April is National Autism Awareness Month. Autism Spectrum Disorder (ASD), as it is formally known, is a developmental disability that typically begins to cause symptoms within the first two years of life. ASD can be diagnosed at any age, however. People who have ASD may experience challenges communicating and interacting with others; have limited areas of interest; engage in unusually repetitive behaviors; and have difficulty functioning in social, school or work situations.
ASD encompasses several conditions that were formerly known as: autistic disorder, pervasive development disorder not otherwise specified (PDD-NOS), Asperger Syndrome and disintegrative disorder. These terms are not used anymore; anyone who would have been diagnosed with one of these conditions is now simply said to have ASD.
As indicated by its complete name, ASD is a spectrum disorder, meaning there is a wide range in the type of symptoms a person may experience. Some people experience mild impacts, while others suffer from more serious effects. Accordingly, some people with ASD will require more significant help than others. Additionally, people who have ASD can range from highly gifted learners to significantly challenged.
It is estimated that close to 2% – 1 out of 54 children – are diagnosed with ASD before age 8. Boys are four times more likely to be diagnosed with ASD than girls.
ASD diagnoses have increased since the early 1990s. Researchers attribute this trend to increased awareness by parents and educators, as well as more robust screening by pediatricians to identify the disorder early in a child’s life. Additionally, the medical field has changed how ASD is identified and diagnosed – years ago, it was more likely that only severe cases of autism would be diagnosed. Now, milder cases are also detected as part of an intentional effort to help children early on with developmental challenges.
While a lot has been learned about ASD is recent years, there is much doctors and scientists still do not understand. There is not a cure for ASD, but it has been established that early diagnosis and interventions will help people better cope with the challenges brought on by the condition. One fact that is well-established is that vaccines absolutely do not cause ASD.
“The most important thing to know is this: following the recommended schedule for well child visits and developmental evaluations is the key to catching ASD early,” explains Dr. Sreemdevi Ramakrishnan, a pediatrician. “For children with ASD, the earlier a diagnosis can be made, the sooner needed interventions can begin. These are designed to help the child adapt and hopefully overcome, at an early age, some of the possible challenges he or she will face.”
Signs & Symptoms
There are several symptoms of ASD and most people who have ASD will experience several symptoms. Importantly, there is often nothing about an autistic person’s physical appearance that distinguishes them from someone who does not have the disorder. Below are some of the common symptoms of ASD.
- Lack of eye contact
- Not looking at or listening to people who are talking
- Not pointing at things (like a plane in the sky); not looking at something that someone else points to
- Unable to engage in a back-and-forth conversation
- Talking at length about one subject
- Unusual tone of voice – monotone or sing-song
- Not showing enjoyment
- Repeating certain behaviors or certain words and phrases
- Seemingly obsessive about certain objects or subjects
- Becoming upset at minor routine changes
- Displaying increased or decreased sensitivity to light, noise and other sensory inputs
- Sleep problems
- Rocking, spinning, walking on toes; other unusual behavior
People with ASD may display extraordinary strengths, as well:
- Excelling in subjects such as math, science, music or art
- Ability to learn detailed subject matter and retain information for an unusually long time
- Excelling at visual and auditory learning
Screening, Diagnosis & Treatment
Diagnosing ASD can be challenging, because there is a not a blood or other type of test used to detect the condition. Instead, a pediatrician evaluates a child’s behavior and developmental history to make a diagnosis.
The American Academy of Pediatrics recommends that children be screened for developmental delays during routine well-child visits at the following ages:
- 9 months
- 18 months
- 24 months
- 30 months
Specific screening for autism should occur at the 18- and 24-month well-child visit. In addition to the pediatrician’s evaluations during these visits, the observations and experiences of parents also play an important role in diagnosing developmental concerns. Parents are encouraged to conduct their own developmental monitoring so they can observe and document their child’s progress. This checklist from the U.S. Centers for Disease Control and Prevention is a helpful guide.
If ASD is suspected by the pediatrician, the child will likely be referred for additional evaluation by a team of doctors that may include a developmental pediatrician, a child psychologist or psychiatrist, a neuropsychologist and a speech language pathologist.
“It is understandably very difficult on parents to be told their child has ASD,” says Dr. Julie Lin, a pediatrician. “We all have big dreams for our children and to be informed that your child has been diagnosed with ASD and may not be able to enjoy the same ‘normal’ life as other children is profoundly difficult. For their own well-being, parents need to have a strong support system around them and give themselves plenty of space to reflect and process this difficult news.”
While an ASD diagnosis is not what any parent wants to hear, the earlier a diagnosis is made, the sooner interventions can begin. There is not a single treatment or strategy that is best in all cases – because ASD is a spectrum and severity and symptoms vary, it is necessary to tailor the treatment for each patient.
ASD interventions can help the child with the challenges of the disease and increase the likelihood that some negative impacts of ASD can be successfully mitigated. Early diagnosis and treatment – especially before age 3 – can help an autistic child learn to walk, talk and engage more productively with others.
In Texas, parents can see if their child is eligible for Early Childhood Intervention (ECI) services through the Texas Health and Human Services Commission. ECI serves children from birth to 36 months who have certain medical conditions or developmental delays. For children older than three, school districts may provide opportunities for specialized learning for children with ASD.
Some children with ASD are able to progress and participate in traditional classroom learning as they get older, while others may need to continue to be in classes for students with special needs. In Texas, nearly 72,000 children with ASD were enrolled in special education classes in the 2018-19 school year, representing 13.5% of all special education students, according to the Texas Education Agency.
In addition to physical and occupational therapies, medication may be prescribed to help with anxiety, depression, hyperactivity, attention problems and aggression. Again, these are symptoms that someone with ASD may experience, but not always.
A personalized treatment plan will help identify the patient’s strengths and seek to build upon them, limit challenging behaviors that result from the disorder, teach necessary communication and interaction skills and help the patient function and complete tasks independently.
What Causes Autism – And What Does Not
Doctors are not sure exactly what causes autism. There are some known factors associated with increased risk:
- Having a sibling with ASD
- Having older parents
- Very low birthweight
- Certain genetic conditions, such as Down syndrome
What does not cause autism? Vaccines.
The myth that vaccines are linked to autism originated with a British physician who made that assertion in a bogus study in the late 1990s. His “research” was soon labeled as fraudulent and subsequently discredited by the scientific and medical community. But with the ability of information to spread quickly online – even though it was false – some parents mistakenly believed that a vaccine/autism link existed. Social media has further enabled this misinformation to spread far and wide.
“Vaccines work by preventing children and adults from getting serious diseases. Any suggestion that vaccines have a link to autism is unequivocally false,” says Dr. Ramakrishnan. “If any parent ever has questions about vaccine safety, they should talk with their pediatrician about their concerns.”
Help is Available
People with ASD may have unique and significant challenges navigating through aspects of life that many of us take for granted – social interactions, attending school, holding a job. The condition may also present significant challenges to parents, as well. Resources and help are available, which can make a real difference for both children with ASD and their parents.
Early intervention strategies can help a child with ASD be more successful in overcoming challenges, while discovering and taking advantage of unique strengths they may have. And parents should not forget that they will probably need help, also. Lean on your pediatrician for support and look into support groups so you can share experiences with other parents going through the same challenges.
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