Autism Spectrum Disorder-if you have any concerns that your child may have an abnormal course of development, please have your pediatrician screen your child for autism at an early age. From an intervention point of view, the earlier we can get a child engaged in treatment services, the better. When I say early, I want to emphasize that we can diagnose ASD with moderate confidence as young as 12 months old. Ideally, if we can engage a child in treatment between the ages of 12-30 months, studies show that outcomes are greater than if we engage a child in treatment at a later age.
I've been performing Autism Spectrum Disorder evaluations since 2008 (this is Ryan Cole writing this post). Let me reveal my bias for a gold standard of ASD diagnosis that I believe every ASD evaluation should include. The test I use for every single ASD evaluation I perform is called the ADOS (Autism Diagnostic Observation Schedule). The ADOS is a set of activities, questions, and conversations that are designed to elicit behaviors/speech that are typical of an individual with ASD. For small children, we engage in play tasks that elicit these behaviors. For older children/adolescents, we begin to engage in social conversations that can elicit various symptoms of ASD. What is great about the ADOS-the examiner can actually OBSERVE the behaviors that are characteristic of ASD. This is critical for diagnostic certainty, because the examiner can observe behavior (as early as age 12 months) and align behavioral observations with diagnostic criteria. So this is my personal bias, but I won't ever diagnose ASD (with a few rare exceptions) without using this gold standard measure.
Diagnosing Autism Spectrum Disorder isn't an easy process. I've previously mentioned some of the core criteria for ASD, and it may seem like a simple matter of A+B=C. However, there are many disorders that display symptoms related to social communication deficits or restricted/repetitive behaviors. For example: anxiety can present with impaired eye contact and difficulties with back and forth conversation. Early childhood trauma (between the ages of 1-3) can present with social communication deficits or more global developmental delays as well as restricted/repetitive behaviors. ADHD can present with social interaction impairments due to the impact of impulsivity and inattention. I.e. if a child is impulsive, he or she may miss out on social cues or disrupt the natural flow of a conversation. Or if a child is inattentive, he or she may not focus or pay attention to social interactions and may display awkward social behavior as a result. Overall, there are many presentations that can present with symptoms of social communication and restricted/repetitive behaviors. Thus, it is important to be evaluated by a professional with experience in diagnosing neurodevelopmental disorders before developing a belief that your child has a specific disorder.
Sensory aspects of Autism Spectrum Disorder. Individuals with ASD can be sensation seeking or sensation avoidant when it comes to experiencing the five senses. Children that seek out sensory information: examples include touch (they touch everything and appear consumed by certain textures; or they prefer the sensation of pressure), hearing (they produce the same sound over and over again, such as striking something metallic to hear the sound it makes); smelling (usually evidenced by smelling more objects than is typical for one's age); seeing (sometimes evidenced by visual inspection of an item-they might pick up a toy or item and look at it in excessive detail or fixate on certain aspects of the toy; I often see children examining an item by holding it on the same horizontal plane as their eyes-but held to the right or left of their eyes); taste (they often seek out certain tastes and refuse any other food). The same is true in the reverse, aka avoiding sensation. You might see children cover their ears when sounds are loud, demonstrate sensitivity to light or visual displays, avoid clothes that have tags or seams, etc.
The second major category to diagnose Autism Spectrum Disorder (ASD) is referred to as restricted, repetitive patterns of behavior, interests, or activities. This is a large category that is not as easily or succinctly defined as the first category (deficits in social communication and social interaction). If we break this down, the common elements are the presence of repetitiveness and restrictedness. Behaviors often occur repetitively and without social purpose. For example, repetitive behaviors at a factory are productive and lead to a good outcome. Repetitive behaviors become a problem when they occur without any social or shared purpose, and there is often a compulsive quality to them. The individual feels compelled to perform the behavior over and over, and often lacks the insight into the abnormal social nature of the behavior. Repetitiveness can occur with the way one speaks, behaves, or even the manner in which they broach interests. The restricted elements occurs when activities/interests/behaviors become restricted compared to the range that is demonstrated in typically developing child. For example, an individual with ASD may only be interested in two topics and only wants to discuss those topics. They may perform the same activity over and over, and they may struggle to transition to different activities. Or they may have to perform a behavior or sequence of a behaviors in a very specific manner, or repeat the same sentence in exactly the same way repetitively. Another example is a preference for routine and doing things in exactly the same way every time. There is much more to this category-we'll speak to the sensory aspect of this category in our next post.
Examples of social interaction deficits in children with ASD: lack of conversation with peers when conversation is developmentally appropriate; speaking about the same topic in depth and in detail without being able to have conversations about topics that interest other children; struggling to have back and forth conversation (e.g. awkward staring or not making eye contact, perseverating on the same topic, struggling to transition to new topics, interrupting or missing social cues about taking turns in conversation, etc); lack of interaction with other same aged children; lack of facial expression or facial expressions that do not "match" the emotion that is present; desire to share the child's imaginative world with others (via interactive play, talking about the imaginative world, or subtlety including others in the enjoyment of what makes them happy about their play/imagination); struggle to respond "appropriately" to other children when they approach the child to initiate play. These are a few examples that can occur in atypically developing young children. (This is one aspect of ASD, diagnosis can not be made based on this criteria alone).
Brain and Body Integration updated their website address.
