Autism
Autism Spectrum Disorder
(ASD) is a neurodevelopmental disorder which affects approximately 1 in
68 children, according to current estimates. While individuals with a
diagnosis of ASD are diverse and differ from each other in many ways,
ASD can be thought of as a learning disability that, rather than
affecting reading, writing or math, affects an individual's ability to
learn the social and communication skills important for everyday life.
ASD is also characterized by a pattern of narrow interests, repetitive
behaviour, insistence on routines and sameness, and differences in
sensory processing. The diagnosis of ASD is complex as there are no
specific symptoms that are shown by every individual with ASD, and no
specific symptoms that only appear in individuals with ASD. Certain
symptoms of ASD can also occur in other disorders such as language
delays, Attention Deficit Hyperactivity Disorder, anxiety disorders,
developmental delays, learning disabilities, and other conditions. These
conditions can also co-occur with ASD. Though many children will not
show symptoms, early signs of ASD include:
Repeated motions (flapping, rocking or spinning)
Not making or avoiding eye contact
Delays in language, including no words by 16 months, or no phrases by 2 years
Repeating words or phrases over and over (echolalia)
Getting upset by minor changes in their environment or in routines
Not enjoying pretend games by 18 months
Not enjoying toddler social games (e.g.: ring-around-the-rosie, peek-a-boo)
Regressions in skills, particularly loss of language skills or diminished interest in people
Not directing attention with pointing and eye contact or not following others' pointing
Odd, flat or sing-song tone of voice that doesn't express emotion
Little use of gestures unless prompted
Lack of interest in or response to other children or friendly adults
Obsessive, narrow interests (e.g.: in vehicles, elevators, vacuums, numbers, letters, etc.)
Using objects in a repetitive, odd way or showing a strong interest
in objects most children don't care much about (e.g.: batteries,
strings, containers, etc.)
Unusual interests in certain sensations (e.g.: looking at things
out of the corner of their eyes, spinning, crashing into things,
mouthing or biting things
Children with ASD who have relatively strong language skills and who
have shown an interest in other people are less likely to be diagnosed
at a young age, but may show greater difficulties as they enter school
and need to cope with more challenging social environments. Signs of ASD
in older children can include:
Difficulties making conversation, describing feelings or reporting on experiences
Tending to lecture or monologue about their interests whether others are interested or not
Lacking interest in age-appropriate social relationships
Attempts to relate to peers that are often awkward, immature or ineffective
Difficulties understanding or predicting how others think or feel
Limited emotional range (e.g.: little expression of emotion, or mostly showing emotional extremes)
Lack of response to friendly approaches from others
Anxiety, frustration or anger when routines are not followed or when others do not follow the rules
Black and white thinking (e.g.: things must be a certain way or they are wrong, rules have no exceptions)
Difficulties with sharing, compromising and solving problems when they interfere with developing or maintaining relationships
Difficulties understanding relationships (e.g.: unrealistic
expectations of friends, being excessively trusting of strangers, or
having excessively negative views of others)
Difficulties relating to same-age peers, a strong preference for adults or younger children
Obsessive, narrow interests in particular topics, activities or
objects that are unusually intense and interfere with other activities
Rigidity and unrealistic expectations for rules and routines to be followed precisely
Marked anxiety, avoidance or distress in social situations
Marked difficulties with anxiety, frustration or anger when outside of narrow comfort zone
Help for Children with Autism Spectrum Disorder
As the
difficulties experienced by individuals with ASD appear to result from
disruptions in the early stages of social skill development in infancy
and early childhood, the treatments for ASD focus on teaching
individuals with ASD the key social, communication, and coping skills
which they did not learn when younger, and building up from these
foundations to develop the more complex skills needed to function as an
older child, adolescent, and adult. Current research has consistently
indicated that behavioural therapies for ASD focused on developing these
skills can improve the functioning of people with ASD, though the
degree and speed of improvement is different for different people. Early
diagnosis and thus earlier intervention has been associated with better
response to treatment, as well as preventing problems that may arise
due to children's needs being misunderstood in school and elsewhere. In
BC, funding is available through The Ministry of Child and Family Development to
help children with ASD and their families access therapies and other
supports. When children enter school, additional funding is available to
help provide support for their social, behavioural, and academic needs
at school as well. This funding is provided until the child's 19th
birthday. To access this funding, children must be diagnosed with an
Autism Spectrum Disorder by a Qualified Specialist according to the
diagnostic process developed by the BC Autism Assessment Network
(BCAAN).
How is Autism Assessed?
At this time
there is no genetic, biochemical, or imaging-based test that can
reliably identify individuals with ASD. However, a diagnostic process
has been developed by the BC Autism Assessment Network. The protocols for assessment of ASD differ depending on the age.
For children under the age of
6, the child must have assessments by a psychologist, a speech and
language pathologist, and a pediatrician. A Qualified Specialist (a
specially-trained psychologist or medical doctor) conducts an assessment
of ASD symptoms involving both direct assessment of the child and a
parent interview, integrates these reports, and makes the final
diagnosis.
For children over the age of 6, a Qualified
Specialist (a specially-trained psychologist or medical doctor) conducts
an assessment of ASD symptoms involving both direct assessment of the
child and a parent interview, integrates these reports and makes the
diagnosis. Speech and language, psychological and pediatric assessments
are not required, though in some cases they may be helpful, and a
pediatric assessment is recommended for any child experiencing
developmental difficulties to exclude medical disorders which can affect
neurological functioning.
For adults aver the age of
19, there is no mandated protocol in place, though use of the same
measures used by the Qualified Specialist to diagnose younger people
remains the gold standard. In the event that parents are not available,
an interview with another individual who has known the person for a long
time, ideally during their childhood, is recommended.
Assessment of ASD is
available through BCAAN as part of the public health system with a
referral from a pediatrician, or through private practitioners with the
appropriate training and experience. We assess ASD according to the
BCAAN diagnostic process, to provide the exact same assessment to the
same standards as is provided through the public system, providing both
psychological and Qualified Specialist diagnostic assessments. We can
also help connect families to speech and language pathologists in the
event that an SLP assessment is also needed, though if a formal SLP
assessment has been done in the past 18 months, reassessment is not
required.
Having
provided assessments for ASD in both the public and private systems
since 2003, Dr. Gibbins is highly experienced in knowing how ASD can
present in children of different ages, ability levels and patterns of
symptoms, as well as in other conditions which can resemble ASD. While
this assessment is designed primarily to assess ASD, not all children
suspected of having ASD will actually turn out to have that condition.
As a result, we work to not simply provide a yes or no answer to the
question of whether children have ASD, but to identify any other
conditions or disorders which may be present and which may contribute to
a child's difficulties. As a result, whatever the outcome of the ASD
diagnostic assessment, we seek to provide a greater understanding of the
child's strengths and challenges, recommendations for supports,
interventions and parenting strategies, and direction to other relevant
agencies or professionals who may be able to help support the family.
Why a private assessment?
Seeking an
ASD assessment through the public BCAAN system is a good choice for many
families, particularly if the wait time is not a major concern.
However, while private assessment is more costly than being assessed
through BCAAN, there are some advantages to a private assessment:
Personalized attention: While
it is crucial to follow the BCAAN diagnostic process, a private
assessment allows parents more control over the assessment, such as when
it will happen, who will be involved, what follow-up is desired, and to
seek further assessment or consultation if needed. We work with parents
to ensure they are fully informed about the assessment and any results
and recommendations, and to provide follow-up consultation and
assistance as needed, including liaising with school and community
teams. The results of the assessments are only released to professionals
or individuals the parents want to see them, save where required by law
(e.g.: child abuse/neglect, clear immanent risk of serious harm to a
person, court order). Parents are free to contact Dr. Gibbins before,
during or after the assessment so that their questions can be answered.
Continuity: Through BCAAN,
the clinician's mandated role ends at the end of the assessment. BCAAN
does not provide follow-up or reassessment unless it is to re-evaluate
the presence or absence of ASD. As some children may benefit from
further assessment or consultation in the future (e.g.: a
psychoeducational assessment to guide their academic program), having
the same clinician involved over the long term allows for more
continuity. Being able to see how a child grows and develops over time
gives greater insight into their strengths and weaknesses, and avoids
the need to start from scratch with each new assessment.
By providing a timely diagnostic assessment
by a Qualified Specialist recognized as able to diagnose ASD in BC, we
can help children with ASD to have their needs recognized and met
earlier, help guide them and their families to the most appropriate
treatment, resources, and supports as indicated by current research, and
help ensure that children receive the understanding, support and
assistance they require to give them the best chance of learning to cope
with their areas of difficulty and to reach their potential.
