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Autism Spectrum Disorder SPRING 2014 HALDIMAND-NORFOLK HEALTH UNIT COMMUNICATION MATTERS A NEWSLETTER FOR PARENTS, TEACHERS, EARLY LEARNING PROVIDERS AND CAREGIVERS OF PRESCHOOL-AGED CHILDREN. Autism spectrum disorder The last time we featured the topic of autism The following table highlights the most important differences between the DSM-5 and in Communication Matters was 2002. the previous edition, DSM-4. A lot has changed since then! More DSM IV DSM V people receive this diagnosis now than Diagnostic Labels Autism Spectrum Disorders Autism Spectrum Disorder: ever. Scientists are working hard to identify include: Level 1, Level 2, Level 3 the causes of autism. And in Ontario, the • Autistic Disorder, (Levels are defined by Ministry of Children and Youth funds a • Asperger’s Disorder, how much support the range of services for children with autism • PDD-NOS (Pervasive individual needs) and their families. Developmental Disorder Not Otherwise Specified) In this issue, we’ll look at some of the Criteria for diagnosis • Impairments in • Impaired Social recent information available about Autism Communication Communication and/or Spectrum Disorder. • Impairments in Social Interaction Interaction • Restricted and/or • Restricted Interests and Repetitive Behaviors What is Autism Spectrum Repetitive Behaviours. Disorder (ASD)? Age of diagnosis Geared towards Symptoms must show in Autism spectrum disorder is a neurological identification in school-aged early childhood even if condition. It affects the way the brain children diagnosis isn’t made until functions and results in difficulties with later. social communication. People with the disorder also exhibit unusual patterns of down to a few things that may have a in the old diagnosis, social skills and behaviour, activities and interests. profound effect on people with ASD and communication were considered their families: separately. The new version recognizes How is ASD diagnosed? • People who were previously identified the integration of these important skill as having Asperger’s or PDD-NOS will areas. We don’t yet have a medical test that can now be identified as having ASD. That • Identification by level may help to diagnose autism. Instead, specially trained doesn’t at all change who they are. But ensure that children receive the physicians and psychologists administer labels are part of our self-identity. If support they need in social and school autism-specific behavioral evaluations. They you or your child had come to terms settings. follow the guidelines laid out in a book with a diagnosis or Asperger’s or • The new version reflects recent called the Diagnostic and Statistical Manual PDD-NOS only to have it changed to research into the unusual behaviors (DSM). ASD now, you may experience initial shown by many people with ASD. anxiety and confusion. If this affects It recognizes that people with One of the biggest recent changes in the your family, be sure to discuss it with ASD often have difficulties with field of autism came in 2013 with the your child’s doctor. sensory processing. You’ll find more publication of the 5th edition of the DSM, • Social communication problems have information about sensory processing commonly referred to as the DSM-5. long been recognized to be the core later in this newsletter, under the All that technical-sounding language boils problem for people with ASD. But section “What does ASD look like?” COMMUNICATION MATTERS What causes ASD? There is no known single cause for autism, but it is generally accepted that the brain of a person with ASD is different in shape, structure and function than the brains of people without ASD. Researchers are investigating a number of theories, including the links among heredity, genetics and medical problems. In many families, there appears to be a pattern of autism or related disabilities, further supporting the theory that the disorder has a genetic basis. But is genetics the sole cause? Some It will take time for clinicians to use the How many children have researchers are exploring environmental DSM-5 before there’s agreement on its the diagnosis of ASD? factors such as viral infections, metabolic value – if there ever is. But it’s promising imbalances and exposure to environmental when a clinician like Dr. Stephen Kanne, The NEDSAC (National Epidemiological chemicals. executive director of the University of Database for the Study of Autism in Missouri Thompson Center for Autism Canada) looked at the number of children British doctor Andrew Wakefield caused a and Neurodevelopmental Disorders, can living with autism every year from 2003 to lot of families a lot of heartache when he say “”the new criteria lend themselves to 2010 in three areas of Canada. published a “study” in 1999 claiming that a more careful and tailored approach to vaccines caused autism. diagnosis” instead of “categoriz(ing) people The area closest to Haldimand-Norfolk according to an all or nothing checklist.” was Southeastern Ontario. Results there Even though it has since been proven showed an increase in autism in children that the data in the Wakefield study was The most important take away for families aged 2 to 5 years from .32 in 1000 (less false, it frightened many parents away is to realize that doctors can only diagnose than 1 in 300) in 2003 to .95 in 1000 (or (1 from potentially life-saving vaccines. It ASD – or rule it out as a diagnosis – if they in 100) in 2010. made some parents of children with ASD have excellent information about the child. experience tremendous guilt wrongly What a doctor sees in his office is rarely If that change wasn’t startling enough, the blaming themselves for their children’s the child’s best, or even typical behavior. U.S. based Centre for Disease Control difficulties. now says that 1 in 88 eight-year old As a parent, you know your child best. children and 1 in 54 eight-year old boys are Even though a specific gene has yet to If you are seeing a doctor because you living with the ASD diagnosis (March 2012). be identified, and researchers aren’t sure have concerns about your child’s social about environmental “triggers” that cause communication and behavior skills, be What’s going on?! autism to develop, we are getting closer to sure to be specific about your concerns. understanding the causes of autism. Write down your observations and bring NESDAC feels that changes in diagnostic that paper with you. Bring any reports criteria and better diagnostic skills are What does ASD look like? you have from other people, like a speech factors in this increase. For example, pathologist or your child’s preschool doctors are better now at picking up “If you’ve seen one child with autism, teacher. Make a note of any questions. the more subtle signs of autism in girls. you’ve seen….one child with autism.” Don’t be afraid to ask or tell anything! The Redpath Centre, a diagnostic centre Like all children, each child with ASD is in Toronto, reports that in the past five a unique and precious individual. People A diagnosis of ASD doesn’t change who years the male-to-female ratio of their with ASD may share certain behavioural, your child is, but it may help others 600 clients a year has risen from 80-20 to social and communication characteristics, understand him better. 60-40. But improved diagnostics doesn’t but they can vary widely in the effect tell the whole story. There is continued that autism has on their day-to-day lives. work on finding the core cause of autism. Sensory processing may be an important 2 SPRING 2014 COMMUNICATION MATTERS factor in creating the behaviours like lack of • bumping into people and things eye contact and hand flapping that worry • squeezing into tight places (e.g. behind parents. the couch) • giving and wanting very tight hugs News Flash! Temple Grandin, one of the world’s best • teeth-grinding or chewing on non-food Check out our new known and most accomplished adults items ONLINE REFERRAL with autism, has identified sensory issues • seeming to ignore things that are said FORM! as an area that needs much recognition to him and research. She writes about her own • wanting the TV turned up loud Go to hnhu.org /speech-referral- experiences of being overwhelmed by her • banging doors form. To access other information brain’s perception of the sounds and sights • flicking lights on and off like our Communication Checklist, of her environment. Grandin suggests • lining things up if you’re not sure what skills to that differences in sensory processing may • looking at things from unusual angles expect at different ages, visit hnhu. even contribute to the social problems • exploring things and people by smelling org/speech. You can also find our of people with ASD. In her book, The or licking them Referral Form there if you’d like your Autistic Brain, Grandin asks “...how can child to be seen for assessment. you socialize people who can’t tolerate the Children with motor planning difficulties environment where they’re supposed to be have trouble organizing their responses to social – who can’t practice recognizing the sensory input. Examples of motor planning treatments offer the most success. emotional meanings of facial expressions in difficulties include: Applied Behavioural Analysis (ABA) and social settings because they can’t go into a Intensive Behavioural Intervention (IBI) are restaurant?” • bumping into people and things designed to actively engage children with • playing with the same toy over and over communication, socialization, learning and Children with sensory processing difficulties in the same way behavioural problems. may be over-sensitive or under-sensitive • not imitating gestures or sounds to sensory information. Children who are • doing an activity just once (e.g.
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