Signs, Symptoms and Diagnosis of Autism in

Children

2

Social

Communication

Motor

SensoryProfound Intellectual Disabilities Gifted

Self-Absorbed Quirky

Non-Verbal Highly Verbal

Awkward Agile

Hyposensitive Hypersensitive

Measured I.Q.

BehaviorAggressive, Destructive

Odd

Spectrum of Autism

Created by Dr. Tina Dyches

Myths about AutismCaused by “cold” refrigerator mothersChildren with eye contact do not have AutismChildren who are “social” do not have AutismAll people with Autism have extraordinary

skills

Myths about Autism (con.)People with Autism just need love to get

betterPeople with Autism just need more discipline

to get betterAutism can be outgrownThere is a cure for Autism

What is Autism?The essential features of Autistic Disorder are the presence of markedly abnormal or impaired development in:social interaction and communicationand a markedly restricted repertoire of activity and interests

—DSM-IV

Causes of Autism??

Probably multiple causesGeneticEnvironmental

A definition : A genetic predisposition with something in the environment that triggers it.

Red Flags in Young ChildrenNo big smiles or other warm, joyful

expressions by six months or thereafterNo back-and-forth sharing of sounds, smiles,

or other facial expressions by nine months or thereafter

No babbling by 12 monthsNo back-and-forth gestures, such as pointing,

showing, reaching, or waving by 12 months

More Red FlagsNo words by 16 monthsNo two-word meaningful phrases (without

imitating or repeating) by 24 monthsAny loss of speech or babbling or social skills

at any age

Thoughts on DiagnosisReasons to get a diagnosis

UnderstandingServices and Intervention

When? ADOS now at 18 MonthsIdentification and Intervention most important

Concerns about getting a “label”

Typical Behavior Characteristics of High-Functioning Individuals with AutismAdapted from C. Bees (1998). The GOLD Program: a program for gifted learning disabled adolescents. Roeper Review, 21, p. 160.

Early ScreeningModified Checklist for Autism in Toddlers (M-

CHAT™)—available readily and free onlineMany false positives; follow up with interviewScientifically validated for children ages 16-30

months oldAmerican Academy of Pediatrics recommends

that all children be screened for Autism at 18 and 24 months old. The M-CHAT is one of their recommended tools.

Diagnostic ToolsCurrent Tools

Observation—Autism Diagnostic Observation (ADOS)

Developmental History (Parent Report)—Autism Diagnostic Interview-Revised (ADI-R)

Childhood Autism Rating Scale (CARS)Future

Brain Imaging—Pinpoint subgroups and treatment

Genetic Testing

Current Prevalence Rates

Prevalence1 out of 88 nationally1 out of 47 in Utah County

Changes in DSM-5Name changed from Pervasive Developmental

Disorder to Autism Spectrum DisorderSingle Diagnosis rather than a category containing

five individual diagnoses (PDD-NOS and Asperger’s eliminated)

Three symptom domains become two DomainsSeverity Criteria added to better capture the idea of

a spectrum (3 levels)New diagnostic category (not on the autism

spectrum) of Social Communication Disorder--Sally Ozonoff, Editorial: DSM-5 and autism spectrum disorders—two decades of perspectives from the JCPP, Journal of Child Psychology and Psychiatry, 53:9 (2012), ppe4-e6

Social Communication & Interaction –proposed A. Persistent deficits in social communication

and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.

Social Communication & Interaction –proposed (continued)

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures

3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

Behaviors, Interests, Activities —proposedB. Restricted, repetitive patterns of behavior,

interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

Behaviors, Interests, Activities —proposed (continued)

3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). NEW

Additional Diagnostic Criteria—proposed C. Symptoms must be present in early

childhood (but may not become fully manifest until social demands exceed limited capacities). NEW

D. Symptoms together limit and impair everyday functioning.