Autism Evaluation

Answer to the question "When should children be screened for ASD?"

According to the American Academy of Pediatrics, all children should be screened for ASD when they are at their 18- and 24-month well-child visits in addition to regular developmental surveillance and screening. This enables children to be identified as early as possible and allows for intervention when the child is most amenable to instruction.

In addition, children should be screened if the parent has concerns about their social, communication, or behavioral functioning. This includes problems with eye contact, social interactions, speech and language development, hyper or hypo sensitivity, repetitive or restrictive behaviors, or fixations.

These screening tools include:

• Ages and Stages Questionnaires SE-2 (ASQ-SE2)
• Pervasive Developmental Disorders Screening Test-II (PDDST-II)
• Communication and Symbolic Behavior Scales (CSBS)
• Modified Checklist for Autism in Toddlers – Revised with follow-up (M-CHAT-R/F)

Answer to the question "What causes ASD?"

Autism is a relatively common childhood disorder as it affects over 2.7% of children in the United States. However, the cause of autism remains highly elusive for researchers.

In trying to understand what brings about autism spectrum disorder (ASD), it is important to distinguish between causes and risk factors. Causes are external events or biological factors that cause a child to develop ASD symptoms. To determine specific causes, scientists need to control experiments and conduct random controlled trials (RCT’s). To date, there have been no studies of this kind that have demonstrated a cause of autism in a controlled manner.

Despite this lack of direct causal connection, there have been significant advances in understanding the risk factors associated with ASD. It is unclear how these risk factors are associated with ASD as many people have these factors but do not express symptoms of ASD. Nevertheless, it is diagnostically and therapeutically important to understand these factors in helping children with autism spectrum disorder. These risk factors fall into 2 major categories: genetic and environmental:

Genetic factors

The heritability of ASD has varied in the literature, but a more recent large scale study estimated the genetic component to account for over 50% of the variance in ASD.
Even with this evidence, researchers are still unable to link genetic variants to the expression of the disorder.

Environmental Factors:

• Older maternal age at conception: A child born from two older parents is 3x more likely to develop autism than were third- or later-born offspring
• Prenatal exposure to chemicals in pollution and pesticides
• Maternal health risk factors such as obesity, diabetes, or immune system disorders
• Birth complications such as very low birth weight, extreme preterm birth, multiple pregnancies, oxygen deprivation

In any discussion of the causes of ASD, it is important to note that scientists and researchers continue to find that vaccines do not cause autism. A user-friendly summary of this research can be found here.

Answer to the question "Do symptoms of ASD change as my child gets older?"

Like most things with ASD, there is significant variability in how an individual will develop. However, ASD symptoms tend to decrease in severity over time. This is seen mostly in maladaptive behaviors (eg. tantrums, reactions to hypersensitivity), and the level of change can depend on the child’s level of intelligence, where children with comorbid ASD and intellectual disability show smaller changes over time.

Much of the research in this realm has focused on children who were already receiving therapy and support, which may account for the decrease in symptoms. It can be difficult to know what change would be expected for a child that does not receive any additional therapy.

Answer to the question "What post-evaluation support services do your neuropsychologists offer for ASD?"

In addition to evaluations, our neuropsychologists also see clients for individual psychotherapy. For children or adults with ASD, this therapy is largely behaviorally focused and works toward creating and implementing plans that help the individual learn appropriate behaviors in their communication, social, and activities of daily living (ADL) skills, as well as manage their expressions of maladaptive behaviors.

Answer to the question "How is autism treated?"

There are numerous treatments for autism, and it is difficult to capture them all in this short answer. The most commonly used and evidence-based approach is using Applied Behavioral Analysis as a teaching method for helping a child with ASD develop appropriate skills. In this approach, the functions of the child’s behavior are analyzed, and this information is used to set up antecedent modifications (i.e. before the behavior) and consequence modifications (i.e. after the behavior).

This method can be used by trained teachers in the classroom or provided by a psychologist or Board Certified Behavioral Analyst (BCBA), who may direct therapy administered by a behavior technician. There are also other approaches, such as the Floortime Model, which help children with ASD learn appropriate skills through engaging their play skills.