Can Autism Skip a Generation? Understanding Genetics and Environmental Factors

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Does autism skip a generation? This question – and similar ones like, “Does autism run in families?” and “Which parent carries the gene for autism?” – implies that there is an easy-to-identify “autistic gene” we can test for. This is not at all the case: autism is a complex, polygenic condition. This means autism is influenced by multiple genes, rather than a single identifiable genetic mutation. 

The exact cause of autism spectrum disorder (ASD) is not fully understood, but research suggests that it results from a combination of genetic and environmental factors that affect early brain development. Let’s take a look at the potential roles of both to gain more insight into, “Can autism skip a generation?”

Understanding Autism and Genetics

Is autism hereditary? Strong evidence shows that, yes, autism has a hereditary component. In fact, twin studies indicate that if one identical twin has autism, there is a high probability the other will too. (More on this later.)

Research indicates that genetics account for approximately 40–80% of the risk for developing ASD. More than 800 genes have been identified as being associated with autism, each contributing a small effect. It’s important to note, though, that these genes are not exclusive to autism – they may also be linked to other neurodevelopmental conditions. ​

In addition to individual genetic variations, certain rare genetic syndromes have a strong association with autism. Fragile X syndrome is the most common, occurring in approximately 1–3% of individuals on the autism spectrum. Rett syndrome, primarily affecting girls, often includes autism-like symptoms. Tuberous sclerosis complex (TSC) can lead to autism alongside other neurological symptoms. 

Right now, there’s no single genetic test that can diagnose autism. Some doctors may recommend genetic testing, such as whole-exome sequencing or chromosomal microarray analysis, for individuals with autism, especially if there are other developmental concerns. These tests can sometimes identify genetic variations associated with autism, but they don’t provide a clear yes-or-no answer. Instead, they help pinpoint possible genetic contributors. 

Many autistic individuals don’t have any identifiable genetic mutation, meaning a genetic test alone can’t confirm or rule out autism. Diagnosis still relies on behavioral assessments and developmental evaluations conducted by healthcare professionals.

Environmental Factors and Autism

While genetics play a big role in autism, researchers have also identified certain environmental factors that may contribute to the risk. For example, parental age – especially having children later in life – has been linked to a slightly increased likelihood of autism. 

Additionally, prenatal exposures can play a role. If a pregnant person contracts certain infections, like rubella or the flu, or experiences an immune system response, it may slightly increase the chance of autism in their child. Exposure to certain medications and toxins during pregnancy, such as valproic acid (used to treat epilepsy) or thalidomide (a drug once prescribed for nausea but later found to cause birth defects), has also been associated with a higher risk. 

Complications during birth, particularly those involving oxygen deprivation, have also been explored as possible contributing factors. 

It’s important to note that while these factors may increase risk, they do not directly “cause” autism on their own – rather, they may interact with genetic predispositions in ways that researchers are still working to fully understand.

If a Parent Has Autism, Will Their Child Have It?

If a parent has autism, their child has a higher chance of being autistic, but it’s not guaranteed. Studies suggest that the hereditary risk of autism is as high as 80%. So, higher than in the general population, but the exact risk varies depending on the specific genetic factors involved. Said simply: autism can run in families.

However, autism can also appear in families without a clear genetic history, likely due to new (de novo) genetic mutations or other influences. Research indicates that de novo mutations account for 30-67% of all autism cases. The impact of de novo mutations varies depending on familial risk factors. 

Of course, if these new genetic mutations are passed down, they could contribute to autism in later generations.

If a Sibling Has Autism, Will Another Sibling Have It?

If one sibling has autism, the chances of another sibling being autistic are higher than in the general population – but, again, there’s no guarantee. Studies show that the recurrence risk of autism among siblings is around 20%, meaning that if one child in a family has autism, there is a 1 in 5 chance that a sibling will also be diagnosed with autism. This risk is significantly higher than the 2.8% chance in the general population.

The likelihood increases if multiple children in the family already have autism, suggesting a stronger genetic influence. Additionally, if a sibling has a more severe form of autism, the chances of another sibling being autistic may also be higher. Identical twins have the highest likelihood of both being autistic, with a 60-90% concordance rate, while fraternal twins and non-twin siblings have a lower but still elevated risk.

If parents are concerned about sibling risk, early developmental monitoring and speaking with a pediatrician can help guide early intervention if needed.

Can Autism Skip a Generation?

Can a child have autism if the parents don’t? Yes, autism can skip a generation, though it depends on the specific genetic factors at play – autism doesn’t follow a strict generation. In some cases, it may just appear that autism has skipped a generation.

Someone may carry genetic variations associated with autism without showing noticeable autistic traits themselves. One family member may be formally diagnosed, while another may have mild characteristics of autism that don’t meet the full criteria for a diagnosis. Now that we have a better understanding of autism, some of these “high functioning” relatives might be diagnosed as having autism today.

What to Do If You Think Your Child Has Autism

If you believe your baby or child may have autism – based on genetics or observed behaviors – see your pediatrician or schedule an autism assessment with an organization like A Bridge to Achievement (ABtA). At ABtA, assessments can be scheduled within two to three weeks, depending on location and insurance – we accept Blue Cross Blue Shield (BCBS), MedCost, Medicaid, and Aetna. 

Regardless of the origins of autism, we are here to support you. Our ABA therapy programs engage ages 2 to 21+ with a variety of fun and fulfilling programs:

  • Building Bridges is a preschool alternative and Kindergarten readiness program for our youngest learners.
  • BRIDGES, designed for ages 8+, is an excellent complement to homeschool. 
  • Social Skills Groups are for kids and teens who want to build their confidence in navigating various social situations.
  • The Vocational Skills program helps teens identify prospective job opportunities and practice pre-employment skills. 

We support caregivers, too – everything we do is in support of the autism community! Have questions? Connect with us. Support starts here.

Do Babies with Autism Smile & Laugh? Insights Into Early Behavior

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Do autistic babies smile and laugh? This frequently asked question stems from the fact that how and when a child smiles and exhibits other developmental milestones can be early indicators of autism. Of course, differences in smiling and other social gestures alone are not diagnostic signs of autism – but they are worth exploring.

In this article, we’ll consider smiling and other frequently-observed symptoms of autism in babies and toddlers, discuss the benefits of early intervention for young learners and their caregivers and families, and share about our program for ages three to six: Building Bridges.

Reflexive vs. Social Smiling 

First let’s look at the different types of smiling and how they are expressed in neurotypical and neurodivergent babies. All babies may smile reflexively in their sleep or in response to pleasant stimuli, such as a warm touch. Social smiling, however, is in response to human interaction. 

In neurotypical infants, social smiling develops by six to eight weeks. By month two or three, they typically smile in response to faces or voices, and around four or six months, laughter emerges as they react to lively interactions, like playing peekaboo or being tickled. The baby smiles, the caregiver smiles back, and this back-and-forth interaction reinforces social bonds. 

Young learners with autism may not engage in this feedback loop or their expression of social smiling and laughter may be reduced, delayed or absent. These differences have the potential to be significant because social engagement, communication, and emotional connection are all areas that can be affected by autism.

mother smiling at baby

Social Smiling and Autism

Autistic babies can both smile and laugh, but they may do so less frequently, differently, or in response to non-social stimuli compared to neurotypical babies. Smiling and laughing are both important forms of early social communication, and differences in how and when a baby engages in these behaviors can sometimes be early warning signs of autism.

  • Less Socially Responsive Smiling & Laughing
    Autistic babies may smile or laugh less frequently in social situations or may not do so in response to typical social cues.
  • Smiling & Laughing at Objects or Sensory Experiences
    Babies with autism may smile or laugh at sensory inputs like spinning objects, flashing lights, or certain sounds. Their facial expressions may be more related to personal experiences rather than social interaction with others.
  • Inconsistent or Unexpected Smiling & Laughing
    Some autistic babies may smile or laugh at unusual times, seemingly unrelated to the environment. They may smile without making eye contact or laugh when alone rather than in response to social play.
  • Limited Reciprocal (Back-and-Forth) Engagement
    Babies on the autistic spectrum may not engage in back-and-forth exchanges of smiles or laughter, making it harder for caregivers to interpret their social interest.
  • Delayed or Atypical Expression
    Autistic babies may smile later or less frequently in response to people. Their laughter may sound different (e.g., high-pitched, monotone, or repetitive) and may occur less frequently or in unexpected situations.

Not all babies with autism smile or laugh less than others – all children develop at their own pace. Some autistic babies smile a lot but have other social interaction differences, such as limited eye contact, delayed gestures, or repetitive behaviors. Let’s look at what gestures infants with autism have and others that may present as they grow.

Other Signs of Autism in Babies & Toddlers

Many of the following communication differences, behavioral patterns, and sensory sensitivities can appear in children who are not autistic, but a baby or toddler who consistently shows multiple behaviors from the lists below may be a candidate for autism assessment.

Babies (0-12 Months)

Social & Communication Differences

  • Limited eye contact with caregivers
  • Does not respond to their name by 9-12 months
  • Minimal or absent babbling (e.g., not making “ba-ba” or “da-da” sounds)
  • Limited gestures (e.g., doesn’t point, wave, or reach to be picked up)
  • Does not imitate sounds, facial expressions, or gestures
  • Little to no interest in social play (e.g., doesn’t enjoy peekaboo or clapping games)
  • Does not show or give objects to share interest

Behavioral & Repetitive Patterns

  • Fixates on objects rather than people (e.g., staring at ceiling fans, spinning objects)
  • Repetitive hand movements (e.g., hand-flapping, finger-flicking, unusual posturing)
  • Rigid body movements (e.g., stiffening arms, rocking)
  • Overly focused on parts of toys (e.g., spinning wheels instead of rolling the toy car)
  • Resists changes in routine (e.g., extreme distress over minor changes)
  • Limited exploration of new objects or repetitive play with the same items

Sensory Differences

  • Unusual sensitivity to touch, sound, or light (e.g., avoids cuddling, covers ears)
  • Under-reacts or overreacts to pain or temperature changes
  • Avoids certain textures or has strong food preferences

Baby with Pumpkins

Toddlers (12-36 Months)

Social & Communication Differences

  • Delayed speech (e.g., no words by 16 months, no two-word phrases by 24 months)
  • Limited gestures (e.g., does not point to show interest or request things)
  • Does not engage in back-and-forth play (e.g., rolling a ball, imitating actions)
  • Avoids or makes fleeting eye contact with caregivers and peers
  • Prefers playing alone rather than engaging with other children
  • Rarely seeks comfort from caregivers or does not respond to affection
  • Repeats words or phrases (echolalia) instead of using them meaningfully

Behavioral & Repetitive Patterns

  • Hand-flapping, rocking, spinning, or other repetitive movements
  • Fixates on specific objects or topics (e.g., memorizing numbers, letters, or shapes)
  • Resists change in routines (e.g., tantrums over small changes in daily activities)
  • Lines up toys instead of playing with them in an imaginative way
  • Uses toys in unusual ways (e.g., flicking a toy instead of playing with it normally)
  • Displays rigid behaviors (e.g., insists on doing things the same way every time)

Sensory Differences

  • Over- or under-reacts to sensory input (e.g., covers ears for loud sounds, loves deep pressure)
  • Avoids certain food textures or has an extremely limited diet
  • Enjoys spinning, jumping, or seeking out intense sensory experiences

What To Do If You Have Concerns

Every baby’s developmental journey is unique. Trust your instincts. If you notice differences, seeking guidance can provide clarity and access to helpful resources, such as the services and programs at A Bridge to Achievement. We engage learners with autism ages 3 to 21+. Your family can grow with ours – we’re here for as long as you need us.

Prepare for an autism assessment by tracking and documenting behaviors, noting when and how often they occur. Keeping a record of your baby or toddler’s milestones can be helpful, such as smiling, babbling, gesturing, and responding to their name. Taking short videos of behaviors can also provide useful information for a pediatrician or specialist.

Pediatricians typically conduct screenings at well-child visits (9, 18, and 24 months). If concerns persist, the doctor may suggest a formal autism evaluation. Some practices, including A Bridge to Achievement, accept new clients without a referral – you simply request services.

Boy playing with blocks looking at the camer

Early Intervention: Building Bridges

Research shows that early intervention can significantly help to build foundational skills in communication, social interaction, emotional regulation, behavior, and adaptive skills during critical stages of brain development. By addressing developmental differences early, children with autism have a greater chance to thrive – improving long-term learning, increasing independence, and reaching their full potential. 

Learn more about early intervention for your learner by checking out our preschool alternative and Kindergarten readiness program, Building Bridges. We offer this one-on-one and small group learning program at our Pineville, University and Winston-Salem locations and accept BCBS, MedCost, and Medicaid. Contact us with questions or go ahead and request services – support starts here.

Dental Care, Haircuts and Autism: Understanding Sensory Sensitivities and How to Make Them Easier

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The hair salon and the dentist office are often sites of significant anxiety for learners with Autism Spectrum Disorder (ASD). Between the unfamiliar sounds, sensations, and smells, and having to sit still for an extended period – these environments can be overwhelming. In this article, we’ll discuss some of the common triggers that learners with autism encounter during routine hair and dental appointments and share some evidence-based strategies to improve their experience.

Autism & Haircuts: Triggers

Neurotypical learners tend to be at ease at the hair salon – after all, it doesn’t hurt when hair is cut off. Learners with autism, though, are bombarded with things to process and tolerate, making an “ordinary haircut” a potentially stressful event. Here are a few examples of how autistic people can struggle with haircuts.

Sensory Sensitivities

The buzzing and vibration of clippers, the snipping sound of scissors, and the feeling of hair falling on the skin can be distressing. Other sensory challenges may include water spray, sudden temperature changes, and the texture of hair products or towels. 

Visual & Auditory Overload

Bright lights, mirrored reflections, and background noise from blow dryers and chatter can contribute to visual and auditory overload. Additionally, the physical sensation of having someone touch their head, face, or scalp may feel uncomfortable or intrusive to learners. 

Fear & Anxiety

For some learners, the disruption to their usual routine and the visual change in their appearance after the haircut can cause heightened anxiety. Fear of pain, anticipation of discomfort, and difficulty communicating their preferences can make the experience even more challenging.

Autism & Dental Appointments: Triggers

The fear of pain is typically more pronounced at the dentist than at the salon due to the more invasive nature of the process. Dental visits often involve oral discomfort, strange tastes and textures, and the sensation of tools inside the mouth. What’s more, the patient can’t easily look around or verbally communicate during some procedures, increasing feelings of frustration, anxiety, and a loss of control. 

Sensory Sensitivities

Aspects of a dentist appointment can be physically uncomfortable. The feeling of latex gloves, dental instruments in the mouth, and gritty or foamy textures from toothpaste or fluoride treatments, as examples, can cause distress. Oral sensations like pressure during cleaning or having a mouth prop in place can also be overwhelming.

Visual & Auditory Overload

Bright overhead lights, the high-pitched whir of dental drills, and constant suction noises can be jarring. The busy environment, with multiple sounds and movements, can make it difficult for learners to process everything at once.

Fear & Anxiety 

There’s a lot that happens during a dentist appointment that’s unpredictable. Being asked to stay still for extended periods and not knowing what comes next can heighten anxiety. Having to lay down or recline and keep your mouth open feels vulnerable. Some learners feel trapped or misunderstood, which can trigger panic or sensory overload.

How to Prepare Autistic Learners for Hair & Dental Appointments

Preparing a learner with autism for a haircut or dental appointment involves several thoughtful steps to reduce anxiety and create a more positive experience.

Choose a Sensory-Friendly Facility

Do some research to find a salon and dentist that has worked with learners with autism before. Ask for recommendations from autism community groups or call salons and dentist offices directly to learn about their experience, comfort level, and examples of accommodations.

Visit in Advance

Take a tour before the appointment to introduce your learner to the space, sounds, and staff. If possible, share your learner’s preferences and sensory sensitivities with the stylist or hygienist and dentist. 

Create a Social Story

Use step-by-step visuals or a story to explain what happens during a haircut or dentist appointment to reduce anxiety. Check out library books that show and tell about experiencing these appointments.

Schedule Wisely

Book at a time when the salon or dentist is quieter to avoid sensory overload. These times may also accommodate dimming the lights and lowering the music or TVs. Compare calendars with a support person if it would be helpful for someone to come to the appointment with you and your learner.

Set Realistic Expectations

If necessary, start with small steps, like sitting in the chair, and work up to a full haircut or dental appointment.

Watch Someone Else

Take your learner to see you or another trusted person have their haircut or teeth cleaned. Tell them what’s happening, how it feels, and why it’s an important part of the appointment. 

Practicing for Hair & Dental Appointments at Home

Learning what to expect with a trusted caregiver can be tremendously helpful for learners with autism. Haircut and dental appointment practice at home can build learner confidence, give you more insight into triggers, and assist you both in advocating for accommodations.

Role Play

Set up a pretend salon or dental office at home. Simulate the experience by using a comb, spray bottle, and toy scissors, or a mirror, toothbrush, and small flashlight. 

Slowly Introduce Tools & Sensations 

Work toward desensitization of certain tools and sensations. For a haircut, start with touching the clippers while it’s off, then slowly work up to turning it on to feel the vibration and hear the buzzing sound. Or maybe practice washing and brushing hair. For the dentist, hold a dental mirror to see what the dentist will see and practice opening wide.

Use Visual Supports

Picture schedules or videos can help learners understand the process. Be sure to vet online videos ahead of time.

Positive Reinforcement

Build confidence by celebrating small milestones, such as sitting still for a period or role playing with pretend salon and dental tools.

Hair & Dental Appointments: Coping Tools & Accommodations

Can autistic kids get haircuts and go to the dentist without high stress and anxiety? While identifying coping tools and implementing sensory accommodations can greatly improve the hair and dental care experience, it’s possible that your learner may always need support at these appointments. Establishing a relationship with a dental practice and salon can go a long way to consistently creating positive experiences.

Observe Triggers

Notice what causes discomfort – specific sounds, textures, or bright lights. Make a sensory preferences checklist to track which accommodations work best (e.g., softer lighting, calming music, unscented products). 

Use Visual Supports 

Bring step-by-step visual schedules or helpful books to the appointment. Countdown timers can set expectations for how long each step will take. 

Try Different Sensory Tools

Experiment with items such as noise-canceling headphones, weighted lap pads, sunglasses, or fidget toys to help provide reassurance, promote self-regulation, and reduce anxiety.

Apply Deep Pressure or Squeezing

Deep pressure or squeezing can help some learners self-regulate. Offer a weighted blanket or tight hugs before and during the appointment.

Use Communication Tools

Non-verbal communication options – like pre-determined hand signals or picture cards – can help reduce stress and offer a greater sense of control. Calming phrases repeated by the caregiver or stylist/dentist can be calming and reassuring.

Empower Breaks & Choices

Allow frequent breaks and let the learner make choices about the process, such as which cape to wear or which toothpaste flavor to use. 

Record Success

Make a video of your learner after a successful appointment to show them ahead of the next one. Ask them what they were afraid of before the appointment and have them share how it wasn’t scary after all. Record which part was their favorite and which coping skills helped best. Consider taking a photo of them with their stylist and dental team so they can be reminded of their faces before seeing them again. 

If you need additional support, A Bridge to Achievement (ABtA) is here to help. We can work directly with caregivers and learners on building tolerance and coping skills for haircuts and dental care through our Balance Program.

At ABtA, we are dedicated to serving the autism community. We offer programming for learners ages 3 to 21+ who have autism – as well as their caregivers – in Charlotte, Pineville, and Winston-Salem. From preschool and homeschool alternatives to vocational and social skills programs, our team is qualified and equipped to help your learner reach their highest potential. Connect with us! Support starts here.

 

What Countries Have the Highest Rate of Autism?

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The United States is the country with one of the highest reported rates of Autism Spectrum Disorder (ASD) in the world. Estimates from a 2023 study from the Centers for Disease Control (CDC) suggest 1 in 36 children are autistic. But this doesn’t necessarily mean that autism is more prevalent here than in other countries. In this article, we’ll compare autism rates by country, explore why ours is seemingly among the highest, unpack some of the cultural stigma around ASD, and touch on how autism is diagnosed and treated around the world.

Autism Rates By Country

Autism rates vary significantly globally. Here are some key countries with notable autism rates in children, as well as the diagnostic prevalence in boys versus girls. 

Country Autism Rate (Children) Boys Girls
Japan (2021)  1 in 33 1 in 23 1 in 50
USA (2023) 1 in 36 1 in 23 1 in 89
South Korea (2011) 1 in 38 Higher* Lower*
Canada (2018) 1 in 50 1 in 34 1 in 151
United Kingdom (2021) 1 in 57 1 in 43 1 in 167
Australia (2015) 1 in 70 1 in 52 1 in 162
Qatar (2019) 1 in 87 1 in 56 1 in 230
Saudi Arabia (2009) 1 in 556 Higher* Lower*
Hong Kong (2008) 1 in 595 Higher* Lower*
China (2010) 1 in 971 Higher* Lower*

* Data unavailable but autism is noted as significantly more prevalent in boys than in girls. Globally, the ratio of boys to girls diagnosed with ASD is generally estimated to be about 4:1.

Looking at this data, an obvious question is: Why is autism so high in the USA? Well, a high rate of autism doesn’t necessarily mean that it’s more prevalent here or in the other countries noted – or that lower rates out of the Middle East and Southeast Asia (and the fact that there are no rates out of Sub-Saharan Africa) indicate that it is less prevalent in those regions. These numbers do not suggest who is at high risk for autism.

Reasons for ASD Diagnostic Variance

Instead, higher rates often reflect better diagnostic practices, societal acceptance, and healthcare infrastructure. Increased global awareness and equitable access to diagnostic tools may narrow the apparent differences over time. Let’s dig a little deeper into the reasons behind these variances:

  • Improved Diagnosis & Awareness

    High-income countries often have better access to diagnostic tools, training for healthcare providers, and public awareness campaigns.

  • Cultural & Societal Factors

    In some countries, stigma around autism leads to underdiagnosis or misclassification of symptoms (more on this later). In others, cultural norms emphasize inclusion and lead to greater identification of children on the spectrum.

  • Healthcare & Reporting Systems

    Countries with robust healthcare systems tend to report higher rates because more children are screened and diagnosed.

  • Research & Funding

    Wealthier nations invest more in autism research, contributing to higher diagnosis rates and better understanding.

  • Population-Based Studies

    Studies in certain countries (like South Korea) reveal higher rates because of targeted efforts to identify undiagnosed individuals.

Cultural Stigma & Autism

Cultural stigma surrounding autism in some countries stems from deeply rooted societal, religious, and historical beliefs. These stigmas often lead to misunderstandings, misdiagnosis, or avoidance of seeking help for individuals with autism. 

  • Lack of Awareness & Education

    In some cultures, autism is misunderstood or seen as a form of “mental illness,” resulting in fear or discrimination. Limited access to accurate information perpetuates myths, such as blaming parents for poor parenting. Without widespread education on neurodiversity, families may struggle to understand autism as a neurological condition, leading to judgment or shame.

  • Social Expectations & Norms

    Many societies value social conformity and place a high emphasis on behaving “normally.” Autistic learners who may exhibit “unique” behaviors are sometimes seen as not meeting societal standards, leading to isolation. In cultures where family reputation is highly valued, a child with autism may be perceived as a failure or source of embarrassment.

  • Superstitions & Spiritual Beliefs

    In some parts of the world, autism is mistakenly linked to curses, evil spirits, or divine punishment. Families may seek help from spiritual healers or religious leaders rather than medical professionals. Some believe that having a child with autism is a test of faith, leading to feelings of guilt or secrecy.

  • Limited Medical & Diagnostic Understanding

    Autism is often undiagnosed or mistaken for other conditions in places with less advanced healthcare systems. Parents (often mothers) are blamed for their child’s autism, with accusations of poor parenting, emotional neglect, or improper diet during pregnancy.

  • Discrimination & Marginalization

    Families may hide a diagnosis to avoid social exclusion or discrimination in schools, workplaces, and communities. Accessing education or employment can be difficult due to rigid systems that do not accommodate neurodiversity.

  • Gender Roles & Expectations

    In some cultures, particularly patriarchal ones, boys are expected to carry on the family legacy – a developmental disability in a male child may be stigmatized more heavily. Girls with autism may be overlooked or misdiagnosed because their symptoms often present differently and are less disruptive in traditional settings.

  • Lack of Role Models or Representation

    Limited or negative portrayals of autism in media perpetuate stereotypes, reinforcing stigma. Having prominent advocates or organizations to normalize autism and reduce stigma.

Reducing the stigma around autism requires a multifaceted approach. Education and awareness campaigns can demystify ASD, promoting understanding and encouraging early diagnosis and intervention. Community-based programs that involve religious and community leaders can address stigma in culturally sensitive ways, fostering acceptance at the local level. Global advocacy from international organizations promoting neurodiversity can go a long way to reducing stigma worldwide. Inclusive school and workplace environments normalize interactions with individuals on the spectrum, breaking down stereotypes and building acceptance.

Autism Diagnosis Worldwide

Autism is diagnosed and treated differently around the world. In the US, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) serves as the primary diagnostic tool, offering detailed behavioral criteria and supporting early screenings as part of routine pediatric care. 

Globally, the ICD-11 (International Classification of Diseases), maintained by the World Health Organization, is widely used and offers broader diagnostic criteria. Some countries, such as China, also use adaptations like the CCMD (Chinese Classification of Mental Disorders). In the UK, both the ICD-11 and DSM-5 are used alongside National Health Service (NHS) guidelines for comprehensive assessments. 

Autism Treatment & Services Worldwide

Treatment approaches also vary significantly. In the US, Applied Behavior Analysis (ABA) is the most prevalent therapy, often supported by insurance and advocacy, and is frequently combined with speech and occupational therapy. 

In Canada and Australia, ABA is widely used but is often supplemented with developmental methods like the Early Start Denver Model (ESDM) and Floortime. In Europe, there is a stronger emphasis on inclusion and developmental approaches. The UK favors methods like TEACCH and Social Stories, while France is shifting from psychoanalysis to evidence-based therapies like ABA.

  • Early Start Denver Model

    ESDM is a play-based, early-intervention approach that focuses on building communication, social, and cognitive skills through natural interactions.

  • Floortime

    A relationship-based therapy, Floortime encourages emotional and social development by engaging children at their developmental level through play and interactive activities.

  • TEACCH

    TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) is a structured teaching method that uses visual aids and organizational strategies to promote learning and independence in individuals with autism.

  • Social Stories

    Social Stories uses short, personalized stories designed to teach children with autism specific social skills and behaviors by describing situations in a clear, step-by-step manner.

In Asia, access to ABA is growing but remains limited. Japan emphasizes group-based interventions for social integration, and urban centers in China are seeing an increase in ABA availability. In the Middle East and Sub-Saharan Africa, therapy access is sparse, and informal or community-based support is more common. 

Thankfully, across all regions, there is a growing global trend toward promoting neurodiversity, inclusion, and culturally sensitive therapeutic approaches.

ABA Therapy at ABtA

At A Bridge to Achievement (ABtA), we are exclusively dedicated to the autism community. We conduct autism assessments and offer a variety of ABA therapy programs:

How can the ABtA family help yours? Contact us with questions or go ahead and request services. Support starts here.

Can Level 2 Autism Become Level 1?

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Autism levels (Level 1, Level 2, and Level 3) are used as a framework to describe the varying support needs of learners with Autism Spectrum Disorder (ASD). Level 1 learners require some support, learners with Level 2 autism need more substantial support, and Level 3 learners need very substantial support. 

These levels have no correlation with intelligence, are not fixed, and can change over time depending on the learner’s development, the interventions they receive, and environmental factors. Some learners have very few symptoms of autism, but the symptoms are more severe Other learners have a number of symptoms, but they are less severe. Support needs are individualized based on what a learner needs to help them be successful.

In this article, we’ll outline the three different levels of autism and answer some questions we’re asked at A Bridge to Achievement pretty frequently about Level 1 and Level 2 autism. Let’s get into it!

Three young children smiling in classroom setting

Understanding Autism Levels

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – known better as the DSM-5 – is a 957-page book that was published in 2013 by the American Psychiatric Association. The Neurodevelopmental Disorders chapter defines the three levels of autism as: 

Level 1 Autism: Requiring Support

Learners with Level 1 have “mild symptoms” of autism and require some support in specific areas, especially with social communication and organization. In the past, Level 1 was often referred to as Asperger’s or high-functioning autism. Many adults with Level 1 autism can live independently with minimal support for social or organizational challenges.

Examples of Challenges:

  • Difficulty initiating or maintaining conversations.
  • Challenges with organization or planning, which may affect independence.
  • Sensory sensitivities that occasionally interfere with daily activities.
  • Some challenges with adjusting to change and emotional regulation.

Examples of Support Needed:

  • Social skills practice to improve conversation and interaction.
  • Guidance with organization or time management tasks.
  • Accommodations for sensory sensitivities, such as a quiet workspace.
  • Help to create structured routines and calming strategies.

Level 2: Requiring Substantial Support

Learners with Level 2 autism have more noticeable verbal and nonverbal communication differences and may struggle more significantly in social settings and with routine changes. 

Some adult individuals with Level 2 autism achieve semi-independent living with substantial support, such as structured routines and regular assistance.

Examples of Challenges:

  • Limited verbal communication or reliance on nonverbal methods (e.g., gestures, pictures).
  • Significant difficulty coping with changes or transitions.
  • Repetitive behaviors or intense focus on specific interests that interfere with learning, socializing, and daily functioning.
  • Difficulty understanding or responding to social cues, leading to struggles in forming or maintaining relationships.

Examples of Support Needed:

  • Speech therapy or augmentative and alternative communication (AAC) devices.
  • Structured environments with clear routines and expectations.
  • Social stories or visual aids to prepare for transitions and changes.
  • One-on-one or small group support to facilitate social skills development.

Level 3: Requiring Very Substantial Support

Level 3 learners have severe challenges with communication, behaviors, and daily functioning. They require intensive support at all ages, making independent living unlikely for adult learners.

Examples of Challenges:

  • Very limited or no verbal communication.
  • Difficulty engaging with others or forming relationships.
  • Extreme distress from changes in routine or environment.
  • Strong sensory sensitivities that can lead to meltdowns or withdrawal from activities.

Examples of Support Needed:

  • Full-time assistance for daily tasks, including personal care and communication.
  • Intensive behavioral therapy to address repetitive or self-injurious behaviors.
  • Specialized communication supports, such as AAC devices or intensive one-on-one interventions.
  • A controlled, sensory-friendly environment to minimize triggers and promote comfort.
  • Programming and/or environmental changes to keep learners safe during concerns related to self-injurious behavior, elopement, and lack of awareness of surroundings.

Can Autistic Learners Shift Between Diagnostic Levels?

One question we’re frequently asked is: Can learners shift between levels? In particular, can Level 2 autism become Level 1, and can Level 1 become Level 2 autism? 

Yes, shifts between levels are observed in some learners – but not everyone experiences significant changes in their level of support needs. Progress or regression is highly individual and depends on various factors such as developmental stages, life changes, or access to (or lack of) support systems.

It’s also important to note that autism does not have a cure. Autism does not get “better” or “worse,” and you cannot grow out of autism. Autism is a lifelong neurological condition that manifests differently in every learner. 

Can Level 2 Autism Become Level 1?

While every individual is different, learners with Level 2 autism have a higher likelihood to shift to a Level 1 diagnosis if they have access to:

  • Therapeutic Intervention
    Applied Behavior Analysis (ABA) therapy can significantly help learners develop communication, social, and adaptive skills, potentially reducing the level of support needed. Early intervention is best when possible, but ABA therapy at any age is shown to be effective.
  • Skill Development
    With support and practice, learners may gain strategies to navigate social situations, communicate effectively, or manage sensory challenges, which can lead to more independence.
  • Environmental Factors
    A supportive environment (at home, school, or work) tailored to the individual’s needs can also reduce the challenges they face, leading to a reevaluation of their level.

Additionally, some individuals naturally acquire skills and adapt as they grow older, reducing the perceived severity of their autism symptoms.

Can Level 1 become Level 2 Autism?

A learner’s diagnosis can shift from Level 1 to Level 2 autism if their support needs increase due to such factors as: 

  • Increased Stress or Life Changes
    Major life transitions, such as starting school, entering the workforce, or a change in routine, can exacerbate challenges, requiring more substantial support.
  • Unmet Support Needs
    If an individual doesn’t receive the necessary interventions or accommodations, they may struggle more significantly over time.
  • Co-occurring Conditions
    Conditions like anxiety, depression, or sensory processing disorders can worsen and increase the individual’s overall challenges.
  • Developmental Changes
    As demands for social, organizational, or adaptive skills grow (e.g., in adolescence or adulthood), some individuals may find it harder to cope without more support.
  • Burnout
    Autistic burnout occurs when long-term stress leads to exhaustion, regression in skills, or difficulty functioning, often increasing the need for support.

What To Do If You Suspect A Diagnostic Shift

Autism levels are determined during diagnostic evaluations. A learner who shows significant improvement or regression in a particular area would benefit from a reevaluation by a qualified professional, i.e. a psychologist, psychiatrist, developmental pediatrician, neurologist, or other clinician. It’s possible that your learner may experience a change in their diagnosis.

If your learner shifts from Level 1 to Level 2 autism, they may benefit from increasing the intensity of ABA therapy and making environmental adjustments at school, work, or home to reduce stress and help manage symptoms. A learner who shifts from Level 2 autism to Level 1 may be able to reduce the intensity of therapeutic interventions. 

Are you interested in having your learner assessed for autism, or retested? Connect with your therapy team or, if you’re new to A Bridge to Achievement, get in touch! Support starts here.

Questions to Ask After Autism Diagnosis

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Parents and caregivers often experience a range of emotions when seeking an autism assessment for their learner. 

Many feel nervous or anxious beforehand, worrying about what the assessment might reveal and what it could mean for their learner’s future. Some feel overwhelmed by researching which practice should do the assessment and the logistical demands of the process, such as gathering documentation or understanding the steps involved. Others feel hopeful, viewing the assessment as an opportunity to gain clarity and better support their learner. Uncertainty or defensiveness can also arise, particularly if they are unsure about whether the assessment is necessary or fear the potential stigma associated with a diagnosis.

There’s a lot to process ahead of the assessment, and even more to consider with a positive diagnostic result. Many caregivers don’t know how to feel after an autism diagnosis. So, what is the next step after being diagnosed with autism? Our advice is to ask questions. The answers you’ll glean will help better understand your learner’s needs, strengths, and the support they’ll require – as well as foster collaboration, set the stage for effective intervention, and ensure compassionate support.

In this article, we’ll give you some categories to think about and some specific questions that may be relevant to your learner and situation. The first two sections – Understanding the Diagnosis and Intervention & Therapy – are higher level, and the ones that follow are more specific to the services we provide A Bridge to Achievement.

Young girl sits on stack of books next to a stack of books wearing a graduation cap

Understanding the Diagnosis

The first thing to do after an autism diagnosis is to understand how your learner’s autism manifests and the type of support they will need. Every autistic learner is unique; an autism diagnosis is not a one-size-fits-all label. By asking the diagnostic professional these questions, you will gain knowledge that sets the foundation for making informed decisions about therapy, interventions, and support systems.

  • What does this diagnosis mean for my learner’s daily life and development?
  • How does my learner’s profile compare to others on the autism spectrum?  
  • What are my learner’s strengths, and how can we build on them?  
  • What specific challenges or behaviors should we prioritize for support?  
  • How might this diagnosis evolve as my learner grows?  

Intervention & Therapy  

Therapeutic intervention can significantly impact a learner’s development and long-term outcomes. ABA therapy, speech therapy, and occupational therapy address specific challenges while building critical life skills. 

Behavioral Strategies  

Asking these questions allows you to understand the “why” behind behaviors and find compassionate, effective ways to respond. 

Family Involvement & Collaboration  

Therapy isn’t just about the professional sessions – it’s a partnership. As a caregiver, you play a vital role in helping your learner succeed.

  • How can we ensure consistency between therapy and home routines?  
  • What kind of training or resources do you offer to help caregivers or siblings understand and support my learner?  
  • How will you involve me in creating or revising my learner’s therapeutic plan?  

Educational Support  

Whether it’s creating an Individualized Education Plan (IEP), ensuring teachers understand your child’s learning style, or exploring alternative educational environments, education is one of the most important arenas where support must be tailored to a child’s needs.

  • How can we collaborate with my learner’s school to ensure effective accommodations?  
  • What should I look for in an IEP to align it with ABA goals?  
  • How can we advocate for my learner’s needs in educational settings? 
  • Do we need to consider homeschool or other learning alternatives for my learner? 

woman and child playing with blocks

Social & Emotional Development  

Social and emotional development is often an area of difficulty for learners with autism, and it’s also one of the most rewarding to nurture. Building social skills and emotional regulation not only helps learners navigate relationships but also improves their overall well-being. Therapy can provide structured ways to teach these skills, and as a caregiver, you can reinforce them in daily interactions can provide structured ways to teach these skills, and as a caregiver, you can reinforce them in daily interactions.

  • How will therapy address social skills, such as making friends or understanding social cues?  
  • How do you help learners regulate emotions and build resilience?  
  • Are there strategies for helping my learner communicate frustrations or needs without challenging behaviors?  

Progress & Expectations  

Measuring progress is a critical part of any therapeutic plan. Regular check-ins with therapists ensure that goals remain relevant and achievable. Progress may vary, and that’s okay – it’s important to set realistic expectations and remain flexible when adjustments are needed.

  • How will you track my learner’s progress, and how often will we review it?  
  • What realistic outcomes can we expect over the next six months or year?
  • How do you handle situations where progress slows or goals need adjustment?  

Professional Credentials & Approach  

Asking these questions of a practice and your assigned Board Certified Behavior Analyst (BCBA) can help you determine if their approach aligns with your values, ensures personalized care, and fosters a strong therapeutic relationship. They also signal that you are invested in a collaborative, thoughtful approach to your learner’s development.

  • What is your experience working with learners like mine?  
  • How do you ensure therapy is individualized to meet my learner’s specific needs?  
  • What is your approach to incorporating the learner’s preferences and interests into therapy?  

Empowerment & Advocacy  

Advocacy is one of the most powerful tools a caregiver can have. Over time, fostering self-advocacy equips your learner to speak up for themselves. 

  • How can I best advocate for my learner in different settings, like school or community activities?  
  • What resources, books, or tools would you recommend to help us better understand autism?  
  • How do you help foster self-advocacy and confidence as my learner grows?  

Long-Term Planning  

While it’s essential to focus on next steps, planning for the future is equally important. Skills learned today – like communication, self-care, and problem-solving – lay the foundation for greater independence as your learner grows. 

  • What skills should we focus on now to prepare my learner’s for the future?  
  • Can ABA therapy help my learner transition to school, work, or independent living as they grow?  
  • Are there local or community resources we should explore for additional support?  

If you’re ready to schedule an autism assessment at A Bridge to Achievement or have questions for our team – get in touch! Support starts here.

How to Prepare for an Autism Assessment

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Pursuing an autism assessment for an autism diagnosis is a significant decision that reflects a deep commitment to understanding and supporting an individual learner. For some families, it can be an emotional journey that comes with cultural, generational, and logistical hurdles. The process can also be time-intensive and, depending on insurance coverage, financially burdensome. But the clarity and therapeutic resources an autism assessment provides often far outweigh the challenges of completing one.

We’ve covered what happens during an autism diagnostic assessment and how many hours an autism assessment takes in a previous article, so here we’ll explore when to consider having a loved one assessed for autism and how to prepare for the appointment(s).

Remember, you are not alone in this process. The autism community represents a rich tapestry that stretches across the globe and encompasses all ages, genders, ethnicities, and socio-economic groups – and you have tremendous allies right in your backyard. A Bridge to Achievement (ABtA) has three learning centers in North Carolina, two in Charlotte and one in Winston-Salem. 

When to Seek an Autism Assessment

Knowing when to seek an autism assessment varies based on the learner’s age because their developmental milestones, behaviors, and social expectations differ widely. It’s never too late to be assessed for autism, however – an autism diagnosis at any age can lead to better understanding and support, empowering individuals and their families to navigate life with confidence.

Here’s a guide on what to look for in preschool-aged children, older kids, and teens/young adults:

Preschool-Aged Children (0-5 years)

Seeking a diagnosis when a learner is very young is critical for accessing early intervention services, which can significantly improve developmental outcomes.

  • Developmental Delays: Lack of babbling by 12 months, no single words by 16 months, or no two-word phrases by 24 months, or a regression in language; delays in nonverbal communication, such as inability to point or follow a point.
  • Social Interaction Challenges: Limited eye contact, lack of interest in interactive play, or failure to respond to their name.
  • Repetitive Behaviors: Repeated motions like hand-flapping, rocking; vocal stimming, like repeating words, phrases, or sounds; and hyperfocus on topics or activities. 
  • Rigidity: Attachment to routines, difficulty adjusting to new people and new environments.
  • Sensory Sensitivities: Strong reactions to light, sound, or textures.

Older Kids (6-12 years)

Diagnosing autism at this stage can provide clarity and access to support systems, including individualized education plans (IEPs) and therapies.

  • Struggles in Social Settings: Difficulty making or maintaining friendships, understanding social cues, or navigating group dynamics.
  • Academic Challenges: Trouble with organization, following instructions, or coping with sensory sensitivities in a classroom environment.
  • Behavioral Signs: Meltdowns in response to changes, rigid thinking, or strong focus on specific interests.
  • Delayed Recognition: Sometimes signs of autism become clearer when social and academic demands increase.

Teens and Young Adults (13-21 years)

A diagnosis can help teens and young adults better understand themselves, access accommodations, and find targeted support to thrive. Tweens and children tend to have an easier time masking challenges typically seen at this developmental stage because their lives are so structured. Young teens are more susceptible to these challenges due to puberty, classes and teachers changing, and friendship dynamics becoming more nuanced. Getting a diagnosis for older teens and young adults is important as they prepare for adulthood – for college, employment, or independent living, as examples.

  • Social Isolation: Difficulty forming close relationships, understanding nuanced communication, or navigating romantic interactions.
  • Mental Health Concerns: Anxiety, depression, or frustration stemming from undiagnosed struggles with social and sensory processing.
  • Executive Functioning Issues: Trouble managing time, organizing tasks, or adapting to increased independence.
  • Late-Identified Traits: Some individuals mask their autism traits until adolescence or adulthood, making diagnosis later in life essential.

Two adults working to do school work with a child

How to Prepare for Autism Assessment

Preparing for an autism assessment involves gathering information, organizing documentation, and managing expectations. What you provide, in concert with the evaluation results, helps to paint a complete picture of your learner’s strengths, challenges, and the therapeutic support that will be most beneficial. The assessments for autism your learner will complete include either all or a combination of:

  • Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)
  • Autism Diagnosis Interview – Revised (ADI-R)
  • Childhood Autism Rating Scale (CARS)
  • Gilliam Autism Rating Scale – Second Edition (GARS-2)
  • Adaptive Behavior Assessment System (ABAS) or Vineland Adaptive Behavior Scales 

Being prepared ahead of the evaluation appointment(s) ensures the experience is as positive and productive as possible and helps reduce caregiver and learner stress. Let’s take a look at what you’ll need ahead of time and consider how you can prepare your learner and yourself for success.

Gather Information & Documentation

  • Medical Records: Bring copies of any relevant medical records, including prenatal and birth history, as well as vaccination history and any existing therapy notes.
  • Developmental History:
    • Ages 0-5: Notes about developmental milestones and delays (e.g., first words, walking).
    • Ages 6-12: Teacher observations, Individualized Education Plans (IEPs), if applicable, examples of classroom struggles, such as difficulty following instructions or socializing.
    • Ages 13-21: High school transcripts, mental health evaluations, reports from employers; review any earlier assessments or interventions for context.
  • Behavioral Observations: Journal of behaviors at home and at school/work, including triggers, responses, and coping strategies. Note any repetitive behaviors, emotional outbursts, communication challenges, unusual behaviors, or sensory sensitivities.

Prepare Your Learner 

  • Prioritize Comfort: Schedule assessments at a time when your learner is usually alert and calm. Bring familiar items or sensory tools to the session. If they’re nervous, offer practical steps like visiting the assessment site beforehand or role-playing the process. Learners who are medicated for anxiety or ADHD should take their medication as normal – it will not interfere with the assessment. 
  • Foster Empowerment: Involve your learner in identifying what they hope to gain from the process, such as accommodations for school or workplace support. Be transparent about what to expect during the sessions. Answer questions honestly and reassure them there’s no “wrong” way to be themselves.
  • Promote Understanding: Use simple, reassuring language to prepare your learner for the appointment, such as: 
    • Ages 0-5: “We’re going to meet someone who can teach us how to help you do the things you love.”
    • Ages 6-12: “We’re meeting someone who can help us understand why some things feel harder for you and make them easier.” 
    • Ages 13-21: Frame the assessment as a tool for self-awareness: “This will help us understand how your brain works so we can better support you.” 

Prepare Yourself

  • Write Down Questions and Concerns: Prepare a list of questions about the focus area of the different assessments for autism that may be administered, how your learner’s results will be shared, and the type of support available afterward. Some people worry about the stigma of a diagnosis or fear the unknown – write these down, too. The professional your learner works with, i.e. the psychologist, psychiatrist, developmental pediatrician, neurologist, or other clinician, will make time for discussion. You can also start a running list of questions in anticipation of an autism diagnosis. 
  • Bring Essentials
    Pack a bag with snacks and drinks for you and your learner, especially if you’re traveling to ABtA from a distance. Bring your notebook – or start one with the commencement of this diagnostic journey – to take notes on feedback, observations, and any post-assessment recommendations.
  • Consider Bringing a Supportive Person
    You’ll share a lot with the clinician and receive a lot of new information during appointment(s). A support person can help to provide insights on observed behaviors, remember details, ask pertinent questions, and offer emotional support.

Scheduling an autism assessment is a big step in advocating for a neurodivergent learner of any age. If you have any questions about the autism assessment process or how to get prepped for it that we haven’t covered, please reach out to our team. And, if you feel ready for next steps, go ahead and request services! Support starts here.

How Long Is an Autism Evaluation?

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If you’re noticing possible challenges with your child’s or teenager’s social or emotional development, you may be wondering if an autism evaluation is needed. When possible, early detection for a child with autism is ideal to ensure they and you have the right support in the years to come. However, testing can be initiated at any age. An autism evaluation is a pivotal step toward effective intervention for your learner, including Applied Behavior Analysis (ABA) therapy.

A professional may use a number of assessment tools to diagnose autism, all of which are designed to help parents and families obtain an accurate understanding of their learner’s developmental profile. 

If you’ve been referred by your child’s educator, doctor, or psychologist for Autism Spectrum Disorder testing, you may have many questions about what to expect. In this article, we’ll answer key questions like:

  • What is done during an autism evaluation?
  • How long is an autism evaluation?
  • How can I prepare my child?
  • What happens after an autism diagnosis?

As you navigate this process with your learner, knowing in advance what to expect and where to find answers to your questions can reduce some of the natural stress you may be feeling.

Assessment room at A Bridge to Achievement

What Is Done During an Autism Evaluation?

A comprehensive autism assessment is usually conducted by a psychologist or medical doctor; a pediatrician in the case of children. These professionals use a variety of assessment tools and methods, including observations, interviews, standardized tests, and questionnaires. This holistic approach ensures a thorough understanding of the learner’s developmental profile, strengths, and challenges.

Most commonly, autism evaluations will utilize one or more of the following:

  • Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)
  • Autism Diagnosis Interview – Revised (ADI-R)
  • Childhood Autism Rating Scale (CARS)
  • Gilliam Autism Rating Scale – Second Edition (GARS-2)

In each instance, autism evaluation tools help your clinical team assess your child’s skills in key domains such as communication, daily life activities, social/peer interactions, and more.

How Long Does an Autism Evaluation Take?

To complete the necessary diagnostic steps, you may need to schedule more than one assessment appointment. Generally, each visit lasts two to three hours. 

An autism evaluation will consist of an interview and observation at an interactive appointment designed to help with making a diagnosis. The process is backed by research, with the goal of producing an accurate profile of your learner.

While some evaluations may be completed in a single day, others require multiple visits over a period of several weeks to capture a comprehensive picture of your learner’s abilities and needs. Many factors – chiefly the assessment tools deployed – affect the amount of time it takes to complete an autism evaluation. Here are some examples of how unique factors influence the duration of testing and diagnosis:

  • Age: A younger child may need more time to engage with your clinical team and give responses.
  • Environments: It’s helpful for experts to observe and interact with your child in a number of settings, such as school, home, or a clinical space.
  • Collaboration: Engaging multiple specialists from different fields can take time to schedule but offer important insights for your learner’s journey.

Overall, families and caregivers typically should be prepared that autism evaluations are complex and simply take time to be completed for a thorough diagnosis. There are a few ways you can contribute to moving the process along efficiently and aiding the work of your clinical team:

  1. Don’t delay
    Young children starting at around 12 to 18 months may show signs of neurodiversity. Seeking an assessment at the youngest age possible positions your learner for the best support during the critical brain development period.
  2. Take notes
    Sharing with the evaluation team your family’s observations (in detail) about milestones and other behavior-related history can help strengthen the diagnostic process. 
  3. Involve your child
    Talk with your learner about upcoming evaluation appointments to help them feel prepared for their experience. This can sometimes help your child lean into the process, giving evaluators more access for diagnostic purposes.

In addition, prepare – ahead of your first appointment – all relevant medical records that could help your evaluation team identify your child’s individual skills or needs.

When you schedule an autism evaluation with A Bridge to Achievement (ABtA), we’ll give you more personalized information about how long each appointment will last and what to bring with you.

What Happens After an Autism Evaluation?

Keep in mind not every learner who is evaluated for autism will be diagnosed with autism. In all cases, you’ll receive a detailed report showing what kind of information was collected during the assessment process and what it means, including recommendations for an alternative diagnosis if needed. 

At A Bridge to Achievement, we’ll meet with you (or discuss over the phone if you live a great distance away) to go over your child’s evaluation results and answer questions, when requested. You’ll receive detailed information about recommended therapies and treatment options – all formed with the specific goals and needs of your learner top of mind.

Often, ABA therapy is part of an individualized treatment plan. Once autism evaluation diagnostic steps are complete, you can begin discussions with your clinical team about the next steps. ABA is designed to foster your child’s development and is often one of many therapeutic options.

Woman and child showing the number 4 on their hands.

The Importance of an Autism Evaluation

A thorough autism evaluation is crucial in understanding a learner’s unique strengths and challenges. This understanding paves the way for targeted interventions that can significantly enhance the child’s development and quality of life. When parents view the evaluation as a positive step, this helps build the necessary support and resources for their child.

In some cases, families are discouraged by either the duration of autism testing or the long waits sometimes encountered to receive assessment appointments. At A Bridge to Achievement, we understand how important the timeline is for connecting your child with support services. 

Between our dedication to serving only the autism community and our three North Carolina locations, we often see shorter wait times than those found at other clinics or centers. That said, we are at the mercy of insurance provider timelines. Typically, it takes five to six weeks between assessment to starting services, if applicable. Our intake team will inform you if this timeline changes.

Your learner’s well-being is our priority, and we are here to help you every step of the way. Call or email us with questions – we can help you navigate the testing process. Support starts here! 

A Guide for Homeschooling a Child With Autism in NC

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It’s not uncommon for families with an autistic learner to choose homeschooling over the traditional education route of a standard school. In this article, we’ll address the advantages and challenges of homeschooling a child with autism, consider the rules around homeschooling in North Carolina, share some valuable resources, and discuss the importance of integrating therapy into the homeschool routine.

Two adults working to do school work with a child

Advantages & Challenges of Homeschooling with Autism

When planned carefully and executed with intention, homeschooling offers far more advantages than challenges to the autistic learner. For the most part, it’s the parent who negotiates the challenges. Let’s look at some of each.

Autism and Homeschooling: Advantages

  • Customized learning environment
  • Specialized resources
  • Flexible schedule
  • Reduced anxiety
  • One-on-one attention
  • Self-set pacing
  • Family bonding

Autism and Homeschooling: Challenges

  • Time and commitment
  • Lack of social interaction
  • Financial strain
  • Limited/coordinated access to services
  • Parent training
  • Burnout potential
  • Regulatory compliance

Parents who are not educators find these challenges particularly intimidating: What school is best for a child with autism? Do I have the ability to homeschool? How do you homeschool an autistic child? What is the best homeschool curriculum for autism? We’ll address choosing curriculum and share some tips on homeschooling an autistic learner below. First, let’s look at the regulations surrounding homeschooling.

Understanding North Carolina Homeschooling Laws

Figuring out how to homeschool a child with autism in North Carolina begins with an understanding of the regulations. Getting started can feel like an uphill climb but, once you’re established, subsequent years are less daunting.

In North Carolina, homeschooling is legally recognized and governed by specific requirements to ensure educational standards are met. Parents intending to homeschool must file a Notice of Intent (NOI) with the North Carolina Division of Non-Public Education (DNPE) in accordance with a few different scenarios: 

  • ​​Age Requirement: When the child reaches the age of 7 and will not be enrolled in public or private school.
  • First-Time Homeschooling: Before beginning to homeschool for the first time.
  • Transferring from Public or Private School: When withdrawing a child from a public/private school to start homeschooling.
  • Returning to Homeschooling: When resuming homeschooling after a period of enrollment in a public or private school.

Note, the North Carolina DNPE does not accept NOIs in May and June, so be sure you file your Notice in a timely manner. Once filed, the NOI does not need to be renewed annually; it remains in effect as long as the homeschooling continues.

To be in compliance, the parent or guardian who will be the homeschool administrator must, at minimum, have a high school diploma. A homeschool must operate on a regular schedule for at least nine months of the year, excluding reasonable holidays and vacations. Parents of all homeschooled children are annually required to maintain attendance and immunization records, as well as have a yearly progress assessment completed. Parents should ensure they are following all appropriate regulations and stay up to date with state requirements.

Parents of homeschooled autistic children might also need to implement individualized education plans (IEPs), utilize specialized teaching methods, and seek additional resources or therapies to effectively support their child’s learning and development.

At A Bridge to Achievement, we can administer progress assessments at all of our locations. Additionally, our BRIDGES program – which is available at our University City campus in Charlotte and at our Winston-Salem location – serves as an ideal complement to the educational components delivered at home by providing a continuation of learning through skills development and social interaction. More on BRIDGES later.

Child uses markers and paints to decorate rocks

Selecting the Right Curriculum & Resources for Homeschooling for Autism

Key to choosing the best homeschool curriculum for autistic learners is flexibility and individualization – this should include the offer of different levels of difficulty so you can be adjusted according to your child’s pace and progress. It’s also beneficial to incorporate elements that allow for repetition and reinforcement of concepts, which can help solidify learning.

Multi-sensory learning materials are particularly effective for children with autism as they engage multiple senses, which makes learning more accessible and engaging, and improves information retention. Examples include the incorporation of: 

  • Tactile materials like sandpaper letters, textured number cards, and manipulatives can help children who benefit from hands-on activities. 
  • Visual aids such as picture schedules, colorful charts, and interactive whiteboards can enhance understanding for visual learners. 
  • Auditory components, including songs, rhymes, and verbal instructions, cater to auditory learners. 

Additionally, it is crucial to select curricula that fosters the learner’s academic and personal growth – including the promotion of social skills and emotional regulation, as these are often areas where autistic learners may need extra support. Look for programs that feature: 

  • Social stories
  • Role-playing activities
  • Emotion recognition exercises
  • Positive reinforcement strategies
  • Clear, simple instructions 
  • Focus on daily living skills
  • Interactive technology
  • Parent training resources

Two girls coloring in a classroom

North Carolina Homeschool Resources

In North Carolina, homeschooling families have access to a variety of supportive resources that help navigate the homeschooling journey, foster community, and ensure educational success for their children.

The North Carolina Home Educators (NCHE) is a prominent organization that offers extensive resources, including workshops, conferences, and an annual book fair to provide educational materials and support. NCHE also facilitates networking opportunities through local support groups and online forums, helping families connect, share experiences, and find encouragement. 

Additionally, many local support groups across the state provide specialized resources and activities for homeschooling families, such as field trips, co-op classes, and social events. Organizations like the Autism Society of North Carolina offer workshops and training specifically for parents homeschooling autistic learners, ensuring they have the tools and knowledge needed to create an effective and supportive learning environment. 

Integrating Therapies into Homeschooling Kids With Autism

Weaving therapeutic services into daily homeschooling routines offers numerous behavioral, social, and personal growth benefits for autistic learners. Let’s look at some examples of how integrating ABA (Applied Behavior Analysis), speech, and/or occupational therapy into the homeschooling day is advantageous:

  • Scheduling
    The flexibility of homeschool affords the opportunity to schedule therapy sessions at optimal times when the learner is most receptive and alert. 
  • Parental Involvement
    Deeply involved in their child’s day-to-day learning, parents can immediately implement therapeutic strategies and techniques at home, leading to more consistent and effective interventions.
  • Enhanced Skill Development
    Combining therapy with homeschooling supports the development of a wide range of skills, from cognitive abilities to social, communication, and daily living skills. This comprehensive approach addresses the whole child, fostering balanced development.
  • Progress Monitoring
    Continuous integration of therapy into the homeschool routine allows for regular monitoring of the child’s progress. Parents can quickly identify areas of improvement or where additional support is needed, enabling timely adjustments to the therapeutic approach.

Implementing Daily Living Skills Training

Incorporating daily living skills into the homeschool curriculum, such as personal care, basic chores, and money management, boosts confidence, increases self-reliance, and ensures that autistic learners are equipped with the practical skills necessary for a more independent and fulfilling life. Engaging in daily tasks also helps develop motor skills, as activities like cleaning, cooking, and handling money, enhance both fine and gross motor coordination. 

The structure and routine introduced by daily living skills training helps reduce anxiety and improve focus. Responsibilities like chores build a sense of accomplishment and self-esteem, while functional academic tasks, such as money management, teach essential math skills. These activities also foster problem-solving abilities and adaptability, preparing learners for real-life challenges. 

Additionally, many of the activities of daily living involve social interactions, providing opportunities to practice communication skills in real-world settings. This practical application makes learning more meaningful and relevant to everyday situations.

The BRIDGES Program at A Bridge to Achievement

BRIDGES is an acronym that stands for Building Relationships, Independence, Determination, Group & Essential Skills. It’s an ABA therapy-based enrichment program that aims to increase learners’ autonomy and confidence in a fun and individualized environment that offers frequent teaching opportunities and peer interactions. Focused on daily living skills and designed for learners ages 8 and up, BRIDGES serves as a powerful supplement to homeschooling by providing: 

  • Consistency & Routine
    Integrating therapy into the daily schedule provides a consistent structure. Predictable routines help reduce anxiety and improve the child’s ability to focus and engage in learning activities.
  • Individualized Learning
    As aforementioned, homeschooling allows for personalized learning plans – including the incorporation of therapeutic goals. This tandem approach ensures that learning is aligned with developmental and behavioral needs, enhancing overall outcomes.
  • Real-Life Application
    Therapy can be seamlessly incorporated into everyday activities, making learning relevant and practical. For example, ABA therapy can be used during mealtime to teach and reinforce communication and social skills.
  • Social Opportunities
    BRIDGES provides opportunities for daily social opportunities, including group hangout sessions and game times. These activities complement a homeschool curriculum by providing frequent social opportunities that may not otherwise be available to homeschooled students.

Programming features a variety of hands-on activities that are often technology-rich, grounded in principles of STEAM (science, technology, engineering, art, and math), and include leisure and recreational skills development. 

BRIDGES is available 30 hours per week (six hours per day) at our University City, Charlotte and Winston-Salem locations, and can be extended to 40 hours per week as needed. 

Interested in learning more about BRIDGES? Get in touch! Support starts here. 

Is Humming While Eating a Sign of Autism?

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The word “spectrum” in Autism Spectrum Disorder (ASD) is key. Each learner’s experience with autism is unique, leading to a diverse spectrum of abilities and needs. Someone with autism may exhibit differences with social interaction, communication, and repetitive behaviors, and may display a wide variety of strengths and differences in sensory processing.

Once you are aware of how neurodiversity can show up for people, you may find yourself asking “odd” questions that didn’t occur to you before – case in point: Why does my kid hum when they eat? In this article, we’ll look at the process of diagnosing autism, consider an array of symptoms and behaviors associated with ASD, pose some frequently asked questions that may surprise you, and get into the underlying clues potentially embedded in their answers. 

boy sitting at the ocean and reading a book

Diagnosing Autism

Let’s start with the question that brought us here: Is humming while eating a sign of autism? The short answer is: maybe.  

Humming while eating could possibly be a sign of autism, but it’s not likely autism if this is the only observable concern. An autism diagnosis requires several symptoms to be present before a diagnosis can be given. And these symptoms must also be apparent in social and communication skills and present as restrictive and repetitive behaviors, or RRBs (more on RRBs later). 

As is well documented, early diagnosis and intervention is tremendously beneficial for learners with autism. Not so well documented, though, is that beginning the diagnostic process is easy. You can request services from a practice you identify through research, or you can ask your doctor for suggestions – most assessments do not require a referral. 

The diagnostic process involves a series of prescribed assessments performed by a psychologist or developmental pediatrician. An autism diagnosis requires interviews, surveys, and deliberate observation – there’s nothing invasive, painful, or difficult about it. The hardest part is waiting for the appointment.

Between deciding to request an assessment and waiting for it, keep a journal of your own observations of yourself or your loved one – taking note of those “odd” questions that come to mind. 

Understanding Autism Signs & Behaviors

It’s important to keep in mind that there are multiple symptoms and behaviors that may be associated with ASD that can also be present in individuals who are not autistic. Humming while eating could simply be enjoyable by someone. This behavior is referred to as sensory stimulation, stereotypy, or “stimming” – a repetitive event that activates the senses and makes us feel better. Stimming is a behavior almost everyone engages in, including people with autism.  

Other symptoms associated with autism include:

  • Challenges with verbal and nonverbal communication
  • Hyperfocus on specific topics or activities
  • Difficulty with changes in schedules or environment
  • Hyper or hypo sensitivity to sensory stimuli

Many autistic learners have some, but not all of these symptoms, and they may look different between individuals. Just as neurotypical people vary greatly in their personality and behavior, so do autistic people – or any individuals in the neurodiverse community. Autism is far from a “one size fits all” diagnosis.

For example, stimming for one autistic person may include repetitive vocalizations. For another, it may be flapping their hands. While another may occasionally pace or walk in circles when excited. All of these behaviors meet the same need for sensory input, but the intensity of the behavior and the way the behavior presents, may differ greatly across individuals.

These are examples of RRBs – restricted and repetitive behaviors. RRBs encompass a wide range of repetitive actions, interests, and behaviors and can include repetitive movements, insistence on sameness or routines, highly focused interests, and sensory-seeking behaviors. These behaviors are one of the core diagnostic criteria for autism and can vary widely in severity and presentation among individuals.

Enlightening, right? Knowing the signs and symptoms of autism can be enormously beneficial when talking with your doctor or beginning the diagnostic process. Certainly, these signs and behaviors will be observed by a psychologist or developmental pediatrician during the formal assessment, but it’s helpful to have some shared language when entering new territory. 

Wall decorated at an ABtA location

Behaviors That May Indicate Autism

Let’s dig into some other observations that have the potential to reveal RRBs and other signs of autism. As we’ve mentioned, you can observe indicative behaviors in people who are not autistic – be sure to seek out a professional diagnosis if you think you or your loved one may have autism. 

Is ripping paper a sign of autism? 

Repetitive behaviors can serve as a way to self-regulate or cope with overwhelming sensory input, providing comfort or a sense of control in otherwise unpredictable environments. In this case, the tactile sensation of tearing paper could provide sensory stimulation or feedback that alleviates discomfort or anxiety.

Is mimicking accents a sign of autism? 

Echolalia involves repeating phrases, words, or sounds heard from others – sometimes including mimicking accents or intonations – and it’s a common communication trait in learners with autism. Accent mimicry within echolalia could stem from a combination of sensory processing differences, a need for communication practice, and a desire for social connection, i.e. attempting to fit in or establish rapport with others by adopting speech patterns perceived as socially appropriate or desirable

Is thumb sucking a sign of autism? 

Considered a self-soothing behavior, thumb sucking serves as a way to provide sensory stimulation, regulate sensory input, and assist in coping with sensory overload or anxiety. Of course, not all autistic individuals suck their thumbs, and self-soothing behaviors can vary widely based on unique sensory profiles and coping strategies. What’s more, self-soothing is a coping mechanism we all have; it’s not unique to autism. 

Is fixation a sign of autism? 

Intense interests, or fixations, are common among learners with ASD, often manifesting as an acute focus on specific topics, objects, or activities. They can serve as a source of comfort and stability in a world that can otherwise feel chaotic or overwhelming due to sensory sensitivities and social challenges. Fixations can also provide a sense of purpose, pride, and a means of connecting with those with similar passions.

Smiling young girl and a woman painting

Is hard blinking a sign of autism? 

Frequent or hard blinking can be a manifestation of sensory input regulation and motor stereotypies, particularly in response to overwhelming visual stimuli. Additionally, hard blinking can serve as a repetitive motor behavior, providing comfort or a means of self-stimulation. Staring, particularly at mirrors or lights, is also a form of visual stimming. 

Is walking backwards a sign of autism? 

Walking backwards can be observed as a motor behavior, potentially serving as a coping mechanism to regulate sensory input or manage anxiety in certain environments. 

Is bedwetting a sign of autism? 

Difficulty recognizing and responding to bodily sensations (sensory processing) as well as challenges in expressing toileting needs (communication), can contribute to bedwetting. Additionally, heightened stress or anxiety commonly experienced by learners with autism can further impact bladder control.

If these questions and answers have led to an “aha” moment, or you’re interested in having your loved one assessed for autism – reach out to our team or go ahead and request services. At A Bridge to Achievement, we conduct private autism assessments and, depending on your proximity to our offices and your insurance coverage, we can typically begin the assessment process within two or three months of your request. We are here to support you.