This makes its discussion a hot topic in the medical and behavioral healthcare fields, and even a political issue in some cases. However, living, learning, and growing with this diagnosis for an individual child and his/her family is about far more than statistics or governmental arguments. It’s about securing the best possible treatment approaches to ensure each boy or girl has their bright future ahead.
Autism is a very complex, life-long neurological condition. It is not a mental illness and it is not an intellectual disability; however, those diagnoses can co-exist. Individuals living with an ASD often display impairments in communication and social functioning and may also display challenging behaviors. These may include:
- Impairments in use of expressive language and understanding of both verbal and non-verbal communication
- Inability to understand others’ feelings or perspectives
- Impairments in social development and reciprocal social interactions,
- Excessive preoccupation with certain topics or activities
- Stereotyped and repetitive behaviors
- Preference for sameness
- Sensory regulatory problems
- Attachment to unusual objects
- Tantrums, aggression, and self injury
The Centers for Disease Control and Prevention (CDC) reports that 1 in 68 children (1 in 42 boys and 1 in 189 girls) have autism spectrum disorder (ASD).8 This includes more than 3.5 million Americans9. The prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68).
(from the National Institute for Mental Health)
Doctors diagnose ASD by looking at a child’s behavior and development. Young children with ASD can usually be reliably diagnosed by age two. Older children and adolescents should be evaluated for ASD when a parent or teacher raises concerns based on watching the child socialize, communicate, and play. Diagnosing ASD in adults is not easy. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as schizophrenia or attention deficit hyperactivity disorder (ADHD). However, getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help.
Diagnosis in Young Children
Diagnosis in young children is often a two-stage process:
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The Centers for Disease Control and Prevention (CDC) recommends specific ASD screening be done at the 18- and 24-month visits. Earlier screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who:
- Have a sister, brother, or other family member with ASD
- Have some ASD behaviors
- Were born premature, or early, and at a low birth weight.
Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine this information with his or her observations of the child. Read more about screening instruments on the CDC website.
Children who show some developmental problems during this screening process will be referred for another stage of evaluation.
Stage 2: Additional Evaluation
This evaluation is with a team of doctors and other health professionals with a wide range of specialties who are experienced in diagnosing ASD. This team may include:
- A developmental pediatrician—a doctor who has special training in child development
- A child psychologist and/or child psychiatrist—a doctor who knows about brain development and behavior
- A speech-language pathologist—a health professional who has special training in communication difficulties.
The evaluation may assess:
- Cognitive level or thinking skills
- Language abilities
- Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.
- Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:
- Blood tests
- Hearing test
The outcome of the evaluation will result in recommendations to help plan for treatment.
Diagnosis in Older Children and Adolescents
Older children whose ASD symptoms are noticed after starting school are often first recognized and evaluated by the school’s special education team. The school’s team may refer these children to a health care professional.
Parents may talk with a pediatrician about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include understanding tone of voice, facial expressions, or body language. Older children may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers. The pediatrician can refer the child for further evaluation and treatment.
Diagnosis in Adults
Adults who notice the signs and symptoms of ASD should talk with a doctor and ask for a referral for an ASD evaluation. While testing for ASD in adults is still being refined, adults can be referred to a psychologist or psychiatrist with ASD expertise. The expert will ask about concerns, such as social interaction and communication challenges, sensory issues, repetitive behaviors, and restricted interests. Information about the adult’s developmental history will help in making an accurate diagnosis, so an ASD evaluation may include talking with parents or other family members.
Developmental disabilities are a diverse group of severe chronic conditions that are due to mental and/or physical impairments. People with developmental disabilities have problems with major life activities such as language, mobility, learning, self-help, and independent living. Developmental disabilities begin anytime during development up to 22 years of age and usually last throughout a person’s lifetime.
An ASD is something an individual is born with; it is not acquired and individuals do not “outgrow” an ASD. It is found in every country, every ethnic group, and every socio-economic group. ASD’s are diagnosed four times as often in males as in females, except for Rett’s Disorder, which affects females almost exclusively. Research supports that ASD’s are most likely complex genetic disorders found on multiple genes and affected by environmental triggers.
9Buescher et al., 2014