5 Things You Might Not Know About Autism Spectrum Disorder
April is autism awareness month, and we want to do our part in increasing awareness and *acceptance*, as well as answer all of your autism-related questions. Our team at The Childhood Collective has a huge heart for autistic children and their families! All of us have spent our careers specializing in diagnostic evaluations and therapy for these children, and have seen many changes occur over the past decade. We hope to offer you some professional insights and share a bit about our own experiences. Let's start with the basics: what is autism?
What is Autism?
Autism spectrum disorder is a neurodevelopmental disorder that impacts a child’s ability to communicate and socially interact with others. Children with autism also show repetitive behaviors and special, focused interests.
The current diagnosis of autism spectrum disorder is made when a child shows differences in communicating and interacting with others and either (currently or in the past) has shown challenges in ALL of the following areas:
- Challenges with social-emotional reciprocity, which could be difficulty having conversations; sharing interests or emotions; starting or engaging in interactions with other people.
- Challenges with nonverbal communication, such as eye contact, body language or use of gestures, or facial expressions. Note: an autistic child might have great eye contact but struggle to use gestures appropriately.
- Challenges in developing and maintaining friendships, sharing imaginative play, or limited interest in peers.
The child must also show behaviors in at least two of the following areas (currently or in the past):
- Repetitive behaviors, body movements, use of objects or speech
- Hand flapping, finger movements, tensing body, spinning, lining up toys, hopping up and down, lining up toys or sorting objects
- Repeating other’s words, repeating lines from television shows or from others, repeating odd or made-up phrases
- Insistence on sameness, inflexible adherence to routines, ritualized verbal and nonverbal behavior
- Distress at small changes
- Difficulties with transitions
- Rigid patterns of thinking
- Performing rituals
- Need to eat the same food each day or wear the same clothes
- Highly restricted, fixated (deep/specialized) interests that are abnormal in intensity or focus
- Strong attachment to objects (e.g., must hold certain objects at all times)
- Interest in age-appropriate topics that is very intense
- Preoccupation or excessive interest in certain people, interests in unusual topics, such as fans, refrigerators, outlets, wheels on cars, etc.
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
- Not caring about pain or temperature
- Intense reactions to sound, textures, tastes, smells, clothing
- Excessive smelling, feeling, or licking of inedible objects
- Fascination with lights or movements
- Staring at objects or people from various angles or corner of eye
As you can see, the diagnosis of an autism spectrum disorder is complex. Many of these behaviors can be hard to observe, especially in children with mild characteristics. Parents often have many questions about autism in their child, so we are providing you with a few insights to help with your understanding.
5 Things You Might Not Know About Autism
1) The definition of autism has changed over the years.
Autism is a relatively new diagnosis, only arriving in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. It wasn't until 2013, that we arrived at our current diagnosis of "autism spectrum disorder" in the DSM-5. Prior the that change, children were given a variety of diagnoses, including: Autistic disorder, Asperger syndrome, pervasive developmental disorder – not otherwise specified (PDD-NOS), Rett's Disorder, and childhood disintegrative disorder. When the new diagnosis of autism spectrum disorder changed, the DSM-5 recommended that practitioners give children with those previous labels the new diagnosis of autism spectrum disorder. One important change to the criteria was the addition of sensory challenges, which was often reported by parents. Another significant change was the removal of Asperger syndrome, which was hotly debated in the autism community at the time. We now refer to all children as having an "autism spectrum disorder", but there are now three different levels of the disorder depending on the severity of symptoms. A level 1 means that more mild symptoms are present, whereas a level 3 indicates that more severe symptoms are present. The use of severity levels at all is also debated.
2) Autism prevalence has significantly increased over the years…or has it?
Because autism rates have increased within the population, many people mistakenly believe that there is an actual increase in the prevalence of autism. However, there is much information to show that this increase is largely due to general awareness in the public, changes to the diagnosis, early screening, and improved detection.
In 1991, the U.S. Department of Education added a special education category for autism. This change resulted in increased identification of children with autism and families seeking a diagnosis. In 1994, Asperger syndrome was included, demonstrating that autism could also have a mild presentation. In 2000, the prevalence of autism was 1 in 150. In 2006, the American Academy of Pediatrics recommended that all children be screened for autism during routine pediatrician visits at 18 and 24 months. The most recent research, which was just released a few days ago, states that 1 in 54 children are diagnosed with autism. Again, there have been many efforts made in the past 20 years to increase awareness about autism and screen children for autism at earlier ages. Additionally, there are now state-provided resources for families who have children with autism, making families more likely to seek out diagnoses.
3) Autism is far more common in boys than girls…but is it really?
Even research in the most recent report on autism shows that boys are around 4 times as likely to be diagnosed than girls. However, recent research is now showing that girls may be better able to mask symptoms than boys. For instance, they often have less noticeable repetitive behaviors than boys. Also, boys more often play alone whereas girls may be more likely to use compensatory behaviors, such as staying in close proximity to peers or weaving in and out of activities. As a result, they may not stand out from their peers as much as boys. We will be discussing this topic in more depth this month, so keep an eye out!
4) Autism can be reliably diagnosed in children as young as 18-24 months, or even earlier.
Timely identification of autism is important because we know how much early intervention can help children and families. The most recent research from the CDC continues to show that children are diagnosed late, with an average age at diagnosis of 51 months. On the other hand, some recent research has shown that children can start to show symptoms as early as 6-12 months. Though this is too early to make a diagnosis, research has shown that diagnoses done by 14-16 months can be reliable. Diagnoses are considered very reliable by 24 months of age.
5) Early intervention = improved outcomes.
Whenever we think about child development, the importance of early intervention cannot be stressed enough. Children's brains are truly amazing, and they can learn many new skills when they are being taught in a way that is appropriate for them! When developmental issues are identified early, and skills are taught directly, there is less of an opportunity for children to fall behind their peers. Also, by teaching communication and supporting a child's play and social skills at a young age, it is less likely that negative behaviors will have the chance to solidify. Parent training is an essential component of early intervention, since even the best therapists can't be with the child all of the time. Parents are arguably the most important person on any early intervention team, because they can continue working on skills throughout the day and night.
We are truly grateful to each of you for following along on our journey. If you aren't yet following us on social media, make sure to jump over and follow along... we don't want you to miss a thing! With all that is going on right now with COVID-19, and many of you making the switch to remote learning, we are offering daily tips and strategies for parents-turned-teachers on our social media.
Thinking of you all this week!
