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 tests 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.