Sunday, January 08, 2017

What to Know About Autism

I want to thank Bethany, my guest poster, for sharing her knowledge on autism with us.  Did you know that autism affects 1 in 66 children in Canada?  I learned this recently and was so surprised at how common it is.  If you think this doesn't affect you in any way, you may be surprised as autism is a spectrum and someone you know and love could very well be on it. Finally, if time is limited, there is a chart included that is a very useful tool. Thank you to Bethany for the oodles of time she put into this post.

Autism prevalence for children and youth in Canada

I have worked with individuals (specifically children ages 2-8) with autism for the past seven years. I started out as a Behaviour Interventionist, working one-to-one with preschoolers with autism. I became increasingly aware of the strengths and challenges that individuals with autism and their families face on a daily basis, and believe that early intervention and continued support services are critical to the development of these kids.

My goal for this post is to inform and provide current research on the definition, causes of and red flags for autism. 

The information below includes links to various reputable sites where further definitions, research and information can be found.

What is Autism?

According to Autism Speaks“Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.”

{Image from Autism Speaks}
This diagram provides an easy visual of the core symptoms of autism, as well as associated neurological issues, systemic issues and related disorders. Expanded definitions of the social challenges, communication difficulties, and repetitive behaviours can be found here

What Causes Autism?

While there is not one specific answer, we do know that there are a variety of factors that can contribute to the disorder. These include:

1. Genetic disposition including gene changes or mutations

2. Environmental factors such as:
- advanced parental age at time of conception (both mom and dad)
- maternal illness during pregnancy
- extreme prematurity
- low birth weight
- difficulties during birth including loss of oxygen to the baby’s brain
- mother’s exposure to high levels of pesticides and air pollution

However, it is important to note that the environmental factors alone do not cause autism, but in combination with genetic risk factors, the risk of having a child with autism increases.   While knowing some of the causes of autism, it is also critical to point out what does not cause autism.

Autism is not caused by bad parenting or cold, unloving mothers or vaccines.

More research is needed to determine the causes and risks of autism. To view current research in the field, you can check out Autism Speaks.

What Are The Red Flags For Autism?
Red flags may look different depending on the child and his/her age, and may be less obvious and subtler in individuals who are on the "higher" end of the spectrum. This is a list of developmental milestones that are present in typically developing children by each year up to age 5. Below is a chart that outlines the core symptoms of autism and what they might look like for children (1) under three and (2) over the age of four. The list has been compiled based on information from Autism Navigator, Autism Speaks, Health Link BC and the Diagnostic and Statistical Manual of Mental Disorders  (DSM-5).

Red Flags
What it might look like for Toddlers (under 3)
What it might look like for Children (4 and up)
Social Communication

Limited gesture use
·         doesn’t point
·         doesn’t wave
·         doesn’t nod or shake head
·         doesn’t give or share items
Same as for toddlers (left list)

Inability to follow a point or a person’s eye gaze
·         doesn’t look where someone is pointing
·         unable to follow where someone is looking
Same as for toddlers (left list)

Delayed speech
·         no babbling or chatting
·         no attempts at imitating words
·         fewer words than other children of the same age
In addition to list on the left:
·         started talking later than 18 months
·         displays echolalia or delayed echolalia
·         misuses pronouns
·         unable to clearly explain wants and needs

Makes odd sounds or uses unusual tone of voice
·         makes sounds that are not clear words
In addition to the left:
·         speaks in a high or low pitched voice
·         speech may sound robotic or monotone

Difficulty coordinating eye contact, gestures and sounds/words at the same time
·         unable to look at you, point to what they want, and use a word at the same time
In addition to the left:
·         may be pointing at something but doesn’t appear to be pointing in the right spot (e.g., at an airplane in the sky or something on a shelf)
·         may make fleeting eye contact when talking

Little or no imitation of other people or pretend play
·         doesn’t imitate simple actions or play steps (e.g., pretending to talk on the phone or games like peek-a-boo)
In addition to the left:
·         doesn’t follow along with what peers are doing at school (e.g., playing tag, or getting a book and sitting at the carpet)

Uses another person’s hand/arm as a tool
·         places an adults hand on a jar for it to be opened
·         uses a person’s hand as an extension of their own to reach for something
Same as for toddlers (left list)
Social Interaction

Difficulty with eye contact
·         too much eye contact or too little eye contact appropriate to the situation
·         may look down or away when talking to someone
Same as for toddlers (left list)

Does not consistently respond to name when called
·         may appear as though they’re deaf
·         may need to call their name multiple times before they notice
Same as for toddlers (left list)

Has a flat affect
·         doesn’t smile when smiled at or share warm, joyful expressions
·         appears as though they’re in their own world
·         may look as though they’re not paying attention
Same as for toddlers (left list)

Displays inappropriate emotional responses given the situation
·         may laugh when seeing someone cry
In addition to the left:
·         doesn’t understand or may react inappropriately to jokes or sarcasm
·         doesn’t show empathy towards others

Does not draw attention to things or show things they’re interested in
·         doesn’t bring you things to show you they’re interested in them
·         doesn’t draw your attention to something they want you to see (e.g., a firetruck driving by)
Same as for toddlers (left list)

Does not share enjoyment or interest with others
·         doesn’t like being around other children
·         doesn’t initiate contact with others
In addition to the list on the left:
·         doesn’t join in with others in play
·         tends to spend time alone and/or enjoys spending time alone
·         may not have friends
Repetitive Behaviours and Restricted Interests

Unusual body or finger movements
·         flapping arms/hands
·         flicking fingers near eyes
·         pulling on ears
·         rocking back and forth
Same as for toddlers (left list)

Rituals such as lining up toys/objects or repeating things over and over
·         may repeat a word or phrase back to you instead of using ‘yes’ or ‘no’
·         may repeat words or phrases from a TV show, or book word for word
·         plays with items the same way each time (e.g., lines them up, or makes them bounce on the roof of a house)
·         lines items up or categorizes items (e.g., puts all red items together, or sorts objects by size)
·         may recreate things seen on a TV show
Same as list on the left and may become more apparent as the child gets older

Extreme focus on or attachment to unusual items
·         keeps small items in hands (e.g., pom poms or pebbles)
·         focuses on small parts of a toy such as the wheels spinning on a car
·         attachment to specific fabric or clothing item
Same as for toddlers (left list)

Excessive interest in particular objects, actions, or activities that interfere with social interaction
·         fascinated by letters, numbers, shapes and colors
In addition to list on the left:
·         high interest in the solar system or specific TV or movie characters
·         fascinated by video games, trading cards, or license plates

Unusual sensory behaviours
·         sniffing items
·         mouthing/licking objects
·         looking out of the corner of their eye
·         fascination with fans, lights or things that spin
Same as for toddlers (left list)

Overreaction or under reaction to sounds or textures
·         vacuum or garburator noise elicits screams
·         being accidently/gently nudged causes overreaction
·         only wears certain types of clothing (e.g., shirts or pants without tags, socks without seams, tight or loose fitting clothing)
Same as for toddlers (left list)

Insistence on sameness and routines
·         eats items in the same order at meal time
·         insists on driving the same route every day to school
·         difficulty transitioning from one activity to the next
In addition to list on the left:
·         difficulty with small changes in routines (e.g., if you said you were going to the toy store, but you had to stop and get gas first, it would result in a meltdown)

One of the best resources for red flags for autism is available through Autism Navigator.  They have a video glossary that compares the skills displayed by a typically developing child and a child at risk for, or with a diagnosis of autism, for each of the core symptoms. The site requires an email address and password to access the videos, but I would highly recommend registering so you can see firsthand the difference between the two children in each case. There is also a description below each video explaining what you are seeing and which skills are either present or absent in each child.

What you can do if you have concerns:

If you have concerns that a child/individual you know might be at risk for autism, there are some online screening tools you can take. The M-CHAT-R is available to take online through the website, as well as through Autism Speaks. This is a checklist that is designed to screen children between the ages of 16-30 months for signs of autism. The M-CHAT-R is also available as a app to download on your phone. Additionally, Autism Canada provides links to 4 types of screening tools for individuals of varying ages which include children under 3, children 3-11 years, teenagers between 12-15 and adults (age 16+). Those tests can be found here.
If the scores indicate that your child may be at risk, contact your doctor. You may also want to refer your child to an Early Intervention/Therapy program. These programs are available locally and provide services for speech-language pathology, occupational Therapy and physiotherapy. They are free services available for children from birth until they enter kindergarten. You can search for service providers  and early intervention programs through Therapy BC.

Pin here for later:
What is autism and what are some of the characteristics to look for at different ages?

Bethany is an autism professional working as a Behaviour Consultant in an ABA program at a local non-profit organization. She is currently in her final year of school working towards completing her M.Ed. in Special Education with a concentration on Autism and Developmental Disabilities. Her goal is to become a Board Certificated Behaviour Analyst and continue to improve the lives of individuals and their families living with autism.

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