Signs, Symptoms and Diagnosis of Autism in Children

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Signs, Symptoms and Diagnosis of Autism in
Children
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Spectrum of Autism
Created by Dr. Tina Dyches
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Myths about Autism

• Caused by cold refrigerator mothers
• Children with eye contact do not have Autism
• Children who are social do not have Autism
• All people with Autism have extraordinary skills

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Myths about Autism (con.)

• People with Autism just need love to get better
• People with Autism just need more discipline to
  get better
• Autism can be outgrown
• There is a cure for Autism

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What is Autism?

• The essential features of Autistic Disorder are
  the presence of markedly abnormal or impaired
  development in
• social interaction and communication
• and a markedly restricted repertoire of activity
  and interests
• DSM-IV

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Causes of Autism??

• Probably multiple causes
• Genetic
• Environmental
• A definition A genetic predisposition with
  something in the environment that triggers it.

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Red Flags in Young Children

• No big smiles or other warm, joyful expressions
  by six months or thereafter
• No back-and-forth sharing of sounds, smiles, or
  other facial expressions by nine months or
  thereafter
• No babbling by 12 months
• No back-and-forth gestures, such as pointing,
  showing, reaching, or waving by 12 months

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More Red Flags

• No words by 16 months
• No two-word meaningful phrases (without imitating
  or repeating) by 24 months
• Any loss of speech or babbling or social skills
  at any age

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Thoughts on Diagnosis

• Reasons to get a diagnosis
• Understanding
• Services and Intervention
• When?
• ADOS now at 18 Months
• Identification and Intervention most important
• Concerns about getting a label

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

• Modified Checklist for Autism in Toddlers
  (M-CHAT)available readily and free online
• Many false positives follow up with interview
• Scientifically validated for children ages 16-30
  months old
• American 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.

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Diagnostic Tools

• Current Tools
• ObservationAutism Diagnostic Observation (ADOS)
• Developmental History (Parent Report)Autism
  Diagnostic Interview-Revised (ADI-R)
• Childhood Autism Rating Scale (CARS)
• Future
• Brain ImagingPinpoint subgroups and treatment
• Genetic Testing

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Current Prevalence Rates

• Prevalence
• 1 out of 88 nationally
• 1 out of 47 in Utah County

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Changes in DSM-5

• Name changed from Pervasive Developmental
  Disorder to Autism Spectrum Disorder
• Single Diagnosis rather than a category
  containing five individual diagnoses (PDD-NOS and
  Aspergers eliminated)
• Three symptom domains become two Domains
• Severity 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 disorderstwo decades of perspectives
  from the JCPP, Journal of Child Psychology and
  Psychiatry, 539 (2012), ppe4-e6

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Social Communication Interaction proposed

• 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
• 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.

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Social Communication Interaction proposed
(continued)

• 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
• 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.

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Behaviors, Interests, Activities proposed

• Restricted, repetitive patterns of behavior,
  interests, or activities as manifested by at
  least two of the following
• Stereotyped or repetitive speech, motor
  movements, or use of objects (such as simple
  motor stereotypies, echolalia, repetitive use of
  objects, or idiosyncratic phrases).
• 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).

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Behaviors, Interests, Activities proposed
(continued)

• 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).
• 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

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Additional Diagnostic Criteriaproposed

• Symptoms must be present in early childhood (but
  may not become fully manifest until social
  demands exceed limited capacities). NEW
• Symptoms together limit and impair everyday
  functioning.