Autism is characterized by deficits/limitations in three areas: social interaction, communication, and restricted/repetitive behaviors, interests, and/or play. Signs of autism will include those behaviors falling into these three criteria: poor eye contact, lack of directed smiling (i.e., smiling while looking at another person), sharing interests with others, difficulty making and keeping friends, unusual play interests and manipulation of objects (i.e., focusing on details or non-productive components), restrictive conversational topics (e.g., conversations about Star Wars, trains, cars, etc). An individual may present with behaviors in all categories to a significant degree, or only a few, which is why the term “autism spectrum” was adopted.
You should discuss your concerns with your pediatrician. It is always helpful to bring descriptions of the behaviors reflecting your concerns. Concrete examples, such as poor eye contact, unusual play behavior, difficulty socializing, are helpful to the pediatrician in determining whether or not an evaluation is needed. Your pediatrician may conduct an autism screening, which should be completed (minimally) at 18 and 24 months of age (Pediatrics, 2007). Your pediatrician should then refer you to an autism specialist. Those professionals with qualifications to independently diagnose autism may include: a pediatric neurologist, a child psychiatrist or psychologist, and/or a developmental pediatrician. In some cases, your pediatrician may direct you to a speech/language pathologist if the concerns appear mostly related to language development. To assure accurate diagnosing, standardized assessment tools, administered by a team of highly qualified specialists, is recommended.
Many therapies exists for autism and sorting out which is best for your child is not your sole responsibility. Prior to the evaluation, inform the diagnostician that you will be looking for specific recommendations for services and supports your child may need. Although the first purpose of the evaluation is to determine a diagnosis, the second goal is to identify which therapies or other services and supports may be beneficial for your child and family. Insist that your doctor direct you to quality programs that address the core deficits of autism and that recommendations for educational programming are included in the assessment results.
The most widely known treatment for autism, with the greatest amount of research demonstrating effectiveness is applied behavioral analysis (ABA). Applied Behavioral Analysis (ABA) is based on principles of behavioral psychology and is intended to reduce disruptive/undesirable behaviors and build functional, alternative skills. While ABA is considered a more structured, adult-directed form of therapy and is often conducted in clinic settings, it can also be appropriate for managing behaviors in the home and/or school. Newer models of (non-ABA) intervention include those based on developmental/relationship based principles. These programs often focus on social and emotional engagement with the child and building social interaction and communication skills with the child in a less structured therapy context than what is often found in ABA programs.
Research shows that early, intensive intervention significantly improves long-term outcomes for children with ASD and in the long run, saves money by reducing the number of resources needed for these children as they age. The current, evidence-based recommendation for intervention is 20-25 hours/week of intensive therapy (NRC, 2001). Because a child’s brain undergoes such rapid growth in early childhood, the best time to “induce” permanent change through intervention, is under the age of three years, and minimally, under the age of five years.
Although the best time to begin intervention is prior to age 3, it is never too late to begin therapy. Different therapy programs exist to address the challenges that arise across the lifespan, whether your child has had early intervention or not. For example, the focus of speech therapy will change as an individual’s communication skills develop over time and across different settings, such as the home to school and school to work. Behavioral therapies are designed to address skill building and eliminating undesirable behaviors at any age. Social stories are another example of an effective approach to teaching social skills in challenging situations. These can be used with younger children, during the adolescent period, and even for some adults.
The goal of any intervention program should be to increase functional and academic skills to move an individual towards independence and increase the chances he/she will live a productive, fulfilled life. No “magic ball” exist which predicts which children will become fully independent as an adult. Many factors are considered when determining outcome. These include: cognitive, language, and adaptive functioning levels at the start of intervention, age intervention was initiated, the individual’s response to intervention, for example. Children diagnosed with PDD and Asperger’s, who fall at the mid-higher functioning range of the spectrum, tend to have better outcomes than those with classic autism and those with significant cognitive impairment/mental retardation.
An individual with autism presents with behaviors in all three categories of socialization, communication and restricted/repetitive behaviors. Additionally, individuals with autism may or may not have cognitive impairments. An individual with Asperger’s presents with deficits/limitations in socialization and restricted/repetitive behaviors, but by definition, have normal to above average cognitive and language skills.
The better question here is, “How do I find a quality program?” Therapy programs for individuals with autism can be found just about anywhere these days and a simple on-line search will produce literally, thousands of services. What caregivers should look for are highly qualified individuals who provide evidence-based therapies known to produce positive outcomes. Caregivers should insist that therapists provide regular measures of progress, as well, so that precious time and money are not wasted on interventions that do not work. Unfortunately, not every child benefits from evidence-based therapies. In those cases, a different type of intervention may work for your child. Research has not yet identified which characteristics of an individual predict success in a given treatment program. Nevertheless, caregivers should always consult with their doctor regarding recommendations for quality services versus making decisions based solely on websites or word-of-mouth.
There are three components to EB services:
a) sufficient studies have been conducted to show that a program or approach is effective in producing a meaningful result,
b) sound clinical judgment regarding the appropriateness of a program or approach, and
c) consideration of family values in selecting an appropriate program or approach.
There are now sufficient studies which demonstrate that vaccinations do not cause autism. It is important, however, for parents to discuss their concerns regarding the effects of vaccinations with their pediatrician. It is the pediatrician’s job to complete a thorough medical and family history of factors associated with negative effects of vaccinations for that individual child. There are conditions which create a higher risk status for side effects in any child. In these cases, your pediatrician may recommend an alternative schedule for your child. Additionally, your pediatrician may choose to delay immunization if your child is sick.
AAC: Augmentative and Alternative Communication system: Any system designed to supplement verbal communication. May include: pictures, gestures, voice output systems, etc.
ABA: Applied Behavioral Analysis therapy
ASD: Autism Spectrum Disorder
BCBA: Board Certified Behavioral Analyst: Qualified individual to provide ABA
CAM: Complementary and Alternative Medicine: Programs and services that are considered non-conventional and are lacking sufficient research to demonstrate effectiveness for large groups of individuals.
CDC: Center for Disease Control
DIR: Developmental, Individual-Difference, Relationship-Based Model
DSM: Diagnostic Statistical Manual
DT: Discrete Trial: A type of ABA utilizing traditional ABA principles and processes, most often implemented in the clinic setting.
ICD: International Classification of Diseases
IEP: Individualized Education Plan: an education plan created by the IEP team (e.g., teachers, social workers, educational psychologist, speech-language pathologist, and/or occupational therapist) and caregivers.
IEPC: Individualized Education Planning Committee
MSW: Masters of Social Work
OT: Occupational Therapist
PDD: Pervasive Developmental Disorder
PECS: Picture Exchange Communication System: a picture system based on ABA principles which utilizes visual depictions of activities, objects, events, persons to improve language, behavior, and academic areas
P.L.A.Y.: Play and Language for Autistic Youngsters: a type of developmental/relationship based therapy
PRT: Pivotal Response Therapy: A type of ABA which incorporates more natural, child-centered environments and procedures than traditional ABA.
RDI: Relationship Developmental Intervention: a type of developmental/relationship based therapy
SCERTS: Social Communication Emotional Regulation Transactional Support therapy: a type of developmental/relationship based therapy
SI: Sensory Integration: a type of therapy provided by an occupational therapist to improve an individual’s responsiveness to sensory stimuli (e.g., noise, touch, movement, taste, etc).
SLP: Speech-Language Pathologist
TEACCH: Teaching and Educating Autistic Children