For Your Health: The diagnosis and misdiagnosis of autism spectrum disorder
In 2018, the Centers for Disease Control and Prevention reported that the prevalence of autism spectrum disorder (ASD) had risen to one in every 59 births in the United States. ASD is a complex developmental disability and affects individuals differently to varying degrees. For children on the spectrum, early intervention can have a major impact on their development later in life. But often, children don’t receive critical intervention because they don’t match the “classic” ASD symptoms. Dr. A. Malia Beckwith, M.D., section chief, Developmental and Behavioral Pediatrics, Children’s Specialized Hospital, an RWJBarnabas Health facility, outlines some of the benefits of early diagnosis as well as the warning signs parents shouldn’t ignore, how ASD can be missed and the resources and therapies available for those with ASD.
Identifying autism spectrum disorder
“Autism spectrum disorder is a multifaceted disorder of communication and social skills, but there can also be the presence of some unusual or repetitive behaviors,” said Beckwith. “Those repetitive behaviors can manifest themselves in different ways — it can present in movements like hand flapping, repetitive verbalization like sound production, memorization of certain content of language such as certain scripts from favorite TV shows that are repeated at inappropriate times or it could also just be a need for sameness.”
Some other common behaviors associated with ASD include sensory issues where an individual may seek out calming or soothing sensations to them or avoid sensations that are upsetting to them.
READ: For Your Health: Help protect your family from rabies
READ: For Your Health: Athletic trainers — not just for athletes
“Parents may notice that their child is really particular about the material of clothing they wear. It can be very tactile,” said Beckwith. “I have patients that will not wear jeans or only wears shorts, even when it’s snowing.”
According to Beckwith, individuals who are higher functioning may have ritualistic patterns and find it hard being flexible or doing anything out of their routine.
“Individuals with ASD may have a schedule and if something is out of routine, they have trouble tolerating change,” said Beckwith. “It can be certain rituals — opening and closing cabinets, putting things in a certain location, etc.”
Beckwith reiterates that ASD really is a multifaceted disorder and in addition to or even in the absence of some of the physical behaviors, individuals with ASD may also have a hard time with certain social skills.
“Difficulty with social skills can be verbal or nonverbal,” said Dr. Beckwith. “Sometimes you may notice your child has difficulty holding a conversation or it could be something as slight as an inability to make eye contact in a conversation or social interaction and other non-verbal communication cues.”
When ASD is missed
In many cases, parents may miss the early signs of ASD because for children who don’t experience speech, language or motor delays, the behaviors can be so subtle, parents might just assume they are a part of the child’s personality.
“When a child is old enough to attend school, the social skill development issues may be the first signs,” said Beckwith. “Parents might notice that their child is having a hard time making friends or reading their classmate’s nonverbal social cues.”
In other cases, a child with ASD may get misdiagnosed with another behavioral disorder — oftentimes attention deficit hyperactivity disorder (ADHD) — because the symptoms overlap.
“Children with ASD tend to be very active, to move around a lot and to pace,” said Beckwith. “That, coupled with the limited social skills, impulsive behaviors and trouble focusing can lead many doctors to misdiagnose ASD as ADHD.”
Early intervention and getting a diagnosis
When it comes down to it, Beckwith wants parents to be reminded that they know their children the best, and if they suspect that their child may be on the spectrum, they should get a proper evaluation.
“Early diagnosis and intervention along with access to appropriate services and support can lead to significantly improved outcomes,” said Beckwith. “The goal is always to try to detect ASD as early as possible because data suggests that if we start earlier, we can see greater outcomes as far as changing a child’s ability level and reprogramming the neurons in the brain to increase functioning. However, at Children’s Specialized Hospital, we are focused on the identification and treatment of ASD at any age so that kids can reach their full potential. We work together with families as partners in making sure that children get the services they need to help each child achieve their full potential.”
The Autism Program at Children’s Specialized Hospital offers different therapies and treatment, such as applied behavioral analysis (ABA), speech therapy, physical therapy, and occupational therapy, to increase the function in parts of the brain that are responsible for things like socialization and communication and is designed to improve the lives of children and adolescents with ASD as well as their families by providing comprehensive evaluations.
“The diagnosis of ASD is made based upon whether or not the child meets the behavioral criteria set forth in the Diagnostic Statistical Manual of Mental Disorders, Volume 5, or the DSM5,” said Beckwith. “We can make that determination through observing and interacting with a child in an evaluation session.”
During an evaluation session, a developmental pediatrician will observe a child’s behavioral skills, play skills, social skills and communication skills. School-aged children, or those older than the age of 4, are observed for around 60 minutes. Children younger than the age of 4 are observed for closer to 90 minutes to allow time for more play-based testing.
Children’s Specialized Hospital is the largest regional provider of services dedicated to working with children and adolescents who have an ASD. For more information on the Children’s Specialized Hospital’s Autism Program, please visit childrens-specialized.org/autism.
Dr. A. Malia Beckwith, M.D., is section chief, Developmental and Behavioral Pediatrics, Children’s Specialized Hospital, an RWJBarnabas Health facility.