For Information on Adult Spectrum Disorders:
The Facts
Autism Spectrum Disorders (ASDs) are the most common developmental disabilities in the United States, affecting 1 in 110 children and 1 in 70 boys in 2010. There are four to five times more commonly diagnosed in boys than in girls, and the prevalence is increasing at a rate between 10% and 17% annually. There is no single identified cause of this epidemic. Only a small number of cases are linked to any known genetic or prenatal cause, although many children with autism have a family history of other learning or attention disorders, emotional or behavior disorders, and autoimmune or inflammatory disorders. Sometimes parents identify environmental triggers, including bacterial, viral, or fungal infections; high fevers; exposures to neurotoxins; or a possible vaccine injury. However, in many cases, there is no identifiable cause or trigger. While researchers continue to look for causes, parents have no time to waste and must focus their attention on education and treatment.
Research has shown that early diagnosis and intensive intervention are often keys to successful outcomes for these children. Infants as young as six months can show the earliest autism spectrum features, especially when there is a family history of ASDs. In our office, developmental screenings can be done with infants, although the Autism Diagnostic Observation Schedule (ADOS-2) is not usually administered until at least 18 months. In milder ASD cases where language milestones were on time, diagnosis may not come until a child is school-aged or older and showing problems with social interaction with peers. The child may have also received other diagnoses first, including an auditory processing disorder, ADHD, anxiety disorders, sensory integration disorders, pragmatic language disorder, selective mutism, hypotonia, developmental coordination disorder, or developmental delays. However, parents of children with ASDs are often quite savvy and suspected all along that there was more going on than these earlier diagnoses suggested.
A diagnosis of an autism spectrum disorder requires the following:
(1) Problems with social communication and social interaction
(2) Restricted patterns of behavior, interests, or activities or atypical sensory reactions
Social Communication
Children with ASDs have differences in the way they communicate. These can range from the most severe impairments for nonverbal children to milder impairments in social conversation skills for higher functioning children. Verbal children may have a tendency to repeat back what is said to them or may memorize and repeatedly recite lines from favorite videos. They may reserve communicative speech for when they really want something and use as little speech as possible to get their needs met. They may also fail to aquire typical gestures like pointing and waving, and they may have difficulty making or sustaining eye contact. Some children with autism spectrum disorders can actually have well-developed vocabulary skills and may be hyperverbal at times. However, they may show an overly formal way of speaking and a tendency to talk excessively about their own interests. They may not think to ask questions about others, and they may not read nonverbal cues very well. These individuals may have other atypical features of their speech, including halting or stammering speech, overly monotone or animated/sing-song speech, problems with volume or rate, or a tendency to overuse certain phrases.
From an early age, there are some differences in the social behavior of children with ASDs compared to typical children. While they may be very loving and attached to their parents, the social difficulties are often noticeable when they are with other same-aged children. These children are often most comfortable enaging in solitary activities or with adults rather than with peers. They may not think to show items or share experiences with others. They may tend to engage in catergorizing and lining up of toys rather than pretend play, and they may tend to be collectors of toys or items even at an early age. They may restrict their social play to times when they can choose the game or activity and want to quit playing if others do not want to follow their lead. For this reason, they tend to struggle with team sports and activities. Their preferred activities may include computer, video games, and favorite videos rather than social play with others. As they get older, individuals with ASDs struggle with team-based activities and work. Their difficulties reading social cues may lead them to avoid interactions or require excessive guidance to get through tasks. As they become more aware of their social difficulties, they may develop secondary anxiety, anger, or depression if not given help and support.
Behavioral and Sensory Processing
Probably the most well-known autism spectrum features are the behavioral and sensory difficulties associated with the disorders. The most observable autistic behaviors include toe walking, hand flapping, finger movements, squealing noises, repetitive jumping or bouncing (especially when excited in front of television), rocking, pacing, darting, and spinning self or objects. Some individuals may be very sensitive to sound, lights, smells, tastes, or textures and may become overwhelmed and upset in overstimulating environments. Others may seek out heightened sensory experiences and enjoy lots of noise and movement. These symptoms are often referred to as self-stimulatory activities or "stimming" by many parents of children with ASDs. Milder examples include lining up or sorting toys excessively, talking repetitively about particular topics, and rigidly adhering to certain daily life routines.
Getting Started
Deciding to seek an autism spectrum evaluation is one of the most terrifying steps a parent can take. However, the evaluation and diagnosis are absolutely necessary to give the child the best chance for improvement. Parents must be brave and trust their instincts in moving ahead with an evaluation.
Even though early diagnosis is ideal, it is never too late to seek an evaluation for a child or adult who is showing the features of an autism spectrum disorder. The ADOS has multiple modules or levels based on the expressive language and developmental level of the person being tested. In addition to the ADOS, the Autism Diagnostic Interview-Revised(ADI-R) is a structured interview done with parents or caregivers to gain a better understanding of the individual's history. We also often include parent and teacher ratings of autism spectrum features.
Autism spectrum diagnoses can be given by psychologists, developmental pediatricians, psychiatrists, or neurologists. Each type of professional brings a unique perspective to the diagnostic process. However, the accuracy of the diagnosis is improved when it is based on results of multiple psychological tests. In order to qualify for special education, disability, or Medicaid-based services, standardized testing by a licensed psychologist and written documentation of the disorder is also usually required. At this time, the ADOS-2 and ADI-R are considered the gold standard tests for an autism spectrum disorder within the research literature. It is important for parents to ask professionals whether they offer these tests as a part of the diagnostic process.
After Diagnosis
After the diagnosis, individuals with ASDs and their families need help sorting through all of the treatment options and adjusting to the changes that the diagnosis brings to their lives. Behavioral, developmental, educational, medical, nutritional, and alternative/complementary medicine approaches are discussed to help with individualized treatment planning. We also offer ongoing support to families as their child's needs change over time.
For more information about these disorders, assessment, diagnoses, or treatments, contact our office at 404-256-9325 or email Dr. Murphy at dr.kellie.murphy@bia.com.
Adults with Autism Spectrum Disorder
Are you an adult concerned that a diagnosis of Autism Spectrum Disorder (ASD) might be relevant to you? Do you have concerns about an adult friend or family member who might be on the autism spectrum?
As an adult, coming to the realization that you might be on the autism spectrum can feel scary and overwhelming. Maybe you are reading this information for yourself, or maybe you have a loved one in mind. Many adults, both young and old, have spent their lifetime with a myriad of professionals “trying to figure out what is wrong.” Individuals may demonstrate difficulty communicating, have limited friendships, awkward interactions, difficulty maintaining employment, limited insight into emotions, relationships, and self-awareness, intense interests, and repetitive behaviors. With diagnoses over the years like ADHD, OCD, Anxiety, Bipolar, and Oppositional Defiant Disorder, which just don’t quite explain everything...sometimes Autism Spectrum Disorder (ASD) might be the missing piece to the puzzle. So what happens next?
Seeking an evaluation with a clinician who has extensive training in and understanding about diagnosing ASD in adults is important in order to be able to differentiate among all of the diagnostic possibilities. The evaluation I conduct for adults looking to determine if they might be on the autism spectrum consists of a few parts, as follows:
1.It starts with an in depth interview with a parent or someone who knew the client as a child to be able to delve into their early childhood with regard to ASD characteristics.
2.The client and a close family member, spouse, or friend will complete a few different rating forms about the client to learn more about current ASD symptoms, general social and emotional difficulties, and how they are functioning on a day to day basis.
3.Finally, the client will come for a testing session which consists of a test of intellectual functioning and the Autism Diagnostic Observation Schedule (ADOS-2), The ADOS-2 is considered the gold standard in differentiating ASD from other diagnoses.
4.The feedback session will offer insight into the unveiled diagnoses and recommendations on what to do next.
So, what can be done to support an adult diagnosed with ASD? Whether it is a new diagnosis or an individual who is transitioning into adulthood with their childhood diagnosis, there are some options.
Individual therapy can be beneficial for adults with ASD to work on concrete items such as time management, setting up a daily schedule, learning new chores, being successful in a job, and money management. Therapy can also be helpful for an individual to gain a better understanding of their own and other’s emotions, practice coping skills to use when feeling anxious and/or depressed, and learn important skills like self-advocacy, small talk, and mindfulness. In my practice, I use a Dialectical Behavior Therapy (DBT) informed approach because of its straightforward, visual, and step-by-step approach to teaching skills in the areas of Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.
Groups can also be helpful for an adult with ASD because they provide a safe place to practice social interactions without fear of rejection or embarrassment. There are a variety of organizations offering groups for adults. Some qualities to look for in a group setting include: professionally trained staff, inclusive setting, and age-appropriate activities.
Medication is sometimes a consideration for this population. While there is no medicine to treat ASD, it may be prescribed to help ease the symptoms of anxiety, depression, and inattention. Seeking support from a psychiatrist with an understanding of ASD can add extra benefits because they have an understanding of how different diagnoses work together and they can offer the medications that will be most effective for your particular profile.
Specific referrals for therapists, groups and psychiatrists can be discussed in order to determine the best fit for you and your family.
Adults with ASD can find comfort in knowing that there are other people similar to them who share their struggles and strengths. Seeking support through formal diagnosis, therapy, and groups can help an individual feel less alone in their struggles and challenges. If you are concerned about yourself or someone you love, please get in touch with us today so we can help guide you on the most appropriate next steps for you and your family.
You can reach Dr. Lauren Castriota at dr.castriota@bia1.com or 404-256-9325 ext. 725