Autism Spectrum Disorder

The Child and Adolescent Mental Health Centre of Excellence has a multidisciplinary team that provides comprehensive clinical assessment and diagnosis to children and adolescents with Autism Spectrum Disorders, in addition to providing support to their families.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that can cause significant social, communication and behavioral challenges. The worldwide prevalence of this disorder is about 1%. Generally, children with autism do not have any physical characteristics that make them appear different than other children, however, they may communicate, interact, behave, and learn in ways that are different from other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. In terms of challenges, there is a range of severity, therefore, some children with ASD need significant support in their daily lives, while others are more independent.

Since the publication of the most recent version of the diagnostic manual in 2013, DSM-5, a diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder.

 

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Children with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and experience change in daily activities difficult. Signs of ASD begin during early childhood and typically last throughout life.

The core feature of ASD is social communication deficits, which may manifest in:

  • not point at objects to show interest (for example, not point at an airplane flying over)
  • not look at objects when another person points at them
  • have trouble relating to others or not have an interest in other people at all
  • avoid eye contact and want to be alone
  • have trouble understanding other people’s feelings or talking about their own feelings
  • prefer not to be held or cuddled, or might cuddle only when they want to
  • appear to be unaware when people talk to them, but respond to other sounds
  • be very interested in people, but not know how to talk, play, or relate to them
  • repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
  • have trouble expressing their needs using typical words or motions
  • not play “pretend” games (for example, not pretend to “feed” a doll)

Furthermore, they may have other symptoms, such as:

  • repeat actions over and over again
  • have trouble adapting when a routine changes
  • have unusual reactions to the way things smell, taste, look, feel, or sound
  • lose skills they once had (for example, stop saying words they were using)

 
There is still a lot to learn about the causes of autism spectrum disorder and research is ongoing in this area.

  • There are probably multiple factors that contribute to the development of autism, including biological, and environmental factors.
  • Genetic contribution is one of the main risk factors. For example, children who have a sibling with ASD are at a higher risk of also having ASD.
  • Furthermore, ASD tends to occur more often in people who have certain genetic or chromosomal conditions, such as fragile X or tuberous sclerosis.
  • Additionally, if the mother takes valproic acid medication during pregnancy it may lead to a higher risk of her child developing autism.
  • Also, children born to older parents are at greater risk for having autism.
  • It’s important to highlight that multiple studies have clearly shown that there is no link between vaccination and autism.

 
Diagnosing autism spectrum disorder (ASD) can be difficult, since there is no medical test, example blood test or MRI. Specialized health professionals assess the child’s behavior and development to make a diagnosis.

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, unfortunately, many children do not receive a diagnosis until much older. This delay means that children with an ASD might not get timely therapy.

Diagnosing an ASD requires two steps:

  • Medical and developmental assessment
  • Semi-Structured Play-based diagnostic evaluation

This comprehensive evaluation includes assessing the child’s behavior and development and interviewing the parents. It may also include a hearing and vision screening, genetic testing, neurological testing, and other medical testing.

In some cases, the primary care doctor might choose to refer the child and family to a specialist for further assessment and diagnosis. Specialists who can do this type of evaluation include:

  • Developmental Pediatricians
  • Child Psychiatrists
  • Speech and Language Pathologists
  • Behavior Analysts
  • Child Psychologists

 
There are no medications that can cure ASD or treat the core symptoms. However, there are medications that can target disorders that may accompany ASD. For example, medication might help manage high activity levels, inability to focus, impulsivity, depression, anxiety, sleep disturbance, constipation, or seizures.

Medications might not affect all children in the same way. It is important to work with a health care professional who has experience in treating children with ASD. Parents and health care professionals must closely monitor a child’s progress and reactions while he or she is taking a medication to be sure that any negative side effects of the treatment do not outweigh the benefits.

Evidence-based interventions

Behaviour and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation.

Applied Behaviour Analysis (ABA)

A notable treatment approach for people with an ASD is called applied behavior analysis (ABA). ABA has become widely accepted among health care professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The child’s progress is tracked and measured.

There are different types of ABA. Following are some examples:

  • Discrete Trial Training (DTT)

DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.

  • Early Intensive Behavioral Intervention (EIBI)

This is a type of ABA for very young children with an ASD, usually younger than five, and often younger than three.

  • Pivotal Response Training (PRT)

PRT aims to increase a child’s motivation to learn, monitor his own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.

  • Verbal Behavior Intervention (VBI)

VBI is a type of ABA that focuses on teaching verbal skills.

Occupational Therapy

Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.

Speech Therapy

Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.

The Picture Exchange Communication System (PECS)

PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation.

Interventions that lack evidence and may be associated with harmful consequences:

Dietary Approaches

Some dietary treatments have been developed by reliable therapists. But many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to the doctor first. Also, talk with a nutritionist to be sure your child is getting important vitamins and minerals.

Complementary and Alternative Treatments

To relieve the symptoms of ASD, some parents and health care professionals use treatments that are outside of what is typically recommended by the pediatrician. These types of treatments are known as complementary and alternative treatments (CAM). They might include special diets, chelation (a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (like deep pressure).

These types of treatments are very controversial. Current research shows that as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, check it out carefully, and talk to your child’s doctor.

 

 
Blue Cafe is an initiative launched by the Child and Adolescent Mental Health Centre of Excellence that focuses on talks by senior professionals and mental health experts to help parents of children with Autism Spectrum Disorder (ASD) develop a better understanding of ASD and the different evidence based practices in the field.

Parents will learn more skills in dealing with social communication and behavioural challenges from an ASD expert who will help in understanding their needs, strengths, and empowering skills. The professionals will guide parents of children with Autism Spectrum Disorder on how to deal with the most challenging needs with children on the spectrum. The areas covered and discussed throughout the programme are a mix of medical and skills development options including nature of ASD, comorbidities, sleep, communication, and behaviour modification strategies.

Programme Outline

1. Talks by and with professionals from Al Jalila Children’s
2. Empowering skills for parents of children with Autism Spectrum Disorder
3. Alternative evidence based practices

Intended Outcomes

Parents
• will be more familiar with misconceptions and treatments in Autism Spectrum Disorder
• will learn some strategies in dealing with their children with Autism Spectrum Disorder
• will learn some tips to maintain healthy family dynamics and fortify their relationships with their children with Autism Spectrum Disorder
• become advocates for other families with similar challenges and help in contributing in creating a more autism-friendly environment

LIVE CHAT

      Al Jalila Children's Specialty Hospital

Al Jaddaf - Dubai United Arab Emirates
800 AJCH (8002524)
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