Autism Spectrum Disorder Diagnosis

What Is Autism Spectrum Disorderasd

Autism Spectrum Disorder ASD is a neurological disorder that is characterized by consistent challenges in social interaction, communication, and repetitive and restrictive patterns of behaviors. ASD is considered to be a lifelong disorder. But it varies in severity depending on the individual

ASD is a developmental impairment brought on by variations in the brain. Some people with ASD have a recognized distinction, like a genetic disorder. Other factors are still unknown. ASD is thought to have a number of underlying reasons that interact to affect how people typically develop. There is still a lot we dont know about these factors and how they affect people with ASD.

Adolescents and young adults with ASD may struggle to make and keep friends, communicate with peers and adults, or comprehend what is appropriate behavior in the workplace or at school. They might be noticed by medical professionals if they also have disorders like anxiety, depression, or Attention-deficit/hyperactivity disorder, which affect people with ASD more frequently than those without ASD.

Understanding Autism Spectrum Disorders

Autism is not a single disorder, but a spectrum of closely related disorders with a shared core of symptoms. Every individual on the autism spectrum has problems to some degree with social interaction, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.

If youre a parent dealing with a child on the autism spectrum, you may hear many different terms including high-functioning autism, atypical autism, autism spectrum disorder, and pervasive developmental disorder. These terms can be confusing, not only because there are so many, but because doctors, therapists, and other parents may use them in dissimilar ways.

But no matter what doctors, teachers, and other specialists call the autism spectrum disorder, its your childs unique needs that are truly important. No diagnostic label can tell you exactly what challenges your child will have. Finding treatment that addresses your childs needs, rather than focusing on what to call the problem, is the most helpful thing you can do. You dont need a diagnosis to start getting help for your childs symptoms.

What’s in a name?

Minor Changes Since Publication

: We linked to the NICE guideline on supporting adult carers in , and .

: Title changed from Autism: recognition, referral, diagnosis and management of adults on the autism spectrum to Autism spectrum disorder in adults: diagnosis and management, for clarity and consistency with other guidance on this topic.

Your responsibility: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

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Section : Screening And Diagnosis

The AAP recommends screening all children for symptoms of ASD through a combination of developmental surveillance at all visits and standardized autism-specific screening tests at 18 and 24 months of age in their primary care visits because children with ASD can be identified as toddlers, and early intervention can and does influence outcomes. This autism-specific screening complements the recommended general developmental screening at 9, 18, and 30 months of age. Efficient screening of all children would be aided by inclusion of valid screening tools in the electronic health record with appropriate compensation for the staff and professional time necessary to complete the administration, scoring, and counseling related to screening.

Screening tools are designed to help caregivers identify and report symptoms observed in children at high risk for ASD. The screens are based on early manifestations of symptoms of core deficits related to social communication. Some of these early symptoms that may alert the provider to the risk for ASD have been called red flags .

The authors of the 2019 AAP developmental surveillance and screening clinical report discuss strategies for billing for screening and counseling in primary care. The following sections describe tools commonly used to screen and diagnose ASD and emphasize the importance of ongoing surveillance, especially in children at high risk.

Medical Management Of Co

Co-occurring medical and other conditions, such as seizures, sleep disorders, gastrointestinal disorders, feeding disorders, obesity, catatonia, and others, have a significant effect on the health and quality of life for children and youth with ASD and their families., In this section, the co-existing conditions commonly observed in children and youth with ASD are described, and anticipatory guidance and management strategies that primary care providers may consider are provided.

Seizures

GI Symptoms

GI symptoms, such as abdominal pain, constipation, diarrhea, gastroesophageal reflux, and feeding problems, are more commonly reported in children and adolescents with ASD than in those with developmental delay or typical development. A large prospective cohort study revealed differences as early as 6 to 18 months of age in stooling patterns and feeding behaviors in children who were later diagnosed with ASD. Because of language delays and atypical sensory perception or report of pain, individuals with ASD may be less likely to report specific GI discomfort and may present with agitation, sleep disruption, or other behavioral symptoms rather than GI discomfort. Characteristics of ASD that might affect GI symptoms include resistance to change , comorbid anxiety , and altered sensory perception . At present, there is no evidence of an association of ASD with celiac disease, specific immune dysfunction, or motility disorders in children with ASD.

Feeding Disorders

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Interventions For Behaviour That Challenges

1.5.1.

Before initiating other interventions for , address any identified factors that may trigger or maintain the behaviour by offering:

• the appropriate care for physical disorders
• treatment for any coexisting mental disorders, including psychological and pharmacological interventions , informed by existing NICE guidance
• interventions aimed at changing the physical or social environment when problems are identified, such as:

advice to the family, partner or carer

changes or accommodations to the physical environment .

1.5.2.

First offer a psychosocial intervention for the behaviour that challenges if no coexisting mental or physical disorder, or problem related to the physical or social environment, has been identified as triggering or maintaining behaviour that challenges.

1.5.3.

When deciding on the nature and content of a psychosocial intervention to address behaviour that challenges, use a functional analysis. The functional analysis should facilitate the targeting of interventions that address the function of problem behaviour by:

• providing information, from a range of environments, on:

factors that appear to trigger the behaviour

the consequences of the behaviour

Psychosocial interventions for behaviour that challenges

Combined interventions for behaviour that challenges

The Structure And Organisation Of Specialist Teams

What structure and organisation of specialist autism teams are associated with improvements in care for autistic people?

Why this is important

The Department of Healths autism strategy proposes the introduction of a range of specialist services for autistic people these will usually be built around specialist autism teams. However, there is little evidence to guide the establishment and development of these teams. There is uncertainty about the precise nature of the population to be served , the composition of the team, the extent of the teams role , the interventions provided by the team, and the teams role and relationship with regard to non-statutory care providers. Therefore it is likely that in the near future a number of different models will be developed, which are likely to have varying degrees of success in meeting the needs of autistic people. Given the significant expansion of services, this presents an opportunity for a large-scale observational study, which should provide important information on the characteristics of teams associated with positive outcomes for autistic people in terms of access to services and effective coordination of care.

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Treatment Considerations: Asha’s Position

Several treatment options and approaches lack scientific evidence of validity and are not endorsed by ASHA. They are Auditory Integration Training , Facilitated Communication , and Rapid Prompting Method . Below are brief descriptions of these treatments, along with ASHA’s position on each. Click on the hyperlinks provided to read ASHA’s full position statements.

Auditory Integration Training

Auditory Integration Training is a type of sensory integration treatment that involves exercising the middle ear muscles and auditory nervous system to treat a variety of auditory and nonauditory disorders, including auditory processing problems, dyslexia, learning disabilities, attention-deficit disorders, and ASD. The treatment typically involves listening to specially filtered and modulated music for two 30-minute sessions per day for 10 consecutive days. The objective is to reduce distortions in hearing and hypersensitivity to specific frequencies so that the individual will be able to perceive soundsâincluding speechâin a normal fashion.

According to ASHA’s position statement titled, Auditory Integration Training, “The 2002 ASHA Work Group on AIT, after reviewing empirical research in the area to date, concludes that AIT has not met scientific standards for efficacy that would justify its practice by audiologists and speech-language pathologists” .

Facilitated Communication

Rapid Prompting Method

Where Can I Get More Information

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:

Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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What Is Autism Spectrum Disorder Previously Called Autism And Pervasive Developmental Disorders

Autism spectrum disorder is a neurodevelopmental disorder characterized by the following:

• Difficulties in social communication differences, including verbal and nonverbal communication.
• Deficits in social interactions.
• Restricted, repetitive patterns of behavior, interests or activities and sensory problems

Many of those with ASD can have delayed or absence of language development, intellectual disabilities, poor motor coordination and attention weaknesses.

How Is Autism Treated

Currently there is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. Some symptoms can be treated with medication. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.

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What Is The Prevalence Of Asd

The Centers for Disease Control and Prevention estimate that 1 in 44 American children currently suffer from autism. According to research, around 1 in 100 children have ASD around the world. ASD is 4 times more prevalent in boys rather than girls. However, it is reported to occur in all racial and ethnic groups.

Cultural And Linguistic Considerations

Awareness of individual and cultural differences is essential for accurate diagnosis. For example, direct eye contact with an authority figure may be considered disrespectful in some cultures, and silence may be valued as a sign of respect. In a U.S. school system, these behaviors could easily be misinterpreted as socially inappropriate.

The core characteristics of ASD may be viewed through a cultural lens leading to under-, over-, or misdiagnosis . Signs and symptoms that are clearly “red flags” in the U.S. health care or educational system may not be viewed in the same way by someone from a culture that does not formally define the disorder.

Cultural and linguistic variables may contribute to the disparity in the diagnosis of ASD among some racial/ethnic groups . For example, Begeer et al. found that Dutch pediatricians might be inclined to attribute social and communication problems of non-European minority groups to their ethnic origin, while attributing these same characteristics to autistic disorders in children from majority groups.

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Level : Requires Substantial Support

People with ASD level 2 will have more obvious problems with verbal and social communication than those diagnosed with level 1. Likewise, they will find it harder to change focus or move from one activity to the next.

Children with level 2 tend to have very narrow interests and engage in repetitive behaviors that can make it difficult for them to function in certain situations. For example, they may pace back and forth or say the same thing over and over again.

A person diagnosed with ASD level 2 tends to speak in simple sentences and also struggles with nonverbal forms of communication.

Diagnosis Of Autism Spectrum Disorder

Similar to any other mental health disorder, your doctor will diagnose autism spectrum disorder depending on the size and symptoms you or your kid is developing.

As you are already aware, there are a huge number of symptoms associated with autism spectrum disorder that is not exclusively associated with the disease. If your health care advisor believes you have autism, then they will suggest you consult with a psychiatrist or psychologist.

Mental health professionals can diagnose autism spectrum disorder better than anyone else. Your psychiatrist or psychologist is going to monitor all the symptoms and behavior patterns.

• Usually, mental health professionals assess social interactions, communication skills, and behavior patterns.
• The professional is going to give a hearing, speech, language, and development test to your kid over the person who is struggling with autism.
• The American Psychiatric Association has released specific criteria for the diagnosis of mental health disorders, and your health care professional is going to follow that.
• Lastly, your healthcare provider might suggest you go for genetic testing to take a look at any genetic disorder.

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Are Siblings At Greater Risk For Autism Spectrum Disorder

The truth is that genetics do play a role in autism. When one child is diagnosed with ASD, the next child to come along has about a 20% greater risk of developing autism than normal. When the first two children in a family have both been diagnosed with ASD, the third child has about a 32% greater risk of developing ASD.

Diagnosing Autism Spectrum Disorder

In order to determine whether your child has autism spectrum disorder or another developmental condition, clinicians look carefully at the way your child interacts with others, communicates, and behaves. Diagnosis is based on the patterns of behavior that are revealed.

If you are concerned that your child has autism spectrum disorder and developmental screening confirms the risk, ask your family doctor or pediatrician to refer you immediately to an autism specialist or team of specialists for a comprehensive evaluation. Since the diagnosis of autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area.

The team of specialists involved in diagnosing your child may include:

Need urgent help? .

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Developmental Screening In Pediatric And Primary Care Practice

Integrating routine developmental screening into the practice setting can seem daunting. Following are suggestions for integrating screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care.

An example of how developmental screening activities might flow in your clinic:

• AAP Coding Fact Sheetsexternal icon

Involving Families in Screening

Research indicates that parents are reliable sources of information about their childrens development. Evidence-based screening tools that incorporate parent reports can facilitate structured communication between parents and providers to discover parent concerns, increase parent and provider observations of the childs development, and increase parent awareness. Such tools can also be time- and cost-efficient in clinical practice settings.2,3,4 A 1998 analysis found that, depending on the instrument, the time for administering a screening tool ranged from about 2 to 15 minutes, and the cost of materials and administration ranged from $1.19 to $4.60 per visit.5

Interventions For Coexisting Mental Disorders

1.6.1.

Staff delivering interventions for coexisting mental disorders to autistic adults should:

• have an understanding of the core features of autism and their possible impact on the treatment of coexisting mental disorders
• consider seeking advice from a specialist autism team regarding delivering and adapting these interventions for autistic people.

Psychosocial interventions for coexisting mental disorders

1.6.2.

For autistic adults and coexisting mental disorders, offer psychosocial interventions informed by existing NICE guidance for the specific disorder.

1.6.3.

Adaptations to the method of delivery of cognitive and behavioural interventions for autistic adults and coexisting common mental disorders should include:

• a more concrete and structured approach with a greater use of written and visual information
• placing greater emphasis on changing behaviour, rather than cognitions, and using the behaviour as the starting point for intervention
• making rules explicit and explaining their context
• using plain English and avoiding excessive use of metaphor, ambiguity and hypothetical situations
• involving a family member, partner, carer or professional to support the implementation of an intervention
• maintaining the persons attention by offering regular breaks and incorporating their special interests into therapy if possible .

Pharmacological interventions for coexisting mental disorders

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