So, what is Autism? Simply put, it's a developmental disorder that affects social interactions. They don't engage socially, so they have decreased eye contact, and don't have shared social experiences. For instance, a normal child will point to show things of interest and will try to get a caregiver's attention when something interests them. Those with autism are not interested in sharing the experience, so may simply watch whatever is interesting them. Communication also plays into this, as these children don't communicate their needs and often seem more independent than normal children because they simply figure out a way to get what they want, instead of communicating that desire to another. Thus, a child who wants a glass of milk may figure out how to set up the stepstool to get a glass out of the cabinet, rather than simply ask for a glass of milk.
Children with Autism have few, detailed interests. For instance, they may enjoy trains (which is not abnormal), but know exactly how the train runs or be more interested in train schedules, much more than another child his age. Or they may be more interested in part of the toy--such as the wheels on the train, and not use the toy itself appropriately. Going along with this, they love routine, and get upset when their routine is disrupted.
Autism is defined by the Diagnostic and Statistical Manual of Mental Disorders, or DSM. In it's fourth edition (DSM-IV), there were several categories of autism: Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Autistic Disorder, Asperger's Disorder, and Childhood Disintegrative Disorder. Each had slightly different criteria for diagnosis. For instance, children with Asperger's disorder had to have limited social behaviors, repetitive behaviors, and no delay in language and a normal IQ. These were the 'high functioning' autistics.
The fifth edition (DSM-V) came out in 2013, and redefined these categories so that all of them fell under 'Autism Spectrum Disorders'. They made this determination because it had proven difficult to categorize all individuals with these disorders into discreet categories. That is, the same patient, seen by two different providers, may provide two different diagnoses, even though the child has the same symptoms. Thus, the DSM-V eliminated the confusion by making it a spectrum. Those who previously had Asperger's Disorder now are reclassified as having an Autism Spectrum Disorder (ASD), and being on the higher functioning end. There is thus less focus on the exact diagnosis, and more focus on the exact symptoms of the particular child. This also allows children who would not have had access to services before to fit the criteria and be labeled with an ASD so that they may have access to these school services.
In general, there are three patterns of autistic development. Previously, there had been considered to have two, but more recent data on these individuals indicates the presence of a third pattern. The first pattern is normal development to a point, and then loss of previously acquired skills. This is referred to 'regression'. The second is normal development and then failure to gain new skills. This is referred to as 'plateau'. Finally, there is early delays that never catch up with peers. This is referred to as 'no regression, no plateau' (I know, creative name, isn't it?).
So, we have the criteria. But how are children monitored for concerns? Well, each pediatrician does it slightly differently, but the American Academy of Pediatrics (AAP) recommends surveillance at every well-child check. If you are a parent, you may recognize this as either written or verbal questions along the lines of 'is your child pulling to stand?' or 'does your child use a fork appropriately?' As Pediatricians, we have a list of developmental milestones that children are supposed to reach at certain ages. In fact, we get tested on them in every test related to pediatrics starting in medical school, in order to identify children who are behind. You can look at the milestones for yourself, by age, here.
In addition to surveillance, there are certain visits where a child should also undergo formal screening. This is typically done in the form of a questionnaire, such as the M-CHAT. These help us determine whether the child should be referred to a developmental pediatrician for further evaluation. Many children who screen as abnormal do not have autism, but may have some other behavioral or developmental abnormality, especially if they are school-age and having difficulty in school.
However, the limitations in these methods are that it is primarily by parent report. One study looked at social behaviors in children diagnosed with autism by analyzing both parental reports and looking at home movies of the children. This study supported the assertion of three distinct patterns of development (as mentioned above), but showed that parents were bad at judging how their children developed.
Less than half of participants (9 of 20) whose home video displayed clear evidence of a major decline in social-communication behavior were reported to have had a regression by parents. Similarly, only 8 of 20 participants with evidence of early delays in social-communication behavior and little evidence of skill decline on video were reported as having an early-onset pattern by parents. Of the 10 parents who described a plateau in development, only three had home video trajectories consistent with such a pattern.
These difficulties are partly why the incidence of autism has climbed so dramatically in recent years. Thirty years ago, the only people being diagnosed with autism were the classic non-verbal and aggressive patients that were sent to institutions. Now, people with much milder forms of social impairment are being classified as having an autism spectrum disorder, because Early Intervention services have been shown to help those with these problems succeed more later in life.
All this is just the tip of the iceberg with regard to Autism, but I hope it was a good primer and gives you some insight into the disorder.
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