Red Flags And Clinical Presentations Of Asd
Overt behavioural signs of ASD are not generally present in the first 6 months of life. Prospective studies of high-risk infants suggest an emerging ASD prodrome in the latter half of the first year of life, which may include delayed motor control , feeding and sleeping difficulties, and/or excessive reactivity or passivity .
Symptoms in the core domains of ASD usually emerge between 12 and 24 months. Initial presentations vary, and there is no one behavioural sign that rules an ASD diagnosis in or out. Parents initial concerns may include language delay, lack of response when the childs name is said, and limited eye contact.
Other early warning signs at different stages of development are summarized in Table 3. Children with ASD may appear relatively typical with respect to early social engagement and communication, then become withdrawn or lose communication or language skills by 18 months . For some children with more advanced language and cognitive skills, ASD signs are relatively subtle in the early years but become more apparent as they reach school age and begin to struggle with increasing social demands .
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.
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Why Does Early Intervention Matter
Autism cant be cured, but people with the condition can live long, fruitful, happy lives. Therapy helps them to achieve those goals, and the earlier the work starts, the better.
Experts say that about half of children with autism who are enrolled in an evidence-based early intervention program from ages 3 to 5 gain enough skills and confidence to head into standard kindergarten programs.
It takes time for families to connect with therapy programs that work. You might bump up against barriers, such as:
- Lack of qualified therapists. You may live in a community with few professionals capable of offering the treatments your child needs.
- Insurance barriers. Your insurance company may require proof that your child has autism, and that could mean many more doctor visits.
- Appointment delays. Some doctors and therapists can see you right away, but others have very long waiting lists.
If your child isnt diagnosed until age 3, and you spend months trying to nail down a treatment program, you could be missing essential intervention windows. Your child could be missing meaningful opportunities to learn.
As the Autism Spectrum Disorder Foundation puts it, early intervention gives your child the potential for a better life. Its important, and there are steps to take to make it happen.
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Very Focused On Or Attached To Unusual Objects
Babies with autism can be very focused on or attached to objects that are unusual for their age, such as long strips of cloth, utensils, chains, rocks, sticks, flowing water, or gadgets they can take apart and put together.
If your child is very focused on or attached to unusual objects, this may be an early sign of autism.
How Is Autism Diagnosed
Like ADHD, Autism cant be diagnosed with a medical test like a blood test or physical exam. Instead, its diagnosed with psychological exams and other observational signs. The DSM-5 changed the way autism is diagnosed significantly. Before the revisions, autism was broken up into different categories based on severity and specific symptoms. However, autism is so variable many clinicians believed the categories werent able to accurately describe autism as a whole. Instead, its now defined as an autism spectrum disorder, which encompasses the full range of possible symptoms and severities.
Its important to note, the criteria for an autism diagnosis looks at deficiencies and uses words like deficit. This language is debated because of the way it may impact people to learn they have a chronic condition that causes deficits. However, being diagnosed with a disorder doesnt mean you are doomed to be deficient, and you may learn to cope with autism on your own or with help in a way that allows you to live a productive and meaningful life.
Heres a breakdown of the diagnostic criteria in the DSM-5:
You must experience persistent deficits in three areas of social communication and interaction. These issues arent just specific to one context, like school or home. Instead, you will struggle with social norms in multiple settings. Social communication and social interaction include:
You must also experience two of the four types of restricted, repetitive behaviors.
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What Is The Role Of A School Psychologist In Bullying
School psychologists have several key roles to play regarding bullying. Most acutely, they counsel children affected by bullying. In this role they engage with the child and talk to them about the bullying and how that makes the child feel. The aim in this respect is to ensure that a child that is being bullied has a safe place where they can talk about their experiences and that they dont internalize the issue.
A school psychologist will also then work to assess the child displaying the bullying behaviors to try to establish underlying causes and ultimately work with them to address the issues. The aim of this work is to help the child with any difficulties they are having and find ways to replace their bullying behaviors with more positive ones. They can also act as a point of contact for parents of all children involved, providing guidance and support materials to help them also effectively deal with the situation.
School psychologists knowledge and experience of child development, psychology and education leaves them uniquely placed to have a role in prevention of bullying. They can provide a useful insight into constructing effective anti-bullying campaigns and activities and can advise around encouragement of more positive social interactions throughout the school environment.
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Current State Of Evidence For Asd Screening
There have been several comprehensive reviews evaluating measures used as ASD screens, specifically for accuracy in particular test populations and contexts, and the evidence for their impact on age of diagnosis, access to intervention services, and long-term outcomes . ASD screening evidence has also been reviewed within previous ASD assessment guidelines and by the US Preventative Services Task Force .
Several conclusions can be drawn. First, ASD screening tools have been evaluated in community contexts that accurately differentiated between toddlers with and without ASD . Second, compared with an open-ended question regarding parental concerns, some screening tools ) detected ASD earlier and more consistently . Third, there is little evidence from clinical trials regarding how ASD screening influences diagnostic timelines and long-term outcomes. One published randomized clinical trial demonstrated younger diagnostic age by implementing the Early Screen for Autism in Toddlers, although differences may have reflected collateral effects rather than the screen itself . The lack of clinical trial evidence was cited by the USPSTF when they found insufficient evidence to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician.
|Table 4. General developmental assessment tools|
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Little Pointing Or Gesturing
Babies usually learn to gesture before they learn to talk. In fact, gesturing is one of the earliest forms of communication. Autistic children generally point and gesture much less than children with nonautistic development. Less pointing can sometimes indicate the possibility of a language delay.
Another indicator of a developmental difference is when an infants gaze doesnt follow you when youre pointing at something. This skill is sometimes called joint attention. Joint attention is often decreased in autistic children.
Is An Early Diagnosis More Likely To Be Incorrect
Multiple studies have confirmed that autism can be reliably diagnosed by age two with little risk of that diagnosis being invalidated later. Though early diagnoses may require a more definite diagnosis as the child grows older.
A 2006 study found that if children with autism were diagnosed at age two, that diagnosis was very likely to remain consistent by age nine.
However, the study noted that diagnostic stability was less reliable for children whose autism involved less severe presentations, meeting the older definition of PDD-NOS. This conclusion means that children with more typical presentations or who did not outwardly display multiple diagnostic criteria were more likely to affect how soon a child would be diagnosed with autism or have a missed diagnosis.
While medical knowledge has improved in the 14 years since that study was published, it is still possible for a child to delay presentation of ASD until age five or later.
One major factor that can prevent a missed diagnosis is input from parents. Because parents can observe some of the subtler signs or pervasive patterns that a single diagnostic test might miss, clinicians can perform a more thorough diagnosis or re-evaluate as the child ages.
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Center For Disease Control: Learn The Signs Act Early Campaign
The Autism Science Foundation is a partner in the CDCs Learn the Signs, Act Early Campaign. The following early indicators of autism were developed by the experts in this program.
Get a PDF of these early warning signs. Also, read more about the importance of early diagnosis.
If your child is two months old, you should consider talking to your doctor if your child exhibits the following behavior:
- Doesnt respond to loud sounds
- Doesnt watch things as they move
- Doesnt smile at people
- Doesnt bring his/her hands to mouth
- Cant hold his/her head up when pushing up on tummy
If your child is four months old, you should consider talking to your doctor if your child exhibits the following behavior:
- Doesnt watch things as they move
- Doesnt smile at people
- Cant hold his/her head steady
- Doesnt make sounds or coo
- Doesnt bring things to his/her mouth
- Doesnt push down with legs when feet are placed on a hard surface
- Has trouble moving one or both eyes in all directions
If your child is six months old, you should consider talking to your doctor if your child exhibits the following behavior:
- Doesnt reach for things
- Shows no affection for caregivers
- Doesnt respond to sounds around her/him
- Doesnt make vowel sounds
- Doesnt laugh or squeal
- Seems unusually stiff or unusually floppy
If your child is nine months old, you should consider talking to your doctor if your child exhibits the following behavior:
If you of autism in older children, teens and adults:
Early Diagnosis Of Autism Helps Children & Their Families
Many parents may worry about their childrens development but feel unsure how to best support their child. If your child is monitored for autism and then diagnosed with the condition around 2 years old, you can begin working with an applied behavior analysis therapist. This professional can help your child learn more words and form sentences, improve emotional regulation so they can manage behaviors, and otherwise support their development.
The earlier this therapy can start, the better for your child. Studies repeatedly show that early treatment results in better long-term outcomes for children with autism.
In 2021, pediatricians are more likely to screen all their patients for autism. Several autism symptoms are subtle or variable, and parents may not notice them. These early screenings are crucial to ensuring cases of autism are recognized and officially diagnosed early, and interventions can then be accordingly delivered.
These screenings are also important for families, so they can understand their childs unique condition and support the childs development. Parents and siblings of children with autism can get support for themselves, so they can better support the child. All of this means better relationships, improved individual self-esteem, and a stronger family unit.
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What Advice Can You Give In Your Clinic
- To accept a referral for a diagnostic assessment â the diagnosis will be beneficial, not detrimental, and there are many risks for the young person if they have undiagnosed ASD that can be reduced with a diagnosis
- To allow the young person as much structure as possible at home and at school
- To give warning as much in advance as possible if there will be a change to their routine in school or at home. This includes change of seating in school, if there is a different teacher, if the plan for the afternoon timetable changes and so on
- Offer visual timetables to explain their structure and routine on a daily basis and talk through any changes to this with them and repeat this as much as possible. If there is a school trip, they need a visual timetable of this ideally a week in advance that they talk through each day
- To ask the school to offer social stories and emotional literacy work on a 1:1 basis to the young person. Social story books and emotional literacy books for children with ASD can easily be sourced online
- Parents could contact the national autistic society at www.autistic.org.uk to gather more information and advice regarding sourcing a diagnosis and how to help their child while awaiting a diagnosis
Seeing Beyond The Quick Diagnosis
There is a tendency that once a patient has a diagnosis, because they have a number of symptoms that fit that diagnosis, clinicians can develop a bit of tunnel vision where some other findings might be overlooked, says Amir Miodovnik, MD, a developmental pediatrician at Boston Childrens Hospital.
Dr. Miodovnik is the lead researcher on a study of autistic children, published in Pediatrics, which linked an initial diagnosis of ADHD to a delay of three years, on average, in the autism diagnosis. Children who had first been diagnosed with ADHD were nearly 30 times more likely to receive their autism diagnosis after age 6 than those for whom autism was their first diagnosis.
The study confirmed Dr. Miodovniks clinical experience. We see a fair number of children we evaluate for autism spectrum disorder at an older age, he says, who previously have had an ADHD diagnosis.
Catherine Lord, PhD, the director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, has a similar concern that an early focus on sensory issues, while it may help kids some, may be delaying autism diagnoses. We see kids who fall on the autism spectrum, she reports, and for years theyve been going to speech and language therapy and occupational therapy for sensory issues, when they should have had people working with them on social skills.
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Challenging Behaviors In Autism
People with autism spectrum disorder may exhibit behaviors which put themselves at risk, cause difficulties for people around them or which are not socially acceptable.
Around 50 percent of people with autism engage in behavior that can cause themselves harm when they feel frustrated, overwhelmed or unwell. Such behaviors can include:
- Banging their head on walls or other objects
- Hitting themselves, e.g. hitting their head with their hands
- Poking themselves in the eye
- Pulling their hair
- Biting themselves
- Smearing feces
A person with autism who feels frustrated, overwhelmed or feeling unwell may also display physically aggressive behavior. This can include:
- Throwing objects
- Hitting, slapping or biting other people
- Pulling other peopleÃ¢â¬â¢s hair
Some people with autism eat objects that are not edible, or keep the objects in their mouth, a behavior known as pica. It is the most common eating disorder found in people with autism spectrum disorder. People may eat anything, including dirt or soap.
Signs Of Autism In Babies
Some parents recognize autism signs when their child is 6-12 months old, depending on the symptoms and their severity. “Pay attention to whether or not the baby is reacting to social information and the environment. Within the first year of life, babies start to babble and use gestures like pointing,” says Dr. Frazier, adding that babies may also smile at their caregivers. “Baby noises should have some social function as well, and they should try communicating with parents.”
Babies with autism sometimes fail to communicate through sounds or gestures, and may not respond to social stimulation. Here are other early signs of autism.
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The Top 9 Signs That Your Infant May Have Autism
By C. Dixon
The most recent statistics show that 1 in 68 children are now being diagnosed with autism. While diagnosis is on the rise, a child typically is not diagnosed by a professional until he or she is over two years old.
However, there are signs that could indicate your child is on the spectrum as early as six months of age. Signs and symptoms can vary, as can the severity of the symptoms. Be sure to monitor your childs development, and consult your doctor if anything concerns you. Its important to note that autism in infants can be recognized by a lack of normal behavior, rather than the presence of strange behaviors.