Early Identification of Autism Spectrum Disorder

Introduction

Autism Spectrum Disorder (ASD) is a group of developmental brain disorders that results in social and behavioral differences in the affected individuals. It is a lifelong disorder with challenges through all phases of life, contrary to most people's perception of it as a childhood disability.

In some people, it is due to a genetic condition. In others, it could be multifactorial. Studies have shown that boys are four times more affected than girls, who often go undiagnosed since they may not show typical symptoms. It is a common disorder, with recent reports suggesting an incidence of one in every 54 individuals.

What Are the Characteristic Features of ASD?

Three main aspects of ASD include difficulty in verbal or nonverbal communication, social interactions, and lack of flexibility in behavior. Early symptoms in children that parents can look for include some of the following:

• Speech is delayed or does not speak.

• The lack of gestures and does not point to objects.

• Does not make eye contact.

• Repetitive Behaviors - Repetition of words, sounds, or any other movement.

• Does not respond well to changes in food, schedule, etc.

• Obsession with specific toys, objects, or topics.

• Few or no facial expressions.

• Prefers to be alone and does not mingle or play with other children.

• May not respond to being called by name.

• Does not participate in social games, for example, peek-a-boo.

• Reacts unusually to sensory stimuli like sounds.

• Has trouble understanding others’ emotions.

• Does not like physical forms of affection like cuddling.

How to Know if the Child Is on the Spectrum?

ASD is not a condition with specific biologic markers; hence, no medical tests are available to diagnose this disorder. Diagnosis is based on exhaustive behavioral and developmental history. Family history is important since a parent or sibling with attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder, schizophrenia, or intellectual disability increases the odds of ASD in a child.

The following processes help to seek medical help at the right time.

1. Developmental Monitoring - This involves keeping a close eye on various developmental milestones of the child and reporting any inconsistencies to the pediatrician. Parents, education providers, and grandparents may be involved in monitoring a child's developing abilities and skills.

2. Developmental Screening - It is recommended by the American Academy of Pediatrics (AAP) that all children undergo regular behavioral and developmental screening at 9, 18, and 30 months of age during the well-child visits. Additionally, AAP recommends specific ASD screening at 18 and 24 months. This is done through questionnaires, interviews with the parents, and clinical interactions with the child. The modified checklist for autism in toddlers, revised with follow-up (M-CHAT R/F), is a popular screening tool with more than 90 % sensitivity and specificity used for the screening tests. If areas of concern are identified, the child is referred to specialists for multidisciplinary evaluation and diagnosis.

The diagnostic statistical manual - 5 (DSM-5) provides the criteria for a diagnosis of ASD but is not a test. However, two tests, autism diagnostic observation schedule (ADOS) and autism diagnostic interview-revised, are dependable tests consisting of well-structured play exams and interviews performed by trained personnel. Multiple stages of screening with a combination of tools are recommended since no single test is absolute for the diagnosis of ASD; rather, a correlation between history, scores on screening tests, and direct interaction gives better accuracy. It also spares children without ASD who might have other developmental problems from detailed tests specific to ASD.

Why the Emphasis on Early Detection and Intervention?

Identification of the disorder before three years can improve the prognosis of ASD considerably. With increasing age, the brain is less plastic and receptive to behavior-modifying interventions.

An early diagnosis confers the following benefits:

• Reduces the probability of serious symptoms.

• Promotes normal developmental processes.

• Helps the family plan ahead to avail the resources and support required for the child.

• Decreases the total cost of treatment.

• Better prospects and quality of life for the child and the family.

• Increases preparedness to navigate through obstacles.

• Early behavioral modification and social instruction increase social competency and peer interaction in schools and lays a foundation for transition through various stages in life.

There are various challenges to early detection, which is evident from the fact that though most children start showing symptoms by 18 months, the average age of diagnosis of ASD is four to five years. This could be attributed to the following reasons:

• Lack of Awareness: People tend to dismiss the symptoms as normal developmental delays and have a sense of false assurance that the child will be alright with time, for fear of the label the child will bear. As a result, they adopt a wait-and-watch approach.

• Laxity in Observation: When multiple caretakers are watching the child for a day, symptoms might be missed or not conveyed appropriately to the parents.

• Delayed Presentation of Symptoms: Some children do not show symptoms until the age of two.

• No Presentation of Symptoms: Few children show normal language and communication, which do not raise suspicion.

• Failure in Symptoms Spotting Due to Lack of Training: Shortage of trained professionals in identifying ASD. Even when parents act on their concerns and take the child for medical evaluation, it happens that they end up consulting several doctors before an actual diagnosis is made. This lengthens the time between the appearance of symptoms and actual support or treatment measures being implemented.

What Are the Early Measures That Will Help?

• A diagnosis of ASD can be overwhelming for the family since it entails re-imagining the child’s entire future; acceptance is the foremost step toward helping the child.

• Gather information and learn all there is to know about the condition. This will ensure the child always takes advantage of every opportunity. An individual can reach out to autism societies or any organization offering support and services for ASD.

• Seek medical attention without delay. ASD requires a multidisciplinary approach. Treatment consists of personalized goals depending on the symptoms of each child. One might require a team of specialists in behavior, speech or language, nutritional, physical, and occupational therapy at various stages of development.

• Treatment is focused on behavior modification to reinforce desirable behaviors, direct the child’s attention toward structured activities, teach social and communication skills, improve emotional understanding, etc.

• Physical therapy helps children who struggle to control physical actions like gait and handwriting. It improves posture, motor coordination, and muscle control.

• A speech therapist can train the child in verbal and non-verbal communication.

• Identify the strengths and weaknesses of the child, and choose various therapies strategically based on building with the strengths and strengthening the weaknesses.

Conclusion

Early detection and treatment of autism spectrum disorder (ASD) is the key to optimizing the long-term outcomes of affected children. Parents, teachers, and other primary caregivers are important in detecting early symptoms. If the diagnosis is delayed, parents can seek generic interventions to tackle symptoms as they appear and avail specific treatment once ASD is confirmed. With the right medical, educational, and social support, the child can navigate the world and emerge successfully.