What is Autism?

Autism is ultimately defined as having symptoms that limit and impair everyday functioning in both of the following areas:

1. Social interaction and communication
2. Restricted and/or receptive behaviors, activities, or interests.

What are the key elements of social interaction that are evaluated for in autism?

1. Non-verbal communication: for instance, a patient may not have good eye contact or may stand too close to others, flat affect/lack of normal range of facial expressions, unable to understand the use of tone in others' voices, difficulty with abstract communication (sarcasm or white lies), may not gesture or point to direct parent's attention, etc.
2. Verbal communication: a child may have a limited vocabulary, not meet developmental milestones for babbling / single word utterances, limited sign language, may mix up pronouns in speech, or may have stereotypic speech patterns (repeating / parroting others, repeating statements from tv / music out of context, etc.)
   
3. Social-emotional reciprocity: not great at the “flow” and back & forth of conversation, lacks empathy, fails to initiate social interactions, doesn’t seek help from others, doesn’t offer comfort, etc.
4. Difficulty in establishing and maintaining relationships: trouble with imaginative play, very few friends, tendency to make friends with much older or younger people, friends center almost completely around one theme (Roblox for instance), difficulty with small talk.

What are the non-social aspects to Autism that may be present?

1. Repetitive movements or abnormal use of objects or toys.
2. Inflexibility to change and an insistence on sameness.
3. Lack of variability in interests and an over-focus on various themes or activities.
4. Sensory problems.

What is meant by repetitive behaviors in patients with Autism?

Examples vary by age, IQ, and severity of autism, but may include:

• Lining up toys or objects
• Flipping objects over and over
• Using objects in ways they weren’t intended
• Repeatedly using a toy in ways it wasn’t intended
• Various hand or arm movements
• Rocking
• Spinning

How does the inflexibility often present?

• Need for the same schedule every day
• Need for the same route to a certain location
• Intense reactions when a routine is broken
• Difficulty with transitioning from a task
• Generally rigid thinking patterns

What is meant by restricted interests?

• Many with ASD can over-focus on specific themes or hobbies, lasting for weeks or months, or even years, before transitioning to another theme or hobby.
• Classic examples include Pokemon, Roblox, Legos, superheroes, trains.
• Many of these interests are normal but it’s the intense focus and the lack of balance/lack of other interests that is concerning.

What are the sensory issues sometimes seen in Autism?

• Disliking certain clothing textures or tags on clothes
• Not liking shoelaces tied too tight or too loose
• Not wanting foods to touch each other
• ARFID/restricted food choices (won’t eat any veggies or won’t eat soft foods, etc)
• Set off by bright lights
• Set off by certain sounds

How are official diagnoses of autism made?

In most cases diagnosis is obtained by a multidisciplinary team that includes psychologists, speech therapists, and occupational therapists. These teams also sometimes include developmental pediatricians. Most will employ a standardized assessment, the most popular of which is the Autism Diagnostic Observation Schedule (ADOS). We provide diagnostic assessments here at our practice! Click here if you are interested in finding out more about this process.

To make the diagnosis of autism, the following are helpful:

1. Obtaining information from the patient and their caregivers is essential.
2. Various symptoms should have been noticeable since early childhood (and are noticeable in children as young as 8 months in some cases).
3. Conversely, many symptoms will dissipate over the years and may not be as noticeable in a patient’s teens or adulthood, as compensatory mechanisms are learned over time to overcome some of the social deficits in autism. But the underlying deficits are still there— it takes continued effort to overcome them.

Is Asperger’s still a clinical diagnosis?

No, in DSM-5, which is the manual used in psychiatry, Asperger’s has been put under Autism. Most with what used to be labeled as Asperger’s are now diagnosed with Autism spectrum disorder without language or intellectual impairment. That said, many individuals continue to identify with the diagnosis of Asperger's and it is important to consider this when interacting with individuals with this diagnosis.

What other qualifiers are included with the diagnosis of Autism?

1. With or without speech impairment. Speech impairment implies delays in language or improper use of language in early and mid childhood. More than 50% of patients with ASD have some element of speech impairment. Of note, it is not uncommon for some language development to look normal at ages 1-2 but then to be lost, or “regress” in autism .
2. With or without intellectual disability, or "ID". ID is when IQ is below 70. Forty percent of those with Autism have ID.

When should genetic testing be sought?

• When accompanied by intellectual disability (IQ < 70)
• Presence of dysmorphic features
• When accompanied by malformations or abnormalities in other organ systems (cardiac, renal, neurologic, endocrine, metabolic, etc.)