DR FAITH B.YISRAEL
A couple weeks ago we celebrated World Down Syndrome Day with our colourful, mismatched socks. On April 2 many of us also commemorated World Autism Awareness Day.
I’ve noticed, though, that many people don’t know the difference between autism and Down syndrome, and many parents need guidance on how to determine if their child has autism and, of course, the next steps.
In this article, I use information gathered from the National Institute of Mental Health (NIMH) and the American Psychiatric Association to answer some of your most pressing questions.
WHAT IS AUTISM SPECTRUM DISORDER?
The NIMH says, “Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behaviour. Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life.”
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association, used to diagnose mental disorders, says people with ASD have:
· "Difficulty with communication and interaction with other people
· Restricted interests and repetitive behaviours
· Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life."
ASD is known as a “spectrum disorder” because the type and severity of symptoms experienced is varied. Individuals from all ethnic, racial, and socio-economic backgrounds may be diagnosed with ASD. Although it is a lifelong disorder, treatment and specialised services can improve an individual’s symptoms and, therefore, ability to function.
The exact causes of ASD are unknown. Scientists have noticed that the risk of having ASD increases when you have (1) a sibling with ASD; (2) your parents are “older”; (3) you have certain genetic conditions like Down syndrome, fragile X syndrome, and Rett syndrome; and (4) you had a low birth weight.
WHAT ARE THE SIGNS AND SYMPTOMS OF ASD?
As previously outlined, these are varied. The communication and interaction behaviours may include:
· "Making little or inconsistent eye contact
· Tending not to look at or listen to people
· Rarely sharing enjoyment of objects or activities by pointing or showing things to others
· Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
· Having difficulties with the back and forth of conversation
· Often talking at length about a favourite subject without noticing that others are not interested or without giving others a chance to respond
· Having facial expressions, movements, and gestures that do not match what is being said
· Having an unusual tone of voice that may sound sing-song or flat and robot-like
· Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions."
The restrictive and repetitive behaviours may include:
· “Repeating certain behaviours or having unusual behaviours. For example, repeating words or phrases, a behaviour called ‘echolalia’
· Having a lasting intense interest in certain topics, such as numbers, details, or facts
· Having overly focused interests, such as with moving objects or parts of objects
· Getting upset by slight changes in a routine
· Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature”
Individuals with ASD may also experience sleep problems and irritability. Although someone living with ASD may experience many challenges, they may also have many strengths, including:
· “Being able to learn things in detail and remember information for long periods of time
· Being strong visual and auditory learners
· Excelling in math, science, music or art”
HOW IS ASD DIAGNOSED?
ASD can be diagnosed by the age of two. It includes a two-step process:
Step 1: General developmental screening during well-child check-ups.
All children should receive “well-child” clinic check-ups at nine-, 18-, and 24- or 30-months. Additional screenings may be necessary if a child is at “high risk” for having ASD.
The experiences and observations of the parents, in addition to what the health care provider notices (or what the ASD screening tools unearth), determine whether a child should be further screened for ASD. Some of these screening tools include the Ages and Stages questionnaires (ASQ); the Communication and Symbolic Behavior Scales (CSBS) tool; the Parents’ Evaluation of Developmental Status (PEDS) tool; the Modified Checklist for Autism in Toddlers (MCHAT); and the Screening Tool for Autism in Toddlers and Young Children (STAT).
Step 2: Additional evaluation.
If determined by step one, the child should be evaluated by a team of professionals who are experienced with diagnosing ASD. This team may include:
“A developmental paediatrician—a doctor who has special training in child development
– A child psychologist and/or child psychiatrist—a doctor who has specialised training in brain development and behaviour
– A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
– A speech-language pathologist—a health professional who has special training in communication difficulties.”
The evaluation may assess: (1) Cognitive level or thinking skills; (2) Language abilities; and (3) Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.
Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may also include blood and hearing tests.
Since 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM), grouped autistic disorder
Asperger’s’ syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS) into one grouping, known as ASD.
The wide range of issues facing individuals with ASD prevents a single treatment. Treatment may include medication for symptoms like irritability, aggression, repetitive behaviour, hyperactivity, attention problems; anxiety and depression.
Individuals with ASD may also be referred to doctors who specialise in providing behavioural, psychological, educational, or skill-building interventions. These programs are typically highly structured and intensive and may involve parents, siblings, and other family members. Some include programmes where they:
· Learn life-skills necessary to live independently
· Learn methods to reduce challenging behaviours
· Learn how to increase or build upon strengths
· Learn social, communication, and language skills
WHERE TO GET MORE INFORMATION?
If you are in Tobago and need more information, you may contact Autism Tobago, an organisation with the mission of improving “the quality of life of the persons living with autism in Tobago.”
Their contact is 278-7012 (phone), email@example.com (email), https://www.facebook.com/autismtobago (facebook), and http://www.autismtobago.com/ (website).
The Child and Adolescent Centre, a component of the Tobago Regional Health Authority (TRHA), is also available to assist with the assessment and treatment of children with ASD. They are at the old Scarborough hospital, Fort Street, Scarborough, and may be reached by calling 660-4744 extensions 3400 and 3401, or by calling 660-7338.
If you believe that your child has ASD, please don’t be afraid. Reach out for help. Talk with your child’s doctor or nurse. If your child has been diagnosed, please call Tobago Autism for additional support.
Dr Faith B.Yisrael (formerly Faith Brebnor) is a health educator, social scientist, public health specialist and politician.
Email address: Imani.Consulting.Tobago@gmail.com
Phone number: 494-8827
Facebook Page: @ImaniConsultingAndFoundationTobago
National Institute of Mental Health, “Autism Spectrum Disorder”: https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml#:~:text=Autism%20spectrum%20disorder%20(ASD)%20is,first%20two%20years%20of%20life.
American Psychiatric Association (APA), “What Is Autism Spectrum Disorder?”: https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder#:~:text=Autism%20spectrum%20disorder%20(ASD)%20is,are%20different%20in%20each%20person.
Centers for Disease Control and Prevention (CDC): “Screening and Diagnosis of Autism Spectrum Disorder for Healthcare Providers”: https://www.cdc.gov/ncbddd/autism/hcp-screening.html