Autism

June 3, 2021

By Dr. Janice Montague

Autism spectrum disorder (ASD) is a Neurodevelopmental disorder that is marked by two unusual kinds of behaviors: 

  • deficits in communication and social interaction 
  • restricted or repetitive behaviors

There are genetic and environmental factors that probably play a role in ASD.  In the past, children with these behaviors were diagnosed with one of a set of distinct disorders—autism, Asperger’s disorder, childhood disintegrative disorder (CDD), and pervasive developmental disorder not otherwise specified (PDD-NOS). Now these separate diagnoses are combined into what’s called the autism spectrum. Symptoms are typically recognized in the first two years of life.

The social/communication piece may appear as follows:

  • Social/emotional problems like difficulty communicating and interacting with others,
  • Little or poor eye contact
  • Not reacting to their name being called
  • Little interest in others’ activities or emotions
  • Getting upset by slight changes in routine or behaviors
  • Repeating words or phrases they hear (echolalia)
  • Inappropriate emotional responses to a conversation or event 

The repetitive piece may appear as follows:

  • Self-injurious behaviors (hand biting, eye-poking)
  • Compulsive behaviors (arranging and stacking objects obsessively)
  • Stereotypy (rocking, hand flapping, pacing)

Other symptoms include but are not limited to:

  • Limited interests or activities that others are interested in but over interest in one of a few areas they like
  • Sensitivity to light, noise, clothing, or temperature (sensory)
  • Sleep problems
  • Digestion problems
  • Irritability (vocal or motoric outbursts expressive of anger, frustration, or distress)
  • Directed acts of aggression toward other people, self, or property
  • Having above-average intelligence – the CDC reports 46% of ASD children have above average intelligence
  • Being able to learn things in detail and remember information for long periods of time
  • Being strong visual and auditory learners
  • Excelling in math, science, music, or art.

Treatment:

Treatment works to minimize the impact of the core features and associated deficits of ASD and to maximize functional independence and quality of life. Therapies such as speech, occupational and physical are often helpful.  There are medications that are used for anxiety and aggression as well.   The most important interventions include behavioral interventions.   Behavioral therapies improve learning, communication, and social skills.

Models of behavioral training are:

  • Applied Behavior Analysis (ABA) reinforcing appropriate behaviors with reinforcers that they like (i.e. candy, tickling) http://www.youtube.com/playlist?list=PLps49GyKLOfZpg163nq91xbYlv-IrpI2Y
  • The Early Start Denver Model Early Intervention is a model that is an evidence based comprehensive and play-based approach to teaching that focuses on helping children develop social communication skills. The Early Start Denver Model emphasizes the development of play skills, relationships, and language.

Prognosis can be quite good for many children as long as it is recognized early and treated.  More research is finding genetic links, environmental factors, medications, and dietary changes that are helping and impacting the lives of these children every day. So please make sure to discuss all concerns with your pediatrician at every visit. We are here to help you diagnose, treat, and support your family.