactions between genes and early brain development. Some key insights:

• Genetic factors play a significant role, with multiple genes involved. Recent research shows that ASD is highly heritable, with both rare and common genetic variants contributing to risk. Rare mutations in over 100 genes (many involved in brain development, gene regulation, and synaptic function) can significantly increase the likelihood of ASD, while common genetic variants each have a small effect but collectively account for most cases.[1, 2, 3]
• Neurobiology: At the molecular level, these genetic changes often disrupt processes such as neurogenesis (the formation of new brain cells), chromatin modification (which affects how genes are turned on or off), and synaptic signaling (how brain cells communicate). These disruptions are especially important during early brain development, particularly in the prefrontal cortex, which is involved in social behavior and decision-making.[4] Studies also highlight the role of imbalances between excitatory and inhibitory signaling in the brain, as well as the involvement of glial cells, which support and protect neurons.[5, 6, 7]
• Differences in brain connectivity and activity patterns may affect how sensory information is processed or how different brain regions communicate. Brain imaging and functional studies reveal that individuals with ASD often have differences in brain structure and connectivity, especially in regions related to social interaction and communication. [8]
• Environmental factors during pregnancy or early life may also contribute but are not considered primary causes.

It’s important to know that autism is not caused by parenting, vaccines, or lifestyle choices. It’s a brain-based difference that has always existed in the human population.

How I Evaluate Autism in My Practice

As a psychiatrist, I provide comprehensive evaluations for children, adolescents, and adults who may be on the autism spectrum. My approach includes:

• Initial intake and history-taking: Understanding developmental milestones, behaviors, medical and family history, and current concerns. I meet with the patient and any other relevant parents, caregivers, loved ones who can help lend insight into the person’s behavior.
• Use of standardized tools when appropriate (e.g., autism-specific screeners, behavior checklists). I am certified in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), which is a semi-structured interview and informs my diagnostic process.
• Collaboration with others involved in care: including therapists, pediatricians, school psychologists, speech and language pathologists, neuropsychologists for intelligence testing, occupational therapists, and teachers to gather a full picture.
• Consideration of co-occurring conditions, such as ADHD (28% in those with ASD), anxiety (20%), or depression (11%), which may influence how autism shows up. There are other conditions that need to be ruled out as well, such as intellectual disability (23%), global developmental delay, intellectual giftedness, social (pragmatic) communication disorder, developmental language disorder, nonverbal learning disorders, genetic conditions such as Fragile X syndrome, neurodevelopmental conditions such as Landau-Kleffner syndrome or Rett Syndrome, epilepsy (8% in ASD but 21% in ASD with intellectual disability), or other neurodevelopmental conditions. [9, 10]
• Laboratory testing: I review any prior lab results and recommend additional tests only if clinically necessary. This may include bloodwork or, when appropriate, a referral for genetic counseling and testing in line with international guidelines. For those with significant language impairment, I also consider testing for folate receptor alpha-autoantibody as the addition of folinic acid (leucovorin) may help with speech, language, and behavior in those with these autoantibodies, which ranges from 33-75% of children with ASD resulting in low folate (vitamin B9) in the brain. [11, 12, 13]

My goal is to provide a thoughtful, personalized evaluation that can lead to clarity, understanding, and a path forward.

Treatment and Support Options

While there is no “cure” for autism, there are many effective ways to support individuals on the spectrum to improve their quality of life. Treatment is highly personalized depending on needs, age, and goals.

In addition to diagnostic services above, here’s what I offer in my practice for treatment:

• Medication: For those co-occurring conditions like anxiety, ADHD, mood disorders, or sleep disorders. There are no FDA approved medications to target the core symptoms of ASD. However, risperidone and aripiprazole are FDA-approved for irritability, aggression, tantrums, and self-injurious behaviors in those with autism and other developmental disorders.
• Parent coaching: to help caregivers understand their child’s needs, reduce stress, brainstorm how to optimize routines, recommend environmental modifications to better suit the child, and promote development.
• Referrals to therapists or behavioral services, including speech-language pathologists, occupational therapists, or other therapists when appropriate.
• Care coordination: I often collaborate with schools, primary care providers, and other specialists to ensure a consistent and supportive care plan. If a diagnosis of ASD is made and there are significant school challenges because of this, I can guide you through the process to obtain accommodations and services at the school to help with those challenges.

I also recognize and support neurodiversity, respecting that autism is not something to “fix,” but rather something to understand and accommodate so that individuals can thrive. I also recognize that individuals are not fixed either, and that they can grow to improve their quality of life and learn to adapt to managing life’s complex challenges.

Other Models of Understanding Autism

Because this is a strong interest of mine, I also like to explore different ways that people have come to understand the experiences that some might label autistic. If you’re interested in these other models that I’ve gathered throughout the years, feel free to take a look at this page.

Ready to Take the Next Step?

Whether you’re seeking answers, looking for support, or just starting this journey, I’m here to help. My practice is welcoming to people of all ages and backgrounds. I bring clinical expertise, compassion, and curiosity to every evaluation and treatment plan.

If you’d like to schedule a consultation or learn more, please click on the button below or visit the New Patients section of this site.

Resources:

Lecture Title: Understanding and Treating Anxiety in Autistic Individuals
Event: Stanford Child Mental Health Projects for Ukraine
Description: I delivered a lecture on the unique presentations of anxiety in individuals on the autism spectrum, with a focus on clinical identification, differential diagnosis, and evidence-based treatment approaches. This session was part of an international initiative to support child mental health professionals in Ukraine.