Autism: Signs and Diagnosis

Autism Spectrum Disorders (ASD) are a group of disorders that share the following common elements: difficulties in social interactions, impaired communication skills and presence of restricted interests and repetitive behaviours. The severity of ASD is classified in three levels and indicates the level of support required for the individual to overcome or counterbalance developmental difficulties, with Level 3 indicating the need for substantial support.

According to recent estimates in the USA, 1 in each 68 newborns will be diagnosed with ASD, with boys being 5 times more likely to receive the ASD diagnosis (1 in 42) than girls (1 in 189).

Autism Spectrum Disorders appear before the age of three with some signs being observable from the first months of life and other appearing around the age of two years. Additionally, some children seem to present a typical development until approximately the age of two, when a loss of already acquired skills is observed and further development ceases. Research data show that a diagnosis of Autism can be given reliably to two years old children but parents and other persons from the close environment may have observed the first signs and started worrying even before the child’s first birthday. Unfortunately, the formal diagnostic process is often delayed by months or years, with thousands of children receiving it even after the age of four. This fact results in a significant delay in the onset of valuable therapeutic interventions.

In order to achieve an early onset of an effective evidence-based intervention, it is important that parents are familiar with developmental milestones and how these are met by children at different ages. This will allow them to seek help from the experts early enough, if their child needs support in any of the developmental areas. In the website of the Centers for Disease Control and Prevention of the USA, you can find a detailed list of developmental milestones (click here) that are expected to be met by a child in different ages, so that you can monitor development.

The diagnosis of ASD is based at the moment on the observation of the behaviours displayed by the child and not on medical tests. Although some children may present a number of behaviours that are also present when an ASD diagnosis is given, this does not necessarily mean that these children will also fall within the Autism Spectrum, since for this a number of impairments has to be present in all relevant areas (i.e., social communication and restricted interests) and these need to be significantly affect the individual’s life. Examples of signs that would lead us to seek expert advice when the child is older than one year of age can be found below:

-Does not respond to name when called
-Does not share interests with us by showing or pointing to objects
-Does not follow with eyes what the adults is showing/pointing to
-Does not establish eye contact with people around
-Does not use language or signs to communicate
-Repeats sounds or movements that do not seem meaningful to people around
-Presents frequent behaviour problems (e.g., tantrums)
-Shows restricted interests (e.g., only plays with specific toys)
-Does not engage in symbolic play (e.g., pretends that a spoon is a phone)
-Reacts in an unusual way to everyday environmental stimuli (e.g., sounds, flavours, lights)

When parents, other caregivers or professionals suspect that a child may have ASD, it is important that expert advice is sought and an initial visit to the paediatrician would help discard other causes for the observed signs (e.g., hearing impairments). Afterwards, if deemed necessary and often after an initial ASD screening conducted with the use of reliable tools, the child may be referred to a multidisciplinary team in order to be assessed and possibly receive a diagnosis. An early diagnosis will allow for an early intensive behaviour-analytic (based on Applied Behaviour Analysis-ABA) intervention to be put in place, which will be adjusted to the child’s individual needs and will facilitate progress in all areas.

For information on evidence-based intervention for Autism, click here.

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