EARLY SIGNS....know what to look for
Earlier screening and diagnosis results in earlier and, therefore, more effective treatment. Screening tools such as The Modified Checklist for Autism in Toddlers can be used by family doctors and pediatricians who are the first health professionals to see infants and toddlers on a regular basis. The earlier the diagnosis can be confirmed by a specialized diagnostic team, the earlier any necessary effective treatment can begin.
Recognizing the early signs of autism can lead to optimal outcomes. Know what to look for.
Early Signs of Autism (12 to 24 Months) – child may demonstrate only a few of these symptoms
- Often begins to develop language then loses it, or doesn’t acquire language at all
- May appear deaf, respond unevenly or not at all to sounds
- Difficulty consoling during transitions (tantrums)
- Difficulty sleeping / wakes at night
- Does not “point and look”
- Failure to bond (e.g. child is indifferent to parents’ presence)
- Self restricted/selected diet
- Limited imaginative play
- Not interested in playing with other children
- Chronic gastrointestinal problems
- Repeated infections
Unfortunately many pediatricians and other physicians are not experienced in diagnosing Autism Spectrum Disorder (ASD). Don’t accept your doctor’s advice if he/she proposes a “wait and see” approach or promises that your child will “catch up”. If your child has normal development and then regresses, you should seek help immediately...
CHARACTERISTICS.....We are all unique
Each person with an Autism Spectrum Disorder (ASD) is unique and will have different abilities. Symptoms caused by ASDs might be very mild in one person and quite severe in another.
Individuals with severe autism conditions may have serious cognitive disability, sensory problems and symptoms of extremely repetitive and unusual behaviour. This can include tantrums, self-injury, defensiveness and aggression. Without appropriate intervention, these symptoms may be very persistent and difficult to change. Living or working with a person with severe autism can be very challenging, requiring tremendous patience and understanding of the condition.
Individuals with mild autism conditions, however, may seem more like they have personality differences, making it challenging to form relationships.
The primary symptoms of autism include problems with communication and social interaction, as well as repetitive interests and activities.
Here are some of the characteristics that may be present.
Strengths exhibited by individuals with autism
- Non-verbal reasoning skills
- Reading skills
- Perceptual motor skills
- Drawing skills
- Computer interest and skills
- Exceptional memory
- Visual Spatial abilities
- Music skills
Weaknesses exhibited by individuals with autism
The above exceptional skills may be combined with subtle or significant delays in other areas of development. All individuals with the diagnosis demonstrate some of the following:
- Impairment in social relationships
- Deficits in communication/language
- Perseveration on interests and activities
- Dependence on routine
- Abnormal responses to sensory stimulation
- Behaviour problems
- Variability of intellectual functioning
- Uneven development profile
- Difficulties in sleeping, toileting and eating
- Immune irregularities
- Nutritional deficiencies
- Gastrointestinal problems
Diagnosis Evaluation based on Observation
Parents, family members or other caregivers of children with Autism Spectrum Disorders (ASDs) are often the first to notice delays in the usual childhood developmental milestones such as speech, eye contact, play with other children or social interactions.
Sometimes autism goes unnoticed or undiagnosed in both children and adults, especially when symptoms are mild or when the person has other disabilities or health problems. In some cases, other medical conditions such as apraxia are present, making autism difficult to recognize. As a result, ASDs may go undetected for years and may only be diagnosed during an educational impasse or a life crisis which puts a person in contact with professionals able to recognize the disorder.
Medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to evaluate autism spectrum disorder and the related social communication disorder (SCD). ASDs are diagnosed based on a combination of specific behaviours, communication delays and/or developmental disabilities.
We are All Different
Autism varies widely in its severity and symptoms. An accurate diagnosis and early identification greatly improve the chances of optimal outcomes by establishing appropriate educational supports, treatments and interventions early on in the intervention process.
Co-occurring / Comorbid Conditions
There are several medical conditions that have been shown to be significantly more prevalent in those with autism spectrum disorders than the general population.
Autism is a whole body disorder diagnosed by what is observable, however these signs and symptoms are often the result of underlying co-occurring / comorbid conditions. Knowing what to look for is the first step in getting the most appropriate treatment.
Some common co-occurring conditions found in those with autism:
- Autoimmune conditions
- Seizure disorders
- Oesophagitis
- Gastritis
- Reflux
- Asthma
- Eczema
- Allergies
- Ear infections
- Respiratory infections
- Migraine headaches
- Allergy disorder (including non IgE-mediated disorders or food intolerances)
At times, it may be difficult for a health care practitioner to properly assess a patient with an ASD. The parent or caregiver may not have known to watch for certain signs because they were told that ‘it was just the autism’. There may be communication barriers or challenging behaviours preventing an obvious observation of a symptom, or perhaps the patients themselves don’t know where the pain originates from. It then becomes even more important for the practitioner to be able to recognize some of the behaviours indicating an underlying comorbid condition.
Behaviours which may indicate an underlying comorbidity:
- Sudden changes in behaviour
- Aggression
- Covering ears with hands
- Loss of acquired skills
- Irritability or moodiness
- Frequent night waking or difficulty falling asleep
- Teeth grinding
- Walking on toes
- Tantrums or oppositional behaviour
- Self-injurious behaviour (biting, hitting, slapping, head-banging, etc.)
- Chewing on clothes or objects
- Vocal expressions (moaning, whining, groaning, sighing)
- Posturing or seeking pressure
- Repetitive rocking or other movements
Common sources of pain and discomfort (chronic, progressive or static):
- Headache
- Earache
- Sore throat
- Constipation
- Diarrhea
- Muscle pain
- Joint pain
Evolution Of Autism...From 1942 to Present Day
Classic Autism was first recognized in 1942 by Dr. Leo Kanner at Johns Hopkins Hospital. ASD has been recognized as a medical disorder only in modern times, but there are many historical accounts indicating that autism existed long before the 20th century.
The possible causes of autism are still far from understood. At one time, autism was mistakenly thought to be caused by “cold” parenting; later it was wrongly classified as childhood psychosis or a type of childhood schizophrenia.
Parenting styles do not cause children to have ASDs. Today, research around the world focuses on possible causes, such as genetics, differences in biological brain function, pre- and post-natal brain development, environmental factors, viral infections and immune responses and deficiencies. Many possible causes are being investigated.
When speaking of ASDs, most people are referring to their historical names:
- Autistic Disorder (also called “autism” or “classic autism” or “AD”)
- PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified)
- Asperger’s Syndrome (also called “AS”, “Asperger’s” or “Asperger’s Disorder”)
Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
A diagnosis of PDD-NOS was made when the strict criteria for Autism and Asperger’s Syndrome were not met. The person would still have had problems with social relationships, impaired communication and repetitive behaviours. Usually people with PDD-NOS also had some language delays.
How is Asperger Syndrome (AS) Different from Classic Autism?
AS was first identified by Dr. Hans Asperger in Austria in 1944, but his work did not find its way into the American Psychiatric Association’s Diagnostic Statistical Manual until 1994. After years of misdiagnosis or lack of diagnosis, there has recently been more recognition of AS and also a very noticeable increase in the number of people diagnosed with AS in North America.
- AS is often considered to be a type of “high-functioning” autism. There is some clinical controversy about whether AS is a milder form of Autism Disorder or a distinct disorder.
- The term “high-functioning” can be misleading in that it doesn’t necessarily translate to lower needs.
- AS tends to be recognized and diagnosed later in life, usually after 3 years of age, when a child is already in school. AS can also be diagnosed much later in teens and adults.
- Unspoken rules of reciprocal social interaction and communication which most of us take for granted, such as body language, social distance, facial expressions and abstract speech or humour, may be very hard for an individual with AS to understand.
- Many people with AS want to develop friendships but lack the social skills to begin and/or maintain a friendship. Inability to reciprocate, to listen to another person’s thoughts or understand their feelings can make it hard to make and/or keep friends.
- People with AS may interpret things very literally and be quite rigid in terms of following rules and habits. Strict adherence to patterns of behaviour or rituals is common and activities and interests may be limited. Sudden changes in routine, setting or expectations can cause great anxiety. Sometimes large crowds or dealing with strangers can be upsetting as well.
- Development of learning and cognition is not usually delayed in AS and can be above average in terms of cognitive ability. Speech may be stilted but people with AS do not have language delays and may read very well or have very large vocabularies for their age. Still, they will struggle with the social uses of language and non-verbal communication. Individual needs assessment is key because functional evaluation may be more relevant than cognitive evaluation.
- Some people with AS have amazing rote memories. Coupled with an obsessive interest and/or unusual creativity, this can lead to great expertise and achievement if there is enough encouragement and opportunity to develop particular skills. History is full of examples of high achieving thinkers, mathematicians and musicians who are believed to have had Asperger Syndrome.
