Autism spectrum disorder is a developmental disability that affects how an individual perceives and communicates with others. It is a difficult condition to identify and diagnose because, as the name implies, it exists on a spectrum. One person with ASD may have symptoms so severe that it is difficult to function, and another may simply come across as introverted and a little eccentric. Although autism is a lifelong condition with no cure, it is possible for people with autism to pick up tools and strategies that can help them to cope with day-to-day life.
Symptoms for autism spectrum disorder typically appear before the age of three. According to the Mayo Clinic, the symptoms fall into two different categories: social communication and patterns of behavior. Again, because autism exists on a spectrum, it is unlikely that any one autistic person will have every one of these symptoms, and a formal screening is needed to determine whether an individual has this condition.
An autistic child tends to exist in her own world and she may come across as selectively deaf, but she becomes so absorbed in her own activities that she genuinely doesn’t hear you calling for her. She may not point at things or bring you toys while she plays because she’s satisfied enough in her own play world that she doesn’t feel the need to share it. Because individuals with autism have difficulty understanding the nuances of social interactions, an autistic child may not know how to express feelings or understand the feelings of others, and she may avoid eye contact and show minimal facial expressions. She may also only approach you for social interactions when she needs something, as she has trouble understanding social interaction for its own sake.
The social communication troubles may also manifest as delayed or unusual speech patterns. An autistic child often comes across as having delayed speech, or he may develop speech normally at first but then lose his communication skills as he grows. He may have trouble starting a conversation or continuing one because he has difficulty with the rules of dialogue, and he may repeat your words and phrases verbatim after most children outgrow it. Some autistic individuals speak with a flat or singsong voice.
Behaviorally, an autistic child may seem to be “stuck in a rut” with play, continually playing with toys in exactly the same way every day. She might have an interest in organization, lining up toys in a specific order or sorting them into specific parts of the playroom. She may get upset at slight changes in routine and throw violent temper tantrums when she’s distressed. An autistic child’s play is also notable for what it doesn’t include, imitative or make-believe play. Most children will pretend to feed or clothe a doll once they reach 18 months of age, but an autistic child doesn’t engage in that sort of pretend play. Non-play behaviors that are common among autistic children include unusual activities like flapping hands, spinning in circles or rocking back and forth. Because autistic children can be highly sensitive to stimuli, they often do not like being hugged or touched and may dislike lights, noises and all but a few foods.
These behaviors apply to children in most age groups, but there are certain signs that are only apparent in older children or adults. One of the key signs is a tendency to take everything literally; humor, sarcasm, irony and figurative language can be difficult for an individual with autism to grasp. Conversely, he might laugh at inappropriate times, believing that someone who’s legitimately having trouble with a task is simply pretending. He may not be able to talk about his feelings when asked, and he may use facial expressions that don’t match the words he’s saying. He also might have a very narrow and obsessive range of interests. For instance, he might have encyclopedic knowledge about baseball statistics or episodes of a certain television show and may talk about this subject constantly because he doesn’t understand that others don’t share his interest.
Because autism spectrum disorder cannot be tested by anything as simple as a blood sample or DNA test, it can be difficult to diagnose. If you suspect that your child has autism, you may be able to ask your child’s pediatrician for an initial screening. Pediatricians typically provide routine screening at nine months, 18 months and 24 or 30 months, but you can schedule another if you worry that your child is displaying autistic behavior.
During the initial screening, the pediatrician will ask you a few questions and may talk and play with the child to see how she moves, communicates and expresses emotion. You may have to fill out a questionnaire about your child’s behavior, or the questions may be asked orally. If your answers or your child’s behavior indicate that your child has symptoms of autism spectrum disorder, your pediatrician will refer you to a pediatric neurologist, developmental pediatrician, child psychologist or psychiatrist, or other qualified specialist for a more detailed diagnostic test.
The second diagnostic test is a comprehensive evaluation performed by the medical specialist. These tests vary, but can include lengthy observations of or interactions with your child, a more detailed questionnaire or interview with you and genetic testing to determine whether your child has a disorder that can contribute to autism, such as fragile X or Rett syndrome. This more detailed test may take several hours or it may occur over more than one session.
The prognosis for autism spectrum disorder depends on several factors, including the severity of the symptoms and the presence or absence of other developmental conditions. An individual with mild autistic symptoms will have an easier time living a normal and independent life than someone with severe symptoms, and autistic symptoms become more difficult to handle if they coexist with mental retardation or psychological disorders. Parents do not have any control over these factors, but they can control the age at which their child is diagnosed with autism spectrum disorder. A child who is diagnosed at a young age can be enrolled in early intervention programs that will help him to integrate with his peers, and parents can learn parenting strategies that will allow them to communicate and connect with their child as early as the preschool years. According to Autism Speaks, early intervention improves young children’s learning, communication and social skills later in life, making it crucial to get the child in for diagnosis and treatment early.
There is no cure for autism spectrum disorder, but there are tools and interventions that you and your child can use to minimize the condition’s impact on day-to-day life. Because every individual with autism is unique, every treatment plan is unique as well. In some cases, your child may need some kind of medication to help manage her symptoms (for instance, antipsychotics can help manage unusual movements and aggressive behaviors, and stimulants such as Ritalin can help to control the hyperactivity and inattention that often go hand-in-hand with autism). However, the most common form of treatment is therapy, which can be used either independently or in conjunction with medicine.
As previously mentioned, early intervention therapies are helpful for very young children. Although the exact methods of these therapies vary, successful programs often involve at least 25 hours of structured activity per week with trained professionals and paraprofessionals. These programs also involve interaction with non-autistic peers and offer clear objectives and benchmarks for the autistic children to meet.
For other individuals with autism spectrum disorder, there are a wide variety of behavioral therapies available, allowing you to choose the one that works best for your child. One of the most popular and effective methods is applied behavior analysis (ABA), which provides rewards and other positive feedback for useful behaviors like listening, holding up a conversation and empathizing. Other therapies take the basic principles of ABA but emphasize specific desired behaviors. For instance, Pivotal Response Treatment focuses primarily on initiating communication, while Verbal Behavior Therapy focuses on learning words and the Early Start Denver Model emphasizes play-based interaction with preschool-aged children. Many of these programs teach behavioral therapy skills to family members as well, allowing parents and other caregivers to apply these principles at home and improve their rapport with their children.
In addition to behavioral therapy, an autistic child may need therapy to develop life skills that are inhibited by autism spectrum disorder. For instance, occupational therapy teaches basic life skills, speech-language therapy helps autistic children to master spoken language or learn to communicate with sign, and sensory integration therapy helps a child to process stimuli correctly, so that he is not overwhelmed by lights, noises or other sensations.
It is worth repeating that none of these therapies will fully cure autism. However, they can teach a child to cope with the disorder and minimize its effect in daily life. If a strategy does not seem to be working, it is critical to meet with your child’s pediatrician or psychiatrist to discuss other possible approaches.
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