Steven Adams, Psy.D., Clinical Psychologist
Cornerstone Counseling & Consulting, P.C.
Springfield and St. Louis, MO
Autism spectrum disorders are neurodevelopmental disorders characterized by developmental delays in language and communication, difficulties with reciprocal social behavior, restricted areas of interests, ritualized, repetitive and stereotyped behavior (Mulick and Rice, 2015). Autism is now called “Autism Spectrum Disorder” (ASD). Starting in 2013 Autism Spectrum Disorder is a term that has been used by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The term “spectrum” is used to describe different variations and levels of severity of autism. ASD encompasses autism and a milder condition, once called Asperger’s Disorder.
According to the Center for Disease Control and Prevention (CDC) ASD is a lifelong condition first evident in childhood. Based on data collected in 2014 it was discovered that 1 in 59 eight-year-old children appear to have ASD. Studying antigens in 2013 (substances in vaccines that cause the immune system to produce disease-fighting antibodies) the CDC found no relationship between vaccinations and the development of ASD. Since 2006 over $3.1 billion has been granted to the CDC, the National Institute of Health (NIH) and other federal agencies to perform research on ASD. New funds were allocated in 2019 for continued research.
Common problems found with children with ASD include academic/learning problems, social skills deficits, difficulties in communication and poor mood regulation. About 60 percent of children with ASD wander. To “wander” means leaving a supervised area. This is common in toddlers who are exploring their environment and learning independence. After age four wandering is less common for most children. For some children this presents safety concerns. Specific symptoms of ASD include:
- Poor eye contact
- Not sharing enjoyment of objects or activities
- Talking at length about specific subjects without realizing are not interest in discussing this subject
- Unusual tone of voice (such as robot voice)
- Difficulty understanding another person’s point of view (such as figures of speech)
- Difficulties with back and forth conversations
- Not responding to having his or her name called
- Repeating certain behaviors or words
- Long term and intense interest in certain specific subjects
- Interest in moving objects or parts of objects
- Becoming upset with changes in routine
- Difficulties when sensory experiences, such as sound, light or clothing
- Difficulty sleeping
RISK FACTORS (from NIMH)
Having a sibling with ASD
Having older parents
Genetic conditions such as Down Syndrome, Fragile X Syndrome or Rett Syndrome
Very low birthweight.
ASSESSMENT AND DIAGNOSIS
Symptoms of ASD generally appear in the first two years of life. The American Academy of Pediatrics recommends that children be screened for ASD. An accurate diagnosis involves more than just an interview or a quick “screening test.” A more comprehensive psychological assessment should involve:
- Reviewing the developmental history of the child;
- Direct observation of their behavior by the clinician;
- Direct testing involves such tests a measures of intelligence, autistic behavior, achievement, adaptive behavior and personality;
- Behavioral observations should be made by parents and teachers using rating scales. These observations are made with various psychological tests designed to measure and categorize various behavior;
- An assessment their language skills;
- A written report should be offered to the parents with diagnoses and recommendations for treatment.
In addition to a psychological evaluation other professionals may also provide help in assessing this issue, such as a pediatrician or a speech-language pathologist.
Educational goals involve the type of educational setting that is appropriate as well as instructional techniques and goals. Such goals should be guided by the assessment recommendations given about the child (such as intelligence and achievement tests findings).
Early intensive behavioral interventions (EIBI) can be very helpful by determining basic behavior problems and determining appropriate strategies to deal with theses behaviors. When delivered early in a child’s life (from ages three to eight) EIBI can help recover delays in learning and language acquisition. Such treatment typically occurs for at least two years.
Treatment of high functioning autism (formerly called Asperger’s disorder) requires less intensive treatment. However, a comprehensive psychological evaluation often discovers learning disabilities, social impairment and other behavior problems in these children that need to be addressed. Typical interventions for these children involve anxiety management, anger management and social skill development. Not to be overlooked is the role of parents in treating ASD. Parents often need education and support in how to manage and teach their children.
Medication treatment of ASD is rather complicated. There is no known medication treatment specifically for ASD. Instead, some psychiatric medications may be helpful in managing certain behaviors or other disorders that also occur with ASD, such as attention problems, difficulties regulating mood or social anxiety.
ADULTS WITH ASD
It is not uncommon that young adults in their twenties or thirties come to our office for a psychological evaluation for ASD. These are usually high functioning cases that were not recognized while in school. As ASD can have major effects on adult functioning and job performance an assessment can be quite helpful in determining appropriate job placement, possible disability and problems in social functioning.
REFERENCES AND SOURCES OF INFORMATION
Mulick, J. and Rice, C. Assessing and treating autism spectrum disorders. In Psychologist Desk Reference,
Oxford Press, 2015.
National Institute of Mental Health
Center for Disease Control
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association.
Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studiesexternal iconexternal icon. Vaccine. 2014 June;32(29):3623–3629.
Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism pdf icon[PDF – 5 pages]external icon. JAMA. 2003;290:1763–6.
Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, et al. A population-based study of measles, mumps, and rubella vaccination and autismexternal icon. N Engl J Med. 2002;347 (19):1477–1482.