Autism in children: a guide for parents

1. Before you begin

It is six o'clock in the evening. Nathan, who is two and a half, is lining up his toy cars along the sofa, always in the same order: the red one, the blue one, then the lorry. You call him three times; he does not turn round. And yet his hearing is perfectly good: the rustle of a packet of biscuits brings him running from the other end of the flat. At nursery, they told you that he plays "in his own world". He says only a few words, and he never points at a plane going over.

Or it is Inès, who is eight. At school she holds it together all day, polite, hard-working, almost too well behaved. When she gets home, she falls apart: she screams because the bread has not been cut the usual way, covers her ears when the vacuum cleaner starts, then stays hidden under the table for an hour.

Three things, straight away.

You are not the cause of your child's autism, and neither is a vaccine. Autism comes, for the most part, from the way the brain was built, with a strong genetic component. Very large studies have shown that upbringing plays almost no part in it, and that the vaccine against measles, mumps and rubella does not increase the risk (section 3).

You do not need to wait for the diagnosis to help your child. The Haute Autorité de santé, the French public authority that publishes healthcare recommendations, asks for intervention to begin from the first warning signs. Many things can start this very week, at home: the second half of this guide describes them step by step.

The aim is not to make your child less autistic, but to make their life, and yours, easier. Nobody is trying to make them look people in the eye, or to get rid of repetitive movements that bother nobody. The aim is for them to be able to make themselves understood, to learn, to calm down and to sleep. And what makes them suffer, such as anxiety or the injuries they inflict on themselves, can be treated.

2. Autism, in plain words

Another way of perceiving and communicating

Autism, which doctors call autism spectrum disorder, or ASD, is one of the neurodevelopmental disorders: it comes from the way the brain developed, from before birth, and it stays with the person throughout their life. Medical classifications describe it through two families of characteristics, which we set out here in our own words.

The first concerns communication and relationships. The child shares what interests them less spontaneously, by showing an object or by seeking the adult's gaze; they struggle to grasp the unspoken rules of conversation and anything that is not meant literally; making friends costs them a great deal. The second brings together restricted or repetitive behaviours and interests: repeated movements, such as flapping their hands, a strong need for things to stay the same, interests of unusual intensity, and unusual reactions to sensations. An ordinary noise may be felt as pain, while a real injury goes almost unnoticed. These characteristics are present from early childhood, but some only become visible when the demands of school exceed what the child can give.

This guide says "autistic child"; other families say "child with autism", and no wording has everyone's agreement. Use the words of your own family, and then, as soon as your child has words of their own for it, theirs.

A very broad spectrum

Some autistic children do not speak; others have an astonishing vocabulary but take everything literally. A synthesis of the studies published around the world, which appeared in 2022, estimates that about a third of the autistic children identified also have an intellectual disability, that is, lasting difficulties in learning and reasoning. The same year, an international commission brought together by the medical journal The Lancet proposed the term "profound" autism for autistic people who cannot be left on their own, who need an adult to be able to step in at any hour of the day or night, and who need help with the basic tasks of daily life, most often because they also have a significant intellectual disability or very limited language. It is an administrative term, intended to get these needs recognised, not a diagnosis, and its authors consider it unsuitable for young children: at the age of two, nobody can know which child will later speak fluently.

How many children

The 2022 synthesis puts the frequency of autism at around one child in a hundred. It attributes the rise in the figures to several factors combined, including better knowledge of autism, a broader definition and better identification. More boys are diagnosed, but a 2017 meta-analysis, that is, a study that statistically pools the results of many others, finds a ratio closer to three boys for every girl than to four for every girl when a whole population is examined: autistic girls are more likely to go undiagnosed.

What often comes with it

In a 2019 meta-analysis covering autistic people of all ages, 28% also had attention deficit disorder with or without hyperactivity, known as ADHD, 20% an anxiety disorder, 13% a sleep disorder and 11% depression. According to a review of the published studies, which appeared in 2019, about one autistic person in eight also has epilepsy. Unlike autism itself, most of these associated conditions can be treated. If your child also has ADHD, ADHD in children and teenagers: the strategies that work at home offers tools for everyday family life.

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