Understanding Autism Spectrum Disorder: What is it?
The Centers for Disease Control and Prevention, describes Autism Spectrum Disorder (ASD) as being a complex brain and developmental disorder where the affected person experiences "social, communication and behavioral challenges," and has a difficult time relating to others. Physically, people with ASD do not look any different than other people, however they think and act differently. Numerous neurodevelopmental disorders and conditions fall under or are classified as Autism Spectrum Disorder, the three conditions are:
- Asperger's syndrome: experiences difficulties with social interactions but are usually highly intelligent people;
- Autistic disorder: experiences difficulties interacting and communicating with other people and exhibit repeat behaviour;
- Pervasive developmental disorder: exhibit developmental delays and sometimes can have difficulties with social communication.
In the past the conditions above were categorized as different types of autism, however in 2013 when the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was published, it redefined and changed the criteria for ASD to combine the three disorders mentioned above as simply Autistic Spectrum Disorder (ASD).
The severity of the problems range from mild, moderate to severe and no two cases are ever the same. While some people with ASD are very bright and gifted, others are more challenged. Some people can cope with their daily life with little support while others need constant support and help.
Autism typically appears in the first two to three years of child's life. It can be diagnosed at eighteen months or even earlier. Usually when a diagnosis is received from a mental health professional by the age of two, it's a fairly accurate and reliable diagnosis, however, most children receive a proper diagnosis when they are older.
There is no known cause for ASD; research has shown it is linked to the brain and its development. According to some studies, the brain goes through an early overgrowth and grows faster than normal. This prevents the different parts of the brain from communicating properly as it should.
Genetics and biology are also known to play a role in the development of ASD and children who have a sibling with ASD are at a higher risk of having the condition themselves, but doctors still don't know exactly which genes are responsible for passing down the illness. People with some genetic conditions such as tuberous sclerosis also run a higher risk of developing ASD while certain prescription drugs taken during pregnancy like valproic acid has also been linked to ASD.
While these factors may play a role in causing ASD, not enough scientific research or data is available to state conclusively what causes ASD. A study looking into the risks and causes of ASD is being conducted in the U.S. right now called Study to Explore Early Development (SEED) with the hopes that more concrete information will be available on cause and prevention of ASD.
WHAT ARE THE SYMPTOMS OF ASD?
Autism can affect anyone of any race, colour or background, however it is 4.5 times more likely to affect a boy than a girl. One of the earliest symptoms of ASD is an infant or toddler who has difficulty in developing communication skills and shows little or no interest in their surroundings or others or appears to be deaf even though they have no hearing problems. In addition they demonstrate a lack of social awareness and tend to live in their own world. The following symptoms may also be present:
- Difficulty in social interactions and communication (this does not mean they don't like people or don't find them interesting, they may simply have difficulty expressing this interest);
- Have difficulty adapting to new environments or routines;
- Lack of response to their name being called;
- Avoiding eye contact or physical contact;
- Intense focus on one activity, for instance lining up toys or blocks;
- Exhibit repetitive and / or persistent behaviour;
- Don't smile or wave back;
- Speak in an atypical manner i.e. monotone voice;
- Have sensory issues i.e. are too sensitive or not sensitive enough when it comes to senses like touch, taste, sight etc.
Symptoms of ASD are easier to pinpoint in toddlers, in fact that's when parents are most likely to notice something is off with their child because it's the age when they start talking regularly, start to interact with other children, and take active part in games and play. As the toddler gets older and starts going to school and eventually enters their teenage years, the early signs can become more pronounced and they may be faced with the following difficulties:
- Trouble adjusting to and fitting in at school;
- Have trouble making friends;
- Have trouble following instructions;
- Have trouble completing homework or other tasks;
- Unable to follow a pattern of conversation i.e. won't be able to take turns when talking and will either do all the talking or all the listening;
- Prefer being alone rather than in a social, group setting;
- Have trouble developing meaningful relationships;
- Display anxious or aggressive behaviour, for instance banging their head against the wall;
- Have trouble sleeping;
- Be depressed;
- Have trouble understanding body language or other non-verbal cues, such as the tone of someone's voice. This leads to difficulty understanding sarcasm or teasing and jokes.
- Show little facial emotion and has trouble reading other's emotions;
At one time or another every healthy, normal toddler, child and adult faces some of the problems listed above for any number of reasons. This does not mean they are ill or have ASD. The concern is raised when several of the symptoms above are present for a prolonged period of time. That could very well be due to ASD and a conversation with the family doctor is a good place to start if there are some concerns relating to autism.
HOW IS AUTISM DIAGNOSED?
According to the American Academy of Pediatrics (AAP), children should be screened for development disabilities during their regularly scheduled 9 months, 18 months and 24 or 30 months visits. Autism specific screening is done during the 18 months and 24 months visit with the pediatrician. The diagnosis is done using a multidisciplinary assessment; meaning a team of professionals are involved in the diagnosis process. These professionals can include a pediatrician, a family doctor, a psychiatrist or a psychologist.
Diagnosing ASD can be a little challenging, as there is no one test or method for testing for the condition such as an ultrasound or blood test or brain scan. Instead Autistic Spectrum Disorder is diagnosed using developmental screening tools and the diagnosis for the condition is based on interviews with parents, an overview of the child's development and through observation of their social interactions. Health professionals also do an assessment on the child's language and cognitive abilities. The screening tools used can be geared specifically to a particular condition (such as ASD) or they can be more general for instance tools which test language or motor skills development. Some examples of screening tests are:
- Autism Diagnostic Observation Schedule
- Autism Diagnostic Interview
- Screening Tool for Autism in Toddlers
- Communication and Symbolic Behaviour Scales
- Parent's Evaluation of Development Status
- Ages and Stages Questionnaires (ASQ)
In order to get a proper diagnosis of ASD, two types of symptoms have to be present. There has to be:
- Problems with communicating and social interactions
- A repetition in the pattern of behaviour exhibited by the patient.
Once a child has been diagnosed with ASD, the health care professionals will also provide a description on the severity of their condition. Treatment is provided based on this description. Some children need little support to lead a normal, fulfilling life while others need a substantial amount of support to function through the day.
In some cases, the only symptom the child exhibits is difficulty in social communication but they behave normally in all other aspects. In those cases, the child is diagnosed with a Social Communication Disorder, not ASD.
Studies have shown that when ASD is caught and treated early, it can have a significant impact on your child's life (in a positive manner) and can affect how they develop. Intervention services are available from birth to 36 months, these services help the child learn important life skills and lessons, for instance how to walk or how to talk and communicate with others socially.
HOW IS ASD TREATED?
Unfortunately there is no real or permanent way of curing ASD or treating the main symptoms of the condition. However, there are several types of treatment options available for people with ASD. These treatment options fall under four categories:
In the hopes of managing or decreasing ASD symptoms, therapists have developed dietary treatments such as adding vitamin supplements to the child's diet or removing certain types of food. However, there is no scientific basis for these treatments and their results have not been proven. Some have found these diets helpful for their child, while others have seen no improvement or difference. Before making changes to your child's diet, you should speak to your doctor and get the go ahead. A healthy diet with the right amount of nutrients and vitamins is important for a child's developing body.
Medication is available to help people with ASD function in a more stable manner. For instance, certain types of medications can help with symptoms of depression, manage energy levels (low or high) or help with seizures. Finding the right balance of medication will be based on trial and error, therefore it's important to work closely with your child's health care provider or pediatrician and find the solution, which works best for you and your family. Your child's health will also be monitored to ensure they do not suffer from any negative effects of the medication they are taking.
- Complementary and Alternative Medicine (CAM):
CAM treatments are very controversial and again have no proven results. They include things like diet changes or chelation (a process whereby lead is removed from the patient's body). All CAM treatments should be discussed with a doctor before you attempt them.
- Behaviour and Communication:
This method has proven to be one of the more successful approaches to treating ASD. According to the American Academy of Pediatrics' and the National Research Council this type of treatment provides the child with structure and direction and helps them fit into their family. Numerous types of therapies such as speech therapy, occupational therapy, sensory integration therapy etc. fall within this treatment category. These therapies focus on the child's emotional as well as physical well being.
One of the more popular and well known methods for treating ASD is Applied Behaviour Analysis. This method is used in schools, clinics and by health care professionals and has seen proven results. Different types of ABA are available, all of which encourages positive behaviour in the child and helps them learn and improve their skillset.
The doctor will be able to recommend what type of treatment is best for you, your child and your family and they will work with you to guide your child, administer the treatments and monitor the results and their progress.
It's important to note (and it cannot be stressed enough) that Autism affects every child differently. No two autism cases are the exact same. If you suspect or have concerns that your child may be autistic you are strongly encouraged to speak to your family doctor, your child's pediatrician or a health care provider. Free evaluations are often offered at clinics and are available without a referral from a doctor. Call your local clinics to find out if this is an option for you.
ASD symptoms should be taken seriously and it's in your best interest to act sooner rather later because if your child does have the condition, the sooner they are diagnosed, the quicker they can begin to receive treatment. Lots of information about the condition and help is also available online for parents and families.
While it can be discouraging as a parent to know there is no cure for your child's illness, many options are available today, which can provide you and your child with a fulfilling life. ASD is not an easy condition to cope with and it can be difficult to deal with these challenges as a family. Therapy and counselling support is always available for parents, siblings and spouses. It's imperative that everyone in the family remain happy and healthy, so make sure to schedule some personal time for yourself, get help when you can, and maintain continuous communication with your doctor. Being armed with the right training tools and information can make all the difference.