Education

Evaluation & Diagnosis

Treatment

Event Presentations & Notes

What is Autism?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, marked by deficits in social communication and interaction skills, as well as the presence of repetitive or stereotyped patterns of behavior. ASD symptom presentation and the severity of symptoms varies quite a bit from one individual to the next. A common refrain among members of the autism community is that, “if you have met one person with autism, then you have met one person with autism.” Nevertheless, ASD has some defining features.

What are the Defining Features of Autism?

The American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) specifies that ASD is comprised of two groups of symptoms:

  1. Deficits in back-and-forth social interaction and communication skills

  2. The presence of restricted, repetitive, or stereotyped patterns of behavior, interests, and activities.

ASD is only diagnosed when both sets of symptoms are present.

There are three subcategories of symptoms within the social interaction and communication group. To meet the diagnostic criteria for ASD, an individual must be exhibiting “persistent deficits” in each of the following:

  1. Social-emotional reciprocity

  2. Nonverbal communicative behaviors

  3. Developing and understanding relationships

To meet the diagnostic criteria for ASD, an individual must also be displaying at least two of the following four subcategories of stereotyped patterns of behavior:

  1. Stereotyped or repetitive motor movements (e.g., hand flapping), uses of objects (e.g., lining up toys), or speech (e.g., repeating the same word over and over)

  2. Inflexible adherence to routines or ritualized patterns of behavior

  3. Fixated interests (e.g., an all-consuming interest in trains)

  4. Sensory sensitivities (e.g., being way over-sensitive to sounds)

What Other Features are Associated with Autism?

Though not part of the diagnosis of ASD, there are a number of issues that children with autism may experience.

  • Speech delays

  • Balance and motor coordination problems

  • Intellectual disabilities

  • Problems with attention and impulse control

  • Sleep disorders

  • Gastrointestinal problems (e.g., chronic constipation)

  • Restrictive eating habits

  • Behavioral problems (e.g., self-harm, tantrums)

  • Anxiety or depression

  • Seizure disorders

What are the Causes of Autism?

We still have a lot to learn about what causes autism, but there are a few things we know right now. Through identical twin studies, we have learned that genetics are a contributing factor of autism. When one identical twin is known to have autism, the likelihood that the other twin also has ASD is about 77%. When compared to the rate of ASD in the general population – which the Center of Disease Control (CDC) currently estimates to be about 1.7% - the above finding clearly indicates that genetics is at play. However, if autism was a purely genetic condition, we would expect the prevalence among identical twins to be 100%. The fact that it is not suggests that other factors in addition to genetics are needed to impact brain development in a manner that results in ASD. Some studies have found correlations between a variety of prenatal and perinatal factors and autism. For instance, the use of certain prescription medications, such as valproic acid and thalidomide, during pregnancy have been associated with increased risk of ASD. Other factors associated with an increased risk of ASD include: certain genetic or chromosomal conditions, such as fragile x syndrome and tuberous sclerosis, and older age of parents. However, it is important to remember that risk factors are not the same thing as causes. We still have more to learn about the causes of autism.

Evaluation

Currently, we are not able to use genetic testing, magnetic resonance imagining (MRI), or other medical tests to diagnose ASD. Therefore, we must diagnose autism through the observation of a child’s behavior and by gaining an understanding of how the child is developing relative to same-aged peers. 

If you are waiting for an evaluation, view the Support Road Map for guidance on what to do in the mean time.

Evaluation Process at HopeCentral Pediatrics and Behavioral Health

During the evaluation, our psychologist will collect information about your child’s behavior and development through a variety of methods, including: an interview of parents/caregivers, direct observation of your child, review of medical and/or school records, and standardized measures of ASD symptoms and daily living skills. Sometimes, one of our pediatricians will do a physical examination to rule out other genetic syndromes or health issues. In other cases, it may be necessary to do an audiology evaluation to determine whether your child has a hearing impairment. Additionally, we may do a cognitive assessment to determine your child’s intellectual abilities.

HopeCentral’s diagnostic process starts with a 20-minute phone intake, during which you will be asked a series of questions that will help us with triage. During the phone intake, we will schedule a time for you and your child to come in and meet with either our clinical child psychologist or a psychology intern. The provider will ask you a series of detailed questions and interact with your child. In most cases, further evaluation will be needed and will be scheduled at the conclusion of the first in-person appointment. We will discuss diagnosis and treatment recommendations with you at the conclusion of the evaluation.

In this video HopeCentral’s Behavioral Health Director, Dr. TK Brasted shares an overview of autism, including the disorder’s signs, associated conditions, and the evaluation process.

What would a Diagnosis of Autism mean for my Child’s Future?

The Americans with Disabilities Act (ADA) defines a disability as “a physical or mental impairment that substantially limits one or more major life activities.” One of the diagnostic criteria for ASD is that “symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning,” (APA, 2013, p. 50). So, by the ADA’s definition, autism is clearly a disability. However, Ann Shearer, an international consultant in services to people with developmental disabilities, offers this reminder:

Just how handicapping the limitation of disability becomes depends either on how well the environment is adapted to the range of people who use it, or on the opportunities they have had to learn to cope with it, or both.

In other words, with the appropriate services and accommodations, having autism does not preclude a person from developing, learning, gaining independence, or living a happy and fulfilling life.

At HopeCentral, we describe care for children with ASD as a three-prong approach. The chart below illustrates this approach and lists examples of care provisions that would fall under each category. Note: This is not a comprehensive list.

Supports

  • Developmental Disabilities Administration (DDA)

  • Arc of WA State

  • Parent to Parent (P2P)

  • Ben’s Fund

Accommodations

  • Alternative & Augmentive Communication (AAC)

  • Sensory Toolkits

  • Visual Schedules 

  • Social Stories

Therapy

  • Applied Behavioral Analysis (ABA)

  • Speech-Language Pathology

  • Occupational Therapy

  • Feeding Therapy

Education content written by Dr. TK Brasted. He leads HopeCentral’s autism diagnostic evaluation team and supports the physicians in the delivery of behavioral health services within the context of primary care.

Event Presentations & Notes

VFAAB Event Guest Speakers