In 2016, the Centers for Disease Control and Prevention reported that the prevalence of autism had risen to one in every 68 births in the United States. Autism spectrum disorder (ASD) is a complex developmental disability. ASD is defined by a certain set of behaviors and is a “spectrum condition” that affects individuals differently to varying degrees.
“Autism spectrum disorder is a multifaceted disorder of communication and social skills, but there can also be the presence of some unusual behaviors– repetitive movements like hand flapping, repetitive verbalization like sound production, or just the need for sameness,” said A. Malia Beckwith, M.D., Section Chief, Developmental and Behavioral Pediatrics, Children’s Specialized Hospital, an RWJBarnabas Health facility. “For example, for kids who are higher functioning, it can be that they’re ritualistic and just can’t be flexible. They have a schedule and if something is out of routine they have trouble tolerating change.”
Other behaviors associated with ASD include:
- Delayed learning of language
- Deficits in social skills – i.e. difficulty holding conversation (verbal) or making eye contact (nonverbal)and nonverbal
- Difficulty with executive functioning – i.e. working memory, flexible thinking and self-control
- Narrow, intense interests
- Poor motor skills
- Sensory sensitivities – children might seek out calming/soothing sensations or avoid upsetting ones
“A person on the spectrum might follow many of these behaviors or just a few, and there are many besides these,” added Dr. Beckwith. “If parents notice any of these behaviors it’s best to discuss them with their pediatrician to determine if a formal evaluation is needed.”
The Importance of Early Identification and Intervention
There is no known single cause of ASD, but increased awareness and early diagnosis and intervention along with access to appropriate services and support can lead to significantly improved outcomes.
“We have a small period of time, until the age of three and four, where the brain is still being molded,” said Dr. Beckwith. “It’s a time of plasticity. Our neurons are still changing, connections are still being made and neurons that are not as functionable or usable are pruned out.”
With early intervention, doctors look to make some very significant, long-term changes to the brain to help it grow in a more normal and functional way. Different therapies and treatment, such as applied behavioral analysis (ABA), speech therapy, physical therapy, and occupational therapy, are utilized to increase the function in parts of the brain that are responsible for things like socialization and communication.
“The goal is always to try to detect ASD as early as possible because data suggests that if we start earlier, we can see greater outcomes as far as changing a child’s ability level and reprogramming the neurons in the brain to increase functioning,” added Dr. Beckwith.
Early Detection – How to Prepare and What to Expect
The Autism Program at Children’s Specialized Hospital is designed to improve the lives of children and adolescents with ASD as well as their families by providing comprehensive evaluations.
“The diagnosis of ASD is really made based upon whether or not the child meets behavioral criteria set forth in the Diagnostic Statistical Manual of Mental Disorders, Volume 5, or the DSM5,” said Dr. Beckwith. “We can make that determination through observing and interacting with a child in an evaluation session.”
A developmental pediatrician determines whether a child meets the DSM5 criteria by observing their behavioral skills, play skills, social skills and communication skills. School-aged children, or those over the age of four, are observed for around 60 minutes. Children under the age of four are observed for closer to 90 minutes to allow time for more play-based testing.
Dr. Beckwith does not recommend an evaluation for children under the age of 12 months.
“It tends to be more difficult to evaluate a child between 12-18 months,” said Dr. Beckwith. “Even when parents have concerns for their child at that age, I’m hesitant to make a diagnosis because we just expect less of children, both socially and behaviorally, at that age.”
“When we’re seeing a child in an evaluation, we do keep in mind that it’s only a snapshot. The behaviors we’re able to see in a single evaluation session might differ from what the family is experiencing every day at home,” added Dr. Beckwith. “In order to comfortably make a determination, we really take a lot of time to talk with the parents about the child in order to get their observations, impressions and concerns and incorporate their feedback into our overall assessment.”
If a child is receiving any kind of therapy, Dr. Beckwith recommends that parents bring their child’s Individualized Service Plan (ISP) to an evaluation. This allows the team to see what kinds of therapy the child is already receiving and gives better insight on the child’s behavior from all of the different parties involved in the child’s care. If at this point a doctor is still unable to make a diagnosis, the child may be required to come back for additional multidisciplinary evaluations with a speech therapist, occupational therapist and child psychologist. The evaluation typically involves three visits and includes neurodevelopmental, psychology, speech/language and occupational therapy evaluations.
Early Intervention Resources
After a diagnosis, the focus turns to a long-term treatment plan. In some cases, the child is already getting the proper services and therapies and not much needs to be changed.
“Sometimes we can just add in behavioral therapy or speech therapy to promote the use of language,
said Dr. Beckwith. “It’s really about looking what kind of therapy they’re already getting and figuring out what they still need based on each child’s individual needs.”
CSH’s Early Intervention Program is specifically designed to provide both evaluation and intervention for children up to three years of age who already have measurable delays or have a condition that impairs or has a high predictability of impairing normal development.
“The Early Intervention Program is delivered in the child’s natural environment, such as their home or in child care,” said Dr. Beckwith. “It promotes social, cognitive, language and physical development in a variety of fun, but educational and therapeutic activities such as speech, occupation and physical therapy, nutrition, family training and developmental intervention.”
The Children’s Specialized Hospital is the largest regional provider of services dedicated to working with children and adolescents who have an ASD.
“At Children’s Specialized Hospital, we are focused on early identification and treatment of autism so that kids can reach their full potential,” said Dr. Beckwith. “We work together with and families as partners in making sure that children get the services they need to help each child achieve their full potential.”
For more information on the Children’s Specialized Hospital’s Autism Program, evaluation and Early Intervention Program, please visit children-specialized.org/autism.