About Autism

Autism is a neurological condition typically diagnosed by the age of three. The traits of autism involve multiple major areas of development and impact the way a person:

Engages in reciprocal social interactions with others
Communicates with others;
Expresses their need for sameness and repetition; and
Experiences and response to sensory input from the world around them

One of the hallmarks of autism is that the characteristics vary significantly among different autistic children and adults. No two autistic people are the same. In addition, different autistic individuals will need support to greater or lesser degrees across a wide range of contexts. Autism is found in all cultures, genders, and socio-economic groups.

Five Diagnosis Steps

1. Causes

No 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.

2. Early 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.

3. Screening

Most “well child” check-ups include a developmental screening.

4. Comprehensive Diagnostic Evaluation

In order to rule in or rule out an ASD diagnosis a comprehensive diagnostic evaluation is required.

5. What Next?

After an autism diagnosis, families want to know how to best support their child.

1. Causes

No 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 every day. 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, but 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.

2. Early Diagnosis

With the documented benefits of early intervention for autistic children, the earlier the diagnosis can be made, the better.

As there is no genetic or medical test for autism, 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:

screening, and
a comprehensive diagnostic evaluation.

3. 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. Parents can track their child’s developmental milestones and learn more about possible concerns using the app and other resources in the Learn the Signs. Act Early. toolkit, developed by the CDC. 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). The results of these screening instruments will demonstrate to the clinician whether a comprehensive diagnostic evaluation should be indicated.

4. Comprehensive Diagnostic Evaluation

In order to rule in or rule out an autism 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 autism, 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 autism 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.

5. What Next?

After an autism diagnosis, families want to know how to best support their child.

Hearing the diagnosis of autism can be an overwhelming experience for 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

When your child receives an autism diagnosis, you are faced with many overwhelming choices. Learning as much as you can, visiting schools and facilities offering intervention, and considering all your options, is a great first step so that you can be ready to make a decision about the treatment options that most suit your child’s needs.

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 an autistic child intervention team. 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, and Neuropsychologist.

Frequently Used Interventions

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 an autistic child to communicate more easily.

Occupational Therapy

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

Physical Therapy

A physical therapist helps autistic children develop muscle strength, coordination, and motor skills.

Applied Behavior Analysis

In general, interventions based upon the principles of applied behavior analysis (ABA) have been documented as 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 autistic children. 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 their communication skills. Some speech therapists who work with autistic children incorporate the principles of 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 autistic child, not the other way around. The goal of the TEACCH approach is to provide the child with the necessary skills to understand their world and other people’s behavior. Because TEACCH tends to build upon skills autistic children already have, some families may see it as more congenial or “congruent” approach than the more structured interventions associated with ABA.