Speech-Language Pathologist
Certified Autism Specialist
Serving Adults and Children

  Mayflower Autism and Therapy Services, LLC

         Brittany Naumann, MA. CCC-SLP

Autism Spectrum Disorders



  If you are concerned your child or loved one might have autism, it is important to seek out a professional immediately to get a screening and possible comprehensive diagnostic evaluation. Early diagnosis can lead to early treatment which may have positive lasting affects on the social, communicative and behavioral development of your child.


  There is no longer a variety of diagnoses that fall under the autism umbrella. According to the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) autistic disorder, Asperger's disorder, and pervasive developmental disorder have been consolidated into Autism Spectrum Disorder. Symptoms are represented on a single continuum of mild to severe impairments in two domains of social communication and restrictive repetitive behaviors or interests. The change occurred to improve the sensitivity and specificity of the criteria for the diagnosis as well as to assist in identifying focused treatment targets of the specific impairments. 

 

  What are the RED FLAGS of autism spectrum disorders?

According to the Autism Science Foundation (2016):

If your child is two months old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t respond to loud sounds
  • Doesn’t watch things as they move
  • Doesn’t smile at people
  • Doesn’t bring his/her hands to mouth
  • Can’t hold his/her head up when pushing up on tummy

If your child is four months old, you should consider talking to your doctor if your child exhibits the following behavior:
  • Doesn’t watch things as they move
  • Doesn’t smile at people
  • Can’t hold his/her head steady
  • Doesn’t make sounds or coo
  • Doesn’t bring things to his/her mouth
  • Doesn’t push down with legs when feet are placed on a hard surface
  • Has trouble moving one or both eyes in all directions


If your child is six months old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t reach for things
  • Shows no affection for caregivers
  • Doesn’t respond to sounds around her/him
  • Doesn’t make vowel sounds (eh, ah, oh)
  • Doesn’t laugh or squeal
  • Seems unusually stiff or unusually floppy


If your child is nine months old,  you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t look where you point
  • Doesn’t respond to his/her own name
  • Doesn’t babble (mama, dada)
  • Doesn’t play back and forth type games
  • Doesn’t seem to recognize familiar people
  • Doesn’t sit with help
  • Doesn’t bear weight on legs with support
  • Doesn’t transfer toys from one hand to the other


If your child is one year old,  you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t point to things
  • Doesn’t learn gestures like waving bye bye, or shaking head yes or no
  • Doesn’t search for things that she sees you hide
  • Doesn’t say single words like mama, dada, up, bye, this, that, juice
  • Doesn’t crawl
  • Loses skills he/she once had
  • Can’t stand when supported


If your child is 18 months old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t point to show things to others
  • Doesn’t know what familiar things (cup, spoon, phone) are used for
  • Doesn’t imitate or copy others
  • Doesn’t have at least six words
  • Doesn’t gain new words
  • Doesn’t notice or react when a caregiver leaves or returns
  • Doesn’t walk
  • Loses skills he/she once had


If your child is 2 years, you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t use 2-word phrases (mama up, want milk)
  • Doesn’t know what familiar things (cup, spoon, phone) are used for
  • Doesn’t imitate actions and words
  • Doesn’t follow simple instructions
  • Doesn’t walk steadily
  • Loses skills he/she once had


If your child is 3 years old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Has unclear speech or drools a lot
  • Doesn’t speak in sentences
  • Doesn’t follow simple instructions
  • Can’t work simple toys (simple puzzles, turning knobs/handles, peg board)
  • Shows little interest in toys
  • Doesn’t want to play with other children
  • Doesn’t play make believe or pretend
  • Doesn’t make eye contact
  • Falls down often or has trouble on stairs
  • Loses skills he/she once had


If your child is 4 years old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Ignores other children
  • Doesn’t respond to people outside the family
  • Shows no interest in make believe or pretending games
  • Can’t retell a favorite story
  • Doesn’t follow 3-step directions
  • Doesn’t use “you” and “me” correctly
  • Doesn’t understand “same” and “different”
  • Speaks unclear
  • Doesn’t scribble or has trouble scribbling with a crayon
  • Loses skills he/she once had


If your child is 5 years old, you should consider talking to your doctor if your child exhibits the following behavior:

  • Doesn’t show a wide range of emotions
  • Shows behavioral extremes (unusually aggressive, fearful, sad, shy)
  • Is unusually withdrawn and not active in social situations
  • Is easily distracted and has trouble focusing on an activity for more than five minutes
  • Doesn’t respond to people or responds only superficially
  • Can’t tell the difference between real and make believe
  • Doesn’t participate in a wide variety of games and activities
  • Can’t give his/her first and last name
  • Doesn’t use plurals, pronouns or past tense properly
  • Doesn’t talk about daily activities
  • Doesn’t draw pictures
  • Loses skills he/she once had
  • Can’t do daily activities (brush teeth, wash and dry hands, or get undressed) without help


 For autism in older children, teens and adults:

  • Impaired social skills
  • Avoiding eye contact
  • Rigid adherence to daily activities
  • Unusual interests or obsessive/repetitive behaviors
  • Being highly sensitive or under-responsive to sound, light or touch

According to the Center for Disease Control and Prevention(2013), these are some signs and symptoms you might see with a child with an autism spectrum disorder (ASD):

  • Not respond to their name by 12 months
  • Not point at objects to show interest (point at an airplane flying over) by 14 months
  • Not play "pretend" games (pretend to "feed" a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people's feelings or talking about their own feelings
  • Have delayed speech and language skills
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel


  HOW IS AUTISM SPECTRUM DISORDER DIAGNOSED? According to the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) the diagnostic criteria for Autism Spectrum Disorder 299.00 (F84.0) is:  

A. Persistent Deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by                history (examples are illustrative, not exhaustive; see text): 

     1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth                           conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

     2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and                           nonverbal communication to abnormalities in eye contact and body language  or deficits in understanding and use of gestures; to a total lack           of facial expressions and nonverbal communication.                                                                                                                                                               3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit                      various social contexts, to difficulties in sharing imaginative play or making friends; to absence of interest in peers.                                                   

     Specify current severity:         

         Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see table 2).     


B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 

       1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects,                        echolalia, idiosyncratic phrases).

       2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at                     small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

       3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects,              excessively circumscribed or perseverative interests).  

       4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to                                pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching or objects, visual fascination with lights or              movement). 


       Specify current severity:

           Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).    


C. Symptoms must be present in the early developmental period (but may not become fully manifested until social demands exceed limited                    capacities, or may be masked by learned strategies in later life). 


D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.


E. 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.


Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not         otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:

  With or without accompanying intellectual impairment

  With or without accompanying language impairment

  Associated with a known medical or genetic condition or environmental factor 

  Associated with another neurodevelopmental, mental, or behavioral disorder 

  With catatonia


Table 2 Severity levels for autism spectrum disorder

 Severity Level
 Social Communication
 Restricted, Repetitive Behaviors
Level 3
"Requiring very substantial support"
 Severe deficits in verbal and noverbal social communciation skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/ difficulty changing focus or action. 
 Level 2
"Requiring substantial support"
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication. 
 Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
 Level 1
"Requiring support"
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures from others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro attempts to make friends are odd and typically unsuccessful. 
 Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

WHERE CAN YOU GET AN EVALUATION in the Greater Kansas City Region? 


  

  • The University of Kansas Medical Center: Center for Child Health and Development   This clinic can evaluate at the earliest age you have a                       concern. If a diagnosis is unable to be confirmed, they will recommend a re-evaluation at a future specified date. 
  • For older individuals, contact local psychologists or counselors who specialize in autism spectrum disorders. 

 



For those under the age of 3: If your child cannot get an evaluation scheduled as soon as your earliest concerns arise and he/she ends up on a waiting list, please do not hesitate to contact early intervention services with your state (Missouri First Steps, Kansas Infant Toddler Services, or local therapy clinics/private practices such as Mayflower Autism) to begin services immediately. 


References 


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association,             2013.

Early Signs of Autism - Autism Science Foundation. (n.d.). Retrieved July 15, 2016, from http://autismsciencefoundation.org/what-is-autism/early-signs-                of-autism/