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Diagnosis
& Consultation
There are
no medical test for diagnosing Autism. An accurate diagnosis
must be made on observation of the individual's communication,
behavior, and developmental levels. However, because many of
the behaviors associated with Autism are shared by other
disorders, various medical tests may be ordered to rule our or
identify other possible causes of the symptoms being
exhibited. At first glance, some persons with Autism may
appear to have mental retardation, a behavior disorder,
problems with hearing, or even odd and eccentric behavior. To
make matters even more complicated, these conditions and
co-occur with Autism. However, it is important to distinguish
Autism from other conditions, since an accurate diagnosis and
early identification can provide the basis for building an
appropriate and effective educational and treatment program.
A brief observation in a single setting cannot present a true
picture of an individual's abilities and behaviors. Parental(
also teachers, and other caregivers) input and developmental
history are very important components of making an accurate
diagnosis.
Early
Diagnosis
Research
indicates that early diagnosis is associated with dramatically
better outcomes for individuals with Autism. The earlier a
child is diagnosed, the earlier the child can begin benefiting
from specialized intervention.
Diagnostic
Tools
The
characteristic of Autism spectrum disorders may or may not be
apparent in infancy (18-24 months), but usually become obvious
during early childhood (2-6 years).
As part of a well baby or well child visit, your child's
doctor should do a "developmental screening" that
will ask specific questions about your baby/child's progress.
The National Institute of Child and Health Development (NICHD),
lists 5 behaviors that signal further evaluation is warranted:
*Does not
babble or coo by 12 months
* Does not gesture (wave, point, grasp) by 12 months.
*Does not say single words by 16 months.
*Does not say two word phrases on his/her own by 24 months.
*Has any loss of any language or skill at any age.
Having one
or more of these "red flags" does NOT mean that your
child has Autism! But because the characteristics of the
disorder vary so much, a child showing these behaviors should
have further evaluations by a multidisciplinary team. This
team may include a neurologist, psychologist, developmental
pediatrician. speech/language therapist, learning consultants,
or other professionals knowledgeable about Autism.
Screening
Instruments
While
there is no behavioral or communications test that can detect
Autism, several screening instruments have been developed that
are now being used in diagnosing Autism:
1)
Childhood Autism Rating Scale (CARS), developed by Eric
Schopler in the early 1970's, is based on observed behavior.
Using a 15- point scale, professionals evaluate a child's
relationship to people, body use, adaptation to change,
listening response, and verbal communication.
2) The
Checklist for Autism in Toddlers (CHAT) is used to screen for
Autism at 18 months of age. It was developed by Simon
Baron-Cohen in the early 1990's to see if Autism could be
detected by 18 months. The screening tool uses a short
questionnaire with two sections, one prepared by the parents,
and the other by the child's doctor.
3) The
Autism Screening Questionnaire is a 40 item screening scale
that has been used with children 4 and over. It is used to
help evaluate communication skills and social functioning.
4) Gilliam
Autism Rating Scale (GARS) is designed for use by teachers,
parents, and clinicians, the GARS helps to identify and
diagnose autism in individuals ages 3-22 and to estimate the
severity of the problem. The 56 items are grouped into 4
subtests that examine stereotyped behaviors, communication,
social interaction, and developmental disturbances for parents
to contribute data about their child's development during the
first 3 years of life.
5) Autism
Behavior Checklist (ABC) -The ABC is part of a broader tool,
the Autism Screening Instrument for Educational Planning (ASIEP),
that profiles abilities in spontaneous verbal behavior, social
interaction, education level, and learning characteristics.
The ABC is designed to be completed independently by a parent
or a teacher familiar with a child older than age 3. It
measures target behaviors for intervention, and can be
repeated to clarify the impact of treatment interventions. The
Checklist has 57 questions divided into 5 categories of
behavior: (a) sensory, (b) relating, (c) body and object use,
(d) language, and (e) social and self-help.
*************************NOTE*************************
What
screening tools can do
Screening tools can help identify children who might have
developmental delays. Screening tools can be specific to a
disorder (for example, autism) or an area (for example,
cognitive development, language, or gross motor skills), or
they can be general, including multiple areas of concern.
What
screening tools cannot do
Screening tools
cannot give sure evidence of developmental delays, and they
cannot be used to make a diagnosis. A positive screening
result should be followed by a thorough assessment. Screening
tools cannot provide in-depth information about an area of
development.
Consulting
with Professionals
Whether
you or your child's pediatrician is the first to suspect
Autism, your child will need to be referred to someone who
specializes in diagnosing Autism spectrum disorder. This may
be a developmental pediatrician, a psychiatrist or
psychologist, or possibly a neurologist.
This multidisciplinary team may consist of some or all of the
following professionals:
*Developmental
pediatrician- Treats health problems of children with
developmental delays or handicaps.
*Child
psychiatrist- A medical doctor who may be involved in the
initial diagnosis.
*Clinical
psychologist- Specializes in understanding the nature and
impact of developmental disabilities, including Autism
spectrum disorder.
*Occupational
therapist- Focuses on practical, self-help skills that will
aid in daily living such as eating and dressing. They can also
work on sensory integration, coordination of movement, and
fine motor skills.
*Physical
therapist- Helps to improve the use of bones, muscles, joints
and nerves to develop muscle strength, coordination and
motor skills.
*Speech/Language
therapist- Involved in the improvement of communication
skills, including speech and language.
*Social
Worker- May provide counseling services or act as a case
manager helping to arrange treatment and services.
It is
important that parents and professionals work together for the
child's benefit. While professionals will use their training
and experience to make recommendations about your child's
treatment options, YOU have unique knowledge about his/her
needs and abilities that should be taken into account for a
more individualized course of treatment.
Once a treatment program is in place, communication between
parents and professionals is essential in monitoring the
child's progress. Here are some guidelines when working with
professionals:
*BE
INFORMED!!! LEARN as much as you can about your child's
disability so you can be an ACTIVE participant in determining
care!!! If you don't understand terms used by the
professionals...ASK THE TO EXPLAIN!!!
*BE
PREPARED!!! Be prepared for meeting with doctors, therapists
and school personnel. Write down what your questions and
concerns are and then write down the answers you are given!
*BE
ORGANIZED!!! Many parents find it useful to keep a notebook
detailing their child's diagnosis and treatment, as well as
meetings with professionals.
*COMMUNICATE!!!
If you don't agree with a professionals recommendations, SPEAK
UP and say specifically why you don't!!!
FIND A DAN
doctor! (DAN stands for Defeat Autism Now)
Getting
Past the Diagnosis
The time
immediately after the diagnosis is often a difficult one for
families...filled with confusion, anger and despair. These are
NORMAL feelings! But there IS life after a diagnosis with
Autism! Life can be rewarding for a child with Autism and all
the people who have the privilege of knowing the child.
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