Autism Spectrum Disorders

Autism spectrum disorders are a group of neurodevelopmental disabilities that

impact development in two core domains, social communication and restricted repetitive patterns of behavior or interest. It is known as a spectrum disorder because of the variability of symptom expression (severity and hence amount of support required).

Prognosis, Early Identification and Signs*

Though autism is a lifelong condition, approximately 70% acquire useful speech and 10% achieve a significant degree of independence. Best indicators for long-term social independence is a child's IQ and if speech is present before age 5.

Early intervention is always better as it ensures treatment can begin earlier, enabling a better outcome. Unfortunately, children with developmental delays are usually not evaluated until after age 4, however the earlier parents can identify and address their concerns, the better the prognosis.

*Note: the following data and statistics are from UC Davis Mind Institute, USA. Unfortunately the same data is currently not available in Sri Lanka but it is likely to depict a similar trend, if not, a more negative situation.

Signs in Infant/Toddlers

• No big smile or other warm, joyful expression by six months of age or thereafter

• No back and forth sharing of sounds, smiles, or other facial expressions by nine months of age or thereafter

• No babbling by 12 months of age

• No use of back and forth gestures, such as pointing, showing, reaching, or waving

• No words by 18 months of age, and no two-word meaningful by the 24 month age

• There may be a limited interest in other children and a limited sharing of enjoyment or emotional reciprocity

• You may see sensory avoidant behaviors, such as a refusal to wear shoes, or clothing, or eat certain foods

• And while tantrums are common in the toddler years, there may be extreme tantrums where the child is simply inconsolable

Examples of Common Characteristics

1. Social Communication

• Unable to initiate and respond to conversations

• Inability to understand non-verbal communications

• Lack of facial expression, gestures

• Difficulty enaging in imaginative play, and making friends

• Difficulty maintaining eye contact

2. Restricted Repetitive Patterns

• Stereotyped or repetitive motor movements

• Highly restricted fixated interests

• a hypo or hyper reactivity to sensory input or unusual interest in sensory aspects of the environment

• Rocking, Hand-flapping, twirling, lining up or flipping objects or other stereotypies

• Resistance to change/ Insistence on routines and rituals (e.g. extreme distress at small changes, difficulty with transitions, rigid thinking patterns, rituals related to greetings, and the insistence on same route or the same food choices at each meal)

In DSM- 5 (Diagnostic and Statistic Manual of Mental Disorders, 5th Edition by American Psychiatric Association), autism is described in terms of levels of support required.

Level 1 - requires support, verbal but has difficulty initiating and sustaining interactions with others. They may have decreased interests in interacting with others. And their restricted, repetitive behaviors may interfere with functioning in one or more contexts.

Level 2- require substantial support. There may be marked deficits in social interactions even with supports in place. The restricted and repetitive behaviors are obvious to the casual observer and may interfere with functioning in many contexts and can cause distress when interrupted or redirected.

Level 3 -require very substantial support. They may have severe deficits in verbal and nonverbal communication, very limited initiation and response to social overtures from others. And the restricted, repetitive behaviors interfere with functioning across all contexts.

Getting a Diagnosis

A comprehensive diagnostic evaluation should include behavioral observations, interviews with caregivers and providers, a medical and behavioural history as well as other medical tests in order to rule out certain genetic conditions (e.g. hearing loss, or other illnesses or conditions that may cause similar behavioral characteristics). Getting a Diagnosis is important to inform the intervention and treatment plan as there is large variability in how autism appears.

Common Misconceptions

It is important to reiterate that autism is a spectrum disorder hence variability is high. Do not assume just because you have met one individual with autism, you know about autism.

Myth: People with autism can’t understand, feel or express any emotion

Truth: People with autism can feel emotions too, they just communicate their emotions (and perceive your expression) in different ways. Individuals with autism may find it difficult to identify emotions indirectly (e.g. recognising sadness based on body language or tone) but when emotions are communicated directly, they can understand better.

Myth: People with autism are intellectually disabled.

Truth: There is great variability in individuals with autism but oftentimes, autism brings with it just as many exceptional abilities as challenges. Many people with autism have normal to high IQs and some may excel at math, music or another pursuit.

Myth: People with autism are easily recognisable and very similar.

Truth: Since Autism is a spectrum disorder, its characteristics vary significantly from person to person. Knowing one person with autism means just that—knowing one person with autism. A person's capabilities and limitations are no indication of the capabilities and limitations of another person with autism.

Myth: Children with Autism are just quirky and will 'grow out of it'

Truth: Autism stems from biological conditions that affect brain development and, for most individuals, is a lifelong condition.

Myth: Children with Autism are selfish and unsociable.

Truth: Children with Autism struggle with a concept known as 'Theory of Mind', this is the ability to understand that other's thoughts, intention, knowledge and desires can be different to our own. Children with Autism usually think what they know, feel, see and understand is the same for others as well. This makes it challenging for them to be 'Socially aware' and makes building friendship more difficult, however many individuals with autism go on to have meaningful relationships and navigate social situation effectively.

It is important to reiterate given the variability of Autism, a diagnosis is critical in understanding the prognosis and treatment for your child. If you have any concerns, it is essential you reach out to a liscensed medical or mental health professional as soon as possible.

Basic Screening Tool:

The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). The screener that will ask a series of 20 questions about your child’s behavior. It's intended for toddlers between 16 and 30 months of age. The results will let you know if a further evaluation may be needed. You can use the results of the screener to discuss any concerns that you may have with your child’s healthcare provider. Click the following link to do the screening for free - https://www.autismspeaks.org/screen-your-child

Disclaimer: The following information is not a suitable replacement for therapy or professional help. Mental health is very complex and there are various individual differences due to circumstances, genetics and life experience. All information published has been generalised and done in good faith. However, we will not be liable for any actions taken as a result of this website/post. If you are facing mental health concerns, it is important you reach out to a professional. You may also contact us at tashya1@gmail.com for further support.