Autism Spectrum Disorder

Autism is a complex, lifelong disability that commonly appears during the early years of childhood. autism refers to a broad range of developmental conditions and behaviors characterized by challenges in speech and nonverbal communication, interpersonal relationships, and social interactions.

The phrase “on the spectrum” refers to a child’s diagnosis and symptoms falling somewhere on the Autism Spectrum Disorder. Autism may be less severe and very minimally impact someone’s life. Or, autism can be a pervasive developmental disorder that requires significant support.

People with autism often find it difficult to have intelligible conversations or express themselves either through words, gestures, or facial expressions. They may have trouble picking up on social cues and understanding what people are thinking and feeling. And they may exhibit very specific interests or repetitive behaviors. For example, they may focus on specific objects (like a toy or television show), or resist any changes to their daily routines.

There are actually several different subcategories of autism based on symptoms and severity. While these were once thought of separate conditions, the medical community has since classified all of them under the umbrella of Autism Spectrum Disorders. However, you may still hear these referred to different names. They include:

• Asperger's Syndrome: You may have heard this term applied to children with mild cases of autism. While these children often have difficulty with social awareness and may have a narrow scope in interest, they are often competent when it comes to speaking and language comprehension.
• Autistic disorder: This is what we most commonly think of when we hear the word autism. It’s generally diagnosed in children younger than 3 years old, and can include communication, behavioral, and/or social problems.
• Childhood Disintegrative Disorder: This term is generally applied to children that may not initially show signs of autism through 2 years of age. However, over time they may lose their communication or social skills.
• Pervasive Developmental Disorder (sometimes referred to as Atypical Autism): This is a catch-all term for children that have autistic behaviors but generally doesn’t fit into any of the categories above.

According to the Centers for Disease Control and Prevention (CDC), about 1 in every 54 children has autism. A few other interesting statistics found in this study include:

• Boys are over 4x more likely to be diagnosed with autism than girls.
• Approximately 33% of children with autism have an intellectual disability.
• Most children are diagnosed with autism around 4 years of age, however, in many cases autism can be reliably diagnosed as early as 2 years old.
• Although there were not substantive differences in autism diagnoses by ethnic or socioeconomic conditions, minority groups tended to be diagnosed later in life.

Perhaps most importantly, this comprehensive study noted that: “Timely evaluation and identification of Autism Spectrum Disorder (ASD) among young children continue to be important public health goals because evidence links early treatment and services for ASD with improved outcomes.”

The signs and symptoms of autism generally appear in the early stage of childhood development - often before the age of 3 years old. As mentioned, these symptoms can vary from mild to severe. Sometimes they’re very easy to observe, in other cases, they may not be noticeable or recognized until your child is school-age.

Therefore, if you notice any developmental differences in your child, it’s important to speak with your healthcare provider or speech therapist. Early intervention is one of the most effective strategies to help a child with autism make progress and overcome their challenges.

According to the American Speech-Language-Hearing Association (ASHA), challenges associated with autism typically fall across communication, social skills, and behaviors. Below we’ve included some common symptoms relevant to each area.

Communication

Communication includes speaking, reading, writing, understanding, and language comprehension. Signs of autism can include:

• Delays in spoken language - may talk very little for their age or not at all.
• Inability to start or maintain a conversation or language.
• Difficulty communicating their needs and desires.
• Difficulty understanding conversations and instructions - may respond to a question by repeating it rather than answering.
• Using challenging behaviors (like crying or temper tantrums) instead of words or gestures to communicate what they want.
• Challenges with learning to read and write - some children with autism may have the ability to read, but have difficulty understanding what they read (also called hyperlexia).
• Repeating words or phrases they just heard or that they heard days or weeks earlier.
• Using a robotic speaking voice that lacks inflection or intonation.

Social Skills

A person with autism may have challenges relating to other people. They may have trouble making friends and associating with their peers, or may show an overall lack of interest. It may be hard for a person with autism to:

• Pick up on social cues and be socially aware.
• Understand how others are feeling.
• Share attention with someone else and focus on the same object or event.
• Develop peer relationships - can include difficulty with sharing toys, taking turns, and making and keeping friends.

Behaviors

Children with autism may have a range of behavioral issues. These can include:

• Restricted or repetitive patterns of behavior - may include hand or body movements.
• Avoiding eye contact.
• Preferring not to be touched, held, or cuddled.
• Laughing, crying, or getting upset easily and for unknown reasons.
• A dislike for certain sounds, smells, or textures (for example, may like very few foods or choose foods based on texture).
• Becoming distressed by a change in daily routine.
• Being attached to certain inanimate objects, such as a toy or television show.
• Repeating unexpected behaviors, such as lining up their toys, rocking their head back and forth, spinning their body, or having trouble staying still.

In addition to the symptoms above, there are several early warning signs that can signal a child may have autism. Of course, many children without autism can show these signs and behaviors - but it’s often better to air on the side of caution. If you notice any of these signs in your child’s first few years of life, it’s important to speak with your healthcare provider and receive a thorough evaluation.

A Child’s 1st Year

Most infants are very social creatures. Even at this early age, it can be possible to recognize signs of autism depending on how they interact with the world around them. These can include:

• Not noticing or responding to a mother’s voice.
• Not recognizing their own name.
• An inability to look people in the eye.
• Lack of speech abilities - which at this age include babbling or pointing.
• Not smiling, laughing, or responding to social cues.

A Child’s 2nd Year

The signs of autism can be more apparent by a child’s second year. This is the age that children begin to really develop their language skills.

• Not pronouncing simple, single words by 16 months.
• Inability to pronounce simple, two-word phrases.
• Loss of language skills
• Lack of interest in the world around them. For example, not responding when a parent points out an object, like a large tree or plane flying overhead.

There is no known cause of autism. This has to do with the complexity of the disorder, as well as that fact that symptoms can vary dramatically. However, most researchers agree that certain risk factors, including genetic and environmental, can increase a person’s likelihood of diagnosis.

Genetics

According to research, several different genes appear to be involved in autism, and the presence of these genes can increase a child’s risk. Some genetic mutations may be inherited, while others can occur randomly.

If a parent carries one or more of these gene mutations, they may be inherited by the child (even if the parents do not have autism). Again, the majority of these gene changes do not cause autism by themselves - but they can increase the risk of developing the disorder.

Environmental

Researchers are continuing to explore whether factors such as complications during pregnancy, air pollutants, lead poisoning, or other environmental determinants play a role in triggering autism.

Other Possible Risk Factors

According to the Mayo Clinic, other factors may increase a child’s risk of developing the disorder, including:

• Gender: As mentioned, boys are about 4x more likely to develop autism than girls.
• Family History: Families who have one child with autism appear to have an increased risk of having another child with the disorder. It's also not uncommon for parents or relatives of a child with autism to also exhibit minor problems with social or communication skills.
• Certain Medical Conditions: If your child has certain medical conditions, it can increase their chance of autism. Examples include fragile X syndrome (also called Martin-Bell syndrome); tuberous sclerosis; and Rett syndrome.
• Pregnancy Complications: Premature babies born before 26 weeks of gestation, as well as those with low birth weight, may be at greater risk for Autism Spectrum Disorder.
• Parents' Ages: There may be a connection between children born to older parents and Autism Spectrum Disorder.

Note: Despite extensive research, no research has shown a link between childhood vaccines and autism. This is a pervasive controversy that is unfounded and has no factual basis. In fact, the original study that ignited this debate initially has since been debunked and retracted due to misrepresentation, poor study design, and questionable research methods.

Diagnosing autism can be challenging. Your healthcare provider will generally look at your child’s developmental history, as well as their communication and behavioral attributes, to make a diagnosis.

While autism can sometimes be diagnosed at 18 months or younger, by age 2 most diagnoses performed by qualified professionals are very reliable. However, some children don’t receive a diagnosis until they’re older, even into their adolescent or adult years.

There are several steps involved in an autism diagnosis. The Centers for Disease Control and Prevention (CDC) outlines each of these three steps in great detail. Ensuring that your child is properly monitored, screened, evaluated, and diagnosed is imperative to getting them the care and services they need to live a productive and fulfilling life.

Developmental Monitoring

There are typical developmental milestones that most children reach by certain ages. These cover how a child plays, learns, speaks, behaves, and moves. The CDC provides a great checklist of milestones broken down by age.

Developmental monitoring observes how your child grows and changes overtime, and whether or not they meet these developmental milestones. This observation is usually the first warning sign that a child may have early signs for autism. That’s why it’s important that parents, guardians, caretakers, and educators participate in closely monitoring the child, as well as documenting and reporting anything that seems atypical or uncharacteristic. Notifying your child’s healthcare provider will empower them with knowledge to further evaluate your child and make a professional recommendation.

Developmental Screening

Developmental screening is a more thorough way to formally assess your child for autism - however, this is not a diagnosis.

Screenings often involve a brief test or questionnaire about your child. The tools used for developmental screenings are based on research, and ask questions about your child’s language, movement, thinking, behavior, and emotions. While these tests are typically administered by a doctor or nurse, they can also be done by other healthcare professionals as well.

Comprehensive Developmental Evaluation

If your healthcare provider recognizes a problem or heightened risk factor during the developmental screening, a more formal evaluation may be needed. This provides a comprehensive and in-depth evaluation of the child’s development, and is usually administered by a trained professional, such as a pediatrician, child psychologist, speech-language pathologist, or other specialist.

The developmental evaluation may include a more thorough examination of your child, a structured test for your child to complete, and questionnaires for you to fill out. The results help determine whether the child may have autism and any special treatments needed.

There is no known cure for autism, nor is there a non-size-fits-all treatment. The goal of treatment is to reduce autism symptoms, support the learning of social, communication, and behavioral skills, and improve a person’s ability to function in their environment.

The number of potential treatments can be overwhelming for parents, and may need to change over time. That’s why it’s imperative you work closely with your healthcare provider, as well as any other specialists such as a speech therapist. They’ll have you craft a treatment plan and strategy tailored to your child’s unique needs.

According to the Mayo Clinic, treatment options may include (but are not limited to):

• Educational Therapies: Children with autism like to maintain routines, and prefer highly-structured learning environments. Preschool children who receive intensive, individualized behavioral interventions have been shown to demonstrate good progress.
• Behavioral Therapies: Applied behavior analysis (ABA) can help children learn new behavioral skills and apply these skills in different situations through a reward-based system.
• Family Therapies: Parents and other family members benefit by learning techniques to play and interact with their child. This coaching can also help them better manage behavioral problems and teach their daily living skills.
• Speech and Language Therapy: Speech therapists can help address challenges with verbal, non-verbal and social communication for people with autism (more information below).
• Other Therapies: Depending on your child’s needs, there are many other beneficial therapies. For example, occupational therapy focuses on teaching activities of daily living, and physical therapy can help improve your child’s movement.
• Medications: No medication can cure autism, but certain medications may help control symptoms. Speak with your healthcare provider about any medications that may be beneficial.

Communication and speech-related challenges, like all autism symptoms, vary from person to person. Some individuals may not be able to speak at all. Others may love to talk, but have difficulty holding a conversation or understanding social cues like body language and facial expressions.

Speech-language pathologists (SLPs) play a key role in an individual’s treatment plan. They can help people with autism become more effective communicators and improve both their verbal and nonverbal communication skills. This can help individuals with autism improve their ability to form relationships and function in day-to-day life

Your speech therapist will work with you, your child, and your family to assess and evaluate communication strengths and challenges, and develop a treatment plan tailored to your specific goals.

Some of the skills your speech therapist will help your child with include:

• Verbal Communication: Your speech therapist can help your child articulate clearer speech sounds and words. This can help them express their thoughts and be understood by others.
• Body language: Our body language is one of the most expressive parts of communication. It can signal whether someone is joking, serious, or excited. Speech therapists can help children understand what others are saying through their body language, match emotions with the correct facial expressions, and recognize subtle physical signals.
• Asking and Answering Questions: Understanding how to formulate and ask questions, as well as understand answers, is essential to navigating through life. Speech therapists can help children develop these vital skills by recognizing and practicing the question-and-answer format.
• Social Pragmatics: Even if children with autism know how to say phrases like “good morning” and “thank you,” it can be more of a challenge to understand when, how, and to whom they should say it. Social pragmatics involve learning the time and place to use appropriate communication in social situations.
• Prosody: This term refers to the melodic sound of a voice as it goes up and down in conversation. Many people with autism have flat prosody, which can often come off as emotionless. Speech therapists can help children with autism to build their vocal skills and modulate their tone of voice.
• Conversation Skills: Knowing how to make brief, simple statements is not the same thing as carrying on a back-and-forth conversation. Speech therapists work with your child to develop their conversation skills, exchange information naturally, and initiate dialogue when unprompted.
• Social Skills: Speech therapists often help people with autism build social communication skills. This can include the ability to communicate, play, and interact with friends and family, stand at an appropriate distance when speaking with someone, pick up social cues, and more.
• Grammar: Some children with autism may refer to themselves in the third person or use incorrect tenses. Speech therapists can help address these grammar mistakes.

Some children may be nonverbal. In these cases, there are many types of assistive devices and technologies to help them communicate. These tools are collectively referred to as Alternative/Augmentative Communication (AAC). Your speech therapist will provide guidance on whether your child would benefit from one of these tools, and teach you how to properly use them. Examples of AAC methods include:

• Sign language
• Picture exchange communication system (PECS)
• Communication applications on tablets or iPads
• Speech output devices (such as Dynavox)

No one knows your child better than you. And as a parent or guardian, no one is better positioned or prepared to support your child at home and during activities of daily living. Below are some recommendations on how parents can stay involved, be your child’s biggest advocate, and provide a safe and nurturing environment to help them grow, learn, and thrive.

Be Proactive

We’ve mentioned this before but it’s worth repeating: if you suspect something is wrong, seek help and treatment right away. Research has shown that earlier interventions and treatment lead to better outcomes. Early treatment can help reduce the symptoms of autism over time. Here are a few tips to stay engaged and proactive:

• Learn Everything You Can: The more you know about autism, the better prepared you’ll be to make informed decisions. Learn more about this disorder, have an open dialogue with your healthcare providers, seek guidance from specialists, and participate in all treatment decisions.
• Ask Lots of Questions: The only dumb questions are the ones you never ask! Don’t ever feel embarrassed - ask as many questions as you can.
• Find a Team of Trusted Professionals: Treating autism often requires a coordinated team of multidisciplinary professionals, including doctors, case managers, speech therapists, social workers, teachers, and more. Ensure that you do your research and find a trusted care team that has your child’s best interest in mind.
• Keep All of Your Records: Your child is going to have many visits, evaluations, and meetings with people in his or her care. Keep an organized file of reports to help you decide treatment options and monitor progress.
• Be an Expert on Your Child: The more information you can provide your healthcare provider and speech therapist about your child, the better treatment decisions they can make. What does your child enjoy? What do they find uncomfortable, calming, or frightening? What types of disruptive behavior are they exhibiting? How are they communicating or sharing their feelings?
• Accept Your Child: Try not to compare your child to their peers. Instead, enjoy their quirks, celebrate their success, and love and accept them unconditionally for who they are. You’ve entered a new and unfamiliar world, and this can be scary and exhausting. But don’t give up. It’s impossible to predict the course of your child’s autism - they have a lifetime to grow and develop.

Provide a Safe and Structured Environment

No one spends more time with their child than you. Making your home life safe, enjoyable, and tailored to your child’s needs will make it easier to accommodate their condition.

• Stay on Schedule: Whether at home or in the classroom, children with autism tend to prefer routines. Do your best to maintain a highly-structured schedule with regular times for meals, play, therapy, television, school, and bedtime.
• Bring Therapy Home: Your child may be seeing several specialists or professionals. However, they often have difficulty applying what they learned in one setting to another. To create a consistent environment and support your child’s progress, it’s important to stay engaged with their therapists and continue these techniques at home. For example, if your child is practicing pronouncing certain speech sounds with their therapist, make flashcards with these same sounds to use at home.
• Reward Good Behavior: Positive reinforcement is extremely important for children with autism. Not only should you regularly praise them for acting appropriately or developing a new skill, but make sure they understand why they’re being praised. If your child particularly enjoys a certain type of food, toy, or activity, use these as ways to reward them

Communicate Verbally and Non-Verbally

Many children with autism have speech-related challenges. However, as your child works on these skills, there are additional ways you can connect and bond with your child.

• Identify Nonverbal Cues: There are many ways your child is trying to communicate - you just have to remain aware and observant. For example, pay attention to the gestures they make when they’re tired, bored, or hungry. Look for particular sounds they utter or facial expressions they use. You can also communicate with your child just by the tone of your voice, your movements, or your body language.
• Pay Attention to Triggers: Many children with autism are hypersensitive to different sensories, which include light, sound, touch, taste, and smell. Try to determine what triggers either cause disruptive behavior or positive responses. This can help you prevent situations that make your child uncomfortable.
• Figure Out Your Child’s Motivation: Just like us, children with autism get frustrated when they feel misunderstood. Oftentimes, this can lead to them acting out. Throwing a temper tantrum is one way of communicating frustration - and it’s up to parents to try to pick up on the nonverbal cues that caused it in the first place.
• Have Fun Together: Your child may be undergoing lots of therapy and education - and sometimes, they just need to be a kid. Make sure that playtime doesn’t get put on the backburner. Find out what makes them laugh and smile, and partake in these activities together. Play is an essential part of learning.

Make Your Needs a Priority

While you may find yourself spending a lot more time with your child, it’s important not to lose sight of your own needs. Raising a child with autism can require a lot of time, energy, and attention. It's easy to feel discouraged at times. However, for your own sake it’s essential that you prioritize your health and wellbeing.

• Support Groups: Joining a support group can help you meet families with similar challenges and circumstances. Parents at these meetups often share information, provide best practices, and mentor parents with newly diagnosed children.
• Respite Care: Never feel guilty taking a break - you deserve it. Respite care offers the chance to have a qualified caretaker take over your responsibilities temporarily - whether that’s a few hours or a few days.
• Counseling: If you’re experiencing stress, anxiety, or depression, you may want to see a psychologist to discuss your experiences and feelings in a safe and accepting environment.

Expressable matches families with a certified speech therapist trained to effectively evaluate and treat speech and language disorders related to Autism Spectrum Disorder. All therapy is delivered online via face-to-face video conferencing.

Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.

Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their communication. For more information on the importance of parental involvement in their child’s speech therapy, click here.

Ages 3-6: Parents attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.

Ages 7 and Up: Most children attend video sessions independently but parents are kept in the loop with updates and tips during each session.

Adults: Adults attend sessions by themselves, but are welcome to bring loved ones or family members as well.

• Why do you think my child does (or doesn't) have Autism Spectrum Disorder?
• What are some of my child’s most prominent symptoms?
• Is it possible to confirm the diagnosis?
• How can I tell how severe his/her autism is (or will be)?
• What changes can I expect to see in my child over time?
• How will autism affect their schooling?
• How will autism affect their ability to communicate?
• How much and what kinds of regular care will my child need?
• What kind of support is available to families of children with Autism Spectrum Disorder?
• How can I learn more about Autism Spectrum Disorder?