What are autism spectrum disorders (ASDs)?
ASDs are neurodevelopmental disorders that are characterized by impairments in social interaction, communication, and behavior. Specifically, individuals with ASDs have difficulty interacting with others and using language in conversation. They also have a restricted range of interests or engage in repetitive behaviors. These deficits are usually evident before the age of 3. Individuals with ASDs often have difficulty learning how to perform everyday activities, and some have intellectual impairments that cause them to learn more slowly than their peers.
Autism, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified
(PDDNOS) fall under the umbrella of Pervasive Developmental Disorders and are commonly referred to as ASDs. Asperger’s Disorder differs from autism because individuals with Asperger’s Disorder do not have a history of cognitive or language delays, yet they have significant difficulties in social interactions and communication. Asperger’s Disorder is often diagnosed later than autism since the deficits may not be observed until the child begins to interact with peers in more structured settings. PDDNOS is a diagnosis that is given when a child exhibits only some of the criteria for autism, an atypical pattern of deficits, or if the onset of the disorder is later than age 3.
How do I know if my child is developing typically?
While there are general trends in how children develop, all children grow and learn differently. Many factors affect a child’s progress toward developmental milestones, and it may be difficult for parents to determine whether their child is on track due to individual differences. If delays are present, early intervention can have a significant and lasting impact. Therefore, it is important to become familiar with child development and discuss any questions with your child’s healthcare providers.
How are ASDs first identified?
Pediatricians are often the first contact when parents become concerned about their child's development. During office visits, the physician may ask questions about the child’s development, and parents often share their concerns at that time.
The American Academy of Pediatrics (AAP) recommends that pediatricians screen for ASDs during well checks at 18 and 24 months and at any time a parent raises a concern. Pediatricians will ask the parent questions to assess their child's progress toward typical milestones. They may utilize one of the commonly used screening instruments, such as the Modified Checklist for Autism in Toddlers (M-CHAT) or the Childhood Autism Rating Scale (CARS). Careful consideration of parents' responses on the screening instrument allows the pediatrician to determine if there is cause for concern and referral. If the screening indicates a number of red flags, the pediatrician may recommend that the child participate in a multidisciplinary evaluation. Although the initial screening does not result in a diagnosis, it provides valuable information for the parents so they can begin treatment while waiting for an appointment with a full evaluation team.
What red flags in young children may indicate the presence of an ASD?
According to the Early Identification of Autism Spectrum Disorders: Guidelines for Healthcare Professionals in New Jersey from the Department of Health, Parents or caregivers should be alert to the following red signs:
- No babbling by 12 months
- No pointing or gesturing by 12 months
- No single words by 16 months
- No 2-word phrases by 24 months
- Loss of previously acquired skills, especially language
In addition to the concerns noted above, presence or absence of the following behaviors may be reason for a referral:
- Lack of joint attention (child does not draw other’s attention to objects in the environment)
- Child does not respond to his/her name
- Lack of pretend, imitative and functional play appropriate to developmental age
- Failure to develop peer relationships appropriate to developmental age
- Child does not imitate others’ behaviors
- Child is rigid in routines or has very difficult transitions
- Child engages in repetitive or stereotypical behavior
- Child has unusual responses to sensory stimuli
What do these concerns actually look like?
Difficulty with social interactions
Many individuals with autism do not spontaneously reach out to others to share information or feelings. They often do not know how to engage in simple social interactions, such as sharing an experience with another person. For example, a 3-year-old child with autism may not point to an animal so that his sister will notice it too. Social skill deficits can make the development of interpersonal relationships difficult. Some individuals with autism have difficulty understanding others’ perspectives, such as recognizing when other people do not share the same interests. However, with effective treatment, many people with autism learn to initiate interactions, successfully navigate social situations, and enjoy time with others.
Difficulty with communication
Another hallmark of autism is a delay in or a lack of development of spoken language. While many individuals with autism develop speech, their communication may consist of single-word utterances or simple sentences. Common speech abnormalities include echolalia (immediate or delayed repeating of information), unconventional word use, and unusual tone, pitch, or inflection. Even if more complex vocabulary is acquired, individuals with autism may still have difficulties having conversations with other people. They also may not understand common nonverbal cues such as body language, facial expressions, and eye contact.
Unfortunately, some individuals with autism do not develop functional speech. However, many learn to communicate using pictures, computers, sign language, and other augmentative devices.
Individuals with autism have a restricted range of interests. For example, a 6-year-old child with autism may play with his or her toy train to the exclusion of all other toys. Additionally, people with autism may engage in repetitive play activities such as spinning the wheels on a toy car rather than pretending to drive it, or dangling a shoelace in front of their eyes for long periods of time. Other repetitive behaviors may include motor movements, such as hand flapping, spinning, or jumping. Individuals with autism can be very resistant to changes in routine or transitions between activities. Even a minor change could be a great upset to an individual with autism. With effective teaching, many individuals with autism can learn to play appropriately with toys and engage in meaningful leisure activities.