GLMS EVENTS
RECOGNIZING AUTISM IN CHILDREN AUTHOR Kathryn Vance
On March 8 , 2022 , the Cato Seniors Group held a meeting and Dr . Charles Oberst , Chair of the Cato committee , welcomed Dr . Julia Anixt , Associate Professor in the Division of Developmental-Behavioral Pediatrics and the Director of the Kelly O ’ Leary Center for Autism Spectrum Disorders at Cincinnati Children ’ s Hospital .
Autism Spectrum Disorder ( ASD ) is a developmental disorder characterized by communication deficits , atypical patterns of social interaction and repetitive behaviors / restricted interests . ASD is a broad spectrum , from mild to severe - no two people ’ s characteristics look exactly the same .
In 2013 , the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ). Dr . Anixt focused on explaining the diagnostic factors of social communication and repetitive behaviors .
1 ) Social communication ( must have all three ): Deficits in social-emotional reciprocity ; deficits in nonverbal communicative behaviors used for social interaction ; and deficits in developing , maintaining and understanding relationships
2 ) Repetitive behaviors ( must have at least two of four ): Stereotyped or repetitive motor movements , use of objects or speech ; insistence on sameness , inflexible adherence to routines or ritualized patterns of verbal of nonverbal behaviors ; highly restricted , fixated interests that are abnormal in intensity or focus ; and hyper- or hypo-reactivity to sensory input or unusual sensory interests .
Symptoms must be present early in the developmental period - the most common period of time Dr . Anixt sees referrals is age 2 , often prompted by delayed speech . In order to be diagnosed with ASD , symptoms must cause significant impairment in important areas of functioning and must not be better explained by intellectual disability or global development delay .
In December 2021 , the CDC released its latest statistic about the prevalence of ASD in the U . S ., citing 1 in 44 children ( 2.3 %), an increase from 2020 at 1 in 54 . So why are the rates of ASD increasing ? This is the question Dr . Anixt is asked the most . It is due in part to the increase of awareness and “ popularity ” of the diagnosis in the last 20 years as well as more recognition of milder phenotypes . It could also be attributed to a diagnostic substitution - as rates of ASD have increased , rates of other intellectual disabilities have gone down .
The cause of ASD is still unknown . It is known that it is a neurobiological disorder and that there is a strong genetic component ; however , there have been more than 1,000 different genes found to be associated with autism .
In primary care settings , the American Academy of Pediatrics recommends that physicians do developmental surveillance at all well child visits , eliciting parental concerns in an open-ended way .
If the family indicates a concern , you should use a standardized screening tool . At 9 , 18 and 30 month well child visits , developmental screenings should be performed whether parents have concerns or not . This should be a tool that identifies multiple domains of development to determine if the child is making good progress on target . The AAP also recommends using a formal screening tool for autism ( most commonly the M-CHAT tool ) at 18 and 24 months during well child visits .
The following are just a few of the characteristics to consider in very young children when there are concerns for autism :
· Avoids or does not keep eye contact
· Does not respond to name by 9-12 months
· Uses few or no gestures by 12 months ( e . g ., not waving “ bye ”)
· Does not play interactive games ( pat-a-cake ) by 12 months
· Does not share interest ( e . g ., showing an object ) by 15 months
· Does not point or follow a point by 18 months
· Does not engage in pretend play ( e . g ., feed a doll ) by 30 months
Diagnosis of ASD uses a multidisciplinary model : a developmental-behavioral pediatrician , a psychologist evaluation and a speech / language pathologist . Several tests are administered such as the Autism Diagnostic Observation Schedule ( ADOS ), standardized language testing , standardized developmental or cognitive testing , measure of adaptive skills and behavior questionnaires . There are often screenings for common co-occurring issues such as sleep disorders , GI issues or seizures .
The challenges with diagnosing ASD are many . Symptoms can be interpreted in many ways and the severity of symptoms and impairment varies . Common conditions overlap with symptoms and development is a moving target , so presentations change with time . To combat these , Dr . Anixt said you must use standardized assessments and a mutidisciplinary approach .
When diagnosing a child with ASD , it is important to remember that the symptoms are broad - and so is the spectrum . She quoted a familiar line : “ If you ’ ve seen one child with autism , you ’ ve seen ONE child with autism .”
To close her presentation , Dr . Anixt shared advice on how to interact with people with ASD / developmental disabilities . We must use inclusive and non-judgmental language and understand that there may be a difference in communication styles . Observe carefully and kindly - meet the person where they are . Be accepting and inclusive and be kind , patient and understanding .
I ’ d say that ’ s a good reminder for all of us , in all walks of life .
Kathryn Vance is the Communication Specialist at the Greater Louisville Medical Society .
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