Autism Spectrum Disorder Diagnosis Criteria
To be diagnosed with ASD, a child must show three types of impairments in social communication and interaction, according to DSM-5:
- Deficits in social-emotional reciprocity - difficulty having back-and-forth conversation; reduced sharing of interests or emotions; failure to initiate or respond to social interactions.
- Deficits in nonverbal communication - trouble integrating gestures and language; poor or no eye-contact/body language; little or no change in facial expression.
- Deficits in developing, maintaining and understanding relationships – difficulty adjusting behavior to different contexts; problems sharing in imaginative play; difficulty making friends; lack of interest in peers.
The child also must show at least two of the following four types of restrictive or repetitive patterns of behavior:
- Repetitive movements, speech or use of objects - hand-flapping or other repetitive body movements; repeating the same phrase; lining up toys or flipping objects.
- Insistence on sameness (inflexible routines), or ritualized patterns of verbal or non-verbal behavior – extreme distress at small changes in routine; difficulty with transitions; need to travel the same route or eat the same food every day.
- Highly restricted, fixated interests that are abnormal in focus/intensity – the child likes trains for example, and is focused on collecting, building, playing with, and talking about trains at the expense of all other toys or topic of conversation.
- Over-reaction or under-reaction to sensory input, or unusual sensory interest – indifference to pain or temperature; adverse response to certain sounds or textures; fascination with certain lights or movements; fixation on smelling or touching objects.
Finally, the impairment must:
- Be present in early development.
- Cause impairment in social, occupational or other areas of functioning.
- Not be better explained by intellectual disability or global developmental delay.
Note that there is no longer a criterion for language delay. People with an earlier (DSM-IV or previous) diagnosis of autistic disorder, Asperger Syndrome or PDD-NOS should now be given a diagnosis of ASD.
Integrative Listening System iLS
CLINICAL DIRECTOR, RON MINSON, MD
DISCUSSES STRATEGIES FROM HIS EXPERIENCE WORKING WITH CHILDREN DEALING WITH SEPARATION ANXIETY DISORDER.
iLs: What is Separation Anxiety Disorder and can you give an example of what it is like for the person who suffers from it and their family?
Dr. Minson: Separation Anxiety Disorder is a medical condition. The person who suffers from it experiences extreme discomfort and anxiety when separated from their parents or caregivers. The same excessive agitation can be experienced even when anticipating leaving home or separating from primary caregivers. This disorder affects up to five percent of children.
Children and adolescents with separation anxiety disorder have a particularly hard time with the start of school. Long tearful goodbyes make them late; they often miss school, overcome by anxiety and inability to leave home; they avoid activities at school and are reluctant to join in with peers. These troubles trigger a downward spiral leading to low self-esteem and poor concentration.
I am reminded of Suzie, the 3-year-old younger sister of a child I was seeing for dyslexia. When her mother tried to accompany her older daughter into my office, Suzie had a tantrum, screaming and yelling at the top of her lungs. Any attempt to console her or attempt to separate her from her mother was met with an increase in her panic reaction. And, the mother’s distress was second only to that of her daughter.
Initially, the only solution was to allow Suzie to accompany her mother into my office. Later, she was able to separate for brief periods that became longer over time, as she accepted a picture of her mother in place of the real person. Also, she was comforted by her “blankie” that she slept with and carried around everywhere at home but not outside. Part of the therapy was to allow Suzie to carry the blankie with her at all times, just like Linus in the Peanuts cartoons.
iLs: How can you tell the difference between simple nervousness about the start of a new experience and an actual disorder?
A certain amount of discomfort over separating from family is experienced by all children and even adolescents. Infants begin to show signs of it at 6-8 months when they become uncomfortable meeting strangers and it may last until age two when the child has accumulated adequate experience with unfamiliar people and situations. And in young children, experiences like vacations or illnesses may heighten difficulties with separation.
But with true Separation Anxiety Disorder, the child is expressing a full blown panic attack with all the physiologic manifestations of fear triggered by separation from the primary caregiver, usually the mother. There is a marked increase in heart rate, sweating, muscle tension and a refusal to let go or separate. A full blow tantrum is typical. The body and emotional reactions far exceed the anticipatory anxiety with encountering unfamiliar situations.
iLs: What resources are available to work with children who have a separation anxiety disorder? Are they effective?
Dr. Minson: If possible, try to avoid separation anxiety developing in the first place. Importantly, separate from your child for brief periods during infancy, gradually lengthening the time apart. For example, date night for parents during the child’s early development is important.
Once the disorder has set in, play therapy with an experienced child therapist can be extremely beneficial. Using familiar objects like the blanket mentioned earlier or a teddy bear or other loved object can do wonders to help with the transition from fear to normal anxiety. Parents need support for their child’s separation anxiety too. Parent groups and couple’s therapy can be very instructive and supportive.
iLs: Can iLs help with a child experiencing separation anxiety?
Dr. Minson: Yes. iLs helps to reset the nervous system’s tendency to go immediately into fear through its proven effect in physiological calming and decreasing sympathetic flight/fight responses. It is most appropriately used in conjunction with other therapies.
ASD Research Project Aims to Collect 50,000 DNA Samples
In an effort to learn about autism spectrum disorder (ASD) causes and potential treatment avenues, a new project will collect genetic information from tens of thousands of people with ASD and their families.
The project, SPARK (Simons Foundation Powering Autism Research for Knowledge, sparkforautism.org), is sponsored by the Simons Foundation Autism Research Initiative, which was launched in 2003. The Simons Foundation’s mission is to support innovative research that will improve the understanding, diagnosis and treatment of ASD.
Participants - people with autism or a family member - fill out a 20-minute online questionnaire about their medical and family history. Those who choose to contribute their DNA receive a cup in the mail to collect and return a saliva sample.
SPARK conducts an advanced genetic analysis on each sample and notify families if the results pinpoint a genetic cause of a particular person’s autism. The testing is free.
Project researchers, who collected samples from about 2,000 people with ASD during the program’s pilot phase, say they are on track to collect 50,000 samples within three years from people with autism and their parents and siblings.
SPARK data will become available to researchers throughout the world later this year.
Project officials say that in the short-term, families can get quick answers from genetic testing, and researchers may be able to draw immediate conclusions about some facets of ASD from the survey information. Over time, the data collected could lead to larger innovations, such as medications or therapies.
What is a Sensory Diet?
A Sensory Diet is a personalized daily schedule of sensory input and environmental modifications that help a child stay calm, focused, and organized throughout the day. After participating in sensory diet activities, a child should be more focused and able to handle the demands of his/her everyday experiences.
Features of a Sensory Diet:
Finding the ‘just right’ combinations of sensory input to achieve an appropriate arousal level
Time oriented routines: Example: during dinner time, during transitions, at school, etc.
Observing the effects of the diet and continuously changing different sensory input, duration, and frequency to achieve optimal outcomes; never force sensory input if the child does not want it.
Communication with family members, teachers, and therapists about the sensory diet and what changes have been made.
Developing a Sensory Diet:
A sensory diet is often developed after instruction from occupational therapist (OT). Through collaboration with an OT, family members, and teachers, a sensory diet is developed and implemented by the parents and/or guardians of the child. The sensory diet should be implemented every day at home and school and changed as needed. Examples of when part of sensory diet should be changed include: If no effect is noticed after input, if the child is over aroused and inattentive after an activity, or if the child is under aroused and too tired to attend to tasks after an activity.
Sensory Activities and environmental changes to help organize the sensory system for the sensory seeking child:
Tactile, Proprioceptive, and Vestibular Input:
Jumping (on a trampoline, couch, or jumping jacks)
Wheel barrow races or animal walks (frog, crab, bear, kangaroo, etc.)
Heavy work (lifting heavy boxes, chairs, bags, etc. or wearing a weighted backpack)
Linear and rhythmical movement on a swing
Deep pressure (bear hugs or rolling under or over ball, i.e. ‘taco roll up’)
Brushing and joint compressions (need to be educated by an OT to perform this)
Vibrating toys or an electric toothbrush
Various tactile materials: playdough, goo, shaving cream, sand, etc.
Wearing a weighted vest, or lap pad (no less than 20 mins to no more than 2 hours)
Sleeping with a weighted blanket
Eating chewy foods or drinking thick smoothies from a straw.
Visual and Tactile Input:
Soft and rhythmical music (classical, acoustic, ocean sounds, etc.)
Dim lights or lava/calm down jars (similar to snow globes)
Vanilla and lavender scents
Handheld Screen Time Linked to
Delayed Speech Development
Children who use handheld screens—smartphones, tablets and electronic games—before they begin to talk may be at higher risk for speech delays, according to research presented at the 2017 Pediatric Academic Societies Meeting.
A team led by Catherine Birken, the study’s principal investigator and a staff pediatrician and scientist at The Hospital for Sick Children (SickKids) in Toronto, examined 894 children (ages 6 months to 2 years) participating in TARGet Kids!, a Toronto practice-based research network, between 2011 and 2015.
“The more handheld screen time a child’s parent reported, the more likely the child was to have expressive speech delays”.
By their 18-month check-ups, 20 percent of the children had daily average handheld device use of 28 minutes, as reported by their parents. Using a screening tool for language delay, researchers found that the more handheld screen time a child’s parent reported, the more likely the child was to have expressive speech delays.
Each 30-minute increase in handheld screen time translated into a 49 percent increased risk of expressive speech delay. Researchers found no apparent link between handheld screen time and other communication delays, such as social interactions, body language or gestures.
The results support a recent American Academy of Pediatrics recommendation to discourage any type of screen media in children younger than 18 months.
Source: The American Speech Language and Hearing Association. 8/16/2017.
Sensory Processing Disorder
'Avoiders' and 'Seekers'
The Sensory Avoider
The most frequently seen type of a sensory modulation problem is the over responsivity to sensations coming from one or several systems. Over responsivity to touch stimuli and sounds is common and often referred to as 'tactile defensiveness' and 'auditory defensiveness'.
The over responsive child's brain cannot inhibit sensations efficiently. They may be easily distracted as they are paying attention to ALL stimuli, even if the stimuli are not useful.
Over aroused and unable to screen irrelevant from relevant, they seek to defend themselves from most sensations. They may respond as though stimuli is irritating, annoying or even threatening.
For the 'out-of-sync' child with over responsivity, MELTDOWNS are common. They may be frequent, intense, emotional and loud. They may last a long time, even hours or all day.
Wearing CalmWear can provide the sensory avoider with all day constant pressure that calms their system and eliminates the fight or flight response from playing out, when overwhelmed with sensory stimuli.
The Sensory Seeker
The sensory seeking child craves MORE stimulation than other children, and never seems to get enough. They may be a 'toucher and feeler' , and a 'bumper and crasher'.
Their brain and body are telling him that he must act, but they often will act in a very disorganized way.
They crave movement and seek vigorous experiences, such as spinning.
Another characteristic of the sensory craver is that they may seek one kind of sensation, but pay little attention to others.
This child is often a risk-taker and a daredevil and may also have poor impulse control.