The current accepted medical terminology for Autism is Autism Spectrum Disorder (ASD). The use of “Spectrum” accurately describes the wide range of
symptoms, levels of impairment or disabilities and their varying degree of
severity. As some children can be only mildly impaired
by their symptoms, others can suffer from severe disability.
In March 2012, the Centers for Disease
Control and Prevention issued their ADDM autism prevalence report. The
report concluded that the ASD
affects 1 in every 88 children born in the United States, with a slightly
higher rate for males, almost 1 in 54.
With occurrence rates that high, almost
everyone knows someone impacted by ASD.
Therefore, it is important we all educate ourselves about this common and
complex issue.
What
are the symptoms of ASD?
As mentioned before
symptomology and severity can vary widely from one child to the next. Generally accepted indicators can include:
- Lack of or delay in spoken language
- Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
- Little or no eye contact
- Lack of interest in peer relationships
- Lack of spontaneous or make-believe play
- Persistent fixation on parts of objects
How is ASD diagnosed?
Whether it is the result of an evaluation specifically initiated by a parent or a routine developmental screening during well-child checkups with a health care provider, children who show some developmental problems are referred for additional evaluation.
Initial Screening
A well-child
checkup should include a developmental screening test, with specific ASD
screening at 18 and 24 months as recommended by the American Academy of
Pediatrics. A parent’s
own experiences and concerns about the child's development are a very important
part in the screening process. Notes
about the child's development, even family videos, photos, and baby albums help
to document behavioral timelines and developmental milestones are all useful to
the health care provider in the evaluation of the child. The initial screening instruments used by the
doctor for toddlers or preschoolers may consist of:
- Checklist of Autism in Toddlers (CHAT)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Screening Tool for Autism in Two-Year-Olds (STAT)
- Social Communication Questionnaire (SCQ)
- Communication and Symbolic Behavior Scales (CSBS).
To screen
for mild ASD or Asperger syndrome in older children, the doctor may rely on
different screening instruments, such as:
- Autism Spectrum Screening Questionnaire (ASSQ)
- Australian Scale for Asperger's Syndrome (ASAS)
- Childhood Asperger Syndrome Test (CAST).
Comprehensive Diagnostic
Evaluation
The next
step in diagnosing ASD involves a thorough evaluation to rule out other causes
or conditions that could be responsible for the symptoms. This stage utilizes a team of health care professionals
that encompasses a wide range of specialties: psychology, neurology,
psychiatry, speech therapy. The
evaluation at a minimum should include the assessment of cognitive and language
levels, and age-appropriate skills needed to complete daily activities
independently. Due to complexity in
nature of ASD and the possibility of other accompanying illnesses more
comprehensive testing may be appropriate:
hearing testing, screening for lead poisoning, brain imaging, genetic
testing, and in-depth memory, problem-solving, and language testing.
How is ASD treated?
Once a child is diagnosed as having ASD, discussions begin on treatment options. As varied and individual as each child, so are the options.
Nonmedical interventions include behavioral and
educational approaches as well as focuses on sensory response and communication.
- Applied Behavior Analysis (ABA) is a treatment plan that includes verbal behavior and pivotal response training interventions centered around shaping and reinforcing new behaviors, such as learning to speak and play, and reducing undesirable ones.
- Developmental, Individual Difference, Relationship-based (DIR)/Floortime Model aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the child.
- TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) emphasizes adapting the child’s physical environment and using visual cues.
- Interpersonal Synchrony targets social development and imitation skills, and focuses on teaching children how to establish and maintain engagement with others.
Medical
interventions, in children ages 5 to 16 who have ASD, with medications such as antipsychotics,
antidepressants, and stimulants
have been known to help reduce symptoms such as irritability
which can often translate into aggression, self-harming acts, or temper
tantrums.
Biomedical treatments include modifications in diet such as the gluten-free/casein-free
diet, addressing food sensitivities, addition of vitamins and minerals
supplements, immune system regulations and others.
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