Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
How autism is diagnosed
There is no single blood test or scan that diagnoses autism. Diagnosis is based on the child’s developmental history and observed behaviour.
A comprehensive assessment may include:
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Developmental history: Early language, social, play, sensory, and behavioural development.
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Parent/caregiver interview: Information about behaviour across home, school, and other settings.
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Direct observation: A trained professional observes communication, social interaction, play, and repetitive behaviours.
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Standardized assessment tools: Depending on the situation, clinicians may use tools such as the ADOS-2 or ADI-R.
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Hearing and vision assessment: Problems with hearing or vision can sometimes contribute to apparent communication or behavioural difficulties.
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Cognitive, language, and adaptive-function assessment: These help identify the child’s strengths and support needs.
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Assessment for other conditions: ADHD, anxiety, language disorders, learning difficulties, sleep problems, intellectual disability, and other developmental or mental-health conditions can occur alongside autism or produce overlapping symptoms.
Autism and Behaviour
Autism, or autism spectrum disorder (ASD), is a neurodevelopmental difference that can affect communication, social interaction, sensory processing, flexibility, and behaviour. Behaviour in autistic people is often best understood as communication or a response to the environment, rather than simply as “good” or “bad” behaviour.
Common behavioural patterns can include:
- Repetitive behaviours: hand-flapping, rocking, pacing, repeating words, or arranging objects.
- Meltdowns: intense reactions that may occur when someone is overwhelmed by sensory input, demands, frustration, or changes in routine.
- Shutdowns: becoming quiet, withdrawn, unresponsive, or unable to communicate when overwhelmed.
- Difficulty with changes: distress when routines, expectations, or familiar environments change unexpectedly.
- Sensory-related behaviours: covering ears, avoiding certain textures, seeking movement or pressure, or becoming distressed by lights, sounds, smells, or touch.
- Communication-related behaviours: challenging behaviour may occur when a person cannot express pain, discomfort, needs, emotions, or wants effectively.
- Restricted or highly focused interests: spending significant amounts of time engaged with particular topics or activities.
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Behavioral problems
Examples that may warrant assessment include frequent severe tantrums, aggression, self-injury, extreme difficulty with changes in routine, significant sensory reactions, communication difficulties, or major problems functioning at home or school.
The key question is not simply whether a behaviour is present, but why it is occurring and how significantly it affects the child’s functioning.
If you’re concerned about a child, starting with their family doctor or pediatrician is appropriate. They can assess development and arrange referral to a developmental pediatrician, psychologist, psychiatrist, or other appropriate specialist.
If you tell me the child’s age and the specific behaviours you’re seeing, I can explain which signs are associated with autism and what kind of assessment is typically appropriate.
- Autism is a neurodevelopmental condition. It can affect communication, sensory processing, social interaction, routines, and how someone responds to their environment.
- Behaviour is often a form of communication. Behaviours such as withdrawal, aggression, repetitive movements, refusal, or emotional outbursts may occur when someone is overwhelmed, unable to communicate a need, experiencing sensory discomfort, or dealing with a change in routine.
- Mental health refers to conditions such as anxiety, depression, OCD, trauma-related difficulties, or eating disorders. Autistic people can experience these conditions, sometimes at higher rates than non-autistic people.
- Behavioural changes can be a sign of distress. A sudden change in behaviour should not automatically be considered “bad behaviour”; it can be useful to look for pain, sleep problems, sensory overload, communication difficulties, medication effects, bullying, environmental changes, anxiety, or other sources of distress.
- Support is usually most effective when it addresses the underlying need, rather than simply trying to suppress the behaviour. This might involve predictable routines, sensory accommodations, communication supports, emotional-regulation strategies, and appropriate mental-health care.
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Sleep disorders and autism
Sleep problems are common in autistic children and adults. They can include difficulty falling asleep, frequent waking, waking very early, irregular sleep schedules, or poor-quality sleep. Sleep difficulties can also worsen daytime irritability, attention, learning, and challenging behaviours.
Common sleep problems
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Difficulty falling asleep: The person may take a long time to settle at bedtime.
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Frequent night waking: They may wake repeatedly or have difficulty returning to sleep.
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Early-morning waking: They wake much earlier than desired and cannot return to sleep.
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Irregular sleep pattern: Sleep and wake times may vary substantially from day to day.
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Sleep-disordered breathing: Snoring, pauses in breathing, gasping, or restless sleep can indicate obstructive sleep apnea.
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Restless legs or periodic limb movements: These can interfere with sleep and may sometimes be associated with iron deficiency.
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Parasomnias: Sleepwalking, night terrors, or unusual behaviours during sleep can occur.
Understanding behaviour
A useful approach is to ask:
What happened before the behaviour? → What did the person do? → What happened afterward?
For example, if a child repeatedly leaves a noisy classroom, the behaviour may be an attempt to escape overwhelming noise rather than deliberate disobedience.
Helpful strategies can include:
- Using clear, predictable language.
- Providing visual schedules or advance warnings about changes.
- Identifying and reducing sensory triggers where possible.
- Teaching alternative ways to communicate needs.
- Allowing appropriate breaks and recovery time.
- Reinforcing desired behaviours rather than relying primarily on punishment.
- Looking for possible causes such as anxiety, pain, fatigue, hunger, communication difficulties, or sensory overload.
Dr. Robin Friedlander, MD, FRCPC, Child Psychiatrist, Vancouver
Management
A consistent sleep routine is often a good starting point:
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Keep bedtime and wake time consistent.
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Establish a predictable, calming bedtime routine.
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Keep the bedroom dark, quiet, and comfortably cool.
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Reduce stimulating activities and screens before bedtime.
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Make reasonable adjustments for sensory sensitivities, such as preferred bedding or lighting.
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Encourage daytime physical activity and exposure to natural light.
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Address pain, constipation, reflux, anxiety, or other medical issues that may interfere with sleep.
Common nutrition considerations include:
- Selective eating: Focus on gradually expanding foods while keeping familiar “safe” foods available.
- Protein and calories: Include foods such as eggs, yogurt, cheese, beans, tofu, meat, fish, or nut/seed butters when tolerated.
- Fruits and vegetables: Offer different colors, textures, and preparations without forcing them.
- Fiber and fluids: Helpful for constipation, which can be common.
- Iron, vitamin D, calcium, B12, and other nutrients: Restricted diets can increase the risk of deficiencies, so supplementation is best based on dietary assessment or medical testing.
- Sensory needs: Temperature, smell, texture, appearance, and predictability can strongly affect food acceptance.
- Gluten-free/casein-free diets: Evidence does not support routinely using these to improve core autism characteristics, and unnecessary restriction can make nutritional adequacy harder.
Autism and Behaviour Nutrition NOW
Andy De Santis, RD, MPH, Registered Dietician
Andy De Santis, RD, MPH, Registered Dietician
Andy De Santis, RD, MPH, Registered Dietician