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Truly Collaborative Care Delivering Personalized Treatment

AUTISM SPECTRUM DISORDER

Diagnosis for ASD in Weston

Autism Spectrum Disorder (ASD) is a developmental condition characterized by major impairments in cognitive and social functioning, communication, rigid, stereotyped or obsessive-compulsive patterns of behavior, and restricted or peculiar interests and movements. This diagnosis covers an enormous range of abilities and functioning.

Until 2013, Pervasive Developmental Disorders were divided into categories including Autistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified. However, this has been revised in DSM-5, the newest version of the “encyclopedia” of generally accepted developmental and psychological diagnoses.

Henceforth, there is one single category for ASD in DSM-5, with diagnostic qualifiers pertaining to a number of important dimensions, including severity and adaptive functioning. How this change will ultimately affect understanding and outcomes in ASD, including ramifications in the way services and benefits are allocated, remains unclear.

HOW COMMON IS ASD?

Once thought to be far less common, alarmingly, the statistics regarding rates of ASD seem to be ever increasing. Why this is happening is a topic that has received enormous attention, but to date, there is no definitive explanation. Broadening of diagnostic criteria and increasing public and professional awareness in recent years may be contributory, though this still does not seem to account for such a dramatic acceleration in prevalence.

Research suggests ASD is four times more common in boys than in girls, which may reflect actual gender-related factors, but also some differences in symptom presentation and social norms that complicate identifying females. In any event, there is no question that ASD is being diagnosed far more often, and earlier, than in previous generations.

WHAT CAUSES ASD?

The search for a single cause of an ASD in a particular person has not been successful. As ASD is heterogeneous, meaning that there are numerous “varieties,” it appears there are likely to be many causal factors involved, including familial genetic vulnerabilities, dysfunction in certain brain structures and pathways, and diverse environmental and medical triggers. Recent studies did not find any connection between early childhood vaccinations and ASD, but there remain many parents who are nervous about this subject.

Although knowledge in this area is constantly increasing, at this point perhaps looking for “why” a given person has an ASD might be a question best left to researchers, and valuable time and resources more fruitfully utilized in finding and implementing effective interventions.

HOW IS ASD DIAGNOSED?

Since early identification of ASD can potentially result in improved outcomes, the good news is that there are screening tools for children as young as two years old. However, there is no single, definitive test for ASD. Though earlier diagnosis is now feasible, there are many who remain undiagnosed for many years, often those that are especially high functioning or live in areas with fewer specialized practitioners.

A comprehensive, multidisciplinary approach is considered “best practice.” This methodology combines family and developmental history, clinical observations, structured questionnaires, and empirically validated tests. Some parents may delay getting their child diagnosed, worrying that their worst fears will be confirmed or fearful of stigma. Some may believe their son or daughter is “just immature” and will “grow out of it.” While this is very understandable, putting off needed evaluations and interventions is not recommended.

Parents are often the first to recognize that their child is not developing typically. If you suspect that your child may have an ASD, it’s best to trust your intuition and seek professional guidance, even if others do not share your concerns or think you are “over-reacting.”

WHAT HAPPENS AFTER THE DIAGNOSIS OF ASD IS MADE?

Following identification of ASD, the most important step is to find resources and evidence-based treatments. This process is often quite daunting. Yet, the promise for helping children with ASD make progress has never been brighter, even in the most severe and complex cases. Some children with ASD will require extremely intensive intervention programs, others less so.

It is also important for parents to address their own emotions and needs along with trying to assist their child. Having a child with an ASD, or in some cases more than one child with this condition is stressful, often straining relationships, careers, finances, and life in general. On a positive note, it seems that given accurate information and positive support systems, some parents not only adjust to this situation, but learn to find purpose and joy as they help their child thrive and move forward toward reaching their highest potential.

WILL TREATMENT BE SUCCESSFUL?

No one, not even experts, can totally predict individual outcomes for ASD. However, there has been a considerable improvement in understanding prognostic factors. Moreover, with consistently implemented evidence-based treatments more persons with ASD seem to be doing “better than expected.” While everyone hopes their own child will “beat the odds” and be able to function independently and “live a normal life,” parents and other relatives often must create new kinds of expectations and redefine what “success,” “normal,” and “a good life” means in their unique circumstances.

The reality is that someone with ASD may never be able to live on their own, work in competitive jobs, or establish truly reciprocal relationships. However, there are also persons with ASD who have strengths that compensate for their deficits, even those with exceptional abilities whose accomplishments far surpass their “neurotypical” peers. Wherever an individual falls on this continuum, our legal and ethical systems not only acknowledges the special needs and vulnerabilities of people with ASD, but is charged with ensuring that they receive the same rights, understanding, and respect as anyone else.

There is No One Treatment for ASD

Remember, no one discipline has all the answers. Medical doctors may be in the best position to address certain ASD related symptoms or issues, while others are best managed by psychologists or other mental and behavioral health professionals. Speech and language pathologists, occupational and physical therapists, or educators are often key members of a comprehensive treatment team. The relevance of engagement in social groups and activities, opportunities for physical exercise a positive lifestyle supporting getting good nutrition, adequate sleep, and opportunities for physical exercise should not be underestimated.


WHAT ABOUT ASPERGER’S SYNDROME (AS)?

Though not considered a diagnosis in DSM-5, it remains in ICD-10. The core issues in AS are in the realms of social behaviors, motor functioning, and the quirky nature and restricted range of interests. Typical manifestations include problems in non-verbal social behaviors such as poor eye contact and facial expressions that are mismatched with situations and expected feelings. Often, those with AS are very literal, speak in an atypical or monotonic cadence, and have difficulty understanding the specific mind-set and emotions of others. They often get along quite well with adults, but less so with those his or her age. However, this is not written in stone. Making true friends is generally very challenging for those with AS.

Having AS can be very frustrating. So it is not surprising that it’s associated with periodic outbursts of temper or, conversely, feelings of alienation and social withdrawal. For family members, the lack of being able to comprehend or feel connected to one’s own child can be overwhelming.

Symptoms of AS

Those with AS often are physically awkward and have sensory issues like over-reacting to noises or needing to smell certain objects. They are often very selective about food. This can lead to problems in getting adequate nutrition. In addition to various kinds of worries and anxieties, stereotyped movements or tics are also a common aspect of AS. ADHD is a common co-occurring problem in this population

Although AS starts in childhood, many are not accurately diagnosed until teenage years or as adults. High intelligence, special talents or strengths, and achievements can mask AS and make diagnosis or acceptance of this condition by parents or educators more difficult. Although AS is not necessarily a barrier to educational, career success per se, high achievers with AS who have had insufficient intervention or lack insight tend to have inadequate or problematic social lives, even if they have been able to attain a relationship. Actually, it is often not AS itself but heightened levels of anxiety, depression, or a relationship issue that lead to first clinical consultation for high achievers with AS.

Although AS was first described clinically, by Dr. Hans Asperger, in 1944, only fairly recently did the prevalence of AS and the need for better diagnostic methods and more effective interventions become evident. In general, AS benefits from a comprehensive approach involving knowledgeable professionals including physicians, psychologists, educators, speech therapists, occupational and physical therapists, and behaviorists. The psychological and behavioral focus is on improving social understanding and social skills (pragmatics), parent education, stress management, and addressing the negative emotions and behaviors that interfere with functioning. A particular concern is the reduction of sensitivities and compulsive behaviors.

While early intervention is optimal, it is really never too late to get help. In fact, there is increasing evidence that many of the characteristic symptoms and problems associated with AS can be improved with proper and consistent treatment.

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