Autism Spectrum Disorder Diagnosis in Children
Autism is a state of being absorbed in oneself and one’s fantasies in order to escape from the real world. It is found in children and it is also one of the symptoms of Schizophrenia, a severe psychotic disturbance that afflicts some 50% of patients at mental hospitals.
Autism Spectrum Disorder
An autistic spectrum disorder (ASD) is a developmental disorder which affects the way a person communicates with and relates to other people and the world around them. The way in which people are affected varies from one individual to another and by age and intellectual functioning.
Symptoms of Autism Spectrum Disorder
Autism spectrum disorder may show itself in early childhood. The autistic child, as the victim of this condition is known, lives in a world of his own. If an object is dropped close to him, he may not show the slightest response. He appears insensitive to pain. He does not relate to people; when they are present, he does not even seem to be aware of them. He develops a few limited patterns of behavior, and he forms an emotional attachment of a sort to some objects.
He may alternate between periods of intense physical activity (hyperactivity), sometimes even causing self-injury, and periods of impenetrable calm. He resists and resents any change in his surroundings.
The mother is the center of the universe to the normal child; the autistic child, however, may not even notice her. An early sign of autism observed by parents is that the child does not answer them when they speak, although his hearing is perfectly normal.
He does not smile or respond to them. They cannot get to him. He may develop a set of signals by which he imperiously lets his parents know his wishes, but that is the limit of his communications
Autism Spectrum Disorder Diagnosis in Children
Health care providers diagnose autism spectrum disorder by evaluating a person’s behavior and development. Autism spectrum disorder can usually be reliably diagnosed by the age of 2.
In order to ascertain the condition of autism spectrum disorder, there are seven specific characteristics or evaluation signs that a child or individual must display. These evaluation characteristics are:
- Social understanding and social behaviour
- Social communication
- Rigidity of thinking
- Anxiety
- Repetitive Behaviours / Stimming
- Special Interests / OCD
- Sensory issues
Social Understanding and Social Behavior
When they are born, most babies seem ready to become sociable and develop communication
skills. Children with autism spectrum disorders find this all very difficult. They may seem less interested in people.
They find it hard to see things from another person’s point of view. They often seem trapped in a world of their own. Some may like being sociable and tactile but don’t seem to understand how to do these things.
A young child with an autism spectrum disorder can’t make sense of people, and may find them frighteningly unpredictable. They may:
- seem to relate better to objects than people
- show preference for individual activity
- only tolerate approaches from very familiar people
- are more adult orientated than peer orientated
- only be receptive to approaches from people they know well
- not want to be comforted in distress
- seem to use people as a means to an end - for example, by taking someone’s hand to obtain something out of their own reach
- have a poor understanding of social rules and conventions
Social Communication (Verbal and Non-Verbal Communication)
Children with autism spectrum disorder may not be eager to communicate. They may not be ready to learn things that other children learn naturally and therefore don’t have the chance to tune into language in the same way. They find it very hard to make sense of the things that happen around them. Words may mean very little to them and they may be unable to link what they see with the things being said to them.
A young child with an autism spectrum disorder may:
- develop speech in a way that is slow, disrupted or disordered - or may not develop speech at all
- often use words out of context and without trying to communicate
- show little desire to communicate socially
- not respond when spoken to
- develop expression before understanding
- talk at, rather than to
- echo words other people say — straight away, or later (this is sometimes called echolalia)
- use words and then ‘lose’ them (not use them again)
- not use eye contact as a natural part of communication
- not appreciate the need to communicate information
- have poor grasp of abstract concepts and feelings
- rarely understand or use gesture
- develop a pointing gesture, but use it to indicate need rather than to share an experience.
Rigidity of Thinking and Difficulties with Social Imagination
Imagination helps us understand the world and predict and see the perspective of other people. Children with an autism spectrum disorder are unable to do this to any great extent. When pretend play begins to appear in children who don’t have an autism spectrum disorder, it’s a sign that imagination is beginning to develop. In children with autism spectrum disorders this process occurs very slowly, in unusual ways, or not at all.
Problems of imagination show themselves in different ways. Some children never seem interested in what a toy is or what it represents. They may focus on the features of the toy such as the wheels of the car or the box the toy came in. Other children may run the toy car in and out of a garage, but don’t act out more complex stories.
Some children seem to act out stories or take on particular characters, but the story turns out to be an imitation of a video or book. This doesn’t mean that children with autistic spectrum disorders don’t have any imagination, it just means they tend to have less ability in this area and they tend to be less interested in sharing their imaginative ideas than other children.
Some children with autism spectrum disorder learn to talk easily, but find it hard to understand communication that is not literal. Expressions like ‘I laughed so much I nearly died’, or ‘If you eat any more you’ll burst’, can be very frightening for them. They may have difficulties understanding that a phrase or story is not real.
Anxiety
One of the things that many parents talk about is how anxious their child seems to be. High levels of anxiety in children with an autism spectrum disorder are often a common feature and it is this feeling of anxiety that might be causing some of the behaviours that you may see in your child. Your child might be feeling anxious about something but is not able to tell you. In fact the way of communicating their anxiety is often through behaviour.
Some of the behaviours you might see are:
- Tantrums and aggressive behaviour
- Becoming withdrawn and resisting any interaction with others
- Experiencing pain
- Become distressed
The reason anxiety is mentioned is because anxiety is not always talked about when your child is diagnosed. But being aware that your child might be anxious about something is such an important part of helping your child.
Anxiety and autism go hand in hand and it is more prevalent in children with autism because they have difficulty making sense of the world around them and understanding social rules. Causes of anxiety are numerous, which makes it very difficult for parents to know what to do or how to react.
Children with autism spectrum disorder experience anxiety for a variety of reasons, which can include:
- meeting strangers
- being given too many choices
- not being able to communicate their needs
- changes in routine
- new activities or places
- experiencing unpleasant sensations, e.g. dog barking, flashing lights, crowded and
- noisy environments
- overpowering smells
- transition from one activity to another — even small transitions
- trauma - remembering unpleasant events e.g. having a haircut, seeing the dentist or doctor, which when being asked to repeat makes them anxious
Repetitive Behaviours/ Stimming
The term repetitive behaviour is used to describe specific types of unusual or seemingly odd behaviours that are often seen in children with autism. Repetitive behaviour is sometimes referred to as self-stimulating behavior or stimming.
This behaviour may involve any or all of the senses in various degrees in different individuals. Several examples are listed below:
- Visual — staring at lights, blinking, gazing at fingers, lining up objects
- Auditory — tapping fingers, snapping fingers, grunting, humming
- Smell — smelling objects, sniffing people
- Taste — licking objects, placing objects in mouth
- Tactile — scratching, clapping, feeling objects, nail biting, hair twisting, toe-walking
- Vestibular — rocking, spinning, jumping, pacing
- Proprioception — teeth grinding, pacing, jumping
Some repetitive behaviours are very obvious while others are more subtle and hard to detect
such as blinking or eye rolling, tapping fingers and mild hair twisting. We all engage in some of these behaviours occasionally, especially when we are stressed. However, your child may engage in these activities excessively to the point that they interfere with learning or daily living activities.
Problems with imagination make the world a very uncertain place, so children with autism spectrum disorders find reassurance in setting up routines and patterns that they can control. Repetitive behaviours and routines are a common feature of autism spectrum disorders.
A young child with an autism spectrum disorder will exhibit the following behaviours:
- cannot easily make sense of sequences and events
- may become distressed if a familiar routine changes
- may impose routines on others
- will often engage in stereotypical body movements (for example, some children will flap their hands, some may rock back and forth)
- will often resist new experiences, for example trying different foods or wearing new clothes
- cannot deviate from one way of doing things
- may be tolerant of situations and then over-react to something minor
- may find it hard to work out what other people are going to do, and cannot make sense of why other people do what they do - they are unable to take someone else’s perspective or point of view
- will only develop symbolic play slowly - if at all (symbolic play is play which involves pretending and using imagination)
- will often pay particular attention to unusual details and struggle to see the bigger picture
- can develop extreme behaviours to avoid some things/experiences.
Obsessive Compulsive Disorder
All children have favourite things games, films, toys but most children can be distracted or engaged in another activity without too much fuss. Also most children like interaction with other people in order to get the most enjoyment from their activities. However, some children with autism spectrum disorder seem to develop interests in a way that makes it seem as though they are obsessed.
These interests are usually referred to as ‘special interests’ and to a child with autism spectrum disorder they might be the most important thing in their life. Children with autism spectrum disorder normally develop interests that do not involve anyone else, where they can retreat into their own little world for hours and hours, whereas other children might want to talk non-stop about their interest, which in turn makes it difficult for them to develop friendships.
These interests are different to repetitive behaviours but some of the reasons for the special interest can overlap, such as:
- Reducing anxiety
- Maintaining a sense of calm
- Makes them happy
- A way of avoiding another task or activity
Special interests can be anything from weird to wonderful. Some of the more common examples of special interests in children might include:
- Lining up toys e.g. cars, trains etc.
- Drawing
- Counting
- Watching things spin
- Dinosaurs
- Cartoon characters
- Thomas the tank engine
- Types of cars
As with repetitive behaviours children can become engaged in their special interest if they are feeling anxious or scared, but the reality is that they have an uncontrollable desire to involve themselves in these things because their interest is real and their enjoyment and satisfaction is real. Children with an autism spectrum disorder will normally have one special interest at a time, but they often change as the child develops and experiences more things.
Sensory Issues
The seven senses are sight, hearing, touch, smell, taste, balance (vestibular) and body awareness (proprioception). In individuals with autism, the brain sometimes processes sensory information differently to those without autism spectrum disorder.
Everybody is different and therefore individuals will experience things differently and respond in different ways.
Sometimes these different sensory perceptions can cause pain, distress, anxiety, fear or confusion and result in ‘challenging’ behaviour as the individual tries to block out what is causing the problem.
In some cases the senses may work too well and the brain receives too much information (hypersensitive) or not well enough where the brain doesn’t get enough information (hyposensitive).
When the senses are hyper you may find that individuals with autism spectrum disorder rock, flap, spin, hit their ears, etc. as a way of trying to block out the overload that they can’t tolerate and to help them to calm down or relieve the pain.
In cases where the senses are hypo, individuals may make or seek out noises, bang objects, etc. as a way of causing more sensations and getting the senses to work better.
Examples of sensory issues that your child may experience include:
- The brain tries to process everything at once without filtering out unimportant things like background noise, wallpaper, people moving about, the feel of clothes on their skin, etc. resulting in sensory overload.
- Sometimes there is an inability to separate foreground and background information so that everything is seen as ‘a whole’. For example, when they look at a room they will see everything at once and so even when something small is changed they will notice. This will make the room look ‘wrong’ and can cause fear, stress and frustration.
- When there is too much information to be processed at the same time it may be difficult for children with autism to break a whole picture down into meaningful units. For example, when talking to someone we will see their whole face but some people with autism may see eyes, nose, mouth, etc. as individual things which all need to be processed separately. This makes it more complicated to process information and can lead to the child focusing on only one aspect or not having enough memory to process everything.
- Sometimes it can take time to process information, particularly if there are distractions (e.g. background noise, scratchy clothing, etc.), if there is a lot of information to process or if the context changes (e.g. they may learn to make a cup of tea in the kitchen but be unable to transfer that skill to a different kitchen).
- In some cases senses become distorted which may mean that the autistic child sees, hears, smells, tastes or feels something different to everyone else. At times one of the senses may appear ‘shut down’ as a way of the child coping with sensory overload. For example, when noises become unbearable the child may appear to be deaf because this enables them to cope and to allow their other senses to work better.
- Due to the difficulties outlined above, some children will use some senses to compensate for others. For example, they may smell, lick or touch objects, or watch their feet whilst walking, etc.
Autism Spectrum Disorder Treatment
No single method for treating autism has been found effective in all cases, but research into its causes and treatment is ongoing. However, there are two methods used in treating autism spectrum disorder: medication and therapies.
A health care provider may prescribe medication to treat specific symptoms. With medication, a person with autism spectrum disorder (ASD) may have fewer problems with: Irritability, Aggression, Repetitive behavior, Hyperactivity, Attention, Anxiety and depression
Also, people with ASD may be referred to health care providers who specialize in providing therapies (behavioral, psychological, educational, or skill-building) interventions. These therapy programs are typically highly structured and intensive, and they may involve caregivers, siblings, and other family members. These programs may help people with ASD in the following ways:
- Learn social, communication, and language skills
- Reduce behaviors that interfere with daily functioning
- Increase or build on strengths
- Learn life skills for living independently
Parents of autistic children can obtain information about the different therapies for autism here
Sources and References
Reader’s Digest Family Health Guide and Medical Encyclopedia
Autism: A Guide for Parents and Carers Following Diagnosis
National Institute of Mental Health: Autism Spectrum Disorder
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