Autism Spectrum Disorder in Children

What is Autism Spectrum Disorder?

Autism Spectrum Disorder is a neurodevelopmental condition characterised by difficulties in communication, social interaction, and restrictive or repetitive patterns of behaviour. 

Those who have this condition have a wide range of abilities and are affected in different ways, hence the spectrum in its name. Some may have more challenges and require more help in their daily lives than others. 

In the latest Diagnostic and Statistical Manual (DSM-V) of the American Psychiatric Association, other conditions that were classified separately such as Asperger Syndrome and Pervasive Developmental Disorder-Not Otherwise Specified are now classified under Autism Spectrum Disorder. 

According to Health Direct, about 1 in 150 Australians are affected by autism. Boys are four times more likely to have it too.  

What are the characteristics of individuals with Autism Spectrum Disorder?

Each individual with ASD is unique. However, people on the spectrum share common primary characteristics such as poorly developed social skills, difficulty in expressive and receptive communication, and the presence of restrictive and repetitive behaviours. 

Difficulty in expressive and receptive communication may present in the following ways. 

• Some people with autism may lack the ability to communicate verbally. 
• Some may be capable of using single words or short phrases. 
• Some may have delayed development of speech and language skills. 
• Some may develop typical speech but have a robotic tone or speak too loudly. They may also miss non-verbal cues and have difficulty detecting sarcasm and misunderstand idiomatic expressions and jokes.  

A person on the spectrum may have one or more of the following social deficits. 

• Difficulty in understanding and following social rules 
• Inability or aversion to maintaining eye contact
• Difficulty in making friends or keeping them
• Have problems relating to other people or are not interested in others at all

Restrictive and repetitive behaviours in persons with autism include the following. 

• Repetitive movements like hand-flapping, spinning, rocking side to side
• Specific food preferences and refuses food with a certain texture 
• Excessive preoccupation with one object or activity
• Overly obsessive on few subjects to the exclusion of others and expecting others to be equally interested in those interests
• Arranging toys or things in a particular way
• Adherence to a strict routine and getting overly upset over small changes in routine
• Difficulty in transitioning from one activity to the next
• Becoming distressed in changes in the environment

Apart from those mentioned above, some children with autism may also exhibit the following characteristics.

• Can be overly sensitive or under-sensitive to stimuli

They may have an averse response to lights, specific sounds, or specific textures. On the other end of the spectrum, they may have sensory seeking behaviour like excessive touching of objects, visual fascination with lights and movement, etc.

• Uneven skill development 

They may develop normal or advanced skills for their stage but other skills may be delayed. For example, a child with autism may display impressive mathematical skills advanced for his age but doesn’t have self-care skills (taking care of personal hygiene, dressing on his own) that are expected of his age. 

How Autism Spectrum Disorder is Diagnosed

Determining if a child has autism can be challenging because no laboratory test can be done to diagnose it. To screen for ASD, doctors look at the child’s behaviour and developmental history. 

The autism-related traits discussed in the previous section pretty much sum up what doctors look for when determining if a child has ASD. However, not all traits can be apparent at an early age.  With autism and other neurodevelopmental conditions, early intervention can make a difference. 

Here are some of the early warning signs to look out for. Remember that if the following behaviours are observed, it does not automatically mean that the child has autism but that it warrants further assessment from a medical professional.  This autism checklist is from spectrum.org.au.

Six months to one year

• Rarely smiles in social situations
• Little to no eye contact
• Doesn’t respond to their name
• Doesn’t react to loud sounds
• Displays a lack of social anticipation (For example, baby doesn’t reach out their arms to be picked up, or doesn’t seem to understand the game of ‘Peek-a-Boo’)
• Doesn’t chatter or babble
• Doesn’t use gestures such as pointing or waving in context
• Dislikes being cuddled or touched
• Displays repetitive and unusual body movements

12 months to 24 months

• Does not speak
• Only walks on their toes
• Unable to follow simple verbal instructions
• Doesn’t imitate actions
• Has intense interest in certain objects and gets stuck on them such as constantly flicking a light switch* 
• Engages in repetitive activities, such as lining up objects.

*Do note that typical curious babies might also be interested in flicking a light switch or doing things over and over. But the difference is that typical babies may lose interest after a while (a few minutes or so), but those on the spectrum are capable of going on for a longer time.

24 to 36 months 

• Has limited speech
• Has difficulty understanding simple verbal instructions
• Has little interest in pretend or imaginative play
• Shows little interest in other children
• Likes to follow a routine and gets easily upset by change.
• Is extremely sensitive to sensory experiences, such as sight, sound, smell and taste.
• Is under-sensitive to sensory experiences such as hot and cold, touch and pain.

If you observe these signs on your child, consult with a health care professional to schedule a thorough assessment.  

What Causes Autism Spectrum Disorder?

The definite cause of ASD has not yet been determined. But imaging studies of people with autism indicate that some regions of their brain have developed differently. 

Experts are looking into several possible causes of these differences in the brain. Many believe that genetics may play a role in the development of autism. Twin and family studies suggest that some people are genetically predisposed to ASD.   

Environmental factors are also being looked into as possible contributors to the development of autism but so far no specific environmental cause has been identified. 

Management of Autism Spectrum Disorder

No medication can “cure” or reduce the symptoms of Autism Spectrum Disorder. Some children with ASD that also have other comorbidities like Attention Deficit Hyper Disorder, anxiety, or seizures may be given medicine for those conditions and help them function better. 

Because the condition affects each individual differently, there is no one standard treatment for ASD  either. But many types of intervention and accommodations can help children with autism.  

Current autism treatments are geared toward helping children gain skills that can help them in their daily lives rather than “fixing” them or reducing their symptoms.  Such skills include self-care, expressing themselves better (verbally or non-verbally), and managing their emotions better among others. 

When they have the skills to express themselves and manage their emotions, they are less likely to have negative behaviours such as self-harming, meltdowns, and aggression. 

The interventions will depend on specific issues that a child with ASD have. A combination of the following may help a child with autism depending on their specific situation.

Physical Therapy

Some children with autism have low muscle tone and have problems in coordination. Physical therapy can help these children develop their gross and fine motor skills and improve muscle strength, posture, balance and coordination.

Occupational Therapy

Occupational therapy aims to help children with autism be as independent as possible. Occupational therapists teach children how to do everyday tasks such as dressing, bathing, eating, etc. 

Social Skills Training

Social skills training teaches kids how to interact with others. This can be done through role-playing, watching videos, playing games and other activities.

Speech-Language Therapy

This type of therapy can help children with autism to communicate more effectively. This may include teaching conversation skills, taking turns when talking, how to use language for different purposes, etc. Speech-language therapy is not only limited to verbal communication but may involve the use of non-verbal communication tools such as picture-based communication and electronic talking devices. 

Sensory Integration Therapy

Many children with autism also have sensory processing issues. They can be overly sensitive to lights, sounds, certain smells, or tastes, or textures. Sensory Integration Therapy can help children cope with sensory difficulties by exposing them to sensory stimulation in a structured way in the form of play. 

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy is based on the premise that thoughts can influence emotions and behaviour. CBT can help a child/person identify negative thought patterns and challenge and replace them with more realistic and objective thoughts. This type of therapy can help children/teens with ASD who also have anxiety or depression. 

Note that the therapies mentioned here are not exclusively for children with autism but may be used for other conditions of children and adults as well. 

Accommodations and Support for Children with Autism

Aside from therapies and training, some children may need accommodations to help them cope. Accommodation and support can include modification of their environment or the use of equipment or devices, or any adjustments that can be made to reduce the barriers to participation of children with ASD.

In a school setting this could mean giving them more time to complete a task, letting them use assistive technology to help them communicate, using visual cues, or putting them in the front row to lessen distraction.

Autism Strengths

Some individuals on the spectrum may have unique strengths such as strong long term memory, talent in music and arts, extensive knowledge of their favourite topics, mathematical and computer skills, intensive focus on their favourite activity, honesty, attention to detail, good at spotting patterns, and more. 

In Conclusion

Autism Spectrum Disorder is a neurodevelopmental condition that affects social communication and interaction and behaviour. It is a lifelong condition that presents many challenges to the individuals affected and the people caring for them.

Despite the challenges of living with autism, it is not all doom and gloom. Some individuals on the spectrum may indeed need assistance until adulthood. But some can live independently when given the proper support.

What is most important is that kids with autism are accepted for who they are. While it is important to help children improve their social, communication, emotional, and self-care skills, it is equally important to acknowledge, focus on, and nurture their strengths.