The current accepted medical terminology for Autism is Autism Spectrum Disorder (ASD). The use of “Spectrum” accurately describes the wide range of symptoms, levels of impairment or disabilities and their varying degree of severity. As some children can be only mildly impaired by their symptoms, others can suffer from severe disability.
In March 2012, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the ASD affects 1 in every 88 children born in the United States, with a slightly higher rate for males, almost 1 in 54.
With occurrence rates that high, almost everyone knows someone impacted by ASD. Therefore, it is important we all educate ourselves about this common and complex issue.
What are the symptoms of ASD?
As mentioned before symptomology and severity can vary widely from one child to the next. Generally accepted indicators can include:
- Lack of or delay in spoken language
- Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
- Little or no eye contact
- Lack of interest in peer relationships
- Lack of spontaneous or make-believe play
- Persistent fixation on parts of objects
Parents, family members or others in close connection with the child should bring any concerns about the potential for ASD in the child to the attention of their health care provider immediately. Early intervention can reduce or prevent the more severe disabilities associated with ASD and may also improve your child's IQ, language, and everyday functional skills, also called adaptive behavior.
How is ASD diagnosed?
Whether it is the result of an evaluation specifically initiated by a parent or a routine developmental screening during well-child checkups with a health care provider, children who show some developmental problems are referred for additional evaluation.
A well-child checkup should include a developmental screening test, with specific ASD screening at 18 and 24 months as recommended by the American Academy of Pediatrics. A parent’s own experiences and concerns about the child's development are a very important part in the screening process. Notes about the child's development, even family videos, photos, and baby albums help to document behavioral timelines and developmental milestones are all useful to the health care provider in the evaluation of the child. The initial screening instruments used by the doctor for toddlers or preschoolers may consist of:
- Checklist of Autism in Toddlers (CHAT)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Screening Tool for Autism in Two-Year-Olds (STAT)
- Social Communication Questionnaire (SCQ)
- Communication and Symbolic Behavior Scales (CSBS).
To screen for mild ASD or Asperger syndrome in older children, the doctor may rely on different screening instruments, such as
- Autism Spectrum Screening Questionnaire (ASSQ)
- Australian Scale for Asperger's Syndrome (ASAS)
- Childhood Asperger Syndrome Test (CAST).
Comprehensive Diagnostic Evaluation
The next step in diagnosing ASD involves a thorough evaluation to rule out other causes or conditions that could be responsible for the symptoms. This stage utilizes a team of health care professionals that encompasses a wide range of specialties: psychology, neurology, psychiatry, speech therapy. The evaluation at a minimum should include the assessment of cognitive and language levels, and age-appropriate skills needed to complete daily activities independently. Due to complexity in nature of ASD and the possibility of other accompanying illnesses more comprehensive testing may be appropriate: hearing testing, screening for lead poisoning, brain imaging, genetic testing, and in-depth memory, problem-solving, and language testing.
Some helpful resources on ASD screening include the Center for Disease Control and Prevention's General Developmental Screening tools and ASD Specific Screening tools on their website.
How is ASD treated?
Once a child is diagnosed as having ASD, discussions begin on treatment options. As varied and individual as each child, so are the options.
Nonmedical interventions include behavioral and educational approaches as well as focuses on sensory response and communication.
- Applied Behavior Analysis (ABA)is a treatment plan that includes verbal behavior and pivotal response training interventions centered around shaping and reinforcing new behaviors, such as learning to speak and play, and reducing undesirable ones.
- Developmental, Individual Difference, Relationship-based (DIR)/Floortime Modelaims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the child.
- TEACCH (Treatment and Education of Autistic and related Communication handicapped Children)emphasizes adapting the child’s physical environment and using visual cues.
- Interpersonal Synchrony targets social development and imitation skills, and focuses on teaching children how to establish and maintain engagement with others.
Medical interventions, in children ages 5 to 16 who have ASD, with medications such as antipsychotics,antidepressants, and stimulants have been known to help reduce symptoms such as irritability which can often translate into aggression, self-harming acts, or temper tantrums.
Biomedical treatments include modifications in diet such as the gluten-free/casein-free diet, addressing food sensitivities, addition of vitamins and minerals supplements, immune system regulations and others.
Here are several links expanding on the topic of ASD awareness: