What is Autism Spectrum Disorder

How do I know if my child has autism spectrum disorder?

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Dr. Mom explores Autism and the signs and symptoms children often show.

As a parent, it’s easy to worry about your child’s development – especially in the early years when they are growing so fast.   Parents often come into my family medicine practice asking questions about their childs development. They will say things like “my older son was saying Mama by age 1, and Jane hasn’t said any words yet!”  Some physicians may often wonder if a child has Autism spectrum disorder if they have challenges with language production, social interaction, or a delay in their developmental milestones.

 

What is Autism Spectrum Disorder?

Autism Spectrum Disorder (ASD, or Autism) is a disorder that begins in the child developmental period.  Its hallmark is problems with of social communication, social interaction, repetitive behaviours, and restrictive interests (i know – that’s a mouthful). The disorder really does affect every child differently.  Some children have rather mild difficulties in social interactions, which was formerly known as “Aspergers Disorder.” Other children may have more severe impairments that may affect their ability to interact and communicate with other people, which may also be accompanied by challenges in intellectual capabilities.

 

How Common is Autism Spectrum Disorder?

Between 0.2-2% (2-20/1000) children have diagnosed Autism.  It is also more commonly diagnosed in boys than girls.

 

What are the Initial Signs of Autism Spectrum Disorder

Signs of a child with ASD might include abnormal speech or language development early in childhood. There are two main types of symptoms.  The first group of symptoms involve difficulties with social interactions and verbal communication. These impairments include things like:   

  • Not pointing at objects to show interest when they are a baby.   
  • Lack of eye contact and not having a “social smile” where they smile to other people or experiences they are having.
  • A delay in speech or a lack of verbal interaction with others.  
  • Not interacting socially with other children.
  • Not playing “pretend” games with other children
  • Difficulty with back-and-forth conversation.  
  • Difficulty understanding metaphors or sarcasm.

 

The second group of symptoms involves restrictive or repetitive behaviours or interests.  These impairments include things like:

  • Some children with Autism can be rigid in their thinking, and therefore have difficulty adapting when a routine changes.  
  • Their sensory system might be altered which could included heightened or reduced sensitivity, or unusual interest in sounds, textures, touch, lights, or smells.
  • Children might also show repetitive body movements such as rocking their body, flapping their hands, or tapping.

 

What Causes Autism:

The cause is not fully understood, but with more awareness and diagnoses in the past decade, more research has been conducted on the subject.  Recent medical literature suggests that Autism Spectrum Disorder is caused by genetic factors that may alter the brain’s development.  There are likely multiple genes involved, not just one single gene. Just like ADHD, Autism develops likely due to a combination of genes that are “turned on” by environmental stimuli.  This process is known as the “epigenetic theory.”

As a result, the connection of cells within the brain are altered, affecting social communication and influencing restricted interests and repetitive behaviours. Environmental factors that may increase the risk for Autism Spectrum Disorder include:

  • Older Parental age (both maternal and paternal)
  • Toxic exposures during pregnancy
  • Some infections during pregnancy

Despite previous remarks by some celebrities, there is overwhelming evidence that there is NO association between vaccinations and Autism.

 

How Do I Determine if my Child Has Autism?

Your physician will do an extensive review of your child’s developmental history.   The history will likely pay particular attention to early social-emotional and language milestones, play skills, behaviour, and loss of skills. Important questions they might ask you on history include:  

  • Does your child know their primary caregivers?
  • How is your child with socializing with other children his/her age?
  • Ability to understand another person’s perspective?
  • Ability to infer about another person’s feelings, beliefs, intentions?

 

Your physician might also ask about:

  • Any history of behaviours such as hand-flapping, body rocking, tapping, or spinning objects?
  • Insistence on routine, sameness, or difficulty adapting to change?
  • Fixated areas of interest in social or leisure activities.  

Your physician might also do a thorough physical exam, including measuring weight, height, head circumference, and do some blood work.  Your family doctor might refer you to a Paediatrician or a Child and Adolescent Psychiatrist for further assessment, if your child continues to show signs of Autism Spectrum Disorder.  They may also make use of diagnostic tools that may involve a psychologist to further make a diagnosis.

 

Learn more from Dr. Mom
What causes ADHD
What can I do to help my child with ADHD
The most effective types of discipline
Do I really need folic acid during pregnancy?

 

 

References:

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]

Baron-Cohen S. Two new theories of autism: hyper-systemising and assortative mating. Arch Dis Child 2006; 91:2.

Ecker C, Bookheimer SY, Murphy DG. Neuroimaging in autism spectrum disorder: brain structure and function across the lifespan. Lancet Neurol 2015; 14:1121.

Muhle RA, Reed HE, Stratigos KA, Veenstra-VanderWeele J. The Emerging Clinical Neuroscience of Autism Spectrum Disorder: A Review. JAMA Psychiatry 2018; 75:514.

Samaco RC, Nagarajan RP, Braunschweig D, LaSalle JM. Multiple pathways regulate MeCP2 expression in normal brain development and exhibit defects in autism-spectrum disorders. Hum Mol Genet 2004; 13:629.

Lopez-Rangel E, Lewis ME. Loud and clear evidence for gene silencing by epigenetic mechanisms in autism spectrum and related neurodevelopmental disorders. Clin Genet 2006; 69:21.

This post was Co-written by Megan Crosby and Dr. Michelle Bischoff

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