Diagnosing Autism Spectrum Disorder

A survey of families published in Neurology found the following:

  • Average age at diagnosis of autism was about 6 years, despite the fact that most parents felt something was wrong by 18 months of age
  • Fewer than 10% of the children were diagnosed at initial presentation
  • Another 10% were either told to return if their worries persisted, or that their child “would grow out of it.”
  • The rest were referred to another professional (at an average age of 40 months), of which only 40% were given a formal diagnosis, 25% were told “not to worry,” and 25% were referred to a third or fourth professional
  • Over 30% of parents referred to subsequent professionals reported that no help was offered (e.g., with education, therapy, or referrals to parent support groups)
  • Only about 10% reported that a professional explained their child’s problems

Hearing for the first (or tenth or twentieth) time that your child may have Autism is a frightening experience for most parents. Whether this suggestion has come from a family member, teacher, or health care provider, parents are often at a loss about how determine if, in fact, their child does have some form of Autism. As noted above, many parents find themselves lost in their attempts to get the help they need.

In the past, different terms have been used to describe what is currently known as Autism Spectrum Disorder.  This term replaces previous descriptions and recognizes that symptoms of autism exist on a spectrum from very mild to very severe.  Sometimes, you may be told that your child has “sensory integration disorder” or “sensory processing disorder.”  But this is not an accepted medical diagnosis.  Rather, sensory problems are usually symptoms of a bigger problems, one of which may be autism.

Whatever term is first used with your child, what these different terms have in common are abnormalities in communication and conversation; problems relating to people in a typical way; problems with play (pretending, taking turns, using toys); problems developing a variety of hobbies and interests; repetitive or unusual behavior or body movements; and sometimes, hypersensitivities to noise, crowds, light, touch, food, or texture (sensory integration problems). Children may exhibit some or all of these kinds of problems and they may exhibit them to many varying degrees. That is why health care providers are now using the term Autism Spectrum Disorder. We understand that the behaviors can be mild or intense and that not all children will have all of the behaviors.

In Washington State the diagnosis of Autism Spectrum Disorder can be made by licensed psychologists or developmental pediatricians. What is necessary to confirm a diagnosis depends on the child. Sometimes, a provider can make the diagnosis rather quickly after having listened to a parent’s description of their child’s developmental history and after having observed and interacted with the child. Other times the diagnosis is harder to make because a child or adult may have fewer obvious behaviors or symptoms. In these cases, it is necessary to spend more time with the child or adult and perhaps gather more historical information from parents, families, teachers, or other sources.

At NNI, we are careful to spend as much time as necessary to make an accurate diagnosis of Autism Spectrum Disorder. We see children, adolescents, and adults for whom this diagnosis is a question. Often times a full neuropsychological assessment is conducted, not just to aid in diagnosis, but to assess where a person’s abilities are in terms of intelligence, memory, learning, academics, attention, language, and problem solving. All of these areas are tested in order to determine strengths and weaknesses and to look for patterns of strengths and weaknesses that are common to Autism Spectrum Disorder.

In addition to testing these areas of cognitive functioning, we also look at social development and social perception. Social perception is a very important part of the assessment since this area of development is always a problem in Autism Spectrum Disorder. Specifically, we evaluate Theory of Mind (ToM). ToM is the ability to understand concepts such as imagination, pretending, emotion, deception, and belief, as well as the ability to understand that others have their own thoughts, ideas, and feelings that may differ from one’s own. ToM also involves the ability to take the perspective of others and to understand how emotion relates to social situations and to recognize and understand facial expressions or body gestures in different situations.

Understanding a person’s cognitive and social/emotional strengths and weaknesses is important to planning after a diagnosis is made. The information from a neuropsychological assessment is used for education and/or vocational planning, to substantiate claims for disability, and to plan for a person’s future.

If you have questions about whether or not someone you know may have an Autism Spectrum Disorder, please contact us for an evaluation.