Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Join Our Email List

Understanding Autism

Autism Spectrum Disorders (ASDs) can be difficult to understand and encompass a wide range of disorders that vary from mild to severe. Today, ASDs affect as many as 1 in every 100 children. Nearly every 20 minutes, a new case of autism is diagnosed and is the fastest growing serious developmental disability in the United States. Once considered rare, autism is now more common than childhood cancer, juvenile diabetes or Down syndrome. Extensive research is being conducted worldwide to understand the reasons for this alarming rate of growth but definitive explanations are still unknown.

Important advances in diagnosis and treatment have been made however. Today, research indicates that a reliable diagnosis can be made as early as 18 months. Typically though, diagnoses do not occur until the ages of 3-4 or even older. This is a reflection of the symptoms of ASD which can be unclear to parents of very young children.

As a parent of a child or young adult who displays evidence of one of the Autism Spectrum Disorders, you will want help in understanding these. Children with ASD have challenges in three main developmental areas:

  • Delayed or deviant language development
  • Disinterest in other people and/or poor social skills
  • Rigid, repetitive, behaviors that are difficult to change

There are three main diagnoses that make up the Autism Spectrum:

  • Classical Autism
  • Asperger’s Disorder
  • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

Classical Autism

Children with classical autism have little to no communication skills, show a preference for objects over people and engage in the same behaviors over and over again. High-functioning autism refers to children who have average to above average cognitive abilities (intelligence).

Asperger’s Disorder

Children with Asperger’s Disorder have average to above average cognitive abilities, have difficulty reading non-verbal cues, talk too much about a narrow range of topics, sound like “little professors”, have difficulty making and maintaining friendships, and show unusual specialized interests (e.g. bus schedules, the Titanic).

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

Sometimes referred to Atypical Autism- Children with PDD-NOS have some characteristics of either autism or Asperger’s Disorder, but do not have enough symptoms to be meet the criteria for the either disorder.

Early SignsEarly Signs of Autism Spectrum Disorders

There is no single sign or symptom that a young child is presenting with, or is at risk of developing, an autism spectrum disorder. Rather, children present with a range of symptoms, including delayed or unusual language development, poor social development and rigid, repetitive behavior patterns.

Researchers are currently looking into the earliest possible “warning signs” that a child is at risk of developing ASD. While there are no conclusive signs, research has identified the lack of response to name by 12 months of age and the lack of sharing interests/attention by 18 months of age as two of the most critical symptoms of possible ASD.

Below is a list of some of the early symptoms that are commonly seen in children with ASD. Please note that this list is not meant to be used for making a diagnosis. Presence of one or even a few of these symptoms does not mean that a child does have ASD. However, if a child does present with several of the symptoms below, further evaluation may be warranted.

0 to 4 months of age:

  • Little to no eye contact
  • Does not look at people when they are making social “sounds” such as humming or clapping
  • Shows more interest in objects than people
  • Does not show a social smile (smiling back to someone who smiles at them, without being cooed at or touched)

5 to 12 months of age:

  • Does not look at people while smiling (baby may smile in response to something fun, but does not also combine this with eye contact)
  • Does not babble (or the babble does not sound like “talking”)
  • Lacks joint attention: Does not look at something interesting, such as a dog, then look at parents, and then back at the dog as a way to get parents to join in looking at the dog
  • Lacks social attention: Does not follow the parent’s eye contact when they are looking at something, such as whey they try to point out an airplane in the sky
  • Does not respond to their own name
  • Does not point using the index finger
  • Does not show a caring or concerned reaction to other people crying

12 to 24 months of age:

  • Does not point to share interests, such as pointing to a slide on the playground
  • Does not use single words by 16 months: no two-word spontaneous phrases (“go car,” “look doggie”) by 24 months

Other Developmental Signs:

  • May develop language normally and then lose these skills
  • Repetitive body movements (hand flapping, spinning)
  • Fixation upon a single object, such as a red block or a toy school bus
  • Cannot tolerate change, such as a new toothbrush or Mom getting a new haircut
  • Oversensitivity to texture, lights, smells and/or sounds
  • Delayed motor skills (late walking, riding a tricycle or learning to jump)
  • Does not interact with peers as expected, such as asking for friends to come over, playing together, taking turns and interacting

How to Get a Diagnostic Evaluation for an Autism Spectrum Disorder

— By Dr. Laurie Stephens

The prospect of seeking out a diagnostic evaluation for a child can seem overwhelming and scary to many parents. Most parents say that they did not even know what their first steps should be. As with many areas of getting services for children with Autism Spectrum Disorders, the exact procedure to getting a diagnosis may vary from state to state. Below you will find the general guidelines to follow to ensure that a child receives the most accurate diagnosis.

I) Talking with Your Pediatrician

  • As soon as you first suspect that your child may be developing differently, you should immediately raise your concerns with your pediatrician.
  • It is recommended that you make a specific appointment to discuss your concerns, rather than bringing them up at your “well baby visit.”  This way your pediatrician will be prepared to listen and spend the time it takes to review and assess your concerns.
  • If they have not done so already, your pediatrician should be encouraged to use a screening tool to determine if your child shows any developmental delay and is in need of further evaluation.
  • There are two kinds of screening tools 1)general screens which assesses for any developmental delays and 2)specific screening instruments which look for signs of a particular disorder. The two most widely recommended general screening tools are:
    • Ages and Stages Questionnaire (ASQ); Bricker (99), Paul H. Brookes Publishing
    • Parents Evaluation of Developmental Status (PEDS), Glascoe, Ellsworth & Vandermeer Press, Ltd
  • The two most widely recommended screening tools that are specific to autism are:
    • Checklist for Autism in Toddlers (CHAT); Baron-Cohen (92), British Journal of Psychiatry
    • Modified Checklist for Autism in Toddlers (M-CHAT) Robins, Fein, Barton & Green (01); Journal of Autism and Developmental Disorders

II) Pursuing a Clinical Diagnosis

  • Most pediatricians do not do a full, clinical assessment of a child. Rather, they screen the child to determine if further evaluation is needed, and provide recommendations as to where to go next. Families will often be referred to one of the following professionals for a full, clinical assessment to determine if the child meets the diagnostic criteria for any autism spectrum disorder:
    • Child Psychiatrist
    • Child Clinical Psychologist
    • Pediatric Neurologist
    • Developmental Pediatrician
  • Many clinics that specialize in the differential diagnosis of ASD often have extremely long waiting lists. You should always place your child on the waiting list as soon as possible, even if you are going to seek services at another clinic if they have a shorter waiting list. However, it is important that you remember to cancel your child’s place in the queue if you do decide to go to a different facility. Many clinics also have “cancellation appointments” which means that a child from the waiting list is called when another family cancels their appointment. Be sure to ask the clinic if they offer cancellation appointments. If you do make this kind of appointment, you should be prepared to show up at the clinic on very short notice.
  • Be sure to show up to your appointment ready. Have all necessary paperwork filled out completely. Also, remember that you will be asked many questions about your child’s development. If you aren’t sure whether you will recall all the relevant details, feel free to bring in baby record books, medical records and even early videotapes of your child (such as a first birthday party).

III) Diagnostic Evaluation

  • No specific “test” can be given to determine if a child has ASD. The diagnosis should be made through a series of assessments, observations and a detailed developmental history.
  • Since there is no clear test for ASD, clinical judgment plays an important role in the diagnostic process. This means that clinicians need to rely on their knowledge and experience with the full range of children with ASD in order to make an accurate diagnosis. Seeking out a professional who specializes in the diagnosis of ASD is highly recommended.
  • Remember there is no one symptom that leads to a diagnosis (e.g. lack of eye contact), nor the presence of any one symptom that rules out the diagnosis (e.g. does not engage in self-stimulatory behavior). A child must display several symptoms in each of the three core areas (language, social, behavioral) in order to receive a diagnosis within the autistic spectrum.
  • Researchers are identifying some of the earliest markers of autism, which means that children can get an accurate diagnosis at a younger age. It is important to know the early warning signs of autism, so that you can seek out screening and diagnosis at the earliest time possible.
  • A thorough diagnostic evaluation should consist of the following components:
    • Review of the child’s medical records, school records and previous evaluation reports
    • A comprehensive developmental history collected by interviewing the parents or primary caregivers. This may include administration of the Autism Diagnostic Inventory (ADI) (Lord & Rutter)
    • Administration of the appropriate module of the Autism Diagnostic Observation Schedule (ADOS) (Lord, Rutter & DiLavore)
    • Rating scales filled out by parents, teachers and children when appropriate. These rating scales should include behavior scales, social skills scales, child development checklists, and adaptive living scales
    • A school observation
    • Psycho-educational/Neuro-psychological testing when indicated (cognitive assessments are not necessary in the diagnosis of ASD)
    • A feedback session with the family to share results, clinical impressions and provide recommendations

A detailed written report providing the developmental history, medical history, current presentation, results from all assessments, the diagnostic decisions and recommendations.

What to do is your child is diagnosed with ASD?

If your child is diagnosed with any of the Autism Spectrum Disorders, early intervention by trained professional is key to enabling the child with autism to achieve their fullest potential.  Intervention during the time when the brain displays the most plasticity affords the opportunity to “rewire” the brain often resulting in the children being able to make significant gains in many areas.

  • As more and more children are being diagnosed at younger ages, there is a greater demand for intensive early intervention services, particularly for those children who receive the diagnosis under the age of three.
  • Research has shown that some very young children with autism, who receive intensive early intervention, may require significantly less intervention when they are school-aged.  Thus, early diagnosis and intervention can make the most critical difference in a child’s long-term prognosis.