Autism Spectrum Disorder (ASD)
ASD is a neurobiological disorder that typically affects development within the first three years of life and is characterized by deficits and symptoms in the following areas:
- Impaired communication ability (may be verbal, partially verbal, or non-verbal);
- Impaired social interaction;
- Restricted and/or repetitive interests (includes repetitive actions; verbally repeating words, phrases, or sentences (i.e. perseverating on a topic)
- Sensory issues—over or under sensory stimulation
Signs and Characteristics of Autism
Parents may notice specific characteristics or behaviors in their child, and sense something is not quite right. Listen to these feelings! The following is a partial list and all children may exhibit other characteristics, or varied levels of the characteristics. Remember: no two people have the exact, same characteristics with autism. If you notice things are “different” about your child, you may not know exactly how to put the differences into words. It is important that parents are in tune to these concerns and discuss them with their health care provider as early as possible. Parents know their children better than anyone and are advocate for their well-being—do not delay! Early intervention is very, very important to improved outcomes with ASD.
According to the First Signs (http://www.firstsigns.org/concerns/flags.html) and Act Early websites (http://www.cdc.gov/ncbddd/actearly/milestones/index.html), the following are possible signs of ASD. If your child exhibits two or more of these signs discuss them with your primary health care provider.
- Difficulty expressing needs or wants
- Difficulty communicating in a functional or meaningful way.
- May cry or laugh for no apparent reason.
- Processing instructions or other forms of communication, or may seem to take a long time to understand an instruction.
- May demonstrate echolalia and repeat back words or phrases (from peers, parents, teachers, television, or other forms of verbal or media input)
- Difficulty or inability to engage in joint attention (i.e. share interest or objects with others, following gazes, point, gesture, or interact socially).
- May line up, spin, or show inappropriate attachment to toys or objects.
- May have frequent tantrums, aggression, or self-injurious behaviors (SIB).
- May demonstrate repetitive, stereotypic self-stimulatory (stimming) behaviors. This repetitive behavior can be in the form of actions (such as spinning, hand flapping, twitching fingers, etc.) or in the form of repetitive conversation (such as repeating words, phrases, sentences, reciting parts of movies over and over, etc.); it is behavior that does not seem to have a purpose, and interferes with daily living.
- May resist change—desire sameness.
- May appear aloof, deaf, or want to be alone.
- Difficulty taking another’s perspective or reading another person, reading body language, facial expression, or gestures (take others literally).
- Difficulty starting or sustaining a conversation.
- Difficulty with peer relationships.
- May not make eye contact.
- Sensory processing issues: hyper or hyper sensitive to sensory inputs.
- Particular about food choices and textures.
- Physically over or under activity.
- Over or under sensitivity to physical pain.
- Difficulty with fine and/or gross motor skills.
- Limited or no eye contact.
- Skills are Fragmented or Splintered—individual may be exceptionally strong in some areas while deficient in others (e.g. outstanding math skills but difficulty with reading and comprehending a book or story).
- Physiological issues—may have gastrointestinal issues, food allergies, and other medical concerns.
American Academy of Pediatrics Recommendation for Screening
The American Academy of Pediatrics has recommended ALL children be screened at well-child visits for autism and other developmental disabilities at 18 and 24 months. The tool that is used is called the “Modified Checklist for Autism in Toddler’s” (MCHAT). This is a 23-question SCREENING tool. It does NOT diagnose autism, but considers possible “red flags”. You can download this tool at NO COST, complete it, and take it to your physician at any time. Remember that this is JUST a screening tool, and even if your child does not have autism, he or she may have some other developmental delay that may need attention and intervention.
The link is: www.m-chat.org. Go to the Parents and Caregivers section, and honestly answer the questions. You will be provided results instantly and you can print and take them to your physician.
New Criteria for Autism Spectrum Disorder (ASD)
The diagnostic criteria for autism changed in 2013. The change was made after 19 years of research and clinical practice. The last update to the autism diagnosis was in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The American Psychiatric Association has just published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- The diagnosis will be called Autism Spectrum Disorder (ASD), and there no longer will be sub-diagnoses (Autistic Disorder, Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified, Disintegrative Disorder).
- In DSM-IV, symptoms were divided into three areas (social reciprocity, communicative intent, restricted and repetitive behaviors). The new diagnostic criteria have been rearranged into two areas: 1) social communication/interaction, and 2) restricted and repetitive behaviors. The diagnosis will be based on symptoms, currently or by history, in these two areas.
- Note that individuals diagnosed under DSM-IV criteria will maintain their existing diagnosis, it should not change.
Source: American Academy of Pediatrics: http://aapnews.aappublications.org/content/early/2013/06/04/aapnews.20130604-1
What the ASD Diagnosis Changes Look Like
DSM-V Diagnostic Criteria for About Autism
Under new DSM-V criteria (effective 2013) the condition is called Autism Spectrum Disorder, and moved from 3 domains to 2 domains (note that domains are areas where individuals are affected):