Does my child have Autism?
Autism spectrum disorder (ASD) is a developmental disability that affects social interaction, communication, interests and behaviour, and it's estimated that more than 1 in every 100 people in the UK have ASD. Usually, symptoms of ASD are present in children between one and three years of age, with a higher proportion of males diagnosed with the condition than females, however this is not always the case.
While there's no "cure" for ASD, speech and language therapy, occupational therapy, educational support and a number of other interventions are available to help support both children and parents.
The following are some ‘myths and realities’ about autism.
MYTH: “Autism only affects social skills”
REALITY: As a Developmental Paediatrician, I am often referred children and young persons whose parents, teachers, or health professionals working with them are worried about the possibility of autism. Just over 50% of the new patients I see at The Portland Hospital have come with the ‘autism’ question.
There are a number of reasons why concerns are raised. The commonest causes for concern in younger children are:
• Delay in speech development
• Poor eye contact with other people
• Little or no interest in playing with other children
• Unresponsive to adults and not following adult direction
• Unusual pattern of behaviour such as strong adherence to routines and reluctance for change, repetitive hand or body movements, lining up toys rather than playing with them, sensory seeking behaviour, for example mouthing non-edible objects, unusual interest in touching objects of certain texture, or placing objects close to the eyes to look at.
In older, school-aged children, some of the common causes for concern include:
• Difficulties in forming and maintaining friendship
• Poor social sense and awareness of other people’s views and interests, therefore appearing to be rude or insensitive
• Following own agenda, and therefore appearing to be disobedient to parents or teachers
• Difficulties in conversation with other people, often showing little interest in what the conversational partner has to say
• Pre-occupation in special areas of interest
• Rigid routines and reluctance for change
However, if one looks for features of autism in anybody, one would find some features in just about everybody. Thankfully, not everybody has autism! One will need to have a substantial amount of features to warrant the diagnosis.
MYTH: “You can always tell if someone has autism”
REALITY: When I see children and young people with concerns regarding the possibility of autism, I will start with a general developmental assessment. As there are a few conditions that may look like autism, it is important to perform a general, holistic assessment, with an open mind. Jumping to conclusion without considering other possibilities is not something I would recommend, especially not for something as serious as autism!
Some of the other conditions that may present with autistic like features include:
• Generalised developmental delay or learning difficulties, causing the child to have speech delay and poor understanding of social interaction
• Specific speech and language disorder, making it difficult for the child to communicate and interact with other people socially
• Emotional difficulties, such as anxiety, insecure attachment, poor self-esteem etc, causing the child to behave in a dysfunctional way
Once I have performed a general developmental assessment, and the findings suggest autism, I will recommend for the children to have a specific autism diagnostic assessment.
There are national guidelines laid down by the National Institute of Clinical Excellence (NICE) on how diagnostic assessments are to be carried out. A specific developmental history with the parents, and specific observational tests on the child, both aiming to elicit the amount of autism features will need to be undertaken. If the child is attending nursery or school, information on how the child behaves and functions at nursery or school will need to be sought. Diagnosis will be based on the information gathered from all of the above, and matched against internationally agreed diagnostic criteria.
MYTH: “It takes years to confirm a diagnosis for autism”
REALITY: For children and families who are able to access the National Health Service, autism diagnostic assessment is provided by their local child development service or Child and Adolescent Mental Health Service (CAMHS). Referral can be made by General Practitioners, Health Visitors and Therapists. This is often what I recommend after an initial general developmental assessment if I feel autism is a strong possibility.
In some areas, there is a long waiting time for autism diagnostic assessment on the NHS. A six month wait is not unusual, and in some areas the waiting time may even be longer. If parents are keen to have a diagnostic assessment sooner, I am happy to provide an initial general developmental assessment, followed by diagnostic assessment within 2-3 weeks. This initial developmental assessment takes 1 hour, and the diagnostic assessment takes between 2-3 hours. The waiting time for initial assessment is usually less than a month.
MYTH: “There’s nothing you can do about autism”
REALITY: While there is no cure for autism, there is much that can be done to help and to facilitate progress and learning. Treatment is by speech and language therapy, occupational therapy, clinical psychology, psychotherapy and by educational means. There is good research evidence that these methods can lead to noticeable and sustained improvements. I have personally seen good results from these treatment.
Further information about autism can be found at The National Autistic Society and Research Autism. the Dr Ian Hay Ltd practice offers support for children and their families who are looking for or wishing to exclude an autism diagnosis.
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