Diagnosing Autism – A Brief Guide

Autism – diagnosis
Autism – diagnosis

See your GP or health visitor if your child is showing symptoms of autism spectrum disorder (ASD), or you’re worried about their development.

If appropriate, your GP can refer you to a healthcare professional or team who specialise in diagnosing ASD, or someone who has access to such a team.

The specialist or specialist team will make a more in-depth assessment, which should be started within three months of the referral.

If you’re referred to an individual specialist, they may be a:

psychologist – a healthcare professional with a psychology degree, plus further training and qualifications in psychology

psychiatrist – a medically qualified doctor with further training in psychiatry

paediatrician – a doctor who specialises in treating children

speech and language therapist – a specialist in recognising and treating communication problems

Some local health authorities use multidisciplinary teams. These are a combination of specialists who work together to make an assessment.

Assessment

A diagnosis of ASD is based on the range of features your child is showing.

For most children:

information will be needed from your GP, nursery or school staff, plus speech and language and occupational therapists, about your child’s development, health and behaviour

a speech and language therapist, and often an occupational therapist, will carry out an assessment

a detailed physical examination will need to be carried out to rule out possible physical causes of your child’s symptoms, such as an underlying condition like neurofibromatosis or Down’s syndrome

the assessment will include a check for any coexisting physical health conditions and mental health problems

In addition, for some children:

you may be asked to attend a series of interviews so a detailed family history and the history of your child’s development and behaviour can be drawn up

your child may be asked to attend a series of appointments so specific skills and activities can be observed and assessed

Once this process is complete, a diagnosis of ASD may be confirmed.

After diagnosis

When a child is diagnosed with ASD, many parents are keen to find out as much as they can about the condition. The National Autistic Society has an excellent range of resources and advice.

Diagnosing ASD in adults

Some people with ASD grow up without their condition being recognised, but it’s never too late to get a diagnosis. Some people may be scared of being diagnosed because they feel it will “label” them, and lower other people’s expectations of them.

But there are several advantages to getting a diagnosis. It helps people with the condition and their families understand ASD and decide what sort of support they need. A diagnosis may also make it easier to access autism-specific services and claim benefits.

See your GP if you think you may have ASD and ask them to refer you to a psychiatrist or clinical psychologist. The National Autistic Society website has information about being diagnosed with ASD if you’re an adult.

If you’re already seeing a specialist for other reasons, you may want to ask them for a referral instead.

Read more about diagnosing ASD in adults and advice for adults living with ASD.

You can also read the NICE guidelines about the recognition, referral, diagnosis and management of adults on the autism spectrum (PDF, 267kb).

Autism and the problem of Bullying – Please help with this research study

Autism and Bullying Research
Autism and Bullying Research

Bullying is a common problem in school-age children, and children with special needs are victims of bullying more frequently than their typically developing peers. Children with Autism Spectrum Disorder (ASD) may be especially susceptible to victimization due to the social and communication deficits inherent to this disorder. Deficits in these areas can be especially problematic in social settings, such as school, as children with ASD may struggle to engage in social reciprocity, understand the perspective of others, or interpret nonliteral language. These difficulties may incite peers to engage in bullying behavior specifically directed towards children with ASD.

Researchers at the Institute for Child Development at Binghamton University (SUNY) are conducting a research study to learn more about perceptions of bullying in children with and without special needs. They have developed an anonymous online survey, which asks individuals to provide their perceptions of various scenarios describing interactions between two children. This research aims to better understand what bullying looks like in children with ASD, and also to understand potential differences between bullying in typically developing children. Findings will be useful to develop better assessment tools more specific to the experiences of children with ASD and will also inform more effective interventions to reduce bullying in this population.

The principal investigator for this study, Hannah Morton, M.S., is a doctoral student in clinical psychology at Binghamton University; she is also a sibling of an individual with ASD. Her research focuses on the experiences of children with ASD and their families, with a goal of understanding how these experiences may differ from typically developing children and place children with ASD at further disadvantage for success across home, school, and community settings. Better understanding of bullying and other experiences can then be used to intervene and provide additional supports for children with special needs (e.g., ASD).

Morton and colleagues are currently recruiting participants for this anonymous online survey, specifically looking for parents of children with special needs (e.g., ASD), as well as educators and service providers for children with special needs. Parents of typically-developing children or individuals who do not have children are also welcome to participate. Participation will take up to 40 minutes, and participants may choose to be entered into a drawing for one of five, $50 gift cards. This study has been approved by the Institutional Review Board (IRB) at Binghamton University.

Please click the survey link below to participate or email autism@binghamton.edu with any questions.

http://surveymonkey.com/r/BullyingBehavior

Characteristics of Autism – which do you share with this list?

My main wish for this year is to make the "judgers" understand
My main wish for this year is to make the “judgers” understand

The characteristics of autistic spectrum disorder (ASD) can vary both from person to person and across different environments.

They can also be different for the same person at different times in their life. That is why autism is usually referred to as a spectrum disorder.

The traits of ASD can be divided into three main groups. They are:

social interaction

social communication

social imagination

The first characteristics of ASD can sometimes be seen in a child who is under the age of two. However, in other children the condition may not be picked up until they are much older.

Social interaction

A person who has ASD may find it hard to relate to other people. They may:

seem distant or detached

have little or no interest in other people

find it difficult to make friends

not seek affection in the usual way, or resist physical contact such as kissing and cuddling

find it difficult to make eye contact with other people

want to have social contact, but have difficulty knowing how to initiate it

not understand other people’s emotions and have difficulty managing their own emotions

prefer to spend time alone

Social communication

A person who has ASD may have difficulty using verbal and non-verbal skills, and some people may remain non-verbal throughout their lives.

People with ASD who do speak may use speech in an overcomplicated way, using odd phrases or odd choices of words.

They may also make up their own words or phrases, and use more words than are necessary to explain simple things. Someone with ASD may also have difficulty:

expressing themselves well

understanding gestures, facial expressions or tones of voice

using gestures to communicate

understanding instructions

Some people with ASD may develop echolalia, where they repeat words that have little meaning or repeat what has been said to them.

Social imagination

Children with ASD may:

have limited imaginative play

play the same games over and over, or play with games designed for children younger than themselves

get upset if their daily routines are interrupted in any way

show repetitive behaviours, such as hand flapping or spinning

In addition, children and adults may also develop obsessions – for example, with specific objects, lists, timetables or routines.

Sensory difficulties

Most people with ASD also have sensory difficulties. This means they may be oversensitive to specific things, such as touch, certain textures, light levels, or sound.

Sensory difficulties can also lead to problems with movement. A person with ASD may appear clumsy or have an unusual way of walking.

Asperger syndrome

Asperger syndrome is another form of ASD. People with Asperger syndrome will generally not have a learning disability and are often of average or above average intelligence.

They will usually have fewer problems with language development, but may still experience difficulties with social communication.

Asperger syndrome is often diagnosed later in children, and sometimes their difficulties may not be recognised and diagnosed until adulthood. This can cause a delay in getting appropriate support for the individual and their family.

Hyperlexia – please share your advice and tips with one of our readers! Is this part of your autism experience?

Hyperlexia - get informed Hyperlexia – get informed[/caption]

A few months ago on our Facebook Page AutismTalk one of our readers, named Lori, asked “Has anyone heard of Hyperlexia, my son is very smart but struggles with comprehension? Reads 7 grades levels above his grade yet comprehension is still at grade level! Looking for suggestions on how to help him?”

Now I have a confession to make up until I read the question I have never heard of Hyperlexia (which may often come with autism) so, as you can imagine I was fascinated by the responses.

To those, like me who are not familiar  with the term Hyperlexia it is defined by Darold Treffert  in the Scientific American  as “the ability to read early” which when it presents itself in children on the autism spectrum “as a savant ‘splinter skill’ as one symptom of an autistic spectrum disorder. They read voraciously usually with astonishing memory for what they read, often accompanied by other memorization tasks and abilities, sometimes linked with number or calendar calculating abilities. There is marked obsessiveness and rigidity”.

It should been mentioned that Hyperlexia does not automatically come hand in hand with autism.  Indeed one type (actually called Hyperlexia Type 3) is often misdiagnosed as ASD.  Like its related condition Einstein Syndrome most children with a diagnosis developed in a fairly neurotypical fashion.  But this is the subject for a future blog post.

But back to Lori’s question.

Quite of a few of our readers were happy to share their experiences.  Amy, for example, was pretty confident of it being Hyperlexia when she remarked “If he taught himself to read at 2 I’d say its hyperlexia. Sounds a lot like my son.”

But Samantha wanted to know ““What tests were done for his comprehension? Maybe he can comprehend what he’s read, but he can’t express it written or verbally to explain what he read. Here’s what I mean; my 9 yr. old has Asperger’s. He has a 9th grade reading level. He was tested in 3rd and this year in 4th grade. After he reads, they give him a written test (this years was on the computer). He has a hard time gripping a pencil, so he doesn’t like to write. So he didn’t test well on the comprehension test in the 3rd grade because he didn’t want to write. So this year, they did computer testing and he also didn’t test well. I am guessing it is just because he didn’t want to do the test. He doesn’t like to be put on the spot and questioned and so he can’t explain verbally what he read about. So they stop the test and say that is his maximum reading level. But I know my son. I know he comprehends what he reads, even if he can’t pass a test about what he read. So what do you need to help your son with? He already reads 7 grade levels above his grade level. Then you don’t need to do anything. Here’s my advice: Sit back, relax, and be proud!””

Pamela gave some very useful advice “My oldest son (19) has Hyperlexia. Be sure to have appropriate goals and objectives in his IEP. There is a Hyperlexia group on FB that can offer a wealth of info. It is not just reading/comprehension….social skills and other factors can….may….will come into play. With proper supports (and making sure educators comply with IEP) he will thrive! My son is doing great at his university and totally independent.”

“I read all content, books, passages before my daughter does and note questions to ask throughout with reference to specific sentences. I then ask them, take her back to the sentence/paragraph and get her to explain how the person felt/what the science looked like etc. It’s a long process but now she knows she will be asked so she will read something then say ‘the boy was upset because his dog ran away’ it’s just a small portion of what she has read and she has ultimately ‘decoded’ the writing but knowing she will be questioned and I will go back through it with her is helping because ultimately she wants to read and then have the task finished. My daughter is 7 reads at the age of 14 and comprehends at the age of 3. It’s extra work and laborious and she HATES it but it works x x”” came the suggestion from Kerry.

But Stephanie shares “I would suggest reading the comprehension questions FIRST and then slowly reading the story and finding the answers, as he reads. This will eventually teach him what the comprehension questions usually consist of. Then, once he understands what information to look out for, he should be doing a little better. He may read more slowly, but at least he will understand what he’s reading. (I’ve dealt with this, my whole [reading] life.)”

We would like to end by sharing Michelle’s excellent suggestions “Please have Lori or anyone else who would like to know about Hyperlexia join us at : (just type this into your search bar, and request membership. I’ll approve you quickly.

Hyperlexia Parents Network on Facebook

A study from Nature Neuroscience offers new information on best practices for helping individuals with autism learn. The study shows that the traditional method of teaching through repetition may be flawed due to an ASD individual’s difficulty transferring knowledge from one context to another. In fact, the study indicates this teaching method may even be counterproductive to learning.

Also, here is a great website with so much information and articles, teaching aids, etc…: http://westwingpublishing.com/Hyperlexia_Parents_Network/Social_Media.html

You can also Google Treffert and Hyperlexia for a wonderful article about the types of Hyperlexia. My daughter is 12 and while we still struggle some, she’s doing great.”

So what next?

Well over to you.  We are really interested in the views and experience of both people with Hyperlexia and their families and caregivers.  Please do think in terms of the following questions but do bear in mind that anything you have to say will be of great interest to our readers.

  1. What were the original signs of Hyperlexia?
  2. How was it diagnosed/ were you told about it?
  3. What strategies did you put in place to help with the Hyperlexia?
  4. How successful were these strategies?
  5. What one bit of advice would you give to a person who has just been diagnosed with Hyperlexia? And to their families and caregivers?

Many thanks in advance for your help and we look forward to reading you comments.

Brain Inflammation and Autism Spectrum Disorder from by Dr. Sonya Doherty.

Dr. Sonya Doherty
Dr. Sonya Doherty

Dr. Sonya Doherty has very kindly allowed us to republish this fascinating article on autism and inflammation. She  is a licensed and board certified Naturopathic Doctor who is an active member of the CAND. Sonya Doherty completed her undergraduate training at the University of Western Ontario in a Bachelor of Science Honors Kinesiology program.  Very experienced in the field of autism you can access her website here.

If you have any questions about the article please feel free to ask them in the comments section at the bottom of the page.

According to recent estimates by the Centre for Disease Control (CDC), 1 in every 68 children has autism. Autism is a complex neurological disorder previously thought to be a mental health issue but mounting evidence is showing significant medical aspects to this growing neurodevelopmental disorder.  A study at Johns Hopkins published in 2005 identified that people diagnosed with autism experience inflammatory changes in their brain tissue.  This finding was crucial because it was a major step forward in redefining autism as a medical disorder that is may be treatable and reversible.

This article will briefly review some of the potential causes of brain inflammation and treatments that are being used successfully to help children today.  With a 30% rise in autism in the last two years, parents are eager to see research translate into treatments that can address medical issues like constipation and diarrhea, as well as advanced approaches that improve social, language and cognitive development.

 

How do methyl B12 injections help with inflammation?

 

Jill James, a PhD biochemist at the Arkansas Children’s Research Institute has identified that 90% of children diagnosed with autism have methylation impairments.  So, what does that mean?  Methylation is the process that supports development in the body.  When babies are conceived, they are not methylated.  As babies develop, methylation makes sure the brain develops properly and is protected against toxicity.  Impairments in this cycle stop the production of a brain antioxidant called glutathione.  Antioxidants protect the body and glutathione is the head honcho when it comes to protecting the brain.  In fact, depletion of glutathione is also one of the medical aspects of autism and is up to 80% decreased in the disorder.

Methylation is fueled by methyl donors and one of the best ways to improve how this cycle functions is by injecting methyl B12.  Dr. James Neubrander was the first physician to use methyl B12 to help children with autism.  What he noticed after injecting his first patient is what hundreds of practitioners have observed since, improved language, social and cognitive skills.  Methyl B12 injections help to remove inflammation by improving glutathione production.

Glutathione is important throughout the body but in the brain, it is the rate limiting step which means are it decreases; it is exactly like a battery.  The lower the glutathione, the more the brain is at risk for developmental concerns.

 Why is your child’s digestion so important in regulating inflammation?

It is estimated that up to 85%  of people with ASD have digestive issues including chronic constipation, diarrhea, reflux, esophagitis and pain.  Research from the National Institute of Health, Human Microbiome Research Project has identified that the gut is 100% responsible for post-natal development.  Microbiome is the term to describe the intricate ecosystem of microbes that populates our intestines.  These microbes include good bacteria that help with nutrient absorption, as well as regulation of inflammation and immune function.  Other research coming out of the microbiome project has shown that children with ASD have 25% less bacterial diversity, meaning that they lack important good bacteria that work to support development in many ways including production of neurotransmitters and genetic expression.  Studies by Dr. Sidney Baker have found that the stool of children with autism shows higher amounts of certain bacterial species (Clostridia, Bacteriodetes, Desulfovibrio) than may cause harm to the brain by creating more inflammation.

 

How do special diets help inflammation?

For me, special diets are a strategy to improve both methylation and gut health. The most well-known “autism diet” is GFCF.  Gluten free, casein free.  This diet removes all sources of gluten and dairy.  While there are multiple mechanisms by which removing these foods may help, the most important is that gluten and dairy stop the production of glutathione. One of the other ways gluten has also been shown to cause inflammation through stimulation of zonulin which increases gut permeability.  Usually, the gut cells are bound closely together, the space between them closely regulated.  Gluten creates inflammation is by causing the separation of gut cells by the activation of zonlulin.  Discovered in 2000 by Dr. Alessio Fasano, zonlulin causes the space between the cells to open, allowing parts of gluten to escape into the blood stream.  This process causes inflammation by allowing what should stay in the gut, out into circulation.

In my opinion, the most effective diet for improving symptoms of autism is the Specific Carbohydrate Diet.  Co-founder of Defeat Autism Now!, Dr. Sidney Baker agrees that this dietary approach is the most comprehensive way to healing the gut.  The fortification of folic acid in our grains (which are all removed in the SCD approach) also slows the methylation cycle.  Removal of grains supports the methylation cycle and its production of glutathione.  Research is showing that limiting complex carbohydrates could play a crucial goal in balancing the good bacteria in the digestive tract.   Research by Dr. Derrick MacFabe on the bacteria Clostridia, is helping to build a strong case for dietary carbohydrate restriction as a way to decrease the impact unbalanced gut flora has on the brain, behaviour, social interaction and cognitive function.  The Gut and Psychology Syndrome book is a fantastic resource for anyone embarking on dietary carbohydrate restriction.  Written by a neurologist with a masters degree in nutrition, it is a powerful book that explains the dietary approach that helped to recover her own son from autism.

 

What is causing brain inflammation in autism?

Moms who have the flu during pregnancy are at increased risk of their children having autism.  Viruses activate the immune system in the brain.  The Johns Hopkins study that identified inflammation in the brain also identified immune activation.  Termed, microglia, the immune system in the brain can turn “on” in response to a virus.  For most of us, the immune system turns on, and then we actually have a low level of brain damage which is then repaired by the brain.  In autism, this microglial activation doesn’t shut off and causes massive issues with managing inflammation in the brain because of too much of the most abundant chemical messenger in the brain – glutamate.  This is termed IMMUNOEXCITOTOXICITY. Broken down, this term explains that chronic activation of the IMMUNE cells (microglia) can cause the brain to become EXCITED to the point of TOXICITY.  At this point, the brain will not function normally and the excess glutamate that is causing the excitement causes damage.

Dr. Russell Blaylock, the neurologist who first postulated that IMMUNOEXCITOTOXICITY may be the central mechanism in autism, believes that both environmental toxicity and infectious agents can “prime” the immune cells in the brain.  Once “primed”, these cells will release higher amounts  of glutamate. After priming, the next time the glia are put on high alert from a toxin, infection or by metabolites from unhealthy gut bacteria, the release of large amount of glutamate can have disastrous consequences for the brain.

Research around the world is striving to make sense of the staggering rise in autism.  Inflammation is a medical issue and research in this area offers hope that as we learn more, the causes can lead to successful prevention and treatment.  In the meantime, Dr. Dan Rossignol and the faculty at the Medical Academy of Pediatric Special Needs (MAPS) are training medical professionals from around the world on biomedical treatments that can be used to prevent and treat developmental delays.  Many of these treatments focus on decreasing inflammation and improving the organ systems, like the gut, that manage the inflammatory process.  By addressing unbalanced microbes in the gut and reducing the impact of toxins, MAPS trained practitioners are able to decrease the excess excitement in the brain, improving social, language and cognitive potential in children diagnosed with autism.