"My husband and I believe that Ryan, our 6-year-old son, may have the milder form of autism. Is it ever too early to get a child diagnosed? How does one go about seeking a diagnosis? And, what are our treatment options?"
If you are noticing some of the early symptoms of High-Functioning Autism (or Asperger's), then it is not too early to seek a diagnosis regardless of the child’s age. Early symptoms usually include problems with social interaction. For example:
- a significant lack of empathy
- can become very upset if someone touches their things, moves furniture or toys around
- demonstrate an extreme aversion or tantrums during transitions
- difficulties with social skills
- display a very narrow or an unusual range of interests, with elaborate or unusual play-based behaviors
- do not notice if a peer or playmate loses interest, or even wanders away
- find interpreting social comments, facial expressions, tone of voice, or body language as difficult as trying to interpret a foreign language
- find unwritten social rules to be confusing
- have difficulty listening to others and understanding their perspective
- have excessive or a complete lack of separation anxiety from parents
- invade other people's personal space
- lack of eye contact or social smiles
- lack of social discrimination
- limitation in reciprocation or give and take interactions
- may act-out elaborate rituals, which appear to be creative play, but are actually scripted activities without the variation or creativity of imaginary play
- may appear hyperactive, and pursue movement to an excessive degree
- may appear to never be able to "let it go," or tend towards appearing argumentative or "splitting hairs"
- may appear very rigid in their point of view
- may become extremely upset if their routine or ritual is changed in any way
- may demonstrate fixations on things (e.g., Pokémon, television shows, computer games, numbers, dinosaurs, trains, etc.)
- may excessively ask the same question over and over
- little or no interest in sharing toys and interests
- preference towards playing alone or with "things" rather than with friends
- tend toward social isolation
- tend to be viewed as "lost in their own little world" at times
- tend to interact very well with adults, but struggle with appropriately initiating peer interaction
- tend toward extreme perfectionism or "having to finish" what they have started
- tend toward lining things up, organizing by color, or even repeating lines verbatim
- tend to be self-absorbed or aloof
- touch or climb people inappropriately
Furthermore, kids with High-Functioning Autism are limited in brain areas that enable them to understand subtle cues. As a result, literal interpretation, misunderstandings, and/or sensory over-stimulation may lead to tantrums, aggressiveness, overreactions, irritability, low-frustration tolerance, anxiety, self-stimulation, depression, or self-injury. In addition, these young people may develop a tendency of distrust towards others due to social failures and negative social experiences over time, which can lead to self-isolation and social phobia. This behavioral reaction can be viewed as "rude" by others, and often kids with this disorder struggle to understand why they are not liked or frequently feel rejected.
How does one go about seeking a diagnosis?
Kids with High-Functioning Autism are usually not diagnosed as early as kids with more severe forms of autism, because the symptoms are not as noticeable. Symptoms may not become a problem until the youngster starts school. Your youngster's doctor will look for signs of developmental delays at regular checkups. If your youngster shows any symptoms of High-Functioning Autism, you'll probably be referred to a specialist who treats kids on the autism spectrum (e.g., pediatric neurologist, developmental pediatrician, child psychologist) for a thorough clinical evaluation.
Because Autism varies widely in severity, making a diagnosis can be difficult. There isn't a specific medical test to determine the disorder. Instead, a specialist may do any of the following:
- Seek a speech and language assessment
- Recommend genetic testing to identify whether your youngster has a genetic disorder (e.g., fragile X syndrome)
- Request physical, neurological, or developmental testing
- Present structured social and communication interactions to your youngster and score the performance
- Establish the history of the youngster's development
- Conduct psychological testing
- Observe your youngster and ask how his or her behavior, social interactions, and communication skills have developed and changed over time
- Interview the parent(s) and others who have frequent contact with the youngster
- Give your youngster tests covering developmental level, language, social and behavioral issues, and speech
- Involve other specialists in determining a diagnosis
For your youngster to be diagnosed with High-Functioning Autism, he or she must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual used by mental health providers and by insurance companies to reimburse for treatment.
High-Functioning Autism often includes (a) problems with social interaction (e.g., lack of eye contact, an inability to understand another person's feelings), (b) problems with communication skills (e.g., not speaking, repeating a phrase over and over again), and (c) restricted, repetitive patterns of behavior, interests or activities that cause impairment in social, occupational or other areas of functioning.
To meet Autism criteria, your youngster must have problems across multiple situations with:
- Developing, maintaining and understanding relationships (e.g., showing a lack of interest in others, difficulty adjusting behavior to suit various social situations, problems sharing imaginative play, problems in making friends)
- Nonverbal communication behaviors used for social interaction (e.g., problems using and understanding body language or gestures, problems making eye contact, lack of facial expressions, difficulty using or understanding nonverbal cues)
- Social and emotional give-and-take in social settings (e.g., reduced ability to share experiences or emotions with others, problems initiating or responding to social interactions, inability to engage in normal back-and-forth conversation)
In addition, your youngster must experience at least two of the following:
- Extra sensitivity or a lack of sensitivity to sensory input, or an unusual interest in sensory aspects of the environment (e.g., visual fascination to lights or movement, negative response to certain sounds or textures, excessive smelling or touching of objects, apparent indifference to pain or temperature)
- Insistence on sameness, rigid routines, or ritualized patterns of verbal or nonverbal behavior (e.g., needing to take the same route to school every day, extreme distress at small changes, expecting activities or verbal responses to always be done the same way)
- Interests in objects or topics that are abnormal in intensity, detail or focus (e.g., excessively limited narrow areas of interest, interests that are excessively repetitive, strong attachment to unusual objects or parts of objects)
- Odd or repetitive motor movements, use of objects or speech (e.g., mimicking sounds, repeating phrases verbatim without understanding how to use them, lining up toys or flipping objects, body rocking or spinning)
The DSM-5 includes functional levels along the autism spectrum. Children who are generally quite functional and in need of less support are usually given the diagnosis of Level 1 Autism Spectrum Disorder. Hence, the term “high-functioning autism.”
The high-functioning autistic child may:
- have significant speech and language delays, but is able to take part in an inclusive academic program because of his or her age-appropriate academic skills
- have anxiety, learning disabilities, and sensory challenges, but has age-appropriate speech and exceptional abilities in music, math, or engineering
- have relatively mild speech and social delays, but has sensory issues which make it difficult for him or her to take part in an inclusive academic program
- be able to complete daily tasks, do math, read, show affection, use age-appropriate language, and write – but may not be able to pick up on social cues, maintain a conversation, hold eye contact, or engage in imaginative play
As you can see, the possible combinations of strengths and deficits are abundant. In any event, even though high-functioning autistic children may not need help with toileting or basic hygiene, many do need a good deal of support in other settings. For instance, a very bright autistic student with severe sensory sensitivities and anxiety may have a more difficult time in the classroom than a less intelligent “typical” student with less anxiety and fewer sensory sensitivities.
The symptoms of these “special needs” children will fall on a continuum, with some showing mild symptoms, and others having much more severe symptoms. This “spectrum” allows professionals to account for the variations in symptoms and behaviors from child to child.
The goal of treatment is to maximize the youngster's ability to function by (a) reducing the symptoms of High-Functioning Autism and (b) supporting development and learning. Treatment options may include the following:
- Behavior and communication therapy: Many programs address the range of social, language and behavioral difficulties associated with High-Functioning Autism. Some programs focus on reducing problem behaviors and teaching new skills, while others focus on teaching kids how to act in social situations and how to communicate better with others. Though kids don't usually outgrow the symptoms of High-Functioning Autism, they can learn to function well.
- Educational therapy: Kids with High-Functioning Autism often respond well to highly-structured educational programs. Successful programs often include a team of specialists and a variety of activities to improve behavior, social skills, and communication.
- Family therapy: Moms and dads can learn how to play and interact with their “special needs” youngster in ways that manage problem behaviors, promote social interaction skills, and teach daily living skills and communication.
- Medication: No medication can improve the core signs of High-Functioning Autism, but certain medications can help control symptoms (e.g., anxiety, depression, behavioral problems, hyperactivity, etc.).
Early identification and intervention are considered key to positive outcomes for kids with High-Functioning Autism. Parents, teachers, school psychologists, mental health professionals, and doctors should work together to become better informed regarding assessment tools, research, and diagnostic criteria, as well as the best interventions to increase appropriate behavior, social skills, personal communication, and peer interaction.
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• Anonymous said… I had a mda multi discipline assessment. through my son's school...he had assessment s and questionnaires, now awaiting diagnoses on the 29 th sept,we have waited no many years for this.my son is nearly 8 next week,he is being assessed for adhd and asbergers, he also has hypermobilty.schools don't normally refer till they are 7-8 years maybe bit younger.good luck x
• Anonymous said… I hope aged 6 isn't too young as my child is 2 1/2 and has just been referred for diagnosis of Aspergers/ASD. I've been warned that as he is so young he might be turned down until he is older. Health professionals such as health visitor and GP are in agreement that my son is definitely somewhere on the spectrum. I'm under the impression we are in for a long wait though. We are in Northern Ireland. Good luck, I hope you get answers.
• Anonymous said… If your in the UK you'll be waiting a long time for a diagnosis as those professionals that perform this task seem to hibernate for 11+ months of the year, or is it reluctance since once diagnosed the council have to fund the schools etc to help them.
• Anonymous said… I'm in Qld Australia and my son was diagnosed before turning 3. We are very fortunate as it means we've been able to access the early intervention funding available for under 7s, and I truly believe this has made a huge difference for him.
• Anonymous said… My son was also diagnosed with Aspergers, just before 3 years old. Early intervention is the best thing for these kids and for their parents as well.
• Anonymous said… My son was diagnosed at 6 years old with ADHD, anexity disorder and HFA (aspergers) we talked to our pediatrics and the recommended a psychotherapist who put his through 21/2 mths of testing. I was thrilled it wasn't just thrown togeather and hear ya go. We have opted with meds and therapy which has turned his world around. Still have some rough days. But they are decreasing.
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