Autism and Your Child
What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a complex developmental condition that often reveals itself during the first three years of life. Autism disrupts the normal development of the brain and impairs thinking, feeling and social functioning. It is considered a “spectrum" disorder because of the wide variation in the types and severity of symptoms.
ASD does not discriminate, as it occurs in all ethnic, racial and economic groups. While there is no cure for autism, early diagnosis and intervention can make a significant difference in a child's ability to function and thrive at home and in school.
Are There Signs or Symptoms of Autism Spectrum Disorder?
Signs of autism can vary, but parents are usually the first to begin noticing changes in their child's social and communication behaviors. According to the Centers for Disease Control and Prevention, nearly half of parents who have a child with an ASD disorder observed problems before their child's first birthday and the vast majority of parents noticed problems by age 2.
Some of the “red flags" or signs parents may see can include…
- Impaired social interaction. A child may have problems engaging in play, making eye contact and understanding personal space boundaries.
- Lack of empathy. A child may have difficulty understanding other people's feelings or talking about his or her own feelings.
- Delayed language development. A child may lack the ability to hold simple conversations or understand social engagement.
- Repetitive movements. A child may rock, spin, flap hands or become intensely preoccupied with objects.
Additional signs can include…
- Flat or monotonous speech
- Difficulty adapting to changes in routine
- Intense focus on one topic
- Self-abusive behaviors
- Sleep disturbances
- Social withdrawal
- Unusual reactions to how things feel, taste, smell, sound or look
- Little or no desire for physical contact
- Unusual reactions in social settings
- Using odd words or phrases
In very young children, signs can include…
- Not responding to his or her name by age 1
- No desire to be held or cuddled
- Difficulty smiling or giggling
- Staring or fixating on objects
- Playing with toys in unusual ways
- Showing little affection toward caregivers
- Delayed or poor motor skills
Can My Child Be Tested for Autism Spectrum Disorder?
The American Academy of Pediatrics recommends that all children be screened for autism at the ages of 18 and 24 months, in addition to regular developmental and behavioral observations at every well-child visit.
Early detection and intervention are important to ensure children receive the proper care. Boys Town Pediatrics encourages parents to schedule an office visit with their pediatrician if they are concerned about their child's developmental progress, or if their child is showing signs of autism.
How is Autism Diagnosed?
Unfortunately, there is no lab test or simple blood test available to diagnose the disorder. Because the symptoms and severity of autism vary widely, diagnosis requires gathering and interpreting a lot of information. Typically, a diagnosis is based on criteria described in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association and used by most healthcare providers.
A doctor will observe a child's behavior and review the child's development history when making a diagnosis. It is important that parents know what signs to look for in their child. Sometimes ASD can be detected at 18 months or younger, and by age 2, a diagnosis can be considered reliable. There are children, however, who do not receive a diagnosis until they are much older. This can happen for a variety of reasons, including being misdiagnosed or having a slow onset of symptoms.
There are several steps in the diagnosis process, including developmental monitoring and developmental screening.
Developmental monitoring involves observing how a child grows and develops and whether the child is meeting developmental milestones or skills, such as taking a first step, sitting without support, playing and moving. Missed milestones may suggest a potential problem, so a physician or specialist may conduct a more in-depth evaluation or screening.
Developmental screening is more thorough and can be done by a doctor, nurse or other qualified healthcare professional, as well as professionals in a school or community setting. Questionnaires and checklists that touch on a child's language, thinking, behavior and mobility are common screening tools. However, it is important to note that screening is not diagnosing. If a child tests positive after a screen, it does not automatically mean the child has autism.
There are a variety of screening tools a doctor will use in order to measure autism symptoms. They often include the following:
- Ages and Stages Questionnaire: This test has a set of questions about behavior and social-emotional development, and includes multiple variations based on a child's age.
- Pervasive Development Disorders Screening Test: This test consists of a 23-item questionnaire with three different varieties based on the screening setting.
- Communication and Symbolic Behavior: This test consists of 22 rating scales grouped into seven “clusters" (communicative functions, vocal communicative means, reciprocity, gestural communicative means, verbal communicative means, symbolic behavior and social-affective signaling).
- Modified Checklist for Autism in Toddlers, Revised with Follow-Up: This test consists of a 23-point questionnaire to assess language delays and concerns about behavior.
What If My Child's Developmental Screening Suggests Autism?
A screening is not a diagnosis, but if it shows areas for concern, a more comprehensive developmental evaluation is the next step. A trained specialist, such as a developmental pediatrician, will review your child's medical history and perform a developmental exam, specifically looking for several language milestones that include:
- Babbling by 12 months of age
- Gesturing by 12 months of age
- Saying single words by 16 months of age
- Saying two-word phrases by 24 months of age
- Delayed or poor motor skills
If additional testing is needed, the pediatrician may refer your family to a developmental behavioral physician who specializes in the diagnosis and treatment of developmental disorders.
In addition to screening measures (see “How is Autism Diagnosed), other tools and diagnostic instruments can be used as part of the comprehensive evaluation.
Diagnostic instruments may be used with different modules, or activities, to accommodate a child's age. For toddler s, a module will be play-based. For older children, the module will be conversation-based. The evaluation does not have right or wrong answers, but instead focuses on whether the child gives others a chance to speak, asks for help if it is needed and is able to follow a change in subjects.
Interviews are another insightful tool that is used. An interview is typically conducted with parents and consists of general development questions and what a parent's current concerns are. In addition, cognitive tests are often administered. This testing allows the individual conducting the assessment to examine the child's behavior in a socially loaded session with less structure. It also gives more understanding into how a child plans, solves and organizes problems.
Is There a Genetic Test for Autism?
Genetic testing and screening, while not intended to diagnose autism, can clarify the cause of some autism spectrum disorders or other developmental delays. The results of genetic testing can be used to enhance the therapies, interventions and medical care provided to children with specific genetic conditions, such as Fragile X syndrome.
The Boys Town Autism Clinic has a team of specialists, clinicians and genetic counselors who can provide evaluation, diagnosis, individual treatment and ongoing support for children who have developmental delays, learning and behavioral disorders and genetic conditions. The ability of genetic testing to identify a specific diagnosis is expanding, allowing our specialists to answer questions such as who else in the family may develop or be affected by neurological problems.
Where Can My Family Go for Support and Help?
Children with autism have unique medical and clinical needs, and often have co-occurring medical conditions. The Boys Town Autism Clinic is staffed by clinicians and specialists who can provide everything from diagnosis and treatment to wrap-around services that address your child's physiological, social, emotional and co-occurring conditions.
School support is also available to help you navigate and encourage your child's academic success. Our specialists will work with your family and your child's school psychologists and counselors to help develop an individual education plan (IEP). You also can take advantage of virtual visits for follow-up care, medication checks and other specialty and clinical services.
At Boys Town, our child-focused and family-centered care targets the unique needs of each individual, so all treatment options can be explored, optimal care can be delivered and the best outcomes can be achieved. Our goal is your goal… to give your child the best opportunity to thrive and reach his or her full potential!