Friday, December 9, 2022

Who Can Diagnose Autism Spectrum Disorder

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A New Understanding Of Asd

After reading and researching ASD and feeling certain this information describes yourself, you may experience an identity shift towards one that is autistic. Reflecting back on moments in your life, you may view things that happened in a different context, through the lens of autism. Retelling the story of your life may now have the ASD perspective. Remembering your stories, reflecting on them, and receiving feedback will change your narrative. This process of self-discovery helps to make sense of whats happened in your life how having ASD has shaped the way you think, react and feel. Maybe some of the confusion is gone, you understand yourself better, and in time you can share this discovery with people you trust.

This new identity may also cause feelings of loss, resentment or anger. Its OK to feel this way as this is a life changing event and it can feel overwhelming. Try to think about the things such as your strengths. People continue to grow, change and adapt throughout their lifespan. You can learn new skills and find new ways to do things that may make life easier and more comfortable.

What Diagnostic Tests Are Used In Autism

 

At the Autism Spectrum Center at Boston Childrens, ASD assessments include:

  • a medical and neurological examination
  • a review of your childs cognitive abilities
  • assessment of your childs speech and language abilities
  • observation of your childs behavior
  • an in-depth conversation with you and your family about your childs behavior and development
  • questions about your childs family history

Making an ASD diagnosis is just the beginning. Our clinicians will then perform in-depth evaluations to understand your childs unique strengths and challenges. This evaluation is crucial for defining what kinds of educational programs and behavioral therapies would be most beneficial.

 

We may involve a number of specialists, such as child neurologists, developmental behavioral pediatricians, speech-language pathologists, child psychologists and psychiatrists, nurse practitioners, educational specialists and occupational therapists. Questions you may be asked include:

  • What kind of language skills does your child have?
  • At what age did his symptoms start?
  • Has he experienced a regression in skills?
  • Does he have any related cognitive or learning problems?
  • Does he have any challenging behaviors?
  • Is he able to pay attention for extended periods?

 

Additional tests may include:

  • hearing and vision screening to see whether your child has a problem that might be contributing to his symptoms
  • blood lead testing
  • nutritional evaluation for children who eat very limited foods

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.

What Happens During An Autism Spectrum Disorder Screening

There is no special test for ASD. Screening usually includes:

  • A questionnaire for parents that asks for information about their child’s development and behavior.
  • Observation. Your child’s provider will look at how your child plays and interacts with others.
  • Tests that ask your child to perform tasks that check their thinking skills and ability to make decisions.

Sometimes a physical problem can cause autism-like symptoms. So screening may also include:

  • Blood tests to check for lead poisoning and other disorders
  • Hearing tests. A hearing problem can cause problems in language skills and social interaction.
  • Genetic tests. These tests look for inherited disorders such as Fragile X syndrome. Fragile X causes intellectual disabilities and symptoms similar to ASD. It most often affects boys.

How Common Is Autism Spectrum Disorder

Diagnosis &management of autistic spectrum disorders

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.

About The Dsm And Autism Spectrum Disorder Diagnosis

When diagnosing autism, professionals like , , and speech pathologists use the Diagnostic and statistical manual of mental disorders , or DSM-5, produced by the American Psychiatric Association.

The DSM-5 lists the signs and symptoms of autism and states how many of these must be present to confirm a diagnosis of autism spectrum disorder. The DSM-5 refers to signs and symptoms, but this article talks about signs and characteristics.

To find out whether a child has autism signs and characteristics and meets DSM-5 criteria, professionals also need to do extra tests. These tests are called adiagnostic assessment.

Evaluation Based On Observation

Parents, family members or other caregivers of children on the autism spectrum are often the first to notice delays in the usual childhood developmental such as speech, eye contact, play with other children or social interactions.

Sometimes autism goes unnoticed or undiagnosed in both children and adults, especially when symptoms are mild or when the person has other disabilities or health problems. In some cases, other medical conditions such as are present, making autism difficult to recognize. As a result, ASDs may go undetected for years and may only be diagnosed during an educational impasse or a life crisis which puts a person in contact with professionals able to recognize the disorder.

Medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders to evaluate autism spectrum disorder and the related social communication disorder . ASDs are diagnosed based on a combination of specific behaviours, communication delays and/or developmental disabilities.

Screening For Asd In Children

There is emerging research indicating that timely diagnosis and intervention can benefit children with ASD and other developmental disorders. Timely diagnosis is important as it is a necessary step in terms of identifying appropriate intervention.

When performing a preliminary assessment for ASD, a health professional or team of professionals will determine a childs level of risk. They will use a combination of standardized questionnaires or tools and their clinical judgment.

Some more familiar screening tools in Canada include the:

  • Infant Toddler Checklist
  • Autism Observation Scale for Infants
  • Autism Diagnostic Observation Schedule Toddler Module
  • Modified Checklist for Autism in Toddlers: Revised with Follow-Up

The first signs of ASD usually present in very early childhood. ASD can be detected through screening in children as young as 12 months old. However, parents are often the first to notice unusual development in their child.

Children with ASD demonstrate areas of concern that help to indicate when an assessment should be done. Not all signs are necessary for a child to receive a diagnosis of ASD.

Table 1: Symptoms of ASD and age when symptoms may be apparent.

Symptoms
X X

ASD develops differently in each individual. Unlike other conditions, there is no typical person with ASD. The term spectrum is used because symptoms can occur in combination or in degrees of intensity. Symptoms can also vary widely from relatively mild to debilitating.

What Is The Outlook For People With Autism Spectrum Disorder

In many cases, the symptoms of ASD become less pronounced as a child gets older. Parents of children with ASD may need to be flexible and ready to adjust treatment as needed for their child.

People with ASD may go on to live typical lives, but there is often need for continued services and support as they age. The needs depend on the severity of the symptoms. For most, it’s a lifelong condition that may require ongoing supports.

A note from Cleveland Clinic

Through research, there has been much that has been learned about autism spectrum disorder over the past 20 years. There is ongoing active research on the causes of ASD, early detection and diagnosis, prevention and treatments.

Last reviewed by a Cleveland Clinic medical professional on 12/29/2020.

References

What Health Professionals Need To Know About Asd

The definition of ASD is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders. This manual, known as the DSM, serves as a basis for widely used assessment tools. It has wide-ranging influences on:

  • mental health research
  • diagnostic and treatment practices
  • social perceptions of mental illness

The DSM may influence diagnostic trends through changes to the criteria used to diagnose a specific disorder. The most recent release was the fifth edition in May 2013. The DSM-5 defines ASD as a central diagnosis given to a continuum of complex conditions.

Diagnosing Autism Spectrum Disorder

Signs of ASD are varied, and may include an unusual speech pattern, speech delays, or no discernable speech at all, not responding socially to caregivers , no interest in pretend play or play with other children, an extreme reliance on routine and structure, a noticeable lack of eye contact, repeating certain words, or repetitive actions, such as hand-flapping.

Early and accurate diagnosis is important for individuals with autism spectrum disorder, so that appropriate interventions and therapeutic plans can be put in place. Its commonly assumed that you can tell if someone has autism spectrum disorder simply by observing their quirks or habits, but this is a myth. In truth, diagnosing ASD involves a great deal of layers and complexities. Its easy to confuse autism with other neurobehavioral, developmental, or intellectual challenges, as well as sensory processing, hearing, or vision disorders. These very same challenges can also occur within autism spectrum disorder, making a proper diagnosis all the more tricky for care providers.

What Is Autism Spectrum Disorder Screening

Autism spectrum disorder is a disorder of the brain that affects a person’s behavior, , and social skills. The disorder usually shows up in the first two years of life. ASD is called a “spectrum” disorder because there is a wide range of symptoms. Autism symptoms can range from mild to severe. Some children with ASD may never be able to function without support from parents and caregivers. Others need less support and may eventually live independently.

ASD screening is the first step in diagnosing the disorder. While there is no cure for ASD, early treatment can help reduce autism symptoms and improve quality of life.

Other names: ASD screening

What To Do If Your Child Is Diagnosed

Autism

If your child receives an autism diagnosis, you might feel overwhelmed and have many questions racing through your mind: Will my child be OK? How will we cope? What does this mean for their future? Where do I even start?

Talk with your pediatrician about services that are available to help autistic kids develop and sharpen their communication, social, motor, and academic skills.

The key is to get educated, find support as early as possible, and have compassion not just for your child but also for yourself.

You also might:

Why Does My Child Need Autism Spectrum Disorder Screening

The American Academy of Pediatrics recommends that all children be screened for ASD at their 18-month and 24-month well-child checkups.

Your child may need screening at an earlier age if he or she has symptoms of ASD. Autism symptoms may include:

  • Not making eye contact with others
  • Not responding to a parent’s smile or other gestures
  • A delay in learning to talk. Some children may repeat words without understanding their meaning.
  • Repeated body movements such as rocking, spinning, or flapping of hands
  • Obsession with specific toys or objects
  • Trouble with change in routine

Older children and adults may also need screening if they have autism symptoms and were not diagnosed as babies. These symptoms may include:

  • Trouble communicating
  • Feeling overwhelmed in social situations
  • Repeated body movements
  • Extreme interest in specific topics

Different Types Of Autism In Adults

Since Autism is a spectrum disorder, this means that there is a wide range of symptoms that people may experience.

Throughout the years, the definition of autism in the Diagnostic and Statistical Manual of Mental Disorders has changed.

In 2013, Aspergers syndrome, childhood disintegrative syndrome, pervasive developmental disorder-not otherwise specified , autistic disorder, and Rett syndrome have been included under the umbrella term of Autism Spectrum Disorder.

These terms are not diagnosis now. They are used as descriptions. They help clinicians and parents better understand the status of their loved one with autism.

The terms may cause confusion as they are difficult to define. Practitioners selected different diagnoses for the same patients.

Therefore, certain terms like severe autism, mild autism and high functioning autism are used to clarify the diagnosis.

How Is Autism Spectrum Disorder Diagnosed

There are no laboratory tests to determine ASD. However, certain healthcare providers receive specific training and can do screenings and evaluations if needed and who might ask parents or teachers to record observations. These providers might include specialized physicians, psychologists and speech-language pathologists.

Social Communication / Interaction Behaviors May Include:

  • Making little or inconsistent eye contact
  • Tending not to look at or listen to people
  • Rarely sharing enjoyment of objects or activities by pointing or showing things to others
  • Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
  • Having difficulties with the back and forth of conversation
  • Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
  • Having facial expressions, movements, and gestures that do not match what is being said
  • Having an unusual tone of voice that may sound sing-song or flat and robot-like
  • Having trouble understanding another persons point of view or being unable to predict or understand other peoples actions

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.

Is There Anything Else I Need To Know About Autism Spectrum Disorder Screening

There is no one single cause of autism spectrum disorder. Research suggests that it is caused by a combination of factors. These may include genetic disorders, , or medicines taken during pregnancy, and an older age of one or both parents .

Research also clearly shows that there is no link between childhood vaccines and autism spectrum disorder.

If you have questions about ASD risk factors and causes, talk to your child’s health care provider.

How Is Autism Spectrum Disorder Treated

ASD is most often a life-long condition. Both children and adults with autism benefit from behavioral interventions or therapies that can teach new skills to address the core deficits of autism and to reduce the core symptoms. Every child and adult with autism is unique. For this reason, the treatment plan is individualized to meet specific needs. It is best to begin interventions as soon as possible, so the benefits of therapy can continue on throughout the course of life.

Many people with ASD often have additional medical conditions, such as and feeding issues, and sleep disturbances. Treatment can involve behavioral therapy, medications or both.

Early intensive behavioral treatments involves the entire family and possibly a team of professionals. As your child ages and develops, treatment may be modified to cater to their specific needs.

During adolescence, children benefit from transition services that promote skills of independence essential in adulthood. The focus at that point is on employment opportunities and job skill training.

Autism And Understanding The Emotions Of Other People

Autism Spectrum Disorder: Do you know the signs to look ...

An autistic person may find it hard to understand the emotions of other people. Emotions are interpreted by subtle messages sent by facial expression, eye contact and body language. These are often missed or misinterpreted by an autistic person. Because of this, autistic people might be mistakenly perceived as being rude or unfeeling. Autistic people may find it difficult to understand how others perceive their behaviour.

What Disorders Are Related To Asd

Certain known genetic disorders are associated with an increased risk for autism, including Fragile X syndrome and tuberous sclerosis each of which results from a mutation in a single, but different, gene. Recently, researchers have discovered other genetic mutations in children diagnosed with autism, including some that have not yet been designated as named syndromes. While each of these disorders is rare, in aggregate, they may account for 20 percent or more of all autism cases.

People with ASD also have a higher than average risk of having epilepsy. Children whose language skills regress early in life before age 3 appear to have a risk of developing epilepsy or seizure-like brain activity. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. Additionally, people with both ASD and intellectual disability have the greatest risk of developing seizure disorder.

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.

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.

Diagnosis Of Autism In Adults

It is not unusual for autistic people to have reached adulthood without a diagnosis. 

Sometimes people will read some information or see something about autism that makes them think That sounds like me. They may then choose to talk to a health professional for a diagnosis, or they may not. 

You may choose to seek an autism diagnosis if:

  • you have been diagnosed with a mental health condition or intellectual disability during childhood or adolescence, but think that you may have autism
  • you have struggled with feeling socially isolated and different
  • your child or other family member has been diagnosed with autism and some of the characteristics of autism sound familiar to you.

If you wish to seek an assessment for autism, you can:

  • talk to a psychologist with experience in the assessment and diagnosis of autism
  • talk to your GP
  • seek a referral to a psychologist or psychiatrist with experience in the assessment and diagnosis of autism in adults from your GP.

A psychologist or psychiatrist with experience in the assessment and diagnosis of autism will ask you about your childhood, and experiences at school and as an adult. They may also do some psychological or psychiatric testing.

A speech pathologist may also be consulted to assess your social communication skills.

All of this information will be used to help make a diagnosis.

What Are The Dsm

In 2013, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders . 

The DSM-5 is now the standard reference that healthcare providers use to diagnose mental and behavioral conditions, including autism. 

Also see: Answers to frequently asked questions about DSM-5 criteria for autism

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 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 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.

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

Finding Someone Qualified To Evaluate Adults With Asd

How Is Autism Spectrum Disorder Diagnosed?

Currently, there are relatively few clinicians who specialize in evaluating and treating adults with autism. Nor do we have established criteria to objectively judge such qualifications. 

In my opinion, your best bet may be a developmental pediatrician, child psychiatrist or pediatric neurologist who is both experienced in evaluating autism in children and open to seeing older patients. So I would recommend talking to the clinician who diagnosed your child. If she or he does not feel qualified to evaluate an adult, he or she may have a respected colleague who would be.

Otherwise I would recommend contacting an established and respected autism center in your area. Examples include the centers in the Autism Speaks Autism Treatment Network. This will provide you with the assurance that the clinician has agreed to adhere to the centers high standards for care for patients with autism, regardless of age.

Thanks again for your question. I hope this information helps and that youll let us know how youre doing.

Diagnosing And Managing Autism Spectrum Disorder

Psychologists can play an important role diagnosing autism spectrum disorder and helping people cope with and manage the associated challenges.

Diagnosing and managing autism spectrum disorder .

Autism Spectrum Disorder is a complex neurodevelopmental disorder that affects behavior, communication and social functioning. According to the latest figures from the U.S. Centers for Disease Control and Prevention, an estimated 1 in 68 children in the U.S. have ASD.

Psychologists can play an important role diagnosing ASD and helping people cope with and manage the challenges associated with the disorder.

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