Welcome back. We are learning about autism from Dr. Abigail Angulo. I've another question now because it seems as if there are many symptoms I just heard about that sound like anxiety or ADHD. How do you know that a child has autism and not one of those other diagnoses? You're right. There are many symptoms of autism that can overlap with other mental health or medical diagnoses. What makes autism especially difficult to diagnose is that diagnoses like ADHD and anxiety can co-occur with autism spectrum disorder. Frequently, we get a referral because a child lines up his toys which is a repetitive behavior in autism. However, the child might have anxiety, and lining up toys is part of his way of coping with changes that make him nervous. Children with ADHD may have a hard time making friends, but this might be due to impulsivity and not necessarily due to an inability to make friends like in many children with autism. It goes back to the motivation behind the behaviors and the quality of those deficits. It's not to say that all children with autism will behave and act the same way, but we can try to tease out why a child might be performing a constellation of behaviors and understand the motivation which can aid in diagnosis. How do you make a diagnosis of autism then? It can be a difficult process at times and certainly very time-consuming. There are two components of a diagnosis: history and behavior. Since autism spectrum disorder is a developmental diagnosis, I need to see social communication deficits and restricted and repetitive behaviors from a young age, usually even before a child enter school. I also need to look at the child in front of me and see those behaviors. Developmental trajectory, of course, is an important part of my job. As I've mentioned earlier, there are many symptoms of autism that could be typical of a young child, like carrying around a special object or jargoning in their own language. However, when these behaviors persist longer than we expect and are more intense than what is typical or skip important milestones, like learning to speak in scripted phrases before single words, we suspect a developmental disability like autism spectrum disorder. Thank you. That was very helpful. Now can you tell us what an evaluation looks like? Absolutely. An evaluation involves several steps. A provider who is knowledgeable about autism will ask several questions of the parents about typical development as well as questions that tease out autism from typical development. This can involve a structured interview, something like the Autism Diagnostic Interview Revised or ADIR or a semi-structured interview based on the diagnostic criteria we've already discussed. The second part involves watching a child interact with his parents, the provider, and how a child plays when there are no expectations. Sometimes this can be an informal play session or even within a doctor's appointment. However, there are times when children do not show enough symptoms consistent with autism or not consistent with autism to rule in or out a diagnosis. In those cases, typically, a semi-structured assessment, like the Autism Diagnostic Observation Schedule second edition or ADOS for short, can be completed by a trained provider. This includes fun, play-based activities that pull or designed to look for social skills, communication skills, and any restricted and repetitive interests and behaviors appropriate to the developmental level of the individual. This test will also allow shy children to warm up and anxious children to settle down. Is this the same tests for all children? There are actually five different versions of the ADOS that are based on a child's language level and developmental level. These tests range from a toddler version meant for pre-verbal or not yet speaking children all the way up to an adult version for older individuals with fluent speech. A child only needs to have a cognitive level of 12 months to be able to diagnose autism spectrum disorder and participate in this evaluation. We need to be able to see a difference of social skills from average or typically developing children. So a child typically will be closer to 18 months old before a parent or provider becomes concerned. Why are there so many versions? Because language is so closely tied to social skills, we want to give children the best chance for showing their best skills. If I was evaluating an adolescent of 15 years old, who thinks and behaves like a five-year-old, I would not expect social skills of a 15-year-old but rather social skills closer to five. I would not want to punish him for not acting like other teenagers when he only has the capacity for skills that are five-year-old level. However, if he only had social skills of an infant or even younger toddler, then I would be suspicious of a diagnosis of autism spectrum disorder. How do you know what the developmental level of the child is? That's a good question. An evaluator should have expert knowledge of typical development. During the interview, it's my job to understand how a child compares to other children his age. Sometimes it can be helpful to have formal assessment of a child's development through developmental or cognitive testing. If the child's social communication skills are delayed compared to his other skills, then this is autism spectrum disorder. It sounds like autism spectrum disorder is similar to a learning disability and social skills. Is that an accurate way to describe it? Yes. Just like in learning disorders, we need to understand where all skills compared to a child's age or development. In autism, if a child has skill development close to a five-year-old but is not yet pointing which is a 9-12 months old skill level, then that child has social communication skills delay and suspicion for autism spectrum disorder. Similar to a learning disorder, a diagnosis of autism does not mean that a child will never learn social communication skills but just that these may be more difficult to learn. Typically, we learn social skills just by watching others with limited direct teaching of skills. However, children with autism frequently miss the social cues and may need more specific teaching to gain the skills needed to navigate social interaction successfully. Thank you for explaining autism to a stock triangular. I look forward to learning more about the causes of autism in our next video. When you are ready, please join us.
