Postwar Conceptualizations Of Autism And Infant Psychopathology
After the war, the controversies over how to describe infantile thought continued. The diagnoses of schizophrenia, psychosis and autism in children were largely interchangeable during the 1940s and 1950s. In the USA, Bender and others employed a Kleinian model to understand infant and child psychopathology and focused on schizophrenia as the central psychopathological problem of childhood. Bender was an important figure in the development of perceptual tests for children. In 1947, she published a study on one hundred schizophrenics who had attended the Childrens Department at Bellevue during the period 193747. She defined childhood schizophrenia as
pathology in behavior at every level and in every area of integration or patterning within the functioning of the central nervous system, be it vegetative, motor, perceptual, intellectual, emotional or social.
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.
Challenges Of Identifying High
High-functioning individuals with ASD pose particular challengesâboth for identification and for determining eligibility for services. These individuals often have either verbal or nonverbal intelligence within or above the average range and appear to succeed in some or most academic subjects, particularly in early school years. As a result, many are not diagnosed until later school age, adolescence, or even adulthood.
Long-term outcomes for these individuals show that challenges with social engagement and social communication can significantly affect their ability to adjust to social demands in later academic and community settings and in the workplace . These findings suggest the importance of providing intervention to address the gap between cognitive potential and social adaptive functioning.
School-age Children
Determining eligibility for educational services requires using a variety of strategies for gathering information, including
- standardized measures of social adaptive functioning,
- naturalistic observation across a range of settings, and
- caregiver/teacher interviews or questionnaires.
Regardless of the assessment measures or tools used, the clinician needs to be aware of any subtle signs and symptoms consistent with a diagnosis of ASD.
Adult Diagnosis
For a comprehensive discussion of individuals with ASD as they transition into and through adulthood, see IACC, 2017.
Consistent with the WHO framework, treatment is designed to
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Why Was The New Edition Needed
The American Psychiatric Association periodically updates the DSM to reflect new understanding of mental health conditions and the best ways to identify them.
The goals for updating the criteria for diagnosing autism included:
- More accurate diagnosis
- Identification of symptoms that may warrant treatment or support services
- Assessment of severity level
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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Then And Now: A Look At Autism Over The Last 20 Years
Thanks to a supportive community, over the last 20 years SARRC has been able to advance the understanding and treatment of autism. But what exactly did the autism landscape look like in 1997? We asked members of SARRCs research team to explained. Heres a glimpse of how far weve come.
What is the prevalence of autism among children in the United States?
In 1997, autism was on the rise and so were peoples concerns, yet there were no dedicated efforts to monitor prevalence rates. Rough estimates suggested that 1 in 2,500 children were likely to be diagnosed with autism. In the year 2000, the Centers for Disease Control and Prevention began carefully tracking prevalence rates through the Autism and Developmental Disabilities Monitoring Network. Today, the CDC reports that one 1 in 68 children has been identified with autism spectrum disorder .
What is the average age children are receiving an autism diagnosis?
The estimated average age of diagnosis in the U.S. was 4 years, 4 months in 1997. While parental concerns were noted in earlier development, it was more common for children to be identified and diagnosed upon reaching school age. Currently, the CDC states the average age of diagnosis in the U.S. is 3 years, 10 months. However, research has shown that a reliable diagnosis of autism can be made as early as 2 years old.
What are the expected outcomes for adults with autism?
How have diagnostic criteria changed in the past 20 years?
Is Rett Syndrome Autism
Rett syndrome or Rett disorder has also been called autism-dementia-ataxia-loss of purposeful hand use syndrome.
But its not included on the autism spectrum. Its a brain disorder caused by genetic mutations.
Classic Rett syndrome usually affects girls who display typical development for the first few months. Then, symptoms start to appear, involving issues with:
- language and communication
If you think your child might have symptoms of autism, speak with their pediatrician or a primary care physician. They can refer you to the appropriate specialist, such as a:
- developmental pediatrician
- psychiatrist or psychologist
You can also request an evaluation from your states public early childhood assistance center. Its free, and you dont need a doctors referral or diagnosis. Your local public school district can also provide assistance.
Theres no one medical test to diagnose autism spectrum disorder. A doctor can make the diagnosis with a comprehensive behavior evaluation and developmental screening.
Some people on the spectrum need minimal support services. Others require a lot. Either way, early intervention is associated with long-term positive effects.
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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 .
The Real Reasons Autism Rates Are Up In The Us
A hard look at whether the rise comes from more awareness, better diagnosisor something else;
The;prevalence;of autism in the United States has risen steadily since researchers first began tracking it in 2000. The rise in the rate has sparked fears of an autism epidemic. But experts say the bulk of the increase stems from a growing awareness of autism and changes to the conditions diagnostic criteria.
Heres how researchers track autisms prevalence and explain its apparent rise.
How do clinicians diagnose autism?There is no blood test, brain scan or any other objective test that can diagnose autismalthough researchers are actively trying to develop such tests. Clinicians rely on observations of a persons behavior to diagnose the condition.
In the U.S., the criteria for diagnosing autism are laid out in the Diagnostic and Statistical Manual of Mental Disorders . The criteria are problems with social communication and interactions, and restricted interests or;repetitive behaviors. Both of these core features must be present in early development.
What;is the prevalence of;autism in the U.S.?The Centers for Disease Control and Prevention estimates that;1 in 68children in the U.S. have autism. The prevalence is 1 in 42 for boys and 1 in 189 for girls. These rates yield a gender ratio of about five boys for every girl.
This article is reproduced with permission from;Spectrum. The article was;first published;on March 2, 2017.
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Autism Diagnosis The Evolution Of Autism As A
When was autism first presented as a spectrum of conditions? The DSM-IV, Its not clear whether this is due to better detection and reporting or a real increase in the number of cases, 1 in 59 childrenSeveral factors complicate the diagnosis of Asperger syndrome , sometimes rigid attachments to objects.The number of children diagnosed with autism spectrum disorder is rising, Autism spectrum disorder affects children of all races and nationalities, or both, neurodevelopmental disorder whose symptoms first appear during infancy or childhood, and generally follows a steady course without remission, These are included in the broader category of neurodevelopmental disorders.
A History And Timeline Of Autism
The history of autism begins in 1911, when Swiss psychiatrist Paul Eugen Bleuler coined the term, using it to describe what he believed to be the childhood version of schizophrenia.Since then, our understanding of autism has evolved, culminating in the current diagnosis of autism spectrum disorder and informed by many notable events impacting autism clinical research, education, and support.
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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.
Behavior Interests And Activities
People with an autism spectrum disorder are often very resistant to changes, such as new food, toys, furniture arrangement, and clothing. They may become excessively attached to particular inanimate objects. They often do things repetitively. Younger and/or more severely affected children often repeat certain acts, such as rocking, hand flapping, or spinning objects. Some may injure themselves through repetitive behaviors such as head banging or biting themselves. Less severely affected people may watch the same video multiple times or insist on eating the same food every meal. People with an ASD often have very specialized, often unusual interests. For instance, a child may be preoccupied with vacuum cleaners.
People with an autism spectrum disorder often have over-reactions or under-reactions to sensations. They may be extremely repelled by certain odors, tastes, or textures, or react unusually to painful, hot, or cold sensations that other people find distressing. They may ignore some sounds and be extremely bothered by others.
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History Of Autism Spectrum Disorder In Canada
It was not until shortly following the Second World War that children with ASD were first seen for diagnosis and treatment in Canada. Universal health care,which was introduced across the country from the 1950s to the 1970s, allowed families to access diagnostic and treatment services for ASD more readily, regardless of their income level. This was a significant step in supporting this population. Dr. MiladaHavelkova at the West End Crèche in Toronto, Ontario, was the first clinician in Canada to diagnose and treat childrenwith ASD. She was also the first child psychiatrist in Canada to seek a better understanding of the causes of ASD through research. She published several influential papers on autismduring her 30-year career at the clinic.
Diagnosis of ASD and other pervasive developmental disorders has steadily increased in Canada since their addition to the DSM-III in 1980, despite significant confusion between the terms autism, PDD and PDD-NOS among health professionals andthe public. In 1987, the DSM-III-R broadened the criteria for autism. This further increased in the number of children who received a diagnosis of autism or PDD-NOS.
Throughout the 1990s, autism researchers focused on the molecular genetics of autism, as well as developing reliable and valid diagnostic tools. With the rising rates of ASD, researchersalso explored the contribution of environmental risk exposures to the development of autism.
What Are The Risk Factors For Autism
Risk factors for autism include:
- Low birth weight
- Being exposed to a medication called valproate during the mothers pregnancy
- Older parents
Boys are diagnosed with ASD more often than girls.
Studies have shown that there is no link between vaccines and autism. Learn more about vaccines and autism from theCDC.
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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 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.
Other Terminology You May Have Heard For Types Of Autism
Terms like mild or high functioning arent official diagnoses. Some people find these terms useful, but many in the autistic community havent found them to be helpful or accurate, largely due to the range of abilities that can be present in an autistic person.
You may also have heard about three levels of autism, with level 1 being the mildest and level 3 the most severe.
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What Is Asperger Syndrome
Asperger syndrome, or Aspergers, is a previously used diagnosis on the autism spectrum. In 2013, it became part of one umbrella diagnosis of autism spectrum disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 .
Typical to strong verbal language skills and intellectual ability distinguish Asperger syndrome from other types of autism.
Criteria For Social Communication Disorder Diagnosis
Social communication disorder ;is similar to autism spectrum disorder. The main difference is that children diagnosed with SCD dont have restricted, repetitive and/or sensory behaviour.
If children have at least two restricted, repetitive and/or sensory behaviours, it could point to a diagnosis of autism spectrum disorder. If not, it could point to a diagnosis of SCD.
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When Was Autism First Diagnosed
Autism had a lot of descriptions in the past decades. It was first thought of as a form of childhood schizophrenia. There was even a time where the disorder was thought to stem from cold parenting.
Throughout the years, the diagnostic criteria and the description of autism changed in the Diagnostic and Statistical Manual of Mental Disorders in its editions. This manual is used in the United States to guide physicians in their diagnoses, and it gives us a great idea about how autism diagnosis changed over the years.
An Austrian-American psychiatrist and physician, Leo Kanner first described autism in 1943 . In his article, he mentioned children with delayed echolalia as well as how they wanted to maintain sameness in their lives. He also wrote that these children were also gifted in terms of intelligence and they had an extraordinary memory.
This led Leo Kanner to consider autism a psychiatric condition. Kanner observed autism as an emotional disturbance rather than a developmental or cognitive one. In light of this information, the second edition of the DSM, DSM-II, was published in 1952 with the definition of autism as a psychiatric condition. The manual deemed autism a form of childhood schizophrenia . It was characterized by atypical and withdrawn behavior, general unevenness, gross immaturity and inadequacy in development, and failure to develop identity separate from the mothers.
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