According to the Centers for Disease Control and Prevention, one in 36 children in the United States have Autism Spectrum Disorder (ASD) – an increase from the previous rate of one in 44 – and boys are nearly four times more likely to be diagnosed with autism than girls. A complex condition with no definitive cause, autism is known as a spectrum disorder because the type and severity of symptoms can vary greatly by individual. 

“Often, symptoms are noticeable by 18 months, and autism can be reliably diagnosed by professionals by age two. Unfortunately, the average age of diagnosis for most children is closer to five years old,” says Robyn Cowperthwaite, M.D., a child and adolescent psychiatrist at Oklahoma Children’s Hospital OU Health and division chief of Child and Adolescent Psychiatry at the University of Oklahoma Health Sciences in Oklahoma City.

She says a child with autism demonstrates persistent difficulties with social and emotional interaction and communication, as well as restricted or repetitive behaviors and interests.

“A lack of social/emotional reciprocity can look like limited social interest, lack of back-and-forth conversation, reduced sharing of interests and emotion with others, or failure to start and respond to social interactions,” says Cowperthwaite. “Reduced understanding and sharing of non-verbal communication is notable to include abnormalities in eye contact, body language, gestures and facial expression. Those with autism also show difficulties with developing, maintaining and understanding relationships. Restricted and repetitive patterns of behaviors can be demonstrated by the need for things to always be the same – this can include the need for behavioral rituals and routines, feeling overly stressed by small changes or having highly specific areas of interest. Many children demonstrate repetitive or stereotyped movements.”

She says early intervention is critical and allows for earlier assistance in skill building to reduce the impact of communication deficits.

“Early intervention in speech and language therapy can increase skills with verbal communication at school and with caregivers,” says Cowperthwaite. “Occupational therapy can better determine sensory sensitivities and teach skills to allow a child to be as independent as possible with dressing, eating, bathing, writing and relating to people. Applied Behavior Analysis can assist schools and families with increasing more socially appropriate and adaptive behaviors. These therapies combined can increase the child’s enjoyment of and participation in more typical childhood activities.”

There are three functional levels of autism to help identify the level of support a patient needs. Level 3 requires very substantial support, Level 2 requires substantial support, and Level 1 requires support. For example, a child with a Level 3 diagnosis may be non-verbal and need assistance with many daily activities. 

“This could require several specialized therapies throughout the week and the need for near-constant supervision,” she says. “Support can look like assistive technology to aid in communication or a specific classroom environment. Some children show significant mood swings, irritability or aggression when exact routines and rituals are interrupted or when faced with unliked activities.”

For all levels of autism, Cowperthwaite says an individualized education should be developed and implemented in the school setting.

If a parent suspects their child may be autistic, a discussion with their primary care physician is a great place to start. 

“Pediatricians are completing developmental screenings at the 9-, 18- and 30-month mark at the recommendation of the American Academy of Pediatrics and autism specific screens are recommended at 18- and 24-months,” says Cowperthwait, adding that the CDC has materials available to help parents track their child’s developmental milestones in order to share concerns with their child’s physician. 

“A primary care doctor can then refer to a specialist who can complete a more in-depth evaluation,” she says. “Developmental pediatricians, child neurologists and child psychiatrists can all diagnose autism, and often recommend confirming the diagnosis via psychological testing with a pediatric psychologist or neuropsychologist.”

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