Screening and Diagnosis of Autism Spectrum Disorder: An Overview

Autism Spectrum Disorder is a neurodevelopmental condition that presents as a variety of social and behavioral challenges. While there is no specific Autism screening test available yet, early intervention is key to understanding your child’s symptoms and determining the kind of treatment needed. Here, we examine how doctors conduct the screening and diagnosis of Autism in young children, with a view to identifying it as early as possible.

Understanding Autism

Autism or Autism Spectrum Disorder (ASD) refers to a range of neurodevelopmental disorders that affect social, behavioral, and communicative abilities. Children with Autism frequently have trouble communicating with others and adjusting to social situations, and may also have sensory processing disorders. The causes behind Autism are unknown in most cases, with a combination of genetic factors and poor health during pregnancy usually held responsible. Early detection through Autism screening enables maximum benefit for the patient through tailored intervention.

Types of Autism

As a spectrum disorder, Autism can present in various ways. There are also other neurodevelopmental disorders that can mimic the symptoms of Autism. Understanding the various types of Autism will help you understand the Autism screening process better and even ask for specific tests for your child as needed. The important types of ASD and related disorders include:

  • Asperger’s Syndrome: This refers to a milder form of Autism wherein the patient displays average or above-average intelligence. While they are frequently advanced in terms of language development, they tend to be uncomfortable keeping up conversations or being in social situations. 
  • Rett Syndrome: This is a rare disorder that mostly affects girls and leads to significant developmental delays. Children may experience communication challenges as well as the loss of standard movement, and even breathing trouble in some cases. However, scientists have now proven it to be a genetic disorder, and as such is considered separate from the Autism spectrum.
  • Kanner’s Syndrome: This is also known as infantile Autism. Children may appear as alert and intelligent as anyone else, but will have trouble regulating emotions, communication challenges, an obsession with handling objects, and a considerable rote memory along with difficulties learning through other ways.
  • Childhood Disintegrative Disorder: This is the most severe form of Autism, in which children rapidly lose language, social, behavioral and other skills between the ages of two and four, even if they had acquired those skills earlier. They may also be susceptible to seizures.
  • Pervasive Developmental Disorder, not otherwise specified (PDD-NOS): This refers to a type of Autism where the symptoms are more severe than in patients with Asperger’s, but less severe than those on the other end of the spectrum.

Most specialists today prefer to not use such classifications and to simply diagnose the patient with Autism Spectrum Disorder.

Levels of Autism

Children with Autism think and learn very differently from their neurotypical peers. While some can function more or less independently as they receive treatment, others will require extensive support all their lives. Depending on the severity of symptoms, Autism Spectrum Disorder is classed into 3 levels by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

  • Level 1: At this level, patients require the least amount of support. They may have trouble maintaining conversations or responding appropriately when others speak. They may also have difficulty adjusting to new environments or changes in routine. They will, however, have no language delays and may in fact have above-average intelligence. 
  • Level 2: People with Level 2 Autism will have significant social challenges and tend to require more support. They may have trouble understanding non-verbal communication, speak in brief answers, and only talk about specific things they are interested in. They will also have trouble with daily functioning and coping with change.
  • Level 3: This is the level at which patients require the most extensive support, usually round-the-clock. They will face significant difficulty getting along with others or adjusting to changes, and may demonstrate repetitive behaviors over and over regardless of where they are or what the situation is. They may also have frequent meltdowns, especially if there is a change to their routine.

Symptoms of Autism

Because there are no obvious physical delays in aspects like crawling or sitting up, the early symptoms of Autism may go unnoticed for a long time. Parents may assume that their child is simply shy, or hyperactive, if they do not talk or behave as expected. Children with Autism will typically display some or all of the following symptoms:

  • Not responding when their name is called
  • Not demonstrating facial expressions or understanding expressions
  • Showing little or no interest in talking
  • Delayed speech and language skills
  • Not showing affection to caregivers or even responding to affection 
  • Playing with toys the same way over and over
  • Obsessing with only a few specific toys
  • Not wanting to play with other children
  • Not wanting to share toys or take turns in games
  • Getting upset with even slight changes in routine
  • Getting upset by certain tastes, sounds, or smells
  • Unconventional eating or sleeping patterns
  • Impulsive, reckless behavior

What to do when you suspect Autism

Early intervention is critical to give your child with Autism the best possible chance at an independent life. The American Academy of Pediatrics (AAP) recommends that all children are given developmental screening at 9, 18, and 30 months of age. Extra screening may be required in case your child has a greater risk of developmental problems because of low birthweight, preterm birth or exposure to toxins like heavy metal. 

There is no single medical test to determine the presence of Autism, which is why Autism screening is often a long and complicated process. If your child has been missing developmental milestones or demonstrating the symptoms of Autism, it is essential to consult your pediatrician at once. The pediatrician will monitor your child closely in the clinic setting and even talk or play with them directly to assess their social and behavioral skills.

If the doctor suspects the presence of Autism, they may conduct a formal developmental screening. This type of Autism Spectrum Disorder screening involves answering a questionnaire about the child’s behaviors, emotions, communication, and social skills. If this too presents concern areas, the doctor will recommend you to a specialist, such as a child psychologist, who will conduct a form of Autism screening test known as developmental evaluation. The doctor may use one or more of several structured tests, including observation as well as questionnaires, to determine what the child’s developmental needs are. They may also test the child directly by setting them tasks that evaluate their thinking and decision-making skills. In addition, the specialist will test for any co-occurring conditions that often show up with Autism, such as ADHD, anxiety, or depression.

Diagnosis and treatment of Autism

In general, a diagnosis received when the child is between 18 and 24 months of age can be deemed accurate, as most symptoms will have fully presented by then. However, for those with milder forms of Autism, a diagnosis may not happen until they reach adolescence or even adulthood. Treatment will be tailored to the patient’s symptoms and may include Occupational Therapy, Speech and Language Therapy, Behavioral Therapy, Social Skills Therapy, and so on. Co-occurring conditions will also require their own treatment. 

In adults who are newly diagnosed with Autism, treatment will usually focus on the social and behavioral skills they need to fit better into college or the workplace. They may also receive therapy for emotional regulation so that they can maintain relationships better. It can be overwhelming for an adult to hear for the first time that they have Autism. Counseling can help them come to terms with the diagnosis and seek appropriate forms of intervention.

FAQs

What are the five Autism Spectrum Disorders?

The five major types of Autism according to the old classification system include Rett Syndrome, Asperger’s Syndrome, Kanner’s Syndrome, childhood disintegrative disorder, and pervasive developmental disorder.

Can Autism be screened during pregnancy?

There is some evidence to show that the brains of infants with Autism may show differences from neurotypical brains during the second trimester of pregnancy. However, in general, prenatal testing is not a reliable way of knowing whether your child will have Autism or not.

Can you be slightly Autistic?

While there is no such thing as being ‘slightly’ or ‘a little’ autistic, many people have a fairly mild version of Autism that involves fewer symptoms. Such people may simply come off as quiet or shy around others, and may avoid certain sensory triggers like bright flashing lights.

Is Level 2 Autism bad?

Level 2 Autism is in the mid-range of the spectrum. Patients will require fairly substantial support and have obvious symptoms such as highly restricted behaviors or difficulties with communicating verbally.

What is hand flapping?

Hand flapping is one among a set of repetitive behaviors that children with Autism might demonstrate. It manifests as the child moving their arm from the elbow upward, with the hand flipping back and forth at the wrist. 

Is Autism a disability?

Autism Spectrum Disorder is classed as a developmental disability. Given that every person’s experience of it is unique, their disability needs will also differ widely.

What are the three main symptoms of Autism in adults?

The key symptoms of Autism in adults include difficulty keeping up a conversation, difficulty understanding non-verbal cues like gestures, and trouble regulating or showing their emotions.

What does hand stimming look like?

Hand stimming involves hand and finger mannerisms such as flapping or finger flicking. It involves any movement that the patient does over and over, usually at a rapid pace.

What is twirling in Autism?

Twirling is a form of stimming in which the person with Autism keeps going round and round, often for extended periods of time and without awareness of their immediate environment.

At what age is hand flapping a concern?

Many young children may flap their hands during the early phase of development. If they continue to do it after three years of age, however, it is of greater concern and could indicate an underlying condition like Autism.

What is hand leading in Autism?

Many children with Autism use hand leading to interact or communicate with other people. It often happens as a result of speech and language delays.

What does scripting mean in Autism?

Scripting refers to the repetition of words or phrases as said by the other person or by someone on television. Many children with Autism will simply repeat back what they heard when spoken to, rather than giving a suitable answer.

In conclusion, the earlier a child undergoes Autism Spectrum Disorder screening, the sooner they can receive a diagnosis and commence treatment. As a parent, therefore, it is important to carefully monitor your child’s development and promptly consult your pediatrician about any delays you may notice.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.