IS IT ASD?
Red Flags and Understanding the Diagnosis
RED FLAGS
Do you have concerns about your own or your child's development? Or perhaps someone else has mentioned the term "autism" or "ASD" to you in reference to yourself or your child. Some of the most common concerns associated with ASD are:
Not respond to their name by 12 months of age
Not point at objects to show interest (point at an airplane flying over) by 14 months
Not play “pretend” games (pretend to “feed” a doll) by 18 months
Avoid eye contact and prefer to be/play alone
Have delayed speech and language skills
Does not share interests with others
Only interacts to achieve a desired goal
Has flat or inappropriate facial expressions
Does not understand personal space boundaries
Avoids or resists physical contact
Is not comforted by others during distress
Has trouble understanding other people’s feelings or talking about own feelings
Reverses pronouns (e.g., says “you” instead of “I”)
Gives unrelated answers to questions
Does not point or respond to pointing
Uses few or no gestures (e.g., does not wave goodbye)
Talks in a flat, robot-like, or sing-song voice
Does not understand jokes, sarcasm, or teasing
Repeat words or phrases over and over (echolalia)
Get upset by minor changes
Have obsessive interests
Flap their hands, rock their body, or spin in circles
Have unusual reactions to the way things sound, smell, taste, look, or feel
UNDERSTANDING THE DIAGNOSIS
Autism is considered a neurodevelopmental disorder. Neurodevelopmental means that it stems from the brain and it affects a persons development.
The term autism is often used interchangeably with the more formal diagnosis of Autism Spectrum Disorder, or ASD.
A diagnosis of autism, or ASD, is made by considering 2 main categories of characteristics, or symptoms. The first is persistent deficits in social communication and social interactions, and the other is restricted or repetitive behaviors or interests. Let me explain both of these in a bit more detail.
Delays or deficits in communication for the purposes of an ASD diagnosis refers directly to the persons ability to use verbal language for conversation, and to initiate or respond to social situations. It also refers to a persons ability to use nonverbal communication, such as eye contact, facial expressions, and gestures. Deficits in social interaction also refers to a persons ability to develop, maintain, and understand relationships, which includes the ability to engage in play, and general interest in friendships. This category can refer to what a person is doing presently, or what they used to do. So that is the first category, it is all about language and socialization.
The second category is the restricted or repetitive behaviors or interests category. This category can also refer to what a person is doing presently, or what they used to do. In this category, 2 out of 4 criteria must be met. The first is stereotyped or repetitive motor movements, use of objects, or speech. Examples of this would be hand-flapping, repetitive phrases, or lining up toys. Just a side note, the terms stereotyped and repetitive basically mean the same thing, and you may here them both used often when it comes to ASD, so I wanted to be sure to present them both here. Okay, the second criteria in this category is rigidity when it comes to routines and rituals. Examples of this include extreme distress over small changes in routine, difficulty with transitions, or needing to do things the same way over and over. The third criteria is highly restricted and fixated interests. Think of an obsession with a certain topic or collection of objects. The fourth criteria relates to sensory issues such as indifference to pain or temperature, oversensitivity to sounds or smells, visual fascination with lights or movements, and so on. So those are the four criteria in this category. For a diagnosis, a person must have or have had 2.
So those are the 2 major hallmarks of an ASD diagnosis, but there are a few other important points to consider. One is that the symptoms must have been present early on in a persons development. Another is that the symptoms must cause clinically significant impairments in the persons functioning. Lastly, the symptoms cannot be better explained by a different diagnosis, such as an intellectual disability or global developmental delay. That is not to say that ASD and intellectual disabilities cannot co-occur, because they often due, but in that case, the specific ASD traits need to be present.
Other features that go along with an ASD diagnosis are specifiers and severity levels. Specifiers are attached to the ASD diagnosis to indicate the presence or absence of certain features. The 5 specifiers associated with an ASD are 1. with or without intellectual impairment, 2. with or without language impairment, 3. associated with a known medical or genetic or environmental factor, 4. associated with another neurodevelopmental, mental, or behavioral disorder, and 5. with catatonia. This is a confusing part of the ASD diagnosis, and I only make mention of it because if you see the diagnosis written on paper, these specifiers may or may not be present.
Lastly, all ASD diagnoses are assigned a severity level that ranges from 1 to 3. Each level corresponds to a label and a set of example criteria. Level 1 is requires support, level 2 is requires substantial support, and level 3 is requires very substantial support. For each of these levels there is a list of criteria that can be used to determine the most appropriate level for a person to be assigned. To simplify, Level 1 can be thought of as having deficits in social communication, and accompanied by the definite presence of restricted interests and/or repetitive behaviors. Level 2 is an increased level of difficulties. Level 3 is a severe level of difficulties.
So there you have it, the diagnosis of autism, or ASD, explained. Remember, it is social communication plus restricted interests/repetitive behaviors. The symptoms must have started early in life, cause impairments, and cannot be better described by another disorder. The diagnosis itself has specifiers and a level is selected to better explain how the person is affected by autism.
WHAT TO DO IF I SUSPECT I (OR MY CHILD) MAY HAVE ASD?
The first step is to obtain a diagnostic evaluation for ASD with a provider who specializes in ASD. ASD evaluations involve a parent/caregiver interview, and diagnostic measures that examine the presence or absence of the characteristics of ASD. Feel free to reach out to me if you have questions about this process or need guidance in taking the next step.