The American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (5th edition; American Psychiatric Association, 2013), which is the reference that healthcare providers use to diagnose mental and behavioral conditions, including autism. In the previous edition (DSM-IV), autism was divided into 5 subcategories: Autism, Asperger’s, Pervasive Developmental Disorder-NOS, Rett’s Syndrome and Childhood Disintegrative Disorder. In the revised edition, there are no subcategories and the diagnostic designation is Autism Spectrum Disorder.
Autism is a developmental disability that typically appears during early childhood and can impact social skills, communication, relationships, and self-regulation. It is defined by a certain set of behaviors and is termed a spectrum condition because it affects people differently and to varying degrees on a wide spectrum of levels of severity.
National Autism Association, Autism Fact Sheet
The following is an abbreviation of the DSM-V definition. Full diagnostic criteria can be located at Center for Disease Control, https://www.cdc.gov/ncbddd/autism/hcp-dsm.html ; a similar definition is found in IDEA (2004), United States Department of Education, https://sites.ed.gov/idea/regs/b/a/300.8
- Persistent deficits (weaknesses) in social communication and social interaction across multiple contexts (situations)
- Restricted, repetitive patterns of behavior, interests, or activities (hand flapping, circling, rocking, lining up toys rather than playing with them)
- Symptoms must be present in the early developmental period (usually around 3 years old), but may not be understood as symptoms until the child is older and social demands become difficult to manage.
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
- These disturbances are not better explained by an intellectual disorder or developmental delay, however intellectual disability and autism spectrum disorder frequently co-occur.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
There is currently no single known cause and no single test used to identify autism. Diagnosis is made through parent interviews, child observations, and behavioral checklists. Since children develop at different rates and no two children with autism exhibit the same symptoms, diagnosis of autism is complex. As with other disabilities, identifying autism requires parents’ careful observations, documentation and research of age appropriate developmental milestones. When going through the checklist of symptoms, it is also important to note that some of the traits are more culturally driven and may not be a sign of autism (i.e. lack of eye contact).
Early diagnosis is critical to obtain the appropriate therapies and interventions the child needs to develop his/her full potential. The Center for Disease Control provides guidance in monitoring developmental milestones to help parents determine if their child is delayed in his/her typical development.
A child with ASD might:
- 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
- Avoid eye contact
- Get upset by minor changes, thrives on routine and structure
- Have obsessive interests (vacuum cleaners, monster trucks, Thomas the Train)
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to the way things sound, smell, taste, look, or feel, over or under stimulated
- Plays with toys the same way every time, lines up toys, or other objects
- Likes parts of objects (e.g., wheels)
- Is very organized
Social issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.
- Prefers to play alone, even in group of other children
- 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
Each person with ASD has different communication skills. Some people can speak well. Others cannot speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.
- Delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- May use Disney lines or TV commercial jingles to communicate
- Reverses pronouns (e.g., says “you” instead of “I”)
- Gives unrelated answers to questions
- 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
Some people with ASD have other symptoms that might include:
- Hyperactivity (very active)
- Impulsivity (acting without thinking)
- Short attention span
- Causing self injury
- Temper tantrums/ meltdowns
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Lack of fear or more fear than expected
Signs and Symptoms of Autism Spectrum Disorders, Center for Disease Control
Johnson, C.P. Early Clinical Characteristics of Children with Autism. In: Gupta, V.B. ed: Autistic Spectrum Disorders in Children. New York: Marcel Dekker, Inc., 2004:85-123
Each child has a unique set of characteristics, therefore, it is imperative to know your child’s needs. Below are some strategies to experiment with until you find those that work best for you and your child. I am certain you will also come up with your own!
- If resistant to change> calendars, daily schedules, clocks and help with transitions (10-minute warning, use of music to signal change, timer).
- If over or under stimulated> sensory objects to play with while working, weighted vest or blankets (deep pressure), compression clothing, noise cancelling headphones, soft music, dim lighting and a quiet place to retreat to when agitated.
- If uncomfortable in social settings> play games that stimulate conversation, create play dates, focus on quality of friendships instead of quantity, use social stories to prepare for outings and family gatherings to reduce anxiety.
- If meltdowns occur>
- learn to identify triggers and redirect child’s attention to something else beforehand
- create a cool down place with low lighting, a bean bag, soft blanket, low music, books, and other calming effects or preferred sensory objects
- create a discipline chart with consequences and be consistent with it: time out, rewards with a point system, or other forms that work for you. Teach the system to your child and stick with it.
- provide 2-4 choices when rewarding good behavior or academic accomplishments, as well as making decisions. This provides a sense of control over their environment.
- If unable to communicate effectively> use visual supports such as Picture Exchange Communication System (PECS) Picture Exchange Communication System (PECS)®; Speech Generated Devices; coloring coding and picture labels.
- Access and make use of appropriate assistive technology, without overusing it.
Autism Parenting Magazine
- Social Stories, https://www.autismparentingmagazine.com/social-stories-for-autistic-children/
- Behavior Interventions, https://www.autismparentingmagazine.com/types-of-autism-behavior-interventions/
TIPS: Therapy and Medical Treatment
- There are many types of therapies available, depending on your child’s needs. Occupational, speech/language, behavioral, and physical therapy as well as art, music and hippotherapy (use of horses) may be helpful in alleviating various symptoms.
- Children with autism often have underlying medical issues (comorbidity) and require treatment to mitigate symptoms and behaviors. It is critical to find a physician that is knowledgeable and experienced in working with children with autism.
- National Autism Association can assist you in locating therapists and medical experts, https://nationalautismassociation.org/
Autism Speaks www.autismspeaks.org , provides a free online screening for toddlers that parents can complete, Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™)
Autism Society www.autism-society.org , is a network of families and professionals sharing their knowledge and expertise to help you navigate the world of autism.
National Autism Association www.nationalautismassociation.org
Do2Learn provides thousands of free pages with social skills and behavioral regulation activities and guidance, learning songs and games, communication cards, academic material, and transition guides for employment and life skills. Do2Learn: Educational Resources for Special Needs
Autism Parenting Magazine, https://www.autismparentingmagazine.com/
Path International helps children special needs through a variety of equine-assisted activities and therapies programs. Although it began with a focus on horseback riding as a form of physical and mental therapy, they have developed a multitude of equine-assisted activities and therapies (EAAT): therapeutic carriage driving; interactive vaulting, which is similar to gymnastics on horseback; equine-facilitated learning and mental health, which partner with the horse in cognitive and behavioral therapy, usually with the participation of a licensed therapist; ground work and stable management. Find a center near you on their website, https://www.pathintl.org/about-path-intl/about-path-intl