Symptoms of Autism
Autism spectrum disorder (ASD) is a complex developmental disability; signs typically appear during early childhood and affect a person’s ability to communicate, and interact with others. ASD is defined by a certain set of behaviors and is a “spectrum condition” that affects individuals differently and to varying degrees. There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes. Some of the behaviors associated with autism include delayed learning of language; difficulty making eye contact or holding a conversation; difficulty with executive functioning, which relates to reasoning and planning; narrow, intense interests; poor motor skills’ and sensory sensitivities. Again, a person on the spectrum might follow many of these behaviors or just a few, or many others besides. The diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity.
In March 2014, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the prevalence of autism had risen to 1 in every 68 births in the United States – nearly twice as great as the 2004 rate of 1 in 125 – and almost 1 in 54 boys. The spotlight shining on autism as a result has opened opportunities for the nation to consider how to serve families facing a lifetime of supports for their children. In June 2014, researchers estimated the lifetime cost of caring for a child with autism is as great as $2.4 million. The Autism Society WNY Chapter estimates that the United States is facing almost $90 billion annually in costs for autism. (This figure includes research, insurance costs and non-covered expenses, Medicaid waivers for autism, educational spending, housing, transportation, employment, related therapeutic services and caregiver costs.)
Know the signs: Early identification can change lives
Autism is treatable. Children do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. For more information on developmental milestones, visit the CDC’s “Know the Signs. Act Early” site.
Here are some signs to look for in the children in your life:
Each person with an Autism Spectrum Disorder (ASD) is unique and will have different abilities. Symptoms caused by ASDs might be very mild in one person and quite severe in another.
Individuals with severe autism conditions may have serious cognitive disability, sensory problems and symptoms of extremely repetitive and unusual behaviors. This can include tantrums, self-injury, defensiveness and aggression. Without appropriate intervention, these symptoms may be very persistent and difficult to change. Living or working with a person with severe autism can be very challenging, requiring tremendous patience and understanding of the condition.
Individuals with mild autism conditions, however, may seem more like they have personality differences making it challenging to form relationships.
The primary symptoms of autism include problems with communication and social interaction as well as repetitive interests and activities.
Here are some of the characteristics that may be present.
Strengths exhibited by some ndividuals with autism
- Non-verbal reasoning skills
- Reading skills
- Perceptual motor skills
- Drawing skills
- Computer interest and skills
- Exceptional memory
- Visual Spatial abilities
- Music skills
Weaknesses exhibited by individuals with autism
The above exceptional skills may be combined with subtle or significant delays in other areas of development. Individuals with the diagnosis may demonstrate some degree of the following:
- Impairment in Social relationships
- Deficits in communication/language
- Perseveration on interests and activities
- Dependence on routine
- Abnormal responses to sensory stimulation
- Behaviour problems
- Variability of intellectual functioning
- Uneven development profile
- Difficulties in sleeping, toileting and eating
- Immune irregularities
- Nutritional deficiencies
- Gastrointestinal problems
- Lack of or delay in spoken language
- Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
- Little or no eye contact
- Lack of interest in peer relationships
- Lack of spontaneous or make-believe play
- Persistent fixation on parts of objects
The characteristic behaviors of autism spectrum disorder may be apparent in infancy (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years).
As part of a well-baby or well-child visit, your child’s doctor should perform a “developmental screening,” asking specific questions about your baby’s progress. The National Institute of Child Health and Human Development (NICHD) lists five behaviors that warrant further evaluation:
- Does not babble or coo by 12 months
- Does not gesture (point, wave, grasp) by 12 months
- Does not say single words by 16 months
- Does not say two-word phrases on his or her own by 24 months
- Has any loss of any language or social skill at any age
Any of these five “red flags” does not mean your child has autism. But because the disorder’s symptoms vary so widely, a child showing these behaviors should be evaluated by a multidisciplinary team. This team might include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professionals who are knowledgeable about autism.
Diagnostic Criteria – DSM-5
In North America, medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (revised May 2013) to evaluate autism spectrum disorder (ASD). For a full copy of this manual, please visit the American Psychiatric Association website.
In an effort to better understand the differences between the DSM-IV and DSM-5, please watch this wonderful presentation by Doreen Granpeesheh, Ph,D explaining the changes.
For your convenience, here is the section from the DSM-5 on Autism Spectrum Disorders:
AUTISM SPECTRUM DISORDER 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyperactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
NOTE: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
TABLE 2 SEVERITY LEVELS FOR AUTISM SPECTRUM DISORDER
Level 3: “Requiring very substantial support”
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
Restricted, Repetitive Behaviors:
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2: “Requiring substantial support”
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.
Restricted, Repetitive Behaviors:
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1: “Requiring support”
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
Restricted, Repetitive Behaviors:
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.
Diagnosis of Autism
Evaluation based on Observation
When parents or support providers become concerned that their child is not following a typical developmental course, they turn to experts, including psychologists, educators and medical professionals, for a diagnosis.
At first glance, some people with autism may appear to have an intellectual disability, sensory processing issues, or problems with hearing or vision. To complicate matters further, these conditions can co-occur with autism. However, it is important to distinguish autism from other conditions, as an accurate and early autism diagnosis can provide the basis for an appropriate educational and treatment program.
Other medical conditions or syndromes, such as sensory processing disorder, can present symptoms that are confusingly similar to autism’s. This is known as differential diagnosis.
There are many differences between a medical diagnosis and an educational determination, or school evaluation, of a disability. A medical diagnosis is made by a physician based on an assessment of symptoms and diagnostic tests. A medical diagnosis of autism spectrum disorder, for instance, is most frequently made by a physician according to the Diagnostic and Statistical Manual (DSM-5, released 2013) of the American Psychological Association. This manual guides physicians in diagnosing autism spectrum disorder according to a specific number of symptoms.
A brief observation in a single setting cannot present a true picture of someone’s abilities and behaviors.
The person’s developmental history and input from parents, caregivers and/or teachers are important components of an accurate diagnosis.
An educational determination is made by a multidisciplinary evaluation team of various school professionals. The evaluation results are reviewed by a team of qualified professionals and the parents to determine whether a student qualifies for special education and related services under the Individuals with Disabilities Education Act (IDEA) (Hawkins, 2009).
Places in WNY to get a Diagnosis of Autism
CHILDREN’S GUILD AUTISM SPECTRUM DISORDER CENTER
Located at Women’s and Children’s Hopital, the center takes a team-based approach to evaluation. During one visit, each child is seen by a developmental pediatrician, child neurologist, and child psychologist. After the visit, the team discusses the child and determines the diagnosis and/or need for any additional testing or services. The Center has a full time social worker and nurse and offers a monthly parent group, newly diagnosed sessions and information resources for parents of children diagnosed with an autism spectrum disorder.
KIRCH DEVELOPMENTAL SERVICES CENTER, UNIVERSITY OF ROCHESTER MEDICAL CENTER
Center Kirch Developmental Services Center is the primary clinical program of the Division of Neurodevelopmental and Behavioral Pediatrics. We provide services to children with developmental delays and disabilities such as autism, cerebral palsy, spina bifida, and intellectual disability. We provide evaluation of children who are suspected of having a disability. When children are known to have a disability, we provide specialized health care, monitoring their progress and paying extra attention to health and behavior challenges that go along with each disability. We provide specialized treatments for certain health and behavior challenges, like spasticity and feeding problems. We provide information and resources to families to help them get the right services or support in their community.
Contact the Autism Society WNY Chapter for a list of private individuals/agencies who also do diagnosis. 716-633-2275 or firstname.lastname@example.org
There are several medical conditions that have been shown to be significantly more prevalent in those with autism spectrum disorders than the general population.
Autism is a whole body disorder diagnosed by what is observable, however these signs and symptoms are often the result of underlying comorbid conditions. Knowing what to look for is the first step in getting the most appropriate treatment.
Some common comorbidities found in those with autism:
- Autoimmune conditions
- Seizure disorders
- Ear infections
- Respiratory infections
- Migraine headaches
- Allergy disorder (including non IgE-mediated disorders or food intolerances)
At times, it may be difficult for a health care practitioner to properly assess a patient with an ASD. The parent or caregiver may not have known to watch for certain signs because they were told that ‘it was just the autism’. There may be communication barriers or challenging behaviors preventing an obvious observation of a symptom, or perhaps the patient they themselves don’t know where the pain originates from. It is then that it becomes even more important for the practitioner to be able to recognize some of the behaviors indicating an underlying comorbid condition.
Behaviours which may indicate an underlying comorbidity:
- Sudden changes in behavior
- Covering ears with hands
- Loss of acquired skills
- Irritability or moodiness
- Frequent night waking or difficulty falling asleep
- Teeth grinding
- Walking on toes
- Tantrums or oppositional behaviour
- Self-injurious behaviour (biting, hitting, slapping, head-banging, etc.)
- Chewing on clothes or objects
- Vocal expressions (moaning, whining, groaning, sighing)
- Posturing or seeking pressure
- Repetitive rocking or other movements
Common sources of pain and discomfort (chronic, progressive or static):
- Sore throat
- Muscle pain
- Joint pain
This information excerpted from the Medical Comorbidities in Autism Spectrum Disorder, A Primer for Health Care Professionals and Policy Makers, July 2014.
Facts & Statistics
- About 1 percent of the world population has autism spectrum disorder. (CDC, 2014)
- Prevalence in the United States is estimated at 1 in 68 births. (CDC, 2014)
- More than 3.5 million Americans live with an autism spectrum disorder. (Buescher et al., 2014)
- Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68). (CDC, 2014) Autism is the fastest-growing developmental disability. (CDC, 2008)
- Prevalence has increased by 6-15 percent each year from 2002 to 2010. (Based on biennial numbers from the CDC)
- Autism services cost U.S. citizens $236-262 billion annually. (Buescher et al., 2014)
- A majority of costs in the U.S. are in adult services – $175-196 billion, compared to $61-66 billion for children. (Buescher et al., 2014)
- Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention. (Autism. 2007 Sep;11(5):453-63; The economic consequences of autistic spectrum disorder among children in a Swedish municipality. Järbrink K1.)
- 1 percent of the adult population of the United Kingdom has autism spectrum disorder. (Brugha T.S. et al., 2011)
- The U.S. cost of autism over the lifespan is about $2.4 million for a person with an intellectual disability, or $1.4 million for a person without intellectual disability. (Buescher et al., 2014)
- 35 percent of young adults (ages 19-23) with autism have not had a job or received postgraduate education after leaving high school. (Shattuck et al., 2012)
- It costs more than $8,600 extra per year to educate a student with autism. (Lavelle et al., 2014) (The average cost of educating a student is about $12,000 – NCES, 2014)
- In June 2014, only 19.3 percent of people with disabilities in the U.S. were participating in the labor force – working or seeking work. Of those, 12.9 percent were unemployed, meaning only 16.8 percent of the population with disabilities was employed. (By contrast, 69.3 percent of people without disabilities were in the labor force, and 65 percent of the population without disabilities was employed.) (Bureau of Labor Statistics, 2014)
As Early as 18 months
Research has found that Autism Spectrum Disorders (ASDs) can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until they are much older. This delay means that children with an ASD might not get the help they need. The earlier an ASD is diagnosed, the sooner treatment can begin.
Developmental Screening Tools
Screening tools are designed to help identify children who might have developmental delays. Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed up with your child’s health care provider immediately if you think something is wrong.
Types of Screening Tools
There are many different developmental screening tools that may be admistered by professionals, community service providers and in some cases parents. These include:
- Ages and Stages Questionnaires (ASQ)
- Communication and Symbolic Behavior Scales (CSBS)
- Parent’s Evaluation of Development Status (PEDS)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Screening Tool for Autism in Toddlers and Young Children (STAT)
- Observation tools such as the Autism Diagnostic Observation Schedule (ADOS-G)
- The Childhood Autism Rating Scale (CARS)
- The Autism Diagnostic Interview – Revised (ADI-R)
This list is not exhaustive, and other tests are available.
For your convenience, Autism Canada has four online screening tools available based on the age of the individual being screened.
Asperger's & HF Resources
The Center for Speech and Language Disorders.This group of children within the Autism Spectrum read far above what would be expected for their age and are fascinated with letters, numbers and logos. Information is available on learning style/remediation techniques.
The Online Asperger Syndrome Information and Support (OASIS) center has joined with MAAP Services for Autism and Asperger Syndrome to create a single resource for families, individuals, and medical professionals who deal with the challenges of Asperger Syndrome, Autism, and Pervasive Developmental Disorder/ Not Otherwise Specified (PDD/NOS).
The Autism Speaks 100 Day Kit and the Asperger Syndrome and High Functioning Autism Tool Kit were created specifically for newly diagnosed families to make the best possible use of the 100 days following their child’s diagnosis of autism or AS/HFA.
The purpose of this article is to provide some basic advice for individuals with autism and their parents, teachers, and employers, along with references for more information. This information will hopefully help individuals with autism find meaningful employment and begin the path of self sufficiency.
The Employment Toolbox is for any viewer who is looking for a job or helping someone with their employment goal. Viewers will find ideas, resources and best practices that assist adults with AS and similar profiles with employment related issues. Each month, new items will be added to the toolbox.