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What is Autism?

Autism Spectrum Disorder (ASD), hereafter referred to as Autism (which includes Asperger’s Disorder and Pervasive Developmental Disorder – Not Otherwise Specified [PDD-NOS]), is a complex, lifelong developmental condition that typically appears during early childhood and can impact a person’s social skills, communication, relationships, and self-regulation. The Autism experience is different for everyone. It is defined by a certain set of behaviors and is often referred to as a “spectrum condition” that affects people differently and to varying degrees.

While there is currently no known single cause of Autism, early diagnosis helps a person receive resources that can support the choices and opportunities needed to live fully.  Autism is estimated to occur in as many as 1 in 36 individuals (CDC). 

Screening and Diagnosis

Autism is characterized in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), which is used by clinicians to diagnose Autism by: Persistent differences in communication, interpersonal relationships, and social interaction across different environments. What this can look like:

  • Being nonverbal, nonspeaking, or having atypical speech patterns, having trouble understanding nonverbal communication, difficulty making and keeping friends, difficulty maintaining typical back-and-forth conversational style.

Restricted and repetitive behavior, patterns, activities and interests. What this can look like:

  • Repeating sounds or phrases (echolalia), repetitive movements, preference for sameness and difficulty with transition or routine, rigid or highly restricted and intense interests, extreme sensitivity to, or significantly lower sensitivity to, sensory stimuli.

Prevalence

Autism is prevalent across the world, although tracking rates can vary due to differences in reporting. In 2023, the Centers for Disease Control and Prevention (CDC) issued its Autism prevalence report.

  • The report concluded that the prevalence of Autism had risen to 1 in every 36 – more than three times as great as the 2004 rate of 1 in 125.
  • Children who receive an Autism diagnosis by age 4, are fifty times more likely to receive services.
  • The 2023 report noted that more White and Black children were identified with Autism than Hispanic children.
  • Previous studies have shown, that children of color may still receive their diagnoses later than White children. Stigma, lack of access to healthcare services due to non-citizenship or low income, and non-English primary language are potential barriers to the early identification of Hispanic children and children of color with Autism.
  • Currently, boys are also approximately 4 times more likely to have an Autism diagnosis than girls of the same age. However, recent research suggests that girls may not display characteristics of Autism in the same way as boys and might go undiagnosed because of their different presentation.

Signs and Characteristics

Autism impacts an individual throughout the lifespan. However, research shows that early diagnosis can lead to improved quality of life. The behaviors of Autism may be apparent in infancy, but they usually become clearer during early childhood. As part of a regular health visit, your child’s doctor should perform developmental screenings focused on Autism. This screening is recommended at ages 18 and 24 months for all children.

Your doctor will encourage you to ask specific questions about your child’s developmental progress. The National Institute of Child Health and Human Development (NICHD) developed a detailed list of behaviors, listed in four categories: communication, social behavior, stereotyped behavior, and other behavior. Additionally, the Centers for Disease Control and Prevention (CDC) developed a list of Signs and Symptoms, which can be found here.

Social Behavior

  • Prefers solitary or parallel play rather than engaging in associative or cooperative play with other children.
  • Preference for predictable, structured play over spontaneous or make-believe play.
  • May not respond to name being called.
  • Struggles to make eye contact to communicate interests and/or needs.

Communication

  • Develops speech later than typical or not at all (nonspeaking).
  • Repetition in language or movement, such as repeating the same words or sounds, hand flapping, or any repeated movement.
  • Atypical nonverbal communication, including avoiding eye contact, giving few facial expressions or having a monotone voice.

Stereotyped Behavior

  • Extremely distressed by changes, including new foods or changes in schedule or routine.
  • Strong, persistent interest in a specific topic, part of a toy, or item.

Other Behavior

  • These characteristics vary widely and do not necessarily mean your child has Autism. However, if your child is showing these behaviors, a screening is encouraged. Many starts by voicing their concerns with their child’s primary physician, with referrals being made to a specialist for further evaluation. 

Useful Links
First Signs of Autism
CDC Developmental Milestones

Causes and Factors

There is no known single cause for Autism, but it is generally accepted that it is caused by differences in brain structure or function. Brain scans show differences in the shape and structure of the brain in people with Autism compared to in neurotypical development. Researchers do not know the exact cause of Autism but are investigating a number of theories, including the links among heredity, genetics, and medical problems. There has been misinformation about the cause of Autism. It is not caused by vaccines or due to parenting style or nutrition.

In many families, there appears to be a pattern of Autism or related disabilities, further supporting the theory that the disorder has a genetic basis.

While no one gene has been identified as causing Autism, researchers are searching for irregular segments of genetic code that people with Autism may have inherited. It also appears that some people are born with a susceptibility to Autism, but researchers have not yet identified a single “trigger” that causes Autism to develop.

Other researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may affect brain development in an unexpected way, resulting in Autism. Still other researchers are investigating complications during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances, and exposure to chemicals.

How is Autism Diagnosed?

There are no medical tests for diagnosing Autism. The DSM-5 is used by clinicians to diagnose Autism and the features of Autism are described in this document. The DSM-5 criteria require that the core features of Autism be present in early childhood. However, for some children, the symptoms may not fully manifest until social demands exceed the person’s capacity to cope with them. In addition, challenges may be masked by learned coping strategies and support.

Autism typically appears by age 3, though diagnosis and intervention can and should begin earlier. In order to be diagnosed accurately, an individual must be observed by professionals skilled in determining communication, behavioral, and developmental levels. Ideally, an individual should be evaluated by a multidisciplinary team which may include a neurologist, psychologist, developmental pediatrician, speech/language pathologist, occupational therapist, education consultant, or other professional knowledgeable about Autism.

However, because many of the behaviors associated with Autism are shared by other disorders, a doctor may complete various medical tests to rule out other possible causes. A brief observation in a single setting cannot present a true picture of an individual’s abilities and behavior patterns. At first glance, the person with Autism may appear to have a learning disability or problems with hearing. However, it is important to distinguish Autism from other conditions, since an accurate diagnosis can provide the basis for building an appropriate and effective educational, vocational, and treatment program.

Therapies and Supports Available

Educational and behavioral therapies are often effective in children with Autism. These methods can be used together with biomedical interventions. Parents, siblings, and friends may play an important role in assisting the development of children with Autism. Typical preschool children learn primarily by play, and the importance of play in teaching language and social skills cannot be overemphasized. Ideally, many of the techniques used in ABA, sensory integration, and other therapies can be extended throughout the day by family and friends.

  • Occupational Therapy
    This can be beneficial for those with sensory needs, who often have hypo and/or hyper sensitivities to sound, sight, smell, touch, and taste. Occupational therapies may also work on fine motor skills, such as handwriting and shoe tying. Sensory integration focuses primarily on three senses — vestibular (i.e., motion, balance), tactile (i.e., touch), and proprioception (e.g., joints, ligaments).
  • Physical Therapy
    This may focus on gross motor skills, such as jumping, kicking, and running. Often children with Autism have limited gross and fine motor skills, so physical therapy can be helpful. Can be helpful for those that walk on their toes or those that have low muscle tone.
  • Speech Therapy
     Speech Therapy focuses on speech and language disorders, including social communications, language impairments, and semantic issues. Sign language, Picture Exchange System (PECs) and Augmentative Communication Devices (ACCs or Aug Comms) may also be very helpful in developing communication skills.
  • Feeding Therapy
    Feeding Therapy is used to help individuals who have difficulties sucking, chewing, eating or swallowing. It can help children who have issues with food selectivity or refusal. A Speech Language Pathologist (SLP) or an Occupational Therapist (OT) may provide feeding therapy.
  • Applied Behavioral Analysis
    Many different behavioral interventions have been developed for children with Autism, and they mostly fall under the category of Applied Behavioral Analysis (ABA). This approach generally involves therapists who work intensely, one-on-one with a child for 5 to 40 hours/week. ABA programs are overseen and managed by a Board-Certified Behavior Analyst (BCBA). Children are taught skills in a simple step-by-step manner, such as teaching colors one at a time. The sessions usually begin with formal, structured drills, such as learning to point to a color when its name is given; and then, after some time, there is a shift towards generalizing skills to other situations and  environments. ABA programs are most effective when started early, (before age 5 years), but they can also be helpful to older children.
  • Auditory Interventions

    Research has shown that AIT improves auditory processing, decreases or eliminates sound sensitivity and reduces behavioral problems in some children. There are several types of auditory interventions including the Tomatis approach, the Listening Program, the SAMONAS method, and Berard Auditory Integration Training. Information about these programs can be obtained from the Society for Auditory Intervention Techniques’ website https://berardaitwebsite.com

  • Behavioral Health Therapy
    Behavioral Health offers a myriad of support, which may include: Cognitive Behavioral Therapy (CBT), Art Therapy, Skill Building, Social Skills Groups, and Family Services, such as Sibshops, Parent Groups, and Family Counseling. 
  • Floortime
    This technique uses your child’s interests for connection, to move forward intellectually and emotionally. Visit stanleygreenspan.com for more information. 
  • Hippotherapy
    A form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities. Unlike therapeutic horseback riding (where specific riding skills are taught), the movement of the horse is a means to a treatment goal when utilizing hippotherapy as a treatment strategy.
  • Relationship Development Intervention (RDI)
    This is a method for teaching children how to develop relationships, first with their parents and later with their peers. It directly addresses a core issue in Autism, namely the development of social skills and friendships. Learn more at www.rdiconnect.com.
  • Social Thinking
    Social Thinking is a treatment framework and curriculum developed by Michelle Garcia Winner, SLP that targets how to enhance and improve social thinking abilities, regardless of diagnostic label. Through the Social Thinking concepts and strategies, individuals are taught social emotional skills and how to improve social problem solving. Visit socialthinking.com for more information and to access free articles, webinars, and books to purchase. 
  • Habilitation
    Habilitation is a service that teaches a person to learn, keep, and improve skills and functional abilities. Habilitation goals are determined with your DDD support coordinator, and habilitation goals make up part of the Individual Support Plan (ISP). 
  • Respite
    Respite is child care that is intended to give the parents or guardians a break. Respite cannot be used so that the parent can work.
  • Attendant Care
    A service that provides a qualified individual to supply needed services in order for an individual
    to remain in his/her home and/or participate in work/community activities.

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