Autism is a neurodevelopmental disorder that affects one’s ability to communicate and interact socially. It is described as a spectrum disorder, which means that it manifests itself across a wide range of behaviors from mild to severe.

Diagnosis

person-puzzle-brain-graphic-iconNo one is sure of what causes autism yet. Researchers are working to understand the etiology of autism, but so far nothing has been consistent across all cases. Human physiology is a long chain of intricate events, starting with genetic code and ending in the outward appearances and personalities we see everyday. Along the way, molecules are combined and taken apart, cells are built, proteins synthesized, hormones regulated, neural function promoted, and on down the line. We know that genetics play a significant role; unfortunately no genes have been explicitly implicated. It is also known that exposure to certain environmental toxins such as thalidomide is associated with a later diagnosis of autism. We cannot rule out the possibility that other toxins may again cause similar symptoms.

 
Diagnosis

With the documented benefits of early intervention for learners with an autism spectrum disorder (ASD), the earlier the diagnosis can be made, the better. As there is no genetic or medical test for ASDs, clinicians rely on behavioral observation, generally quantified through the use of a standardized diagnostic scale, to arrive at the diagnosis. In general, diagnosis is a two step process: 1) screening, and 2) a comprehensive diagnostic evaluation.

 

 

Screening

Most “well child” check-ups include a developmental screening. Parent observations, impressions and concerns are an essential part of the screening and may be supported by such “documentary” information as family videos and baby albums. Once concerns are voiced, the parents may be asked to complete any of a number of standardized screening instruments such as the Checklist for Autism in Toddlers (CHAT) or the Screening Tool for Autism in Two-Year-Olds (STAT). If following the screening process there continues to be concern, a comprehensive diagnostic evaluation is indicated.

 
Comprehensive Diagnostic Evaluation

In order to rule in or rule out an ASD diagnosis a comprehensive diagnostic evaluation is required. This evaluation is generally done by a team of trained professionals that may include a psychologist, a neurologist, a psychiatrist, a speech and language pathologist, or other relevant professional (e.g., occupational therapist). Given the complexity often associated with ASDs, special attention during the evaluation should be paid to neurological testing along with in-depth cognitive and language testing. Other tests may include a hearing evaluation and a lead screening. Lastly, assessments specifically designed to reliably identify presence of an ASD are used. Primary among these is the Autism Diagnostic Observation Schedule (ADOS) but the Autism Diagnostic Interview-Revised (ADI-R) and the Childhood Autism Rating Scale (CARS) are also commonly used.

 
What next?

Hearing the diagnosis of autism is an overwhelming and potentially devastating blow to families. However, the time of diagnosis is also the time to stay focused and ask questions. In addition to providing the diagnosis, members of the evaluation team are a family’s best, most immediate source for information, recommendations, direction and referrals. It is important that families not leave this meeting without the names and numbers of trained professionals, programs and related resources in their geographic area. Early diagnosis can lead to effective early intervention which can lead to significant gains for the newly diagnosed individual but only if the family now knows where, and to whom, to turn.

From “What Is Autism Spectrum Disorder?” at the National Institutes of Mental Health, available online here.

 

 

Intervention

Your child has received a diagnosis of autism. You are faced with many choices that can seem overwhelming. You have taken an important first step by seeking out information. If you learn as much as you can, visit schools and facilities offering intervention, and consider all your options, you’ll be ready to make a decision about the treatment options that most suit your child’s needs. It may also be comforting to know that The American Academy of Pediatricians advises that recent evidence indicates that “early and intensive behavioral and educational intervention can make a significant positive impact on long-term outcomes.”

Potential Members of the Intervention Team

The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that several types of professionals and services be involved in taking care of a child with autism. This team should be under the direction of one professional that will develop, organize, advocate for, and watch over your child’s specific program. The team may include some or all of the following professionals: Developmental Pediatrician, Child Psychiatrist, Board Certified Behavior Analyst, Child Psychologist, Special or General Education Teacher, Occupational Therapist, Physical Therapist, Speech/Language Therapist, Social Worker, Neuropsychologist.

 

Picture Exchange Communication Systems (PECS)

One of the main areas affected by autism is the child’s ability to communicate. PECS helps get basic language underway as well as provides a way of communicating for those children that do not talk. PECS uses ABA-based methods to teach children to exchange a picture for something they want—such as an item or activity. This approach enables a child with autism to communicate more easily.

 
Occupational Therapy

Children with autism may benefit from working with an occupational therapist. An occupational therapist is a trained and licensed healthcare professional who evaluates the impact of the disorder on the activities of a child or adult with autism at home, school, and work. The occupational therapist works with other members of the team to reduce physical and psycho-social disabilities through activities with specific goals.

 
Physical Therapy

A physical therapist helps children with autism to develop muscle strength, coordination, and motor skills.

Frequently Used Interventions

Applied Behavior Analysis

In general, interventions based upon the principles of applied behavior analysis (ABA) have been documented as highly effective in teaching a range of academic, social, communicative, motor, and adaptive skills. The central theory behind ABA is that “Behavior rewarded (reinforced) is more likely to be repeated than behavior ignored.” Behavioral intervention seems to help children “learn to learn.” Research has shown interventions based upon the principles of ABA consistently teach new skills and behaviors to children with autism. ABA is an intensive approach to intervention and children usually work about up to 40 hours a week with a trained, ideally Board Certified, professional. Waiting lists for Board Certified ABA therapists can be long because the demand is so great.

 
Speech and Language Therapy

Communication challenges are at the heart of an autism spectrum diagnosis and may contribute to behavior problems. The addition of a speech/language therapist to your child’s team may help improve his or her communication skills. Some speech therapists who work with children with autism incorporate the principles ABA into their practice to encourage positive behavior as the children either successfully imitate speech, or communicate properly on their own. A child’s progress in language acquisition can be rated with a tool used by many speech therapists, and other members of the team. The Assessment of Basic Language and Learning Skills (ABLLS) is an assessment, curriculum guide, and skills tracking system used for children with autism. ABLLS allows therapists and teachers to carefully track a child’s specific task objectives.

 
Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)

TEACCH is a structured teaching approach based on the idea that the environment should be adapted to the child with autism, not the other way around. The goal of the TEACCH approach is to provide the child with the necessary skills to understand his or her world and other people’s behavior. Because TEACCH tends to build upon skills children with autism already have, some families may see it as more congenial or “congruent” approach than the more structured interventions associated with ABA.

 
Picture Exchange Communication Systems (PECS)

One of the main areas affected by autism is the child’s ability to communicate. PECS helps get basic language underway as well as provides a way of communicating for those children that do not talk. PECS uses ABA-based methods to teach children to exchange a picture for something they want—such as an item or activity. This approach enables a child with autism to communicate more easily.

 
Occupational Therapy

Children with autism may benefit from working with an occupational therapist. An occupational therapist is a trained and licensed healthcare professional who evaluates the impact of the disorder on the activities of a child or adult with autism at home, school, and work. The occupational therapist works with other members of the team to reduce physical and psycho-social disabilities through activities with specific goals.

 
Physical Therapy

A physical therapist helps children with autism to develop muscle strength, coordination, and motor skills.