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.
What Is The Difference Between Autism And Autism Spectrum Disorder
The term autism was changed to autism spectrum disorder in 2013 by the American Psychiatric Association. ASD is now an umbrella term that covers the following conditions:
- Autistic disorder.
- Pervasive developmental disorder not otherwise specified .
- Asperger syndrome.
People with ASD have trouble with social interactions and with interpreting and using non-verbal and verbal communication in social contexts. Individuals with ASD may also have the following difficulties:
- Inflexible interests.
- Insistence on sameness in environment or routine.
- Repetitive motor and sensory behaviors, like flapping arms or rocking.
- Increased or decreased reactions to sensory stimuli.
How well someone with ASD can function in day-to-day life depends on the severity of their symptoms. Given that autism varies widely in severity and everyday impairment, the symptoms of some people arent always easily recognized.
Diagnosis Of Autism In Children
Autism in children is diagnosed through observation by a multidisciplinary team of the following health professionals:
- psychologist or psychiatrist
- speech pathologist.
Some children will show signs of autism by the age of two and will be diagnosed then. Other may be diagnosed when they are older. The earlier autism can be diagnosed the sooner therapy can begin. Early intervention has been shown to improve outcomes for autistic children.
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What Role Do Genes Play
Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, then the other will be affected between 36 to 95 percent of the time. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder also increases. Many of the genes found to be associated with autism are involved in the function of the chemical connections between brain neurons . Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social communication skills or engage in repetitive behaviors. Evidence also suggests that emotional disorders such as bipolar disorder and schizophrenia occur more frequently than average in the families of people with ASD.
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” .
Rapid Prompting Method
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Symptoms Of Autism Spectrum Disorder In Adults
Common symptoms of autism in adults include:
- Difficulty interpreting what others are thinking or feeling
- Trouble interpreting facial expressions, body language, or social cues
- Difficulty regulating emotion
- Trouble keeping up a conversation
- Inflection that does not reflect feelings
- Difficulty maintaining the natural give-and-take of a conversation prone to monologues on a favorite subject
- Tendency to engage in repetitive or routine behaviors
- Only participates in a restricted range of activities
- Strict consistency to daily routines outbursts when changes occur
- Exhibiting strong, special interests
Autism spectrum disorder is typically a life-long condition, though early diagnosis and treatment can make a tremendous difference.
What Are The Signs And Symptoms Of Asd
Every person with ASD is unique, so the timing and severity of the first signs and symptoms can vary widely. Some children with ASD show signs within the first few months of life. In others, symptoms may not become obvious until 24 months or later. Some children with ASD appear to develop normally until around 18 to 24 months of age and then stop gaining new skills and/or start losing skills.
During infancy , a child may show symptoms that include:
- Limited or no eye contact
- No babbling
- Appearing not to hear
- Playing with toys in an unusual or limited manner
- Showing more interest in objects instead of people
- Starting language skills but then stopping or losing those skills
- Showing repetitive movements with their fingers, hands, arms or head
Up to 2 years of age, there may be continuing symptoms from infancy. A child may also:
- Focus only on certain interests
- Be unable to have reciprocal social interactions
- Move in unusual ways, such as tilting their head, flexing their fingers or hands, opening their mouth or sticking out their tongue
- Have no interest in playing with other children
- Repeat words or phrases without appearing to understand them
- Have behavioural issues, including self-injury
- Have trouble controlling their emotions
- Like to have things a certain way, such as always eating the same food
Possible signs of ASD at any age:
Restricted Or Repetitive Patterns Of Behavior Or Activities
These can include:
- an increase or decrease in sensitivity to specific sensory information from their surroundings, such as a negative reaction to a specific sound
- fixated interests or preoccupations
Autistic people are evaluated within each category, and the intensity of their symptoms is noted.
To receive an autism diagnosis, a person must display all three symptoms in the first category and at least two symptoms in the second category. Get more information on symptoms and how they may manifest in kids.
The exact cause of ASD is unknown. The most current research demonstrates theres no single cause.
Some suspected risk factors for ASD include:
- having an immediate family member whos autistic
- genetic mutations
An ASD diagnosis involves several screenings, genetic tests, and evaluations.
Autism Is Not An Illness
Being autistic does not mean you have an illness or disease. It means your brain works in a different way from other people.
It’s something you’re born with or first appears when you’re very young.
If you’re autistic, you’re autistic your whole life.
Autism is not a medical condition with treatments or a “cure”. But some people need support to help them with certain things.
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Can Diet Have An Impact On Autism
Theres no specific diet designed for autistic people. Nevertheless, some autism advocates are exploring dietary changes as a way to help minimize behavioral issues and increase overall quality of life.
An autism diet may instead focus on whole foods, such as:
Those advocates believe that gluten creates inflammation and adverse bodily reactions in certain autistic people. However, scientific research is inconclusive on the relationship between autism, gluten, and another protein known as casein.
What Are The Treatment Options For Autism Spectrum Disorder
There are three main types of treatment for ASD:
- Educational and behavioral interventions
- Alternative therapies
Most clinicians prefer to begin with non-medical therapies to manage the symptoms that hinder social and academic success and lead to a turbulent home life. Behavioral therapy and early-intervention therapy both help children learn new skills to better interpret the world with the challenges of ASD.
When these interventions arent sufficient, medication may help. A class of medicines called atypical antipsychotics often helps with motor restlessness, repetitive behaviors, and sleep disturbances in children with autism. Typical prescriptions include aripiprazole , quetiapine fumarate , and risperidone (Risperdal, which is the only one approved by the FDA for treating behaviors associated with autism.
Many people with chronic conditions like ASD supplement traditional therapies and medications with alternative treatments, though their effectiveness is not well researched. Parents of children with ASD and adults with the condition should consult with a physician before taking any supplements or trying any alternative treatment methods.
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Getting The Right Environment
Environment is important to quality of life for autistic people. There are ways you can adapt and improve your environment to make it as comfortable and supportive as possible for you or your child.
The social model of disability is a way of looking at the world that treats the difficulties people with disabilities have as being caused by barriers in society, rather than just the disabilities themselves. These barriers can be physical for example, buildings not having accessible toilets. Barriers can also be caused by peoples attitudes for example, many people will assume someone is lying because they dont make eye contact while talking.
The social model of disability can be a helpful way of considering the difficulties someone faces, and how to adapt their environment so it works for them.
Common changes to an environment that can help autistic people include:
- sensory changes for example, being given a quiet space to work, being able to use sensory toys like fidget spinners, or being allowed to make noises while working
- communication changes for example, using email or apps to communicate, using very clear language, allowing additional time to ask questions, or using visual communication such as photos or pictures as well as written words
- routine keeping to a regular routine and giving warning of any changes as far in advance as possible
What Are Some Common Signs Of Asd
Even as infants, children with ASD may seem different, especially when compared to other children their own age. They may become overly focused on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.
The severity of ASD can vary greatly and is based on the degree to which social communication, insistence of sameness of activities and surroundings, and repetitive patterns of behavior affect the daily functioning of the individual.
Social impairment and communication difficultiesMany people with ASD find social interactions difficult. The mutual give-and-take nature of typical communication and interaction is often particularly challenging. Children with ASD may fail to respond to their names, avoid eye contact with other people, and only interact with others to achieve specific goals. Often children with ASD do not understand how to play or engage with other children and may prefer to be alone. People with ASD may find it difficult to understand other peoples feelings or talk about their own feelings.
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How Is Autism Diagnosed
ASD is diagnosed by a medical professional. To be diagnosed with autism, a child must have symptoms that include both social challenges and repetitive behaviors. These symptoms must get in the way of the childs daily life. Symptoms must exist by the time the child is two years old, even if they are not obvious until the child is older. Autism can be diagnosed in kids as young as two years old.
An autism diagnosis will list all of the childs symptoms. For each symptom, the diagnosis will say how much support the child will need. The level of support is based on how severe the symptoms are. There are three levels of support:
- Requiring support
- Requiring substantial support
- Requiring very substantial support
Children with autism often have problems with reasoning and learning as well. This is called an intellectual development disorder. A child should only be diagnosed with autism if their social struggles cannot be explained by an intellectual development disorder.
Children who only have problems with social behaviors and do not show repetitive behaviors are not diagnosed with autism. Instead, they are usually diagnosed with a condition calledsocial communication disorder.
Symptoms Of Autism Spectrum Disorders
Symptoms of autism spectrum disorders may appear in the first 2 years of life, but in milder forms symptoms may not be detected until school age.
Children with an autism spectrum disorder develop symptoms in the following areas:
Social communications and interactions
Restricted, repetitive patterns of behavior
Symptoms of an autism spectrum disorder range from mild to severe, but most people require some level of support in both areas. People with an ASD vary widely in their ability to function independently in school or society and in their need for supports. In addition, about 20 to 40% of children with an ASD, particularly those with an IQ less than 50, develop seizures Seizure Disorders In seizure disorders, the brain’s electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure… read more before reaching adolescence. In about 25% of affected children, a loss of previously acquired skills occurs around the time of diagnosis and may be the initial indicator of a disorder.
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How Is Asd Diagnosed
ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps.
Autism spectrum disorder is diagnosed by clinicians based on symptoms, signs, and testing according to the Diagnostic and Statistical Manual of Mental Disorders-V, a guide created by the American Psychiatric Association used to diagnose mental disorders. Children should be screened for developmental delays during periodic checkups and specifically for autism at 18- and 24-month well-child visits.
Very early indicators that require evaluation by an expert include:
- no babbling or pointing by age 1
- no single words by age 16 months or two-word phrases by age 2
- no response to name
- excessive lining up of toys or objects
- no smiling or social responsiveness
Later indicators include:
- impaired ability to make friends with peers
- impaired ability to initiate or sustain a conversation with others
- absence or impairment of imaginative and social play
- repetitive or unusual use of language
- abnormally intense or focused interest
- preoccupation with certain objects or subjects
- inflexible adherence to specific routines or rituals
Treatment Of Autism Spectrum Disorders
Applied behavior analysis
Speech and language therapy
Sometimes drug therapy
Applied behavior analysis is a therapy doctors use to improve, change, or develop specific behaviors in children who have an ASD. These behaviors include social skills, language and communication skills, reading, and academics as well as learned skills such as self-care , daily-living skills, punctuality, and job competence. This therapy is also used to help children minimize behaviors that may interfere with their progress. Applied behavior analysis therapy is tailored to meet the needs of each child and is typically designed and supervised by professionals certified in behavior analysis.
Educational programs for school-aged children with an ASD should address social skills development and speech and language delays and help prepare children for education after high school or for employment.
The federal Individuals with Disabilities Education Act requires public schools to provide free and appropriate education to children and adolescents with an ASD. Education must be provided in the least restrictive, most inclusive setting possibleâthat is, a setting where the children have every opportunity to interact with nondisabled peers and have equal access to community resources. The Americans with Disability Act and Section 504 of the Rehabilitation Act also provide for accommodations in schools and other public settings.
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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 .