April is Autism Awareness Month
By Krestin Radonovich, Ph.D. and Catherine Zenko, M.S., CCC-SLP
Chances are good that you know someone with autism spectrum disorder, or ASD. In March 2012, the Centers for Disease Control and Prevention put the incidence of autism and its related disorders of Asperger’s disorder and pervasive developmental disorder not otherwise specified at a rate of one out of every 88 children.
At one in 88, we now have more than one million children directly affected by autism, making it more common than pediatric cancer, diabetes, and AIDS combined.
But, what is autism?
Currently, the diagnosis of autism is made according to three areas of impairment:
- Social interaction
- Restricted, repetitive and stereotyped patterns of behaviors, interests, and activities.
One of the hallmarks of autism is the lack of social-emotional reciprocity—in other words, the back-and-forth dance of social and emotional sharing that is present very early in typically developing children. Many associated problems are seen in autism, such as sensory processing issues, behavioral challenges and a host of medical issues. Yet, it is important to remember that the diagnosis is made according to the three areas of social interaction, communication and restricted/repetitive behaviors.
The American Academy of Pediatrics has published guidelines for screening for autism at the 18- and 24-month well-child visit. Early identification of autism is key because studies have shown that children with autism can show great gains in communication, social skills and even significant gains in IQ (Dawson et al., 2010). More recently, we are finding that early intervention can even normalize brain activity in young children with ASD (Dawson et al., 2012). Some of the earliest signs between the first and second years of life are failure to respond to name when called and lack of joint attention, or when two people experience a shared common experience. One way to observe this is with a “three-point gaze.” For example, if the young child wants a toy that is out of reach, she or he would look at the toy, then look at you, then look back at the toy. These signs, coupled with a delay in verbal language, often drive parents to seek answers which can lead to wondering about a diagnosis of ASD.
New diagnostic criteria will be published in May 2013 by the American Psychiatric Association’s DSM-5. It will define ASD as one unified spectrum with a range of difficulty associated with two core features, instead of the previous model of three core areas of impairment (American Psychiatric Association DSM-5 Development, 2012). The DSM-5 will combine the domains of impairments in social interaction and communication into the same general category and keep the restricted, repetitive and stereotyped patterns of behaviors, interests and activities domain. While the clinical diagnosis is moving to one unified classification, the DSM-5 incorporates ways to represent the range of symptoms expressed by assigning severity levels and other clinical specifiers. Rather than provide separate clinical diagnoses to represent variations of ASD, the evaluators are to describe how each domain is affected uniquely in individuals with ASD. Descriptions of severity level will be made based on the child’s support level needs.
1 in 88—what does it mean for you? For the University of Florida Department of Pediatrics, it translates into patients we treat every day. Behind all of these statistics are real families, real individuals struggling each and every day. The symbol for the autism movement is the puzzle piece. Autism is a puzzle. It is challenging. Autism is a complicated disorder. It requires long-term, integrated care from a team of providers trained to treat each of the aspects of impairment in autism: communication and language, social interaction, repetitive behaviors, sensorimotor impairment, nutrition, behavior, and a host of medical issues.
The UF Department of Pediatrics is creating a new, multidisciplinary Center of Excellence for Autism and Neurodevelopment that will provide services to families affected by autism and other developmental disorders. We envision the center as the regional home for innovative programs for children with autism. More information on this exciting new initiative to come soon!