Autism and ASD Spectrum Disorders In Children
What Is Autism?
An Autism Spectrum Disorder (ASD) is a range of complex neurological conditions marked by communication disorders, social impairments, and repetitive behaviors by the time a child is three years old. Those who have an autism spectrum disorders handle information in the brain differently than other people.In the psychiatric community, thinking about autism has changed, as reflected in the new DSM-5 guidelines.
What had been considered a set of distinct conditions described as pervasive developmental disorders — autism, Asperger’s disorder, childhood disintegrative disorder (CDD), and pervasive developmental disorder not otherwise specified (PDD-NOS) — are now considered one disorder that presents along a spectrum of symptoms and behaviors of varying severity.
Autism spectrum disorder (ASD) impacts a child’s development in two core areas: the first is social communication and social interaction, and the second is restricted, repetitive patterns of behavior and interests. Although a child is born with an ASD, we may not see the sign until social demands exceed a child’s limitations.
We understand that there is not one specific autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism occurs on a spectrum, each person with autism has a distinct set of strengths and challenges. The ways in which people with autism learn, think, and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.
Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression, and attention issues.
Indicators of autism usually appear by age 2 or 3. Some associated development delays may appear even earlier, and often, it can be diagnosed as early as 18 months. From as early as 1 to 2 years of age, people with ASD have an impaired ability to interact with other people; they are often more comfortable dealing with objects. These affected children have difficulty understanding and using non-verbal social cues such as eye contact, facial expressions, gestures, and body language. The inability to recognize and use these cues makes it hard for affected children to understand the feelings of others or communicate their own feelings appropriately. Behavioral signs of ASD, such as reduced eye contact and social interaction, can sometimes be detected before age 2. However, the condition is usually diagnosed between ages 2 and 4, when more advanced communication and social skills, such as learning to play with others, typically begin to develop. Research clearly shows that early intervention leads to positive outcomes later in life for people with autism.
Autism is not a single disorder, but a spectrum of closely related disorders with a shared core of symptoms. Every person on the autism spectrum has problems (to some degree) with social interaction, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.
No matter what doctors, teachers, and other specialists call the autism spectrum disorder, it’s your child’s unique needs that are truly important. No diagnosis can tell you exactly what challenges your child will have. Finding treatment that addresses your own child’s needs, rather than focusing on what to call the problem, is the most helpful thing you can do. You don’t need a diagnosis to start getting help for your child’s symptoms.
Keep in mind that just because your child has a few autism-like symptoms, it doesn’t mean he or she has Autism Spectrum Disorder. Autism Spectrum Disorder is diagnosed based on the presence of multiple symptoms that disrupt a person’s ability to communicate, form relationships, explore, play, and learn.
Several diagnoses that used to be classified as separate conditions are now grouped together under the diagnosis of ASD. For example, autistic disorder was a term that was used when affected people had limited or absent verbal communication, often in combination with intellectual disability. By contrast, Asperger syndrome was a diagnosis formerly applied to affected individuals of average or above-average intelligence who were not delayed in their language development.
This broader diagnosis of ASD was established because many people fall outside of the strict definitions of the narrower diagnoses, and their intellectual and communication abilities may change over time. However, this also means that some individuals who were previously diagnosed with one of the subtypes now do not meet all the criteria of the new umbrella diagnosis.
Autism Spectrum Disorders, including Asperger’s Syndrome – which is no longer a diagnosis in the DSM-V, though it remains well used for psychiatrists and their patients – represent a continuum of disorders ranging from mild to very severe. While those with ASDs share similar problems, there are many differences in onset, severity and nature of symptoms.
ASDs occur across all racial, ethnic and socioeconomic groups and ASDs are four times more likely to occur in boys than in girls.
What’s With All Of The Name Changes?
There is a great deal of confusion about the names of various autism-related disorders. Some professionals speak of “the autisms” to avoid addressing the usually subtle differences among the conditions along the autism spectrum. Up until the release of the DSM-V in 2013, there were five different “autism spectrum disorders.” These differences among those five made it hard for parents trying to figure out which – if any – of these conditions affected their child.
If you’re a parent raising a child on the autism spectrum, you may hear many different terms including high-functioning autism, atypical autism, autism spectrum disorder, and pervasive developmental disorder. These terms can be confusing, not only because there are so many, but because doctors, therapists, and other parents may use them in dissimilar ways.
The American Psychiatric Association attempted to simplify matters by combining the pervasive developmental disorders into a single diagnostic classification called “Autism Spectrum Disorder” in the latest edition of the diagnostic bible known as the Diagnostic and Statistical Manual of Mental Disorders. As many people were diagnosed prior to the change in the classification system and since many professionals still refer to the pre-2013 labels, they are summarized for reference only
For purposes of clarity, we want to emphasize that all of the following conditions are now encompassed under the umbrella classification “Autism Spectrum Disorder” (ASD).
The three most common forms of autism in the pre-2013 classification system were:
Autistic Disorder – (also known as “classic” autism) AD is the most severe form of autism and people with autistic disorder have unusual interests and behaviors, intellectual disabilities, significant language impairment, and severe social and communication problems.
Asperger Syndrome– a milder form of autistic disorder. People with Asperger Syndrome may have social challenges, unusual interests and behaviors, but generally do not have issues with language or intellectual disabilities.
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) (also known as “atypical autism“) these are people who meet some but not all of the diagnostic criteria for autistic disorder or Asperger Syndrome. People with PDD-NOS tend to have milder and fewer symptoms.
These three disorders share many of the same symptoms, but they differ in their severity and impact. Autistic disorder was the most severe. Asperger’s Syndrome, sometimes called high-functioning autism, and PDD-NOS, or atypical autism, were the less severe variants.
Childhood Disintegrative Disorder and Rett Syndrome were also among the pervasive developmental disorders. Because both are extremely rare genetic diseases, they are usually considered to be separate medical conditions that don’t truly belong on the autism spectrum.
In large part due to inconsistencies in the way that individual people were classified, all of the above-named variants of autism are now referred to as “Autism Spectrum Disorder.” The single label shifts the focus away from where your child falls on the autism spectrum to whether your child has Autism Spectrum Disorder.
If your child is developmentally delayed or exhibits other autism-like behaviors, you will need to visit a medical professional or a clinical psychologist who specializes in diagnostic testing for a thorough evaluation. Your doctor can help you figure out whether your child has Autism Spectrum Disorder and how severely he or she is affected.
Things To Look For In Your Child:
As a parent, you’re in the best position to spot the earliest warning signs of autism. You know your child better than anyone and observe behaviors and quirks that a pediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your child’s pediatrician can be a valuable partner, but don’t discount the importance of your own observations and experience. The key is to educate yourself so you know what’s normal and what’s not.
If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.
The earliest signs of autism involve the absence of normal behaviors—not the presence of abnormal ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.
Some autistic infants don’t respond to cuddling, reach out to be picked up, or look at their mothers when being fed.
Early signs: Your baby or toddler doesn’t:
- Make eye contact, such as looking at you when being fed or smiling when being smiled at
- Respond to his or her name, or to the sound of a familiar voice
- Follow objects visually or follow your gesture when you point things out
- Point or wave goodbye, or use other gestures to communicate
- Make noises to get your attention
- Initiate or respond to cuddling or reach out to be picked up
- Imitate your movements and facial expressions
- Play with other people or share interest and enjoyment
- Notice or care if you hurt yourself or experience discomfort
Regression of any kind is a serious autism warning sign: Some children with autism spectrum disorder start to develop communication skills and then regress, usually between 12 and 24 months. For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or a child may stop playing social games he or she used to enjoy such as peek-a-boo, patty cake, or waving “bye-bye.” Any loss of speech, babbling, gestures, or social skills should be taken very seriously, as regression is a major red flag for autism.
Monitor your child’s development: Autism involves a variety of developmental delays, so keeping a close eye on when—or if—your child is hitting the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays don’t automatically point to autism, they may indicate a heightened risk.
Take action if you’re concerned: Every child develops at a different pace, so you don’t need to panic if your child is a little late to talk or walk. When it comes to healthy development, there’s a wide range of “normal.” But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child’s doctor immediately. Don’t wait.
Don’t accept a wait-and-see approach: Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply “grow out of” their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.
Trust your instincts. Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it’s telling you something is wrong, and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.
Developmental Red Flags Parents Should Watch For:
The following delays warrant an immediate evaluation by your child’s doctor:
By 6 months: No big smiles or other warm, joyful expressions
By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions
By 12 months: Lack of response to name
By 12 months: No babbling or “baby talk”
By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving
By 16 months: No spoken words
By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating
What Causes Autism?
One of the most common questions asked after diagnosis of autism is: “what caused the disorder?”
Currently we understand that there’s no singular cause of autism. Research leans toward the idea that autism develops from a combination of genetic, non-genetic, and environmental, influences working together.
Some of these influences appear to increase the risk that a child will develop autism, but it’s important to remember that increased risk factors are not the same as cause. As an example, certain gene changes that have been identified as associated with autism are also found in people who don’t have the disorder. Likewise, not everyone exposed to an environmental risk factor for autism will develop the disorder; in fact, most will not.
Genetics:
ASD has a tendency to run in families, but the inheritance pattern is usually unknown. People with gene changes associated with ASD generally inherit an increased risk of developing the condition, rather than the condition itself. When ASD is a feature of another genetic syndrome, it can be passed on according to the inheritance pattern of that syndrome.
If a parent carries one or more of these gene changes, they may get passed to a child (even if the parent does not have autism). Other times, these genetic changes arise spontaneously in an early embryo or the sperm and/or egg that combine to create the embryo. Again, the majority of these gene changes do not cause autism by themselves. They simply increase risk for the disorder.
Changes in over 1,000 genes have been reported to be associated with ASD, however a large number of these associations have not yet been confirmed. Many common gene variations, most of which have not been identified yet, are thought to affect the risk of developing ASD, however it must be noted that not all people with the gene variation will be affected.
Most of the gene variations have only a small effect, and variations in many genes can combine with environmental risk factors, such as parental age, birth complications, and others that have not been identified, to determine an person’s risk of developing autism. Non-genetic factors may contribute up to about 40 percent of the risk for development of ASDs.
In about 2 to 4 percent of people with ASD, rare gene mutations or chromosome abnormalities are thought to be the cause of the condition, often as a feature of other syndromes that involve additional signs and symptoms affecting various parts of the body. For example, mutations in the ADNP gene cause a disorder called ADNP syndrome. In addition to ASD and intellectual disability, this condition involves distinctive facial features and a wide variety of other signs and symptoms. Other syndromes can include Fragile X Syndrome and Tuberous Sclerosis. Some of the other genes in which rare mutations are associated with ASD, often with other signs and symptoms, are ARID1B, ASH1L, CHD2, CHD8, DYRK1A, POGZ, SHANK3, and SYNGAP1, but the significance is currently unknown. In most people who have ASD caused by rare gene mutations, the mutations occur in only a single gene.
Many of the genes associated with ASD involve the development of the brain. The proteins produced from these genes affect multiple aspects of brain development, including production, growth, and organization of neurons. Some affect the number of neurons that are created, while others involve the development or function of the connections between neurons (synapses) where cell-to-cell communication takes place, or of the cell projections (dendrites) that carry signals received at the synapses to the body of the neuron. Many genes affect development by controlling (regulating) the activity of other genes or proteins.
The specific ways that changes in these and other genes relate to the development of ASD are unknown. Studies indicate that during brain development, some people with ASD have more neurons than normal and overgrowth in parts of the outer surface of the brain (the cortex). Additionally, there are often patchy areas where the normal structure of the layers of the cortex is disturbed. Normally the cortex has six layers, which are established during development before birth, and each layer has specialized neurons and different patterns of neural connection. The neuron and brain abnormalities occur in the frontal and temporal lobes of the cortex, which are involved in emotions, social behavior, and language. These abnormalities are believed to underlie the differences in socialization, communication, and cognitive functioning characteristic of ASD.
Environmental Risk Factors:
The role of environmental factors in the development of autism is a crucial area of study. We know that genetics strongly influence the risk for developing autism spectrum disorder (ASD). However, genetics alone do not account for all instances of autism. For good reason, the increasing prevalence of autism has generated great interest in the potential involvement of toxins in our environment. For example, prenatal exposure to the chemicals thalidomide and valproic acid has been linked to increased risk of autism and other disorders.
However, it must be made clear that there are any number of factors that are being currently (or will be) studied to determine the pertinent environmental factors – and not all the research is conclusive.
The most widely accepted risk factors operate during gestation or around the time of birth. Various pregnancy and birth complications, such as maternal hypertension, abdominal bleeding, as well as prematurity, preterm labor, low birth weight, maternal diabetes have been causally linked to the development of autism.
Also noted, the maternal immune system appears to play a role in autism risk. Infections (especially those that cause fever), serious illnesses (like the flu), and hospitalizations during pregnancy have been linked to an increased risk of autism in a child. Women with autoimmune diseases, in which the body attacks its own tissues, are also at an elevated risk of having an autistic child.
Exposure to the drug valproate, which is used to treat bipolar disorder and epilepsy, in the womb is known to increase the risk of autism, as well as a variety of birth defects.
Other Associated Risk Factors:
- Advanced parent age (either parent)
- Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])
- Abdominal bleeding during pregnancy
- Pregnancies spaced less than one year apart
Decreased risk:
- Prenatal vitamins containing folic acid, before and at conception and through pregnancy
No Effect On Risk:
- Vaccines. Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The bogus “research” that purported to show a causal link was fraudulent and has been retracted, and no reliable evidence has ever emerged to support it. The results of this research is clear: Vaccines do not cause autism. The American Academy of Pediatrics has compiled a comprehensive list of this research.
- Maternal Vaccinations During Pregnancy: Despite the links between maternal immune factors and autism, routine vaccinations given during pregnancy, such as those against influenza and whooping cough, do not appear to boost autism risk.
- Maternal Smoking: Scientists have also exonerated smoking during pregnancy as a contributor to autism. Of course, smoking during pregnancy is harmful for many other reasons and should never be encouraged.
How do these genetic and nongenetic influences give rise to autism? Most appear to affect crucial aspects of early brain development. Some appear to affect how brain nerve cells, or neurons, communicate with each other. Others appear to affect how entire regions of the brain communicate with each other. Research continues to explore these differences with the aim to developing treatments and supports that can improve quality of life.
While scientists have not pinpointed an exact cause for autism, it’s likely that environmental and genetics work together to cause autistic spectrum disorders. A number of genes are associated with autistic spectrum disorders, as are certain brain irregularities.
And, please let me say it again:
It has been disproved time and time again that autism is caused by vaccines. Autism is in no way related to vaccinations.
What Are Common Signs and Symptoms of Autism?
Signs of autism spectrum disorders usually begin before age three and last a person’s lifetime – although the severity of symptoms may diminish over time. Children with autism spectrum disorder are characterized by a combination of two unique kinds of behaviors: problems in communication and social skills, as well as restricted or repetitive behaviors. These symptoms, as this is a spectrum disorder, will vary greatly in severity from child to child – even within families.
It’s important to note that while many of these behaviors occur in children with autism, autism is a SPECTRUM disorder, meaning that the severity of the symptoms will vary from child to child. Some infants display symptoms of autism spectrum disorders, while other children may not exhibit signs of autism until 24 months old. The hallmark of autism is impaired social interaction with adults, parents, and other children.
Social Behavior And Social Understanding:
The signs of social deficits you may see in a developing child include aversion and avoidance of displays of affection such as cuddling and hugging, with a preference for solitary play. In kids under 3, you may note a failure to respond to their own name ass a red flag, as is disinterest in giving, sharing, or showing objects of interest. In older children, warning signs can include difficulty carrying on a conversation with someone else, a profound lack of eye contact, as well as difficulty using and reading body language. Children who may fall on the ASD spectrum, may have difficulty recognizing others’ emotions, responding appropriately to different social situations, and a decided lack of understanding social relationships.
While social and communication difficulties and unusual behaviors define ASD, affected individuals can have a wide range of intellectual abilities and language skills. The majority of people with autism have mild to moderate intellectual disability, while others have average to above-average intelligence. Some have particular cognitive abilities that greatly surpass their overall level of functioning, often in areas such as music, mathematics, or memory.
Some people with ASD do not speak at all, while others use language fluently. However, fluent speakers with ASD often have problems associated with verbal communication. They might speak in a monotone voice, have unusual vocal mannerisms, or choose unusual topics of conversation. Some children with autism don’t talk; while others talk in a stilted, “robotic” tone, or in an exaggerated singsong. A child with autism may also repeat certain phrases without appearing to understand their significance, or possess what experts call “non-functional knowledge”- information the child can recite, but not actually use to solve problems or carry on a conversation.
Young children who have autism don’t point at objects of interest, don’t make eye contact, and don’t use gestures to communicate a need or describe something.
As kids with autism age and acquire language skills, their tone or pattern of speech can be odd; some have a habit of reversing pronouns – a child asking his mom for juice might say “You want juice” instead of “I want juice.” High-functioning children with autism may monopolize conversations while showing little capacity for reciprocity, or displaying any type understanding what the other party wants or feels.
Basic social interaction can be difficult for children with Autism Spectrum Disorders. Signs may include:
- Resistance to being touched
- Difficulty or failure to make friends with children the same age
- Unusual or inappropriate body language, gestures, and facial expressions (like avoiding eye contact or using facial expressions that don’t match what he or she is saying)
- Lack of interest in other people or in sharing interests or achievements (showing you a drawing, pointing to a duck)
- Unlikely to approach others or to pursue social interaction; comes across as aloof and detached; prefers to be alone
- Difficulty understanding other people’s feelings, reactions, and nonverbal cues
Speech And Language
Many children with Autism Spectrum Disorder struggle with speech and language comprehension. Signs can include:
- Delay in learning how to speak (after the age of two) or the child may be nonverbal
- Speaking in an abnormal tone of voice, or with an odd rhythm or pitch
- Repeating words or phrases over and over without communicative intent
- Trouble starting a conversation or keeping it going
- Difficulty communicating needs or desires
- Doesn’t understand simple statements or questions
- Taking what is said too literally, missing humor, irony, and sarcasm
Restricted Behaviors And Play:
Major behavioral signs of an ASD include the performance of repetitive actions and rituals, and fixation on tiny details to the point of being distracted. Children with autism can often be upset by the slightest change in daily routine. In young kids, signs of autism include ordering toys instead of playing with them. In older children, the repetitive behavior can manifest as a consuming interest in a specific topic or object.
| AvPD Subtype and Description | Notable Personality Traits |
|---|---|
| Phobic avoidant (including dependent features) | General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolized by repugnant and specific dreadful object or circumstances. |
| Self-deserting avoidant (including depressive features) | Blocks or fragments self awareness; discards painful images and memories; casts away untenable thoughts and impulses; ultimately jettisons self-harm and suicide. |
| Hypersensitive avoidant (including paranoid features) | Intensely wary and suspicious; alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly. |
| Conflicted avoidant (including negativistic features) | Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; unresolvable angst. |
Repetitive behaviors in ASD can include simple actions such as rocking, hand-flapping, or repetition of words or noises (echolalia). Affected children often dwell on, or repeatedly express, particular thoughts; this behavior is called perseveration. People with ASD tend to be rigid about their established routines and may strongly resist disruptions such as changes in schedule.
They may also have difficulty tolerating sensory stimuli such as loud noises or bright lights. The DSM-V behavioral criteria now includes sensory processing problems. Many children with autism are unusually sensitive to sounds, lights, textures, or smells. They may be overwhelmed by too much sensory input, or be disturbed and uncomfortable because of a lack of sensory input, which they may try to get by bumping into things, and excessively touching and smelling things.Children with Autism Spectrum Disorder are often restricted, rigid, and sometimes obsessive in their behaviors, activities, and interests. Signs can include:
- Repetitive body movements (such as, hand flapping, rocking, spinning); constant movement
- Obsessive attachment to unusual objects (such as smoke detectors, rubber bands, keys, light switches)
- Preoccupation with a narrow topic of interest, sometimes involving numbers or symbols (such as the planets, maps, license plates, sports statistics)
- A strong need for sameness, order, and routines (lines up toys, follows a rigid schedule).
- Child becomes upset by any change in their routine or environment.
- Clumsiness, abnormal posture, or odd ways of moving
- Fascinated by spinning objects, moving pieces, or parts of toys (spinning the wheels on a race car, rather than playing with the whole car)
- Hyper- or hypo-reactive to sensory input (reacts badly to certain sounds or textures, seeming indifference to temperature or pain)
How Children With Autism Spectrum Disorder Play
Children with Autism Spectrum Disorder are often less spontaneous than other kids. Unlike a typical curious child, pointing to things that catch their eye, children with ASD often appear disinterested or unaware of what’s going on around them. They also tend to show differences in the way they play. They may have trouble using toys that have a basic intended use, such as toy tools or cooking set. They usually don’t “play make-believe,” engage in group games, imitate others, collaborate, or use their toys in creative ways.
Related Signs And Symptoms of Autism Spectrum Disorders
While not part of autism’s official diagnostic criteria, children with autism spectrum disorders often suffer from one or more of the following problems:
Sensory problems: Many children with autism spectrum disorders either underreact or overreact to sensory stimulus. At times, they may ignore people speaking to them, even to the point of appearing deaf. However, at other times they may be disturbed by even the softest sounds. Sudden noises such as a ringing telephone can be upsetting, and they may respond by covering their ears and making repetitive noises to drown out the offending sound. Children on the autism spectrum also tend to be highly sensitive to touch and to texture. They may cringe at a pat on the back or the feel of certain tag on clothes against their skin.
Emotional difficulties: Children with autism spectrum disorders can have difficulty regulating their emotions or expressing them appropriately. For example, your child may start to yell, cry, or laugh hysterically for no apparent reason. When stressed, he or she may exhibit disruptive or even aggressive behavior (breaking things, hitting others, or harming him or herself). The National Dissemination Center for Children with Disabilities also notes that kids with ASD may be unfazed by real dangers like moving vehicles or heights, yet be terrified of harmless objects such as a stuffed animal.
Uneven cognitive abilities – ASD occurs at all intelligence levels. However, even kids with normal to high intelligence often have unevenly developed cognitive skills. Not surprisingly, verbal skills tend to be weaker than nonverbal skills. In addition, children with autism spectrum disorder usually do well on tasks involving immediate memory or visual skills, while tasks involving symbolic or abstract thinking are more difficult.
Savant Skills In Some Individuals Who Have Autism Spectrum Disorder
Approximately 10% of people with autism spectrum disorders have special “savant” skills, such as Dustin Hoffman portrayed in the film Rain Man. The most common savant skills involve mathematical calculations, calendars, artistic and musical abilities, and feats of memory. An autistic savant might be able to multiply large numbers in his or her head, play a piano concerto after hearing it once, or quickly memorize complex maps.
What Other Conditions Occur With Autism?
There are a number of diseases and conditions associated with autism and autism spectrum disorders.
Fragile X Syndrome – a genetic disorder caused by changes in the FMR1 gene. The FMR1 gene creates a protein vital for brain development. A defect in the gene causes the body to produce too little of the protein or – in some cases – none at all. This can cause developmental problems.
Tourette’s Syndrome – a tic disorder in which a person has multiple motor tics, including at least one vocal tic. This disorder is diagnosed in childhood, but may appear at any point, and is not related to any medication or substance.
Tuberous Sclerosis – a genetic disorder that causes noncancerous (also known as benign) tumors to grow in various parts of the body. Tuberous sclerosis is part of a group of diseases called “neurocutaneous syndromes,” which means that both the skin and central nervous system are affected.
Epilepsy – episodes of altered brain function that cause motor, cognitive, and sensory changes thought to result from changes in excitability in neurons.
ADHD – is a disorder characterized by excessive restlessness, inattention, distraction, and an impulsive nature that interferes with the person’s daily life, and his or her ability to function in everyday activities
Learning Disabilities- refers to difficulties in learning and using skills due to disturbances in neurological functioning. Typically, the most affected skill areas include reading, writing, listening, speaking, reasoning, and math
How Are Autism Spectrum Disorders Diagnosed?
The path to an ASD diagnosis can be long, winding, difficult, and time-consuming. Unfortunately, it can be two or three years since the appearance of ASD symptoms before a diagnosis can be made. This may be related to concerns about labeling or diagnosing a child so you. In addition, an ASD diagnosis may be delayed if the doctor doesn’t take a parent’s concerns seriously or if the family isn’t referred to health care professionals who specialize in developmental disorders.
If you’re worried that your child has ASD, it’s important to seek out a clinical diagnosis. Don’t wait for the full diagnosis to get your child into treatment. Early intervention during the preschool years will improve your child’s chances for overcoming his or her developmental delays. As your pediatric physician for a referral to certain kinds of treatments for, look into treatment options and try not to fret if you’re still waiting on a definitive diagnosis.
Putting a potential label on your kid’s problem is far less important than treating the symptoms.
Diagnosing Autism Spectrum Disorder
In order to determine whether your child has autism spectrum disorder or another developmental condition, clinicians look carefully at the way your child interacts with others, communicates, and behaves. Diagnosis is based on the patterns of behavior that are revealed.
If you are concerned that your child has autism spectrum disorder and developmental screening confirms the risk, ask your family doctor or pediatrician to refer you immediately to an autism specialist or team of specialists for a comprehensive evaluation. As the diagnosis of autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area.
Diagnosing ASDs is not a brief process. Unfortunately, there exists no single medical test that can diagnose ASDs definitively; instead, multiple evaluations and tests may be necessary.
The team of specialists that should be involved in diagnosing your child can include:
- Child psychologists
- Child psychiatrists
- Speech pathologists
- Developmental pediatricians
- Pediatric neurologists
- Audiologists
- Physical therapists
- Special education teachers
Evaluation and Diagnosis of ASDs May Include The Following:
Parent Interview: During the first phase of the diagnostic evaluation, you need to provide your doctor background information about your child’s medical, developmental, and behavioral history. If you’ve been keeping a journal or taking notes on anything that’s concerned you, share that information. The doctor will also want to know about your family’s medical and mental health history.
Medical Exam: The medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. Your child will undergo this full screening to determine the cause of his or her developmental problems as well as identify any co-existing conditions that may require treatment.
Hearing Test: Hearing problems can result in social and language delays, and they need to be excluded before an Autism Spectrum Disorder can be diagnosed. Your child will undergo a formal audiological assessment where he or she will be tested for any hearing impairments, in addition to any other hearing issues or sound sensitivities that can co-occur with autism.
Observation: Developmental specialists will observe your child in a variety of settings to look for the hallmark behaviors associated with the Autism Spectrum Disorder. Sometimes they may watch your child playing or interacting with other people.
Lead screening: Because lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children with developmental delays be screened for lead poisoning.
Depending on your child’s and symptoms and their severity, the diagnostic assessment may also include speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs:
Speech and language evaluation: A speech pathologist will evaluate your child’s speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.
Cognitive Testing: Your child may be given a standardized intelligence test or an informal cognitive assessment.
Adaptive Functioning Assessment: Your child may be evaluated for her/his ability to function, problem-solve, and adapt in real-life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.
Sensory-Motor Evaluation – Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child’s fine motor, gross motor, and sensory processing skills.
Is There Treatment for Autism?
Today, there are no cures for autism. Furthermore, most people who have autism do not feel that they have a disease or anything that needs curing. Here are some of the ways autism can be managed in some children and families:
Early Intervention Services
Research shows that early intervention treatment services may greatly improve a child’s development. Early intervention services help children from birth to 3 years old (36 months) learn important skills. The early intervention services include therapy to help the child talk, walk, and interact with others. This is why it’s crucial to talk to your child’s doctor as soon as possible if you think your child has an ASD or other developmental problem. Diagnosis of an ASD can take a great many months, so as soon as you suspect any ASD symptoms, early intervention should be explored.
Even without a an ASD diagnosis, your child may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA )says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this same system, you can ask for an evaluation.
In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis. While early intervention is extremely important, intervention at any age can be helpful.
Other Treatment Ideas
There are many different types of treatments available, including auditory training, discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy, and sensory integration.
The different types of treatments can generally be broken down into the following categories:
- Behavior and Communication Approaches
- Dietary Approaches
- Medication
- Complementary and Alternative Medicine
Behavior and Communication Approaches
According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD provide structure, direction, and organization for the child in addition to family participation.
Applied Behavior Analysis (ABA)
An important treatment approach for people with an ASD is Applied Behavior Analysis (ABA) as it has become widely accepted among health care professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills, while tracking and monitoring for progress.
There are different types of ABA. Following are some examples:
Verbal Behavior Intervention (VBI): VBI is a type of ABA that focuses on teaching verbal skills.
Discrete Trial Training (DTT): DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors while incorrect answers are ignored.
Pivotal Response Training (PRT): PRT aims to increase a child’s motivation to learn, monitor their own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.
Early Intensive Behavioral Intervention (EIBI):This is a type of ABA for very young children with an ASD, usually younger than five, and often younger than three.
Other therapies that can be part of a complete treatment program for a child with an ASD include:
Speech Therapy
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
Occupational Therapy:
Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.
Developmental, Individual Differences, Relationship-Based Approach (DIR; also called “Floortime”):
Floortime focuses on emotional development (feelings, relationships with caregivers) as well as to focus upon how your child deals with sights, sounds, and smells.
Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH)
TEAACH uses visual cues to teach skills, such as picture cards to teach a child how to get dressed by breaking information down into small steps.
Sensory Integration Therapy:
Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.
The Picture Exchange Communication System (PECS)
PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation
Dietary Approaches
Some dietary treatments have been developed by reliable therapist, however, many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another.
Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.
If you are thinking about changing your child’s diet, talk to the doctor first. Or talk with a nutritionist to be sure your child is getting important vitamins and minerals
Medications For Autism and ASD
There are no medications that can cure ASD or treat the core symptoms, but there are medications that can help some people with ASD function more easily, such as medication to manage high energy levels, inability to focus, depression, or seizures.
Medications might not affect all children in the same way so you must work with a medical team who has experience in treating children with ASD, as these medications must be closely monitored to determine each child’s progress and reactions to the medications and to be sure that any negative effects do not outweigh the benefits.
Remember that children with ASD can get sick or injured just like children without ASD so regular medical and dental exams should be part of a child’s treatment plan. Sometimes, it’s hard to determine whether or not a child’s behavior is related to the ASD or is caused by a separate health condition, such head banging, which could be a symptom of the ASD, or it could be a sign that your child is having headaches. In those cases, a thorough physical exam is needed. Monitoring healthy development means not only paying attention to symptoms related to ASD, but also to the child’s physical and mental health, as well.
Complementary and Alternative Treatments
To relieve the symptoms of ASD, some parents and health care professionals use treatments that are outside of what is typically recommended by the pediatrician. These types of treatments are known as complementary and alternative treatments (CAM).; and may include special diets, chelation (a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (like deep pressure).
These types of treatments are very controversial. Current research shows that as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, check it out carefully, and talk to your child’s doctor.
If You’re Concerned That Your Child Has Autism:
Research has proven that early intervention services can greatly improve development. If you think your child may have an ASD, contact your pediatrician for a thorough evaluation. You can request a referral for a specialist for an in-depth evaluation if you remain concerned. Don’t wait for a diagnosis; take the steps now.
First, call your state’s early childhood intervention system for a free evaluation to see if your child qualifies for services. You don’t need a referral to contact early intervention.
If your child is under three, call National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.
If your child is three or older, contact your local public school system even if your child isn’t yet school-aged. They’re well-equipped to handle it.
If you’re unsure who to contact, call National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.
Additional ASD And Autism Resources:
While Autism Speaks is a nonprofit that raises awareness of autism and ASD, while looking for a cure, however we at Band Back Together do not include it in our references on purpose as we do not believe that people who have ASD need or want to be cured.
The Complete Guide to Asperger’s Syndrome by Tony Attwood. A heavy read, almost like a textbook.
Look Me in the Eye: My Life with Asperger’s by John Elder Robison. Written by a man who was not diagnosed with Asperger Syndrome until he was an adult. It’s a great first-person account.
The OASIS Guide to Asperger Syndrome: Completely Revised and Updated: Advice, Support, Insight, and Inspiration by Patricia Romanowski Bashe and Barbara L. Kirby. This book was written by two mothers of children with Asperger Syndrome. It compiles information they’ve gathered from studies, personal experience, and the experiences of the many, many parents who come to the website they founded — one of the first resources for parents of children with AS.
The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition and The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Kranowitz.
