An early diagnosis of autism spectrum disorder is important so that earlier needed interventions can begin, however, there are still many concerns about "labeling" a young child with autism spectrum disorder. There is a lot of evidence that indicates intensive early intervention in optimal educational settings for at least 2 years during the preschool years is very effective in improving outcomes in most young children with autism spectrum disorder.
Behavioral characteristics are the first clues clinicians use to make a diagnosis of autism spectrum disorder. Some of the characteristic behaviors of autism spectrum disorder are apparent in the first few months of life, or appear at any time during the early years. A diagnosis of autism spectrum disorder may be made if there are deficits in at least one of the following areas before the age of 3:
•Communication
•Socialization
•Restricted behavior
There are two stages to the diagnosis process:
1.Developmental screening during "well child" check-ups
2.A comprehensive evaluation by a multidisciplinary team
If your routine "well child" check-up does not include a developmental screening test, you should ask that it be done. As a parent or caretaker, your own observations and concerns about the child's development will be very important in helping to evaluate your child.
Screening tools used to gather information about a child's social and communication development within medical settings include:
•The Checklist of Autism in Toddlers (CHAT)
•The modified Checklist for Autism in Toddlers (M-CHAT)
•The Screening Tool of Autism in two-Year-Olds (STAT)
•The social communication Questionnaire (SCQ) (for children 4 years of age and older)
Other screening tools include:
•Parent responses to a questionnaire
•Combination of parent report and observation
Screening tools do not provide individual diagnosis. They serve to assess the need for referral for possible diagnosis of autism spectrum disorder. These screening methods may not always identify children with "mild" autism spectrum disorder like those with high-functioning autism or Asperger syndrome. Evaluators feel a key difference in children with autism from other children before the age of 2 include pointing and pretend play.
In the last few years screening tools devised to screen for Asperger syndrome and higher functioning autism include:
•The Childhood Asperger Syndrome Test (CAST) (the most recent)
These screening tools are reliable for identification of school-age children with Asperger syndrome or higher functioning autism. Concentration includes:
•Social and behavior impairments in children without significant language delay
The second stage of diagnosis is a comprehensive diagnostic evaluation. The comprehensive diagnostic evaluation is designed to accurately rule in or rule out an autism spectrum disorder or other developmental problem. The evaluation is usually done by a multidisciplinary team that includes:
•A psychologist
•A neurologist
•A psychiatrist
•A speech therapist
•Other professionals who diagnose children with autism spectrum disorder
Autism spectrum disorders are complex and often involve other neurological or genetic problems. A comprehensive evaluation should include neurologic and genetic assessments as well as in-depth cognitive and language testing. The measures developed specifically for diagnosing autism often include:
What is the Autism Diagnosis Interview-Revised (ADI-R)?
The Autism Diagnosis Interview-Revised is a structured interview that contains over 100 items and is done with the caregiver. This tool consists of four main parts:
•The child's communication
•The child's social interaction
•The child's repetitive behaviors
•Age-of-onset symptoms
What is the ADOS-G?
This is an observational diagnostic tool that is used to "press" for socio-communicative behaviors that are often delayed, abnormal, or absent in children with autism spectrum disorder.
The Childhood Autism Rating Scale (CARS)
The Childhood Autism Rating Scale (CARS) is another screening tool professionals often use to evaluate:
•The child's body movements
•Adaptation to change
•Listening response
•Verbal communication
•The child's relationship to people
The Childhood Autism Rating Scale is suitable for use with children over 2 years of age. The evaluator not only observes the child, but also obtains related information from the parents. The evaluator then rates the child on a scale based on deviation from the typical behavior of children of the same age.
Other Tests
Two other tests that should be used to assess any child with a developmental delay are:
•A formal audio logic hearing evaluation
•Lead screening
Experts feel some hearing loss can occur with autism spectrum disorder; however, some children with autism spectrum disorder may be incorrectly diagnosed with hearing loss. Children who remain in the oral-motor stage for a long period of time require lead screening. A child with an autistic disorder usually has elevated blood lead levels.
The Responsibility of the Multidisciplinary Team
The multidisciplinary diagnostic team has a responsibility to thoroughly evaluate the child. They will assess the child's unique strengths and weaknesses, and then determine a formal diagnosis. Once a diagnosis has been made the team will meet with the parents or caretakers of the child to explain the evaluation results.
Meeting with the Parents or Caregivers for a Final Diagnosis
Most parents are already aware that "something" was just not quite right with their child. Nonetheless, when the diagnosis of autism spectrum disorder is given, it can be devastating. Some parents may even go into a denial stage, and it may be difficult to focus on asking questions. One of the best opportunities the parents have to ask questions is while the evaluation team is together. The focus now should be: What further steps parents or caretakers of a child with autism spectrum disorder should take? It is to the best advantage of the parents or caretakers to learn as much as possible at this meeting. Take note of the name or names of professionals who you can contact later if you have further questions.
Source: National Institute of Mental Health
Disclaimer: *This article is not meant to diagnose, treat or cure any kind of a health problem. These statements have not been evaluated by the Food and Drug Administration. Always consult with your health care provider about any kind of a health problem and especially before beginning any kind of an exercise routine.
This article is FREE to publish with the resource box. Article written 5-2007.rce: National Institute of Mental Health
With Autism Spectrum Disorder
Autism spectrum disorders are common in the pediatric population, however not as well known about as other conditions such as diabetes, spinal bifida, or Down syndrome. A recent study of a U.S. metropolitan area show that 3.4 of every 1,000 children 3-10 years old had autism; the results of this study suggest a need for earlier and more accurate screening for the symptoms of autism spectrum disorders.
Experts agree that earlier diagnosis of the disorder and treatment interventions provides the best results toward reducing symptoms and increasing a child's ability to grow and learn new skills. Many times pediatricians, family physicians, teachers and parents dismiss the early warning signs of autism spectrum disorder and think the child is just a little slow and will eventually catch up or overcome the slowness.
All children with autistic spectrum disorders demonstrate deficits in:
?Social interaction
?Verbal and nonverbal communication
?Repetitive behaviors or interests
The signs and symptoms of autistic spectrum disorder can be mild to severe and will be present in each individual child differently. For example, a child may have no trouble learning to read, but show extremely poor social interactions. Each child, who has autism spectrum disorder, will display communication, social and behavioral patterns that are individual to them, but fits into the overall diagnosis of autism spectrum disorder.
Social Symptoms
Infants are social beings very early after birth. They may stare at people, turn their heads towards voices, and grasp hold of a finger, coo and smile. Children with autism spectrum disorder seem to have a lot of difficulty learning to engage in the give-and-take of everyday human interactions. In the first few months of life, many children with autism spectrum disorder do not interact and they avoid eye contact. They do not seem interested in other people and often prefer to be alone.
Research suggests that children with autism spectrum disorders are attached to their parents, but their expression of the attachment is unusual and difficult to understand. The parents may feel as if the child is not attached to them at all. Children with autism spectrum disorder may resist hugs and cuddling.
Communication Symptoms
A typical one year old toddler says words, turns when he hears his name, points when he wants a toy. Some children with autism spectrum disorder remain mute throughout their lives. Some children may learn to communicate using pictures or with sign language. The children who do speak often use language in unusual ways. They may speak only single words or repeat the same phrase over and over.
Mildly affected children may show slight delays in language, or even have unusually large vocabularies, but have a lot of difficulty sustaining a conversation. They may carry on a monologue about a favorite subject and give no one else a chance to speak. Another difficulty experienced by children with autism spectrum disorder is the inability to understand body language, tone of voice, or phrases of speech.
It is also difficult for others to understand what ASD children are saying and what their body language says. Gestures and facial expressions rarely match what the child with autism spectrum disorder is actually saying. Tone of voice may be a high-pitched, sing-song, or flat, robot-like voice. Those who have relatively good language skills may speak like little adults.
This difficulty with language and meaningful gestures often cause children with autism spectrum disorder to be at a loss to let others know what they need. They may just simply scream or grab what they want, until they are taught better ways to express their needs. Autistic children who grow into adults become more and more aware of their difficulties in understanding others and in being understood. This often results in anxiousness or depression.
Repetitive behavior symptoms
Children with autistic spectrum disorders usually appear physically normal with good muscle control, however, odd repetitive motions differentiates them from other children. The behaviors range from extreme and very apparent to more subtle. Examples are autistic children who spend a lot of time repeatedly flapping their arms or walking on their toes.
Children with autistic spectrum disorder demand absolute consistency in their environment. Any change in routine of mealtimes, dressing, taking a bath, going to school at a certain time or by a certain route, can be extremely disturbing to the child with autistic spectrum disorder. They may spend hours lining up their cars or trains in a particular way, rather than rolling them over the floor in normal pretend play. If one of the toys is moved, the child with autistic spectrum disorder may become tremendously upset.
Repetitive behaviors also take on the form of persistent, intense preoccupations with a certain subject like science or a great interest in numbers and symbols. A child with autistic spectrum disorder might be obsessed with learning all about how the ceiling fan works, a bus schedule, or lighthouses.
Other problems that may accompany autistic spectrum disorder include:
?Sensory problems
?Mental retardation
?Seizures
?Fragile X syndrome
?Tuberous Sclerosis
Sensory problems: If sensory information is incorrect a child's experiences of the world can be confusing. Many children with autistic spectrum disorder are painfully sensitive to certain sounds, textures, tastes, and smells. Certain sounds like the telephone ringing or a sudden storm can cause these children to cover their ears and scream. I knew a 3 year old who would scream and cry when the telephone rang, and repeatedly ask: ?What's that??
Mental retardation: Many children with autistic spectrum disorder have some mental impairment as well. They may be normal in some areas, but weak in other areas. They may do well on parts of a test that measure visual skills, but not so well on language subtests.
Seizures: One out of every four children with autistic spectrum disorder develops seizures.
Fragile X syndrome: Is the most common inherited form of mental retardation. Fragile X syndrome affects about two to five percent of people with autistic spectrum disorder.
Tuberous Sclerosis: Is a rare genetic disorder that manifests as benign tumors in the brain and other vital organs. One to 4 percent of people with autistic spectrum disorder also have tuberous sclerosis.
If you have a child or know of a child who displays the signs and symptoms of autistic spectrum disorder, remember that early diagnosis and early appropriate treatment interventions is a crucial aspect to that child's overall well being and will provide greater opportunities for personal growth and independence as an adult.
Source: National Institute of Mental Health
Disclaimer: *This article is not meant to diagnose, treat or cure any kind of a health problem. These statements have not been evaluated by the Food and Drug Administration. Always consult with your health care provider about any kind of a health problem and especially before beginning any kind of an exercise routine.
This article is FREE to publish with the resource box. Article written 5-2007
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