A recent discussion on autism screening created a lot of anxious parents on the support group. So this is an attempt to provide some basic information about autism and its spectrum of disorders.
April is Autism Awareness Month.
What is Autism?
Autism or Autism Spectrum disorder (ASD) is a brain-developmental disorder. As more information about this becomes known, definitions of this condition get revised. The latest revision was done in 2013 but a lot of the information available online may not have been updated to reflect this.
Before the new DSM-5 guidelines came out in 2013, ASD had several different conditions under this label: Autistic Disorder, Asperger’s disorder, Pervasive developmental disorder Not Otherwise Specified (PDD-NOS), Rhett’s syndrome and childhood dis-integrative disorder (CID). We are not going to look at details of each but it’s important to know that after 2013, Rhett’s has been removed from under this umbrella.
The new DSM-5 reflects the scientific consensus that Autism, Aspergers, CID and PDD-NOS are actually one condition with different levels of symptoms severity in two major aspects- 1) Social communication and social interaction 2) restrictive repetitive behaviors(RRB)
A diagnosis of ASD requires the child have both these aspects present. Without RRB’s a diagnosis of ASD cannot be made with just language or social deficits.
What are the signs and symptoms of ASD?
Children with ASD display a wide range of symptoms in their severity and individual abilities and behavior. As we talked about the two aspects of diagnosis earlier, let’s first look at the variety in these areas.
- Social communication and interaction:
- Inability to have a conversation (going back and forth on a topic), less shared interests, reduced affect and failure to initiate or respond to social interactions.
- Reduced eye-contact, abnormalities in body language, inability to understand gestures and non-verbal communication.
- Difficulty with imaginative play, friends and adjusting social behavior to various social contexts.
2. Restricted, Repetitive behaviors (RRB) (At least 2 are needed for a diagnosis)
- Repetitive or stereotypical motor movements, speech or use of objects (lining up toys, flipping objects, repeating speech phrases, echolalia)
- Inflexibility for change in daily routines and verbal patterns and exhibiting extreme distress at small changes.
- Intense fixation that restricts interaction outside of that attachment to unusual objects or interests.
- Aspects of sensory processing disorder like being hypo/hyper sensitivity to pain, sounds, textures, smells and visual stimuli.
Other considerations for a diagnosis are:
- Symptoms must be present in the early years (These may not manifest to their fullest until the demand exceeds the limited capacities)
- Symptoms case clinically significant impairment in functioning.
- Symptoms are not explained by any other diagnosis like intellectual disability, global developmental delays.
How can ASD be indentified?
There is no medical test to diagnose ASD. A screening is mandatory in most countries at 18 months but many symptoms used for diagnosis may not be fully clear till the child is older and higher social or communication demands are being made.
M-CHAT (Modified Checklist for Autism in Toddlers) is a screening tool used at 18 months. The checklist has a series of 20 questions to be answered in yes/no. A high score indicates high risk and the child need to be given in-depth assessment. There is a parent follow-up interview in the new revised version of the M-CHAT (here)
ADOS-G (Autism Diagnostic Observation Schedule- Generic), ADI-R (Autism diagnosis interview-revised) and CARS (childhood autism rating scale) are the standardized assessments used for in-depth check of social, communication and RRB’s.
How can ASD be treated?
There is no cure for ASD. All treatment (medical and non-medical) is geared to allowing better functioning of the person with ASD.
Medical:
Children with ASD could find medication helpful to deal with anxiety, depression or seizures. But medication may not have desired affect so it’s extremely important to be under professional care while medications are prescribed.
Children with ASD also need to be monitored for regular health issues. Frequently due to communication issues, headaches, stomach aches and other routine issues may be missed.
Early Intervention:
A team of speech therapists, occupational and or physical therapists, special educators and psychologists are recommended to start early intervention services as soon as the child is found to be at high-risk. Several types of approaches have been found to be beneficial to children with ASD. Finding one that works for the family and child is an important aspect of early intervention.
Complimentary:
There is new evidence emerging on efficacies of dietary modifications in children with ASD. There are a whole lot of these and each one needs to be looked at carefully before trying.
So what does this mean?
- ASD is different from a pure language and attention deficit. There is a significant aspect of RRB’s to be observed before parents should worry about ASD.
- Use M-CHAT to screen your child at 18 months. In case of red flags, talk to a professional.
- Early intervention is the best and fastest way to deal with symptoms and gain best functional level of skills.
- Research is still current in the field of ASD and things are changing frequently. It is better to be informed and speak to professionals in case of concerns rather than relying on other people’s observations.
Knowing and identifying a plan is better than unsubstantiated worrying. Till then..
Happy Parenting.
Puja.
4/17/2015.
References:
Center of Disease Control and Prevention.
http://www.cdc.gov/ncbddd/autism/index.html
American Psychiatric Association, DSM-5.
http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf
Autism Speaks
https://www.autismspeaks.org/science/science-news/revised-m-chat-improves-autism-screening-toddlers
Kim SK. Recent update of autism spectrum disorders. Korean J Pediatrics, 2015. 58(1): 8-14.
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