What is autism?
Autism Spectrum Disorders (ASD) are complex disorders of brain development that appear in the first three years of life and affect social and communication skills. Autism can be mild to severe and each person’s profile of strengths and limitations is unique. These disorders include varying degrees of difficulty in: social interaction, verbal & non-verbal communication, repetitive behaviors, responsiveness to the environment/sensory processing, and narrow or overly focused interests. Autism spectrum disorders include Autistic disorder, Rett syndrome, Childhood disintegrative disorder, Pervasive Developmental Disorder- not otherwise specified (PDD-NOS) and Asperger syndrome.
What are signs or symptoms of autism?
Many signs and symptom of autism are shared with other diagnoses and can be indicative of general developmental delays.
- Not speaking or has limited speech
- Loss of words that child was able to say at younger age
- Difficulty expressing basic wants and needs
- Difficulty maintaining words in vocabulary
- Problems following basic directions
- Repeats what others say; repeats memorized text from movies, TV, and/or books
- Speech that sounds different (e.g. robotic or high pitched)
- Does not point to objects to request or show others what they are looking at
- Will pull others to desired objects as a way of indicating what they want
- Has difficulty using gestures to communicate
- Does not look at what others are looking at or pointing to
- Prefers self-directed/isolated play
- Has difficulty initiating or maintaining eye contact at all or in certain circumstances (e.g. up close or is only able to look at others when on their backs)
- May not respond to eye contact, facial expression or being talked or sung to
- Interacts with others only to get wants or needs met
- Does not seek adult feedback around accomplishments (looking at adult after doing something)
- Overly focused on topics, objects or components of objects
- Appears to be overwhelmed, disinterested, or avoidant of interactions with others
- Shows a lack of empathy
- Difficulty staying with group activities and/or showing interest in peers
Response to Environmental/Sensory Input
- Startles/becomes upset at certain noises or appears not to hear them
- Easily becomes upset in loud, busy environments
- Reacts negatively when touched unexpectedly; arches when held; sensitive to different types of clothes
- Craves deep input-seeks small, tight spaces-craves firm hugs and massage
- Constantly “on the go”-seeks rhythmical movement such as swinging, car rides
- Becomes visually focused for long periods on spinning/moving objects; almost always notices small details or examines environment/objects from different angles (turning head or object to focus on the edge or certain component; observes motions of own fingers from side)
- Has a heightened or low response to pain
- Poor motor coordination; appears floppy, has a hard time sitting upright; moves quickly and frequently- often in a disorganized way
- Needs to be taught how to use toys functionally and to play out simple representational schemes such as feeding a doll
- Play is dominated by creating preferred sensory input: spinning objects, creating noises with toys, licking/mouthing non-food items, stacking objects, rubbing objects/surfaces, rocking/spinning body
- Play schemes are limited to a few ideas and expansion of these ideas is difficult
- Has difficulty imitating others
- Has difficulty with toys/play that has multiple steps
- Likes to lay on side and line up toys; limited functional play with toys
- Rigid and/or becomes upset when “order” or routine pattern of play is disturbed
- Difficulties with pretend or imaginative play
- Frequent tantrums
- Difficulty falling or staying asleep
- Difficulty attending to non-preferred activities
- Narrow interests
- Aggressive to others or to self
- Has a strong need for things/actions in the environment to stay the same
- Is drawn to toys/objects/stimuli that is always the same such as letters, numbers, videos
- Repeats body motions or engages in repetitive motions with objects
- Picky eater; eats a limited variety of foods; eats only certain brands; refuses to try new foods
- Engages in rocking, hand flapping, spinning, head banging or other movements when excited, upset, or for no known reason
- Difficulty with transitions or changes in routines
What types of tests/evaluations are performed for children with signs of autism?
Routine developmental exams should be done by your child’s pediatrician. More extensive evaluations may be needed when there is concern by the doctor, parents, and/or teachers to rule out or confirm the diagnosis of ASD.
Speech and Language:
Children demonstrating difficulties with expressive and receptive communication would benefit from an evaluation by a speech and language pathologist. An experienced speech and language pathologist will be able to provide an in-depth examination of your child’s language and social emotional abilities. If you have concerns regarding your child’s ability to engage and relate to others in addition to communication difficulties be sure and communicate this to your therapist as well.
Children demonstrating difficulties processing sensory input, or demonstrating difficulties with motor planning/play skills, self-regulation, social-emotional skills and/or motor coordination would benefit from an evaluation by an occupational therapist. This will provide an extensive picture of your child’s strengths and limitations and can often help to understand many “signs/symptoms” such as difficulty with eye contact or the fascination with lining up objects. Again, communicating concerns to your therapist if you have concerns about your child’s ability to engage and interact with others and if it is possibly indicative of autism is important.
Children demonstrating difficulties attaining gross motor milestones are very clumsy and/or appear to be weak would benefit from a physical therapy evaluation.
Pediatrician/ Neurologist/Psychologist/Psychiatrist/Developmental Pediatrician:
When concerns arise due to a child demonstrating a significant number and/or a wide range of signs and symptoms of autism often a referral to a health care provider who has experience in diagnosing autism is needed to make or rule out the actual diagnosis. Since there is no medical test for autism the diagnosis is based on specific criteria from the DSM IV-TR. The evaluation process often includes a complete physical and neurological examination. A screening tool specific for autism may also be used such as:
- Autism Diagnostic Interview-Revised (ADI-R)
- Autism Diagnostic Observation Schedule (ADOS)
- Childhood Autism Rating Scale (CARS)
- Gilliam Autism Rating Scale
- Pervasive Developmental Disorders Screening Test-Stage 3
Because autism includes a broad spectrum of symptoms and these symptoms can manifest themselves differently in different environments and situations it is important that information be collected over time and reported to the diagnostician. It is very difficult to assess a child’s true abilities in a single evaluation session. If your child is already receiving therapy to address identified areas of developmental challenges be sure to gather reports and/or updated progress reports to send to your healthcare provider. Some physicians work in developmental teams and perform multi-disciplinary evaluations. This will provide a broader and more in-depth picture of your child’s abilities but again this is a one-time snapshot view by a group of people that your child is unfamiliar with. Picking a team or practitioner that is willing to gather information from other healthcare practitioners that have been working with your child will provide a more complete picture of his true abilities and difficulties. Many professionals will not officially diagnose your child if they are very young or have just begun the process of getting therapy. They will wait a period of time (up to a year) to see how your child has responded to therapeutic intervention, which is a good indicator of overall prognosis. Some children may not display the same signs and symptoms after an initial intense period of intervention and no longer fit the criteria to receive the autism diagnosis.
Children who receive the diagnosis of autism or demonstrate significant developmental challenges may also benefit from a range of medical testing to rule out potential contributing factors. This may include genetic testing (to rule out chromosomal abnormalities), metabolic testing, neurological testing (to rule out seizure activity), and/or testing for food/environmental allergies and sensitivities. Ongoing consultations with a health practitioner who specializes in autism and developmental challenges will help determine the appropriate tests to pursue.
What treatments are available for autism?
Though there is no known cure for autism, intervention can help your child make gains in many of the developmental areas. Participating in therapy to address the specific areas of challenge for your child such as speech and language therapy, occupational therapy, physical therapy, and/or play therapy will begin to address your child’s underlying areas of difficulty. Parents may also choose to set up an intense behavioral intervention program such as Applied Behavioral Analysis (ABA®) or TEAACH to work on specific skills. Others may choose a behavioral program that is relationship based such as Developmental, Individualized, Relationship-Based Approach® (DIR/FLOORTIME®) or Relationship Development Intervention®(RDI) which focuses on the child’s ability to connect and interact with others as well as improve underlying capacities. It is important for parents to research the different approaches to understand their underlying philosophies and methods to make sure it is the best match for your child and your family.
What is the prognosis of autism?
Autism is a very complex disorder and has a very broad range of signs and symptoms. People who receive the diagnosis of autism can vary greatly in not only the number of signs and symptoms they have but also in their severity. Response to intervention is another indicator of overall prognosis. Some children will begin to show changes almost immediately and for others the progress is very slow. Beginning intervention at as early an age as possible and with as much intensity as possible is highly beneficial. Receiving input from your therapy team how to best facilitate growth in the identified areas of challenge and following through at home is also a key factor in overall progress.
What other resources are available to further understand autism?
There are several organizations dedicated to providing detailed information and current research in the area of Autism Spectrum Disorders. The list provided under the Resources tab is not exhaustive and the inclusion on this list does not imply endorsement of the organization or of the content of their website by Kick Start Pediatric Therapy Network, PC.