February 12, 2018
ARTICLE:

Autistic Spectrum Disorder – Part 2

By Dr Megan Yap - Paediatrician

Hi there everyone,

Here is the long anticipated “Part 2” to our enthralling article on Autistic Spectrum Disorders.

Had an absolutely epic weekend just gone, celebrating my big brother’s birthday in Sydney (and Troy and I left the rugrats at home with grandparents – WOOT WOOT!!), so boy am I glad that I had written this week’s blog post in advance!!

As promised, today we are going to look at:

  • What are the different types of autism (classification)?
  • How is autism diagnosed (and who exactly can diagnose it)?
  • Other conditions that can LOOK like autism, that aren’t autism
  • How is ASD treated?

Let’s get to it then…

 

What are the different types of autism?

This question has a bit of a complicated answer!

Previously, in accordance with the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders 4thedition) autistic disorders were classified under the umbrella diagnosis of “Autistic Spectrum Disorder.”  This classification previously encompassed but individually defined

  • Autistic disorder – a disorder of social interaction, communication and imagination in children under 3 years of age with impaired intelligence
  • Asperger’s syndrome – children with the same social problems and restricted, repetitive interests as autistic disorder but with average to above-average intelligence on testing. This is sometimes informally referred to as “high-functioning autism.”
  • Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) – children with some autistic behaviours that didn’t fit into the other categories
  • Childhood Disintegrative Disorder – a rare disorder where children develop normally for at least 2 years (but up to 10 years of age) and then lose some or most of their communication and social skills, often with seizures. Its existence as a separate condition was a matter of debate for many years.
  • Rett Syndrome – occurs primarily in girls where they start to develop normally but then regress and lose communication and social skills. Between 1-4 years of age, purposeless hand movements replace functional use of hands and there is usually severe intellectual impairment.  It no longer falls under ASD classification, as the cause for Rett’s is confirmed as genetic.

The DSM-5 was released in May 2013, and all of these conditions are now just under the one heading of “Autistic Spectrum Disorder” differentiated by severity:

Level 3 – “Requiring very substantial support”

Level 2 – “Requiring substantial support”

Level 1 – “Requiring support”

You will still often hear people referring to the old classification system of these disorders which can make things a bit confusing.  As a general and broad comparator, kids with a “Level 1” diagnosis are usually the kids who would have previously been classified as “Asperger’s” as they usually have an IQ (that is, their intelligence) in the normal range.

 

How is it diagnosed (and who can diagnose it)?

There is no specific medical test that can be ordered to diagnose ASD.  Diagnosis is made by a thorough clinical history, observations of the child in different environments and evaluation of their development (particularly communication and social abilities) through various clinical tools and assessments.

The requirements of who can make a diagnosis vary from state to state in Australia even though the diagnostic criteria (as per the DSM-5) remain the same. Some states require a child to be diagnosed by a multidisciplinary team, whereas other states allow a single specialist (ie, a paediatrician or paediatric psychiatrist) to make the diagnosis on their own.[5] In Queensland, ASD can only be diagnosed by a paediatrician or a child psychiatrist (although I must say personally, I frequently ask the opinion of my allied health colleagues if there if I have any uncertainty in the diagnosis).

In the case of autism, “If it looks like a duck and it quacks like a duck…” it ISN’T always a duck.  Because the diagnosis of autism is complicated and certain criteria need to be met, just because a child LOOKS like they have autistic features does NOT mean they have ASD.  There are plenty of other conditions that can appear or present like autism, that in fact are not.

Conditions that can LOOK like ASD that aren’t ASD (again – not an exhaustive list!)

  • Anxiety
  • Obsessive Compulsive Disorder
  • Intellectual impairment
  • Speech and language disorders
  • Global developmental delay
  • Social (pragmatic) language disorder
  • Reactive attachment disorder
  • Trauma/PTSD; early childhood exposure to trauma (eg domestic violence, abuse etc)
  • Depression
  • Hearing or vision impairment
  • Psychosis or schizophrenia (rare in children)
  • Epilepsy (eg absence epilepsy)

This is why it is important to see your doctor if you have concerns about ASD.  Many of these conditions are very treatable!

 

How is autism treated?

There is no known cure for autism.  The only known and evidence-based treatment for autism that has been shown to improve outcomes for children is early, intensive therapy intervention.

Due to plasticity of the brain (that is, the ability of the young brain to adapt and change) in childhood, early identification of ASD and subsequent implementation of intervention contributes to a significant improvement in outcomes.[6]  During the clinical work up and diagnostic process, a developmental profile is formed that details deficits and strengths.  From this is generated appropriate referrals to multidisciplinary early intervention services and a program of intensive therapy is personalised to the child’s individual needs with the ultimate goal of reducing the impact of disability.  So if a child with ASD has speech delay, poor social interaction and play skills and sensory issues, referrals might be made to Speech Pathology, Occupational therapy and maybe Psychology.

Effective, intensive and evidence-based treatments (TALK TO YOUR PAEDIATRICIAN ABOUT THIS!!) need to be started as soon as possible to optimise a child’s developmental outcomes.

 

Okay… so I think that’s all I got peeps.

 

Fingers crossed this has more helped than baffled you…

Would love to hear your thoughts and feedback.

 

Until next time..

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

 

 

 

 

 

REFERENCES

[1] Christensen DL, Baio J, Braun KV et al.  Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012. MMWR Surveill Summ 2016;65(No.SS-3)(No.SS-3):1-23

[2] Brugha TS, McManus S, Bankart J, Scott F et al.  Epidemiology of Autism Spectrum Disorder in Adults in the community in England. Arch Fen Psychiatry 2011;86(5):459-465

[3] < https://www.webmd.com/brain/autism/understanding-autism-basics#3>

[4] http://raisingchildren.net.au/articles/autistic_disorder_signs_and_symptoms.html

[5]  http://www.autismawareness.com.au/diagnosis/who-can-diagnose/

[6] https://ama.com.au/position-statement/autism-spectrum-disorder-2016

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