How Autism Is Diagnosed
There is no known biological marker for autism. That means that no blood or genetic test can diagnose the disorder. Instead, clinicians rely on observation, medical histories, and questionnaires to determine whether an individual has autism.
Physicians and specialists may use one or several of the following screening tools:
- Modified Checklist for Autism in Toddlers, Revised , a 20-question test designed for toddlers between 16 and 30 months old.
- The Ages and Stages Questionnaire , a general developmental screening tool with sections targeting specific ages used to identify any developmental challenges a child may have.
- Screening Tool for Autism in Toddlers and Young Children , an interactive screening tool, comprising 12 activities that assess play, communication, and imitation.
- Parents Evaluation of Developmental Status is a general developmental parent-interview form that identifies areas of concern by asking parents questions.
The American Academy of Pediatrics encourages autism screening for all children at their 18 and 24-month well-child checkups. Parents and caregivers can also ask their pediatrician for an autism screening if they have concerns. In rare cases, individuals with autism reach adulthood before receiving a diagnosis. However, most individuals receive an autism diagnosis before the age of 8.
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 developmentparticularly in language development and social relatednessat about 14 months of age on average .
- Infants at risk forand later diagnosed withASD showed a decline in eye fixation within the first 26 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 sensorymotor 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 forand later diagnosed withASD 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 .
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.
What Is The Prevalence Of Autism
The exact prevalence of autism in Australia and internationally is unknown.
The Australian Bureau of Statistics reports that there were 205,200 Australians with autism in 2018, which is around 1% of the population or 1 in 100.
Internationally this rate varies significantly, from 1 person in every 59 people in the USA, to the average prevalence across Asia, Europe, and North America is between one and two percent.
Statistics also show that:
- the number of Australians diagnosed with autism increased by 42% between 2012 and 2015;
- three out of four people diagnosed with autism are young people, aged between 5 and 24 years; and
- 1-2 out of 4 Australians diagnosed with autism are female.
While the reported prevalence of autism varies around the world, there has been a clear increase in the number of people diagnosed on the autism spectrum in recent years, but this doesnt necessarily suggest that there are more autistic people in the world than there were ten or twenty years ago.
Evidence suggests that the increase is the result of a number of cultural and clinical factors, including social influences driving greater awareness of autism, and improved diagnostic procedures and changes in diagnostic criteria allowing more people to access a diagnosis.
According to Professor Whitehouse, from Australias Autism CRC, research shows the majority of the increase in autism prevalence over this period was due to an increase in diagnosing children with less severe behaviours.
What Are The Causes Of Autism
Its natural to want to know what causes autism, however it is likely that there is not one single cause. While genetic differences are known to cause some types of autism, the causes of autism are largely unknown.
We do know that autism is a neurobiological difference, meaning that the brain processes information differently for people with autism, than it does for people who do not have autism.
We also know that parenting styles do not cause a child to develop autism.
Autism is not caused by vaccinations during or before pregnancy, and the falsely-reported link between the measles-mumps-rubella immunisation and autism has been retracted from the paper it was published in, and completely discredited by the research, scientific and medical community.
For more information about the current studies being undertaken into the causes of autism, visit our what causes autism section.
A Bit Of A Background On Autism
Understanding the history of autism may help some parents. The word autism comes from the Greek word autos meaning self and has been used for more than 100 years. The term autism, therefore, describes a condition where a person is detached from social interaction, and hence, an isolated self.
A Swiss psychiatrist, Eugene Bleuler, began using the term autism around 1911 to refer to the group of symptoms for schizophrenia. Until the 1940s, research on autism and schizophrenia was done together as one subject. In the 1960s, the medical professionals began to formulate separate understandings of autism in children. The role of behavioral therapy and the use of controlled learning environments came to light in the 1990s. The previous method of electroshock therapy used in the 1960-70s was put to rest. Today the cornerstone for research and therapy is focused on behavior, and language therapies.
Treatment Considerations: Transitioning Youth And Adults
The core challenges associated with ASD can have an impact on the ability to succeed in postsecondary educational programs, employment, and social relationships, and to acquire the skills needed to live independently .
Individuals with ASD who are transitioning to young adulthood experience high rates of unemployment and underemployment and may have difficulty maintaining employment once secured . Socially, they may discontinue friendships, participate in fewer social activities , and experience social isolation .
These findings highlight the need for continued support to facilitate a successful transition to adulthood. SLPs are involved in transition planning in high school and may be involved, to varying degrees, in other support services beyond high school.
Transition planning for individuals with ASD may include
- determining the need for continued therapy, if appropriate;
- identifying career goals and educational needs;
- providing academic or career counseling;
- providing opportunities for work experience;
- discussing housing options; and
- facilitating community networking .
Effective transition planning involves the student as an active and respected member of the team as well as their family, who can provide valuable information about the student’s needs. See ASHA’s resource on transitioning youth.
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 soundsincluding speechin 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
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 SLPwho has been trained in the clinical criteria for ASD and who is experienced in diagnosing developmental disordersmay 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 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 .
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 ASDparticularly of young childrenis 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 .
What Are Some Of The Symptoms Of Asd
There is no single symptom that would lead to a diagnosis of autism. But someone who shows a number of the following characteristics and behaviours would likely be diagnosed with an ASD:
- Shows no interest in other people
- May be interested in people, but does not know how to talk, interact with or relate to them
- Has difficulty initiating and maintaining a conversation.
- Is slow developing speech and language skills, which may begin to develop and then be lost, or may never develop fully.
- Has difficulty interpreting non-verbal communication such as social distance cues, or the use of gestures and facial cues, like smiles, that most of us take for granted.
- Repeats ritualistic actions such as spinning, rocking, staring, finger flapping, and hitting oneself.
- Has restricted interests and seemingly odd habits, like focusing obsessively on only one thing, idea or activity.
As well, people with ASD may have secondary problems such as:
- Neurological disorders including epilepsy.
- Fine and gross motor deficits.
- Anxiety and depression.
Children with ASD develop motor, language, cognitive and social skills at different rates from other children their age. For instance, they may be very good at solving math problems but have great difficulty making friends or talking.
How Are Asd Levels Determined
While its difficult to determine a persons ASD level, trained psychologists have some tools that can help them accomplish this, such as the Autism Diagnostic Observation Schedule, Second Edition . This assessment is typically paired with a thorough developmental history.
ASD can be diagnosed as early as 18 months . However, many children, and even some , may not be diagnosed until much later.
Being diagnosed at a later age can make treatment more difficult. If you or your childs pediatrician think they may be autistic, consider making an appointment with an ASD specialist. Learn more about testing for ASD.
Associated Medical & Mental Health Conditions
- Autism can affect the whole body.
- Attention Deficient Hyperactivity Disorder affects an estimated 30 to 61 percent of children with autism.
- More than half of children with autism have one or more chronic sleep problems.
- Anxiety disorders affect an estimated 11 to 40 percent of children and teens on the autism spectrum.
- Depression affects an estimated 7% of children and 26% of adults with autism.
- Children with autism are nearly eight times more likely to suffer from one or more chronic gastrointestinal disorders than are other children.
- As many as one-third of people with autism have epilepsy .
- Studies suggest that schizophrenia affects between 4 and 35 percent of adults with autism. By contrast, schizophrenia affects an estimated 1.1 percent of the general population.
- Autism-associated health problems extend across the life span from young children to senior citizens. Nearly a third of 2 to 5 year olds with autism are overweight and 16 percent are obese. By contrast, less than a quarter of 2 to 5 year olds in the general population are overweight and only 10 percent are medically obese.
- Risperidone and aripiprazole, the only FDA-approved medications for autism-associated agitation and irritability.
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.
What’s It Like To Have Autism Spectrum Disorder
A kid with autism might have trouble:
- talking and learning the meaning of words
- making friends or fitting in
- dealing with changes
- dealing with loud noises, bright lights, or crowds
Kids also might move in an unusual way or do the same thing over and over .
A kid with autism may have a little trouble with these things, or a lot. Some kids need only a little bit of help, and others might need a lot of help with learning and doing everyday stuff.
Treatment Modes And Modalities
Treatment modes and modalities are technologies or other support systems that the SLP can use in conjunction with, or during implementation of, various treatments. For example, the SLP can use video-based instruction in peer-mediated interventions to address social skills and other target behaviors.
A number of treatment modes and modalities are described below. When selecting a mode or modality, the SLP considers the intervention goal and the individual’s developmental stage. For example, a mode or modality that is appropriate for an individual who is at the emerging language stage may not be appropriate for an individual who is at the prelinguistic stage. The list below is not exhaustive, and inclusion does not imply an endorsement from ASHA.
Augmentative and Alternative Communication
An AAC system is an integrated group of componentsincluding symbols, selection techniques, and strategiesused to enhance communication. AAC uses a variety of techniques and toolsincluding picture communication systems, line drawings, photographs, video clips, speech-generating devices , tangible objects, manual signs, gestures, and finger spellingto help the individual express thoughts, ideas, wants, needs, and feelings. AAC can be used to supplement existing expressive verbal communication or with individuals who are unsuccessful at learning expressive verbal communication.
Activity Schedule and Visual Supports
When Was Autism Identified
Autism was first described in the early 1940s by two doctors who were working independently of each other. Leo Kanner and Hans Asperger identified a common set of symptoms they found among the children they were studying.
Both used the word autism from the Greek word for self to describe these children, who seemed enclosed in their own solitary worlds.
Kanner was a child psychologist at Johns Hopkins Hospital in Baltimore, Md. Asperger, whose work was published a year after Kanner’s, was a pediatrician in Vienna.
Since Asperger included people who had average to high IQs in his definition, the scientific community reserved “Asperger syndrome” to describe prodigies and certain high-functioning people with an autistic disorder.
It has been suggested by some that Microsoft founder Bill Gates exhibits the characteristics of Asperger syndrome. He has often been seen rocking and tends to speak in monotones both habits acknowledged to be symptoms.
Autism Screening And Diagnosis
It can be hard to get a definite diagnosis of autism. Your doctor will focus on behavior and development.
For children, diagnosis usually takes two steps.
- A developmental screening will tell your doctor whether your child is on track with basic skills like learning, speaking, behavior, and moving. Experts suggest that children be screened for these developmental delays during their regular checkups at 9 months, 18 months, and 24 or 30 months of age. Children are routinely checked specifically for autism at their 18-month and 24-month checkups.
- If your child shows signs of a problem on these screenings, theyâll need a more complete evaluation. This might include hearing and tests or genetic tests. Your doctor might want to bring in someone who specializes in autism disorders, like a developmental pediatrician or a child . Some psychologists can also give a test called the Autism Diagnostic Observation Schedule .
If you werenât diagnosed with autism as a child but notice yourself showing signs or symptoms, talk to your doctor.
Diagnosis In Older Children And Adolescents
ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the schools special education team. The schools team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in ASD for additional testing.
Parents may talk with these specialists about their childs social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.
Some People Use Other Names For Autism
There are other names for autism used by some people, such as:
- autism spectrum disorder the medical name for autism
- autism spectrum condition used instead of ASD by some people
- Asperger’s used by some people to describe autistic people with average or above average intelligence
Unlike some people with autism, people with Asperger’s do not have a learning disability.
Some people call this “high-functioning” autism.
Doctors do not diagnose people with Asperger’s anymore.
But if you were diagnosed with it before, this will stay as your diagnosis.
What Is It Like To Be Autistic
In case you are wondering if your child may have autism, the following most common signs of autism could be a good signal. Typically children diagnosed with autism spectrum are:
- Likely to be oversensitive by sight, sounds, and smell and touching which are normal for everyone else
- Likely to exhibit repetitive body movements, like rocking to & fro and making unusual finger movements in front of his/her eyes
- Likely to display strong attachments to certain objects around them
- Likely to get confused by changes in daily routines, often resorting to aggressive behavior
- Likely to observe even small changes in the people or their surroundings
Restrictive / Repetitive Behaviors May Include:
- Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
- Having a lasting intense interest in certain topics, such as numbers, details, or facts
- Having overly focused interests, such as with moving objects or parts of objects
- Getting upset by slight changes in a routine
- Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:
- Being able to learn things in detail and remember information for long periods of time
- Being strong visual and auditory learners
- Excelling in math, science, music, or art
Autism Where Is It Heading
To conclude, over time, the definition of autism has changed from being one disorder to a spectrum of tens of disorders with overlapping symptoms. With intensive research and serious funds being propelled into Autism development, a lot has been achieved in the recent past and the future looks really bright for autism treatment.
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.
Diagnosis In Young Children
Diagnosis in young children is often a two-stage process.
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at a very low birth weight.
Parents experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the childs behaviors and combine those answers with information from ASD screening tools, and with his or her observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention website.
Children who show developmental problems during this screening process will be referred for a second stage of evaluation.
Stage 2: Additional Evaluation
This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.
This team may include:
The evaluation may assess:
- Blood tests
How Is Asd Diagnosed
There is no single test that will confirm that someone has an ASD. A diagnosis is based on the number and pattern of typical characteristics and on the observation of specific behaviours and disabilities.
Someone with a mild case could go undiagnosed for years, and it might only be detected when the person goes through a crisis that brings contact with professionals who are able to recognize the disorder.
How Is Autism Spectrum Disorder Treated
There is no cure for autism, but treatment can make a big difference. The younger kids are when they start treatment, the better.
Doctors, therapists, and special education teachers can help kids learn to talk, play, and learn. Therapists also help kids learn about making friends, taking turns, and getting along.