Autism Spectrum Disorder – An Overview
Autism Spectrum Disorder, or ASD, is a developmental disability that affects about 1 in 54 children. The number of children diagnosed with ASD has been growing over the past few decades, a fact that has spurred much debate regarding the cause of this increase. It is most likely a result of clinicians, families, and schools being more aware of ASD, increased screening by Pediatricians, and changes in the definition of the diagnosis itself. Prior to 2013, there were four distinct disorders under the category of autism: Autistic Disorder, Pervasive Developmental Disorder – not otherwise specified (PDD-NOS), Asperger Syndrome, and Childhood Disintegrative Disorder. This has subsequently changed, however, and now these conditions are all grouped in the broad category of Autism Spectrum Disorder.
Autism affects social skills, communication, and behavior. Children with ASD will usually have normal motor skill development. Since motor skills are more evident within the first year while communication and social skills develop somewhat later, symptoms and recognition of ASD often are delayed into toddlerhood or the preschool years.
Early Signs of Autism
Recognizing signs of ASD early on can be key in early diagnosis. It is important to remember that Autism Spectrum Disorder is just that – a spectrum of different levels or severity of dysfunction. Some children are very mildly affected, while some are severely affected. Therefore, some children will have many of the symptoms listed below while some will have only a few. Many will fall somewhere in the middle. The American Academy of Pediatrics and HealthyChildren.org splits these symptoms up into 3 categories:
Communication
- Speech delay between 12-24 months of age. This occurs either through lack of initial development (does not learn new words as expected) or through regression (stops saying words previously used).
- Repeats words without using them correctly, ie – parroting
- Does not respond to name
- Does not engage in conversations
Social
- Difficulty initiating or maintaining eye contact
- Lack of reciprocal smile
- Lack of response to facial expressions and/or difficulty understanding facial expressions (in parents and other family members as well as strangers).
- Lack of response to parental gestures – ie, not looking when parent points to an object
- Does not try to get parental attention or attempt to show parent an object.
- Lack of concern for others (empathy)
- Difficulty interacting with peers, playing with others, and making friends.
Behavioral
- Displays “stereotypic behaviors” such as rocking, spinning, flapping hands.
- Significant difficulty with changes in routine
- Increased tolerance to pain
- Sensitive to textures, sounds, and lights
- Repetitive play with certain toys – seems to fixate or “obsess” on objects
The CDC has a free “Milestone Tracker” app available to help parents monitor child developmental milestones and promote early awareness of difficulties. (cdc.gov/MilestoneTracker).
Screening and Diagnosis
The American Academy of Pediatrics recommends that all children be screened for Autism Spectrum Disorder at the 18- and 24-month well child visits. Along with simple observation of how children interact with parents, siblings, and the physician, there are particular tools that are used to identify children who are high or medium risk for autism. Each office may use a slightly different screening tool, as there are several that have been approved for use and shown to be effective. Early identification can lead to early interventions, which have been shown to help improve long-term outcomes for many autistic children.
It is important to know that screening for ASD is NOT the same thing as diagnosing a child with ASD. Screening tools are used to determine which children need further evaluation and formal diagnosis. Unfortunately, we cannot diagnose ASD through blood tests or x-rays, like we would diabetes or a broken bone. Diagnosis requires a combination of observation of behavior by the Pediatrician, developmental and autism specialists, extensive history-taking, and sometimes medical testing for genetic causes. Developmental and behavioral specialists are in high demand and often have long waiting lists for patients to be seen. This can be a very frustrating part of the diagnosis process for families. Thankfully, many patients with symptoms of ASD will qualify for therapies based on developmental delays or sensory disorders, making it easier for them to start treatments for symptoms prior to an official diagnosis.
Therapies
Depending on the severity of ASD in a child, he or she may qualify for multiple services, including speech therapy, occupational therapy, and applied behavioral analysis (ABA) therapy.
Speech therapy – most children with ASD have some level of speech delay, from a simple lack of robust vocabulary to a complete lack of verbal communication. As a result, speech therapy is often the first intervention they receive. Many children with ASD will be established in speech therapy long before they have an official diagnosis.
Occupational therapy – fine motor skills will often be preserved, but occupational therapy can also aid children with sensory issues, including feeding difficulties and texture aversions.
Applied Behavioral Analysis (ABA) therapy – this type of therapy is behaviorally-based, and is unique to children with ASD. It helps to increase helpful behaviors and decrease harmful behaviors through positive reinforcement in real situations. ABA can be done at home or in a clinic setting and are usually very time-intensive.
Additionally, children under the age of 3 years should be referred to the local Early Intervention program. Children over the age of 3 years should be transitioned into the local school district’s special education system through the preschool program. School aged children with ASD will often be included in the general population for classes at school, though they may be pulled into special education classes for certain subjects or to receive therapies.
Final thoughts
Autism Spectrum Disorder is an increasingly common diagnosis. Chances are, you know or care for a child with ASD. These children can be delightful, and they can be challenging. There are a multitude of resources available to help them become as independent as possible, and to help parents navigate their childhood with less difficulty. The key is early recognition and intervention, as studies have shown that outcomes are significantly improved when children start therapy – particularly ABA – at earlier ages. If you are concerned about the possibility of autism in your child, please reach out to your Pediatrician.
Resources
https://www.cdc.gov/ncbddd/actearly/milestones-app.html
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