Autism Spectrum Disorder (ASD) evaluation and accurate diagnosis have become even more critical as the number of children having ASD has increased in recent years. The assessment process can seem overwhelming for parents of a child who is experiencing significant developmental delays, including social, behavioural, and communication difficulties.
According to the most recent data from the Centers for Disease Control and Prevention (CDC), Autism and Developmental Disabilities Monitoring (ADDM) shows that 1 in every 68 children in the United States has been identified as having an Autism Spectrum Disorder. Individuals are diagnosed with ASD across all racial, ethnic, and socioeconomic groups, and the diagnosis is 4.5 times more common in boys than girls.
Early identification is important for the treatment of individuals with ASD. A diagnosis by an experienced professional can be considered very reliable by age two. However, symptoms of ASD can sometimes be detected as early as 18 months or younger. It is important to do screening, evaluating, and diagnosing children with ASD as early as possible to ensure that they have access to the services and support they need.
What is Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) is a neurological and developmental disorder. It affects the ability of the child to learn, behave, how to interact with others and communicate. It is also described as a “developmental disorder” because symptoms generally appear in the first 2 years of life. American Psychiatric Association created a guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which helps healthcare providers to diagnose mental disorders and people with ASD. It describes that people with ASD often have:
- Repetitive behaviours and restricted interests.
- Symptoms that affect their ability to perform in school, work, and other areas of life.
- Difficulty in communication and interaction with other people.
Autism is known as a “spectrum” disorder because the type and severity of symptoms may differ from person to person. People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. It is a lifelong disorder and requires treatments and services that can improve a person’s symptoms and daily life. The American Academy of Pediatrics recommends that all children must receive screening for autism. Caregivers should talk to their child’s healthcare provider about ASD screening or evaluation.
What are the Signs and Symptoms of ASD?
People diagnosed with ASD may show some common behaviours. Not all people with ASD will show these behaviours, but most will have many of the behaviours listed below.
Social communication/interaction behaviours
It may include:
- They make little or inconsistent eye contact.
- Appearing to avoid looking at or listening to people who are talking.
- They have difficulties with the back-and-forth of conversation.
- Not responding or being slow to respond to one’s name or to other verbal bids for attention.
- Having an unusual tone of voice that may sound sing-song or flat and robot-like.
- Often, talking at length about a favourite subject without noticing that others are not interested or giving others a chance to respond.
- Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions.
- Difficulties adjusting behaviours to social situations.
- Displaying facial expressions, movements, and gestures that do not match what is being said.
- Difficulties sharing in imaginative play or in making friends.
- Infrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others).
Restrictive/repetitive behaviours
It may include:
- Repeating certain or unusual behaviours, such as repeating words or phrases (echolalia).
- Becoming upset by slight changes in a routine and having difficulty with changes.
- Showing overly focused interests, such as with moving objects or parts of objects.
- Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature.
- Having a lasting intense interest in specific topics, such as numbers, details, or facts.
People with ASD may also have irritability and sleep problems. People on the autism spectrum also may have many strengths, including:
- Excelling in math, science, music, or art.
- Being strong visual and auditory learners.
- They can remember information for a long time and learn things in detail.
What are the Causes and Risk Factors for ASD?
The primary cause of ASD is not known. Still, studies suggest that a person’s genes with aspects of their environment can act together to affect development in many ways that can cause ASD. Some factors can increase the risk of developing ASD, such as:
- Other siblings are diagnosed with ASD.
- Certain genetic conditions (such as Down syndrome or Fragile X syndrome) run in the family.
- A very low weight at the time of birth.
- Having a baby at a very old age.
How is ASD Diagnosed?
Healthcare providers can diagnose ASD by evaluating a person’s behaviour and development. Usually, it is diagnosed by age 2 and is considered reliable. It is important to seek an evaluation as soon as possible. The person gets treatments and services as early as the ASD is diagnosed.
Diagnosis in Young Children
It is a two-stage process.
Stage 1: General developmental screening during well-child checkups.
Every child should receive well-child checkups with a paediatrician or an early childhood healthcare provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, 24-, or 30-month well-child visits and specific autism screenings at their 18—and 24-month well-child visits. If a child has a higher risk of ASD or developmental problems, they may receive additional screening. It includes those children who have a family member with ASD, show some behaviours that are symptoms of ASD, have older parents, have certain genetic conditions, or have a very low birth weight.
The healthcare provider may ask questions about the child’s behaviours from caregivers. Because caregivers’ experiences and concerns are an important part of the screening process for young children. The healthcare provider can use this information to evaluate those answers in combination with ASD screening tools and clinical observations of the child. The healthcare provider may refer the child for additional evaluation if a child shows developmental differences in behaviour or functioning during this screening process.
Stage 2: Additional diagnostic evaluation.
It is important to accurately detect and diagnose children with ASD as early as possible. Early detection can also help caregivers determine which services, educational programs, and behavioural therapies are most likely helpful for their child. An expert team of healthcare providers experienced in diagnosing ASD will conduct the diagnostic evaluation. This team comprises child neurologists, psychologists and psychiatrists, developmental paediatricians, occupational therapists, speech-language pathologists, and educational specialists. The diagnostic evaluation may include:
- Medical and neurological examinations.
- Observation of the child’s behaviour.
- An in-depth conversation with the child’s caregivers about the child’s behaviour and development.
- Assessment of the child’s cognitive abilities.
- Assessment of the child’s language abilities.
- Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.
ASD is a complex disorder, and sometimes, it may occur with other health issues or learning disorders. So, it may require a comprehensive evaluation by blood and hearing tests.
Diagnosis in Older Children and Adolescents
Caregivers and teachers are the first who can recognise ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional assessment with their primary healthcare provider or a healthcare provider specialising in ASD.
A child’s caregivers may discuss their child’s social difficulties, including problems with subtle communication, with these healthcare providers. For example, some children may have problems understanding facial expressions, body language, or tone of voice. Older children and adolescents may have problems understanding figures of speech and humour, such as sarcasm. They also may need help forming friendships with peers.
Diagnosis in Adults
In adults, diagnosis of ASD is often more difficult than in children. Some ASD symptoms can overlap in adults with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD). Adults should talk with a healthcare provider and ask for a referral for an ASD evaluation if they notice signs of ASD. Although evaluation for ASD in adults is still being refined, they may be referred to a psychologist, neuropsychologist, or psychiatrist expert in ASD. The expert will ask questions about:
- Sensory issues
- Social interaction and communication challenges
- Repetitive behaviors
- Restricted interests
It may also include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis. Receiving a correct diagnosis of ASD as an adult can help a person identify personal strengths, understand past challenges, and find the right help. Many studies are in process to determine the types of services and supports helpful for improving the functioning and community integration of autistic transition-age youth and adults.
What Treatment Options are Available for ASD?
Treatment for ASD should begin as soon as possible after diagnosis. Early treatment is important because proper care and services can reduce individuals’ difficulties. It also helps them learn new skills and build on their strengths. People with ASD may face a wide range of issues, which means that there is no single treatment that is best for ASD. Working closely with a healthcare provider is important in finding the right combination of treatment and services.
Medication
A healthcare provider may prescribe medication to treat specific symptoms, such as:
- Anxiety and depression
- Aggression
- Irritability
- Repetitive behavior
- Attention problems
- Hyperactivity
Behavioural, Psychological, and Educational Interventions
A healthcare provider may refer people with ASD to these programs. Behavioral, psychological, educational, or skill-building interventions are often highly structured and intensive. They may involve caregivers, siblings, and other family members. It may help people with ASD with:
- Learn social, communication, and language skills.
- Learn life skills for living independently.
- Reduce behaviours that interfere with daily functioning.
- Increase or build upon strengths.
Other Resources
Many services, programs, and other resources can help people with ASD. Here are some tips to get these additional services:
- To learn about special programs or local resources, contact your healthcare provider, local health department, school, or autism advocacy group.
- Record conversations and meetings with healthcare providers and teachers. This information may help decide which programs and services are right for you or your loved ones.
- Keep copies of health care reports and evaluations. This information may help people with ASD to qualify for special programs and services.
- Find an autism support group to share information about your experiences. It can help people with ASD and their caregivers learn about treatment options and ASD-related programs.
