What is Autism?

Autism is a complex developmental disability, most often characterized by impairments in social communication and by restricted or repetitive behavior.

Also referred to as autism spectrum disorder, this developmental disorder appears early in a person’s life.

The current version of the Diagnostic and Statistical Manual (DSM-5) includes a single diagnosis, autism spectrum disorder, for all of autism. This diagnosis emphasizes “deficits in social communication and social interaction” and “restricted, repetitive patterns of behavior, interests, or activities.” Autism spectrum disorder (ASD) replaces the DSM-IV category of pervasive developmental disorders (PDDs) and the specific diagnoses of autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS).

To see the DSM-5 definitions of autism spectrum disorder and social (pragmatic) communication disorder, please click here.

There has been some concern that some individuals previously given one of those diagnoses might not meet DSM-5 criteria for autism spectrum disorder and might experience a loss of supports. However, the DSM-5 definition includes the statement:

Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Autism is generally thought to be present from birth, but the behavioral characteristics associated with autism may not be apparent right away. Some parents of children with autism describe their children as being “different” soon after birth. They may appear to be either very quiet and “good babies” or very fussy and they often do not develop language and other skills at the same time as other children. Other parents report that their children appear to develop normally until approximately 18-24 months of age. At this time the children seem to stop developing new skills and often lose skills that they had previously mastered. Parents often report that the child stops talking and is no longer interested in playing with them.

It’s important to monitor your child’s development and discuss any concerns you may have with your child’s physician. You can learn more about when children typically reach certain developmental milestones by clicking here.

Some early indicators include:

    • Not responding to name by 12 months of age
    • Avoiding eye contact
    • Preferring to be alone
    • Decreased use of gestures to communicate (such as pointing)
    • Engaging in certain repetitive body movements (e.g., spinning, flapping hands)
    • Doesn’t engage in pretend play (e.g., feeding a doll) by 18 months of age
    • Decreased babbling or use of language

The Centers for Disease Control and Prevention lists developmental milestones, fact sheets on developmental disabilities and resources.

Since there is no blood test to determine the presence of autism, diagnosing this disorder can be difficult.  Doctors look at the child’s behavior and development to make a diagnosis.  Educators look at the impact these factors have on the student’s ability to access the general curriculum.  It is important to keep in mind that a medical diagnosis of autism and an educational diagnosis are not the same.

Medical Diagnosis

Autism Spectrum Disorder (ASD) can sometimes be detected at 18 months or younger.  By age 2, a diagnosis by an experienced professional can usually be considered reliable. However, many children do not receive a diagnosis until much older.  This delay means that children with ASD might not get the early intervention they need.

What does screening mean – does this mean there is a diagnosis?

Screening is a way to monitor development–it is not the same as a diagnosis. The purpose of screening is to identify children who might have a developmental delay or disorder.  Screening tools are developed for a specific problem or condition. Identifying atypical or delayed development as early as possible is important so that children can access appropriate interventions.  The American Academy of Pediatrics recommends screening for autism at both the 18-month and 24-month well-child visits.

What does Autism screening look like?

The screening process usually involves completion of a questionnaire by caregivers to assess social and communication development. It may also include direct observation by a specialist and a review of the child’s clinical history.  A variety of validated screening tools can be found here.

A good screening process will identify almost all of the children who have a delay or disorder. It will also, inevitably, identify some children who do not have the condition because no screening tool is perfect. The sensitivity of an autism screening tool indicates how well the tool correctly identifies children who have ASD and is the most important factor in a good screening tool.  If a physician suspects autism spectrum disorder, a referral should be made for a comprehensive evaluation. An audiology evaluation may also be ordered and often the child will be referred to Early Intervention (Part C) services.

Assessment & Diagnosis

An accurate diagnosis is based on a comprehensive history of early development and the observation or report of specific behavioral characteristics across a variety of environments and situations. The diagnostic criteria for autism are found in the Diagnostic and Statistical Manual – Fifth Edition (DSM-5) which can be viewed on the Autism Speaks website.

multidisciplinary diagnostic assessment  is recommended. This is a thorough review that differentiates autism from other developmental disabilities. The process should include direct observation with validated tools, and consideration of clinical history and caregiver concerns.   Additional assessment may include: review of medical history, neurological evaluation, genetic testing, metabolic testing, hearing and vision screening and other medical testing.

The assessment team should include professionals who have experience with assessing and diagnosing autism as well as the parents or primary caregivers for the child.  These professionals may include the following: pediatric neurologist, developmental pediatrician, child psychiatrist or psychologist or another licensed medical professional.  Given the impact autism has on social interaction, communication and other behaviors, it is also helpful to have a speech language pathologist, occupational therapist and behavior analyst on the team.

Educational Diagnosis/Identification

A child who receives a medical diagnosis of Autism Spectrum Disorder will not automatically receive the educational disability category of Autism and may not immediately be eligible for special education services through the public school system. Parents are encouraged to contact the Special Education Department of their local school division to request an assessment when there is any concern that their child may have autism   Please visit the Virginia Department of Education’s (VDOE) website for more information.

References

American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics. 2006;119:1808–1809]. Pediatrics. 2006;118 :405 –420

Gupta VB, Hyman SL, Johnson CP, et al. Identifying children with autism early [published correction appears in Pediatrics. 2007;119:867] Pediatrics. 2007;119 :152 –153

While to date, no cure has been found for autism, research has demonstrated that there are numerous interventions which do effectively target the core symptoms.  Evidence indicates that early intervention is critical and many educational/behavioral interventions have been shown to be effective for individuals under the age of 22, as reported by the National Autism Center.

Please visit the National Autism Center’s 2015 National Standards Report to view the report on treatments, Evidence-Based Practice, and Autism in the Schools.

References:

Autism Spectrum Disorders: Treatment. (2010). Retrieved October 1, 2010, from
http://www.cdc.gov/ncbddd/autism/treatment.html

Visit the Association for Science in Autism Treatment to learn more about evidence-based interventions.

According to the Centers for Disease Control and Prevention, it is estimated that 1 in 68 children in the United States have an Autism Spectrum Disorder.  That means that as many as 1.5 million Americans today are believed to have some form of autism, including the potential for there to be an excess of 125,000 Virginians. (View CDC press release on prevalence.)

For more information on child health data as it relates to Autism Spectrum Disorders, check out this online resource.

For more information on the latest research on prevalence and risk factors, check out the latest from Dr. Oswald’s Blog.

At this time, autism is not a reportable health condition in Virginia, so the only data available is that provided by the Virginia Department of Education (VDOE).  Since VDOE posts their annual child count data each year, it is clear from these statistics that the numbers continue to grow.   In 1998 VDOE reported 1,521 children identified with ASD.  This number increased to 19,566 students as of 2017.

 

 

 

For more information about Autism Spectrum Disorders, we love this informative video from Amazing Things Happen.

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