Benefits Of Early Accurate Diagnosis
An early, accurate diagnosis of ASD can help families and caregivers access appropriate services, provide a common language across interdisciplinary teams, and establish a framework to help families and caregivers understand the child’s difficulties. Any diagnosis of ASDâparticularly of young childrenâis periodically reviewed by members of the interdisciplinary team because diagnostic categories and conclusions may change as the child develops.
The identification of early behavioral indicators can help families and caregivers obtain appropriate diagnostic referrals and access early intervention services, even before a definitive diagnosis is made . Furthermore, early intervention can improve long-term outcomes for many children . A number of researchers have been reporting the benefits of providing intervention to at-risk infants that targets pre-linguistic communication .
Group Differences In Asd
Among those 1 in 59 children, the CDC also reports breakdowns by gender, race and socioeconomic status. 1 in 37 boys has a diagnosis of ASD compared to 1 in 151 girls. Boys are four times more likely to be diagnosed by the age of 8 than girls. While its unclear why this occurs, there does seem to be a statistically higher prevalence in boys.
Autism occurs in all racial, ethnic, and socioeconomic groups. There are no statistical differences in prevalence among these groups. However, there are large differences in how early and how often minority groups receive a diagnosis. Major disparities in access to early diagnosis and early intervention occur in minority and economically disadvantaged communities, particularly for Hispanic and Latino children. These differences can also translate into differences in educational and social outcomes for minority children with ASD.
Distinction From Other Disabilities
, intellectual disability is a subtype of or , which is a broader concept and includes intellectual deficits that are too mild to properly qualify as intellectual disability, or too specific , or acquired later in life through or like . Cognitive deficits may appear at any age. is any disability that is due to problems with . This term encompasses many that have no mental or intellectual components, although it, too, is sometimes used as a euphemism for intellectual disability.
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Where Can I Find Additional Information On Autism Spectrum Disorders
There are 350 articles available on autism spectrum disorders. The organization, Autism Help has answers to just about any question you may have on autism spectrum disorders.
Books on autism spectrum disorder include:
Thinking in Pictures: My Life with Autism by Temple Grandin, The Way I See It: A Personal Look at Autism and Aspergers by Temple Grandin and Ruth Sullivan and Aspie Teens Survival Guide: Candid Advice for Teens, Tweens, and Parents, from a Young Man with Aspergers Syndrome by J.D. Kraus
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:
Diagnosing Autism Spectrum Disorder is not a brief process. There is no single medical test that can diagnose it definitively instead, in order to accurately pinpoint your childs problem, multiple evaluations and tests may be necessary.
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What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world. NINDS and several other NIH Institutes and Centers support research on autism spectrum disorder.
Nearly 20 years ago the NIH formed the Autism Coordinating Committee to enhance the quality, pace, and coordination of efforts at the NIH to find a cure for autism. The NIH/ACC has been instrumental in promoting research to understand and advance ASD. The NIH/ACC also participates in the broader Federal Interagency Autism Coordinating Committee , composed of representatives from various U.S. Department of Health and Human Services agencies, the Department of Education, and other governmental organizations, as well as public members, including individuals with ASD and representatives of patient advocacy organizations. One responsibility of the IACC is to develop a strategic plan for ASD research, which guides research programs supported by NIH and other participating organizations.
Social And Communication Skills
Impairments in social skills present many challenges for individuals with ASD. Deficits in social skills may lead to problems with friendships, romantic relationships, daily living, and vocational success. One study that examined the outcomes of adults with ASD found that, compared to the general population, those with ASD were less likely to be married, but it is unclear whether this outcome was due to deficits in social skills or intellectual impairment, or some other reason.
Prior to 2013, deficits in social function and communication were considered two separate symptoms of autism. The current criteria for autism diagnosis require individuals to have deficits in three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships.
Some of the symptoms related to social reciprocity include:
- Lack of mutual sharing of interests: many children with autism prefer not to play or interact with others.
- Lack of awareness or understanding of other people’s thoughts or feelings: a child may get too close to peers without noticing that this makes them uncomfortable.
- Atypical behaviors for attention: a child may push a peer to gain attention before starting a conversation.
Symptoms related to relationships includes the following:
- Defects in developing, maintaining, and understanding relationships.
- Difficulties adjusting behavior to fit social contexts.
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Early Signs And Symptoms
Diagnostic features of ASD are present in very young children. Most families and caregivers report observing symptoms within the first 2 years of life and typically express concern by the time the child reaches 18 months of age.
Studies of children with ASD found the following:
- Parents of children with ASD reported first noticing abnormalities in their children’s developmentâparticularly in language development and social relatednessâat about 14 months of age on average .
- Infants at risk forâand later diagnosed withâASD showed a decline in eye fixation within the first 2â6 months of age. This pattern was not observed in typically developing infants .
- Children with autism used fewer joint attention gestures and behaviors as infants and toddlers than did age-matched peers who were typically developing .
- Children with autism showed subtle differences in sensoryâmotor and social behavior at 9 to 12 months of age when compared with typically developing peers .
- Children with autism showed lower rates of canonical babbling and fewer speech-like vocalizations across the 6- to 24-month age range than did typically developing peers .
- Infants at risk forâand later diagnosed withâASD used significantly more distress vocalizations than did children who were typically developing and children who were developmentally delayed this may reflect the difficulties that children with ASD have with emotional regulation .
How Common Is Autism
In 2018, the Centers for Disease Controls Autism and Developmental Disabilities Monitoring reported that approximately 1 in 59 children in the United States has been identified with an Autism Spectrum Disorder . This estimate is a 14% increase from the 1 in 68 rate in 2016 and a 47% increase from the 1 in 88 rate in 2012. In the 1980s autism prevalence was reported as 4 in 10,000. In the nineties, prevalence was 1 in 2500 and later 1 in 1000.
It is problematic to compare autism rates over the last three decades, as the diagnostic criteria for autism have changed with each revision of the Diagnostic and Statistical Manual , which outlines which symptoms meet the criteria for an ASD diagnosis. In 1983 the DSM did not recognize PDD-NOS or Aspergers syndrome, and the criteria for autistic disorder were more restrictive. The previous edition of the DSM, DSM-IV, included autistic disorder, childhood disintegrative disorder, PDD-NOS, and Aspergers Syndrome. Due to inconsistencies in diagnosis and how much we are still learning about autism, the most recent DSM only has one diagnosis, autism spectrum disorder , which encompasses each of the previous four disorders. According to the new diagnostic criteria for ASD, one must have both deficits in social communication and interaction, and restricted repetitive behaviors, interests, and activities .
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Role Of The Slp In Diagnosis
Interdisciplinary collaboration in assessing and diagnosing ASD is important due to the complexity of the disorder, the varied aspects of functioning affected, and the need to distinguish ASD from other disorders or medical conditions.
Ideally, the SLP is a key member of an interdisciplinary team with expertise in diagnosing ASD. When there is no appropriate team available, an SLPâwho has been trained in the clinical criteria for ASD and who is experienced in diagnosing developmental disordersâmay be qualified to diagnose these disorders as an independent professional .
Some state laws or regulations may restrict a licensee’s scope of practice and may prohibit the SLP from providing such diagnoses. SLPs should check with their state licensure boards and/or state departments of education for specific requirements.
See the Assessment section of the Autism Spectrum Disorders Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.
Interdisciplinary collaboration and family involvement are essential in assessing and diagnosing ASD. The SLP is a key member of an interdisciplinary team that includes the child’s pediatrician, a pediatric neurologist, and a developmental pediatrician. There are a number of available algorithms and tools to help physicians develop a strategy for early identification of children with ASD .
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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How Is Autism Treated
There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. 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.
What Are The Best Ways To Treat Autism Spectrum Disorders
Early treatment is the key to treating autism spectrum disorders. Discrete trial training is a type of treatment that separates sessions into a series of desired steps leading to the desired behaviors or responses. Floor time focuses on feelings, caregiver relationships and the sights, sounds and smells in the childs environment. Speech therapy helps with communication problems. If speech is not possible, the picture exchange communication system teaches you how to use symbolic pictures to communicate with others.
Dr. Temple Grandin, author of several books about her own life with Asperger syndrome and the subject of an HBO film, frequently lectures about the need for swift and early intervention.
Although there are no pharmaceutical treatments available, medications are sometimes prescribed to help manage high energy levels, attention problems, depression and seizures. There is some anecdotal evidence that changes in diet can reduce the effects of autism spectrum disorders.
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How To Begin A Diagnosis Process
Adults who suspect they or a loved one might be autistic can do a self-assessment test for adults. A person can find these tests online. While they cannot give a diagnosis, the tests are a good starting point.
A person seeking a diagnosis can take the results of such a test to a primary care doctor who will try to determine whether ASD may be present by:
- enquiring about the symptoms, both current and during childhood
- observing and interacting with the person
- speaking to a loved one
- checking for other physical or mental health conditions that may be causing symptoms
If no underlying physical condition can explain the symptoms, the doctor may refer the person to a psychiatrist or a psychologist to make an ASD diagnosis.
If symptoms are not present in childhood but begin in adolescence or adulthood, this may indicate a cognitive or mental health condition other than ASD.
It may be difficult to find a specialist who can diagnose ASD in adults. Individuals who would like a diagnosis for themselves or a loved one may need to do research to find a provider with experience diagnosing autistic adults.
Another option is to speak to a developmental pediatrician or child psychiatrist who is willing to see adult clients.
Behavior And Communication Approaches
According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation .
Applied Behavior Analysis A notable treatment approach for people with ASD is called applied behavior analysis . ABA has become widely accepted among healthcare professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors to improve a variety of skills. The childs progress is tracked and measured.
There are different types of ABA. Here are some examples:
- Discrete Trial Training DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts, and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.
- Early Intensive Behavioral Intervention This is a type of ABA for very young children with ASD, usually younger than 5 and often younger than 3. EIBI uses a highly structured teaching approach to build positive behaviors and reduce unwanted behaviors . EIBI takes place in a one-on-one adult-to-child environment under the supervision of a trained professional.
- Early Start Denver Model
There are other therapies that can be part of a complete treatment program for a child with ASD:
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How Common Is Autism Spectrum Disorder
Based on most recent CDC report, ASD is estimated to affect about 1 in 54 children, with boys being more likely to have ASD than girls. There were more than 5 million adults in the US, or 2.21% of the population, with ASD as of 2017. Government statistics suggest that the prevalence of ASD has risen 10% to 17% in recent years.
Who Resolution On Autism Spectrum Disorders
In May 2014, the Sixty-seventh World Health Assembly adopted a resolution entitled “Comprehensive and coordinated efforts for the management of autism spectrum disorders ,” which was supported by more than 60 countries.
The resolution urges WHO to collaborate with Member States and partner agencies to strengthen national capacities to address ASD and other developmental disabilities.
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Human Rights And Legal Status
The law treats person with intellectual disabilities differently than those without intellectual disabilities. Their human rights and freedoms, including the right to vote, the right to conduct business, enter into a contract, enter into marriage, right to education, are often limited. The courts have upheld some of these limitations and found discrimination in others. The , which sets minimum standards for the rights of persons with disabilities, has been ratified by more than 180 countries. In , and several states, persons with intellectual disabilities are disenfranchised. The ruled in Alajos Kiss v. Hungary that Hungary violated the applicant’s rights by a blank disenfranchisement of persons with intellectual disabilities who did not hold legal capacity.
What Are The Levels Of Asd
ASD is divided into three levels:
- Level 1. People at this level may have symptoms that dont interfere too much with their work, school, or relationships. This is what most people are referring to when they use the terms high-functioning autism or Aspergers syndrome.
- Level 2. People at this level require some outside support on a daily basis. Examples of outside support include speech therapy and social skills training.
- Level 3. People at this level require substantial outside support on a daily basis. In some cases, support may include full-time aides or intensive therapy.
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How Children With Autism Spectrum Disorder Play
Children with Autism Spectrum Disorder tend to be less spontaneous than other kids. Unlike a typical curious little kid pointing to things that catch their eye, children with ASD often appear disinterested or unaware of whats going on around them. They also show differences in the way they play. They may have trouble with functional play, or using toys that have a basic intended use, such as toy tools or cooking set. They usually dont play make-believe, engage in group games, imitate others, collaborate, or use their toys in creative ways.