Autism Spectrum Disorder (ASD) is an increasingly common neurodevelopmental disorder that impacts the learning, emotional, social and behavioral functioning of children and adults. It is a misunderstood disorder that isn’t always easy to identify in children because of the unique pattern of strengths and needs that each individual with autism has.
Identifying autism early is key to helping children and families get the support they need to have better, happier lives.
What are the Symptoms of Autism?
Autism is a developmental disorder characterized by difficulties with social skills, repetitive behaviors, limited interests, speech, and nonverbal communication. Behaviors occur along a spectrum with some children having cognitive impairments and others having normal or high intelligence along with these specific behaviors, but all children with ASD have a functional impact on their daily life, socialization, and often learning, language skills, and attention.
Core symptoms of autism include:
- Social communication difficulties
- With verbal and nonverbal communication
- Difficulty with aspects of spoken language (nuances of social communication)
- Interpreting gestures (including interpreting body language)
- Initiating and maintaining eye contact
- Interpreting and using facial expressions
- Understanding and/or regulating tone of voice
- Restricted, repetitive behaviors and interests
- Narrow or extreme interests in specific topics
- Need for structured routine/resistance to change or can become upset
- Repetitive body movements (e.g. rocking, flapping, spinning, running back and forth)
- Repetitive motions with objects (e.g. spinning wheels, shaking sticks, flipping levers)
- Staring at lights or spinning objects
- Ritualistic behaviors (e.g. lining up objects, repeatedly touching objects in a set order)
- begin in early childhood (but not be noticed as clinical issues until later)
- are persistent
- interfere with daily living
What is the Difference Between the Terms “Autism” and “Autistic”?
The terms “autism ”and “autism spectrum disorder” reflect that clinical diagnosis of autism, whereas the term “autistic” often is a reference to the behaviors associated with autism. While some people with ASD prefer to be referred to as a “person with autism,” others prefer to be preferred as an ”autistic person.” With autism in adults and children increasing, being respectful with our communications is important.
Using first person language and asking the parent or individual their preferred language is always the most respectful way to refer to their ASD.
How Is a Diagnosis of Autism Made?
The diagnosis of ASD is based on identifying observed and reported behaviorally defined clinical symptoms and therefore these children often can be missed and not receive the support they need.
Most children are still being diagnosed after age four, although autism can be reliably diagnosed as early as age two, so that means families and children aren’t getting the solutions early, and early intervention could have a huge positive impact on brain and behavioral development.
Diagnostic Criteria for 299.00 Autism Spectrum Disorder
To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction plus at least two of four types of restricted, repetitive behaviors.
A) Persistent deficits in social communication and social interaction across multiple contexts
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, and understand relationships
B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
- Symptoms must be present in the early developmental period (but may not fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
- 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.
Why is Autism So Hard to Diagnose?
Autism is hard to diagnose for several reasons but ultimately it is due to misinformation about the disorder amongst both lay people and professionals and no single standard assessment.
Part of the confusion about what autism looks like is because it occurs along a spectrum with each individual presenting with different strengths and needs. So, one child may have difficulty initiating social interaction and another may not but both can’t sustain social interaction but with the later, it may be missed because it may appear they have the skill.
It is important to note that professionals not having the correct information is another major hurdle for identifying kids with autism. It took more than 12 years for the American Academy of Pediatrics to update their Autism guidelines, which meant that not only did physicians not have the right information but neither did parents.
Children with autism also have comorbid conditions that make diagnosis a challenge due to the layers. Issues such as ADHD, ODD, anxiety, OCD, learning difficulties and executive functioning are common co-occurring difficulties.
Amanda’s Autism Diagnosis Story
In evaluating a child for autism almost 20 years ago, a young girl named Amanda looked like she had good social skills because she kept trying to interact with her peers. Upon closer observation at school, I could see that while she was trying over and over to interact, she never once could actually sustain her interactions with peers within the classroom or at recess.
The school chose to overlook that she had restricted interests and repetitive behaviors because they believed she was interacting with her peers. Children with Asperger’s Syndrome or what is now referred to high functioning autism, can be especially hard to diagnose because of the child’s normal to superior intellect. While a desire to interact with others meant that Amanda had more assets, it didn’t negate that she didn’t have an ability to have sustained interactions.
What are the Rates of Autism in the US?
Autism is dramatically on the rise and has risen more than 10 percent since 2000 where the prevalence rate nearly tripled, from 0.67 to 1.85 percent in the US population.
According to the CDC, about 1 in 44 children have autism, with boys being four times more likely to be diagnosed than girls. Studies show this is a global problem with rates of autism at 1% and 2% in countries in Europe and Asia and ASD is reported to occur in all racial, ethnic, and socioeconomic groups.
Approximately 44% of children with autism have a normal or above cognitive ability and the remaining 56% have borderline or functional cognitive impairments with all children on the autistic spectrum needing some level of specialized assistance.
At the current rate of growth, projection rates for autism will put an unbelievable strain on families, school systems, medical and behavioral services, and the US government social services. Schools and other support services do not have enough personnel to service and support children with ASD and that means children and families will suffer if we don’t put proactive resources in place for children and their families.
Did the Pandemic Increase Rates of Autism?
For the first time in their child’s life, the pandemic forced parents to become their child’s primary teacher and this unique situation gave parents an insight into how well their child could focus, learn, cope with stress, and socialize.
For many parents during the pandemic, it was surprising to witness how much support their child needed to stay alert, manage transitions, follow instructions and cope with stress. At my Ridgefield, CT center, parents having this birds eye view of their child’s struggles, led to seek understanding and solutions such as behavioral therapy, executive functioning coaching, and neurofeedback.
What are the Severity Levels of Autism?
Autism affects how a person thinks, acts, and interacts and communicates with others. A child’s assets and needs have an impact on the severity of their autism.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), there are three levels of autism spectrum disorder (ASD). Each level corresponds to the level of daily functioning a child with ASD has in daily life.
Understanding what level your child is at can help a parent prepare for their child’s therapeutic and educational needs. While these levels are useful to help guide parents in their child’s support needs, they don’t represent the full potential of each child. Early intervention and long-term social skills support is critical to help children with autism thrive.
Looking at science-backed therapies for autism such as neurofeedback, nutrition, speech, physical and occupational therapy and parent and behavioral therapy is critical. It is also important to recognize that there is no medication for autism and it is often used to medically constrain children without any research to substantiate its efficacy.
In our BrainBehaviorReset™ Program, we guide parents of children with ASD in calming the brain and improving their child’s behavior and family stress. We understand the unique needs of children with ASD and their families not because Dr. Roseann has had the privilege of supporting these families for more than 30 years, but because we have staff who love someone with autism at home.
To learn more about how to improve your child’s or teen’s executive functioning, register for Dr. Roseann’s free webinar on executive functioning.
CDC (2022). Data & Statistics on Autism Spectrum Disorder https://www.cdc.gov/ncbddd/autism/data.html
CDC (2022).Diagnostic criteria for autism. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Hyman, S. L., Levy, S. E., Myers, S. M., & COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (2020). Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447
Always remember… “Calm Brain, Happy Family™”
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime.
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Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
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