Does My Child Have Autistic Spectrum Disorder (ASD)?
It can be hard to identify the underlying causes of a child’s behaviour, and diagnosis is often not clear cut. For example, if a child has a severe speech and language difficulty, some of the symptoms can look like traits of Autism Spectrum Disorder. Children can get very frustrated and upset and have meltdowns because they do not understand the language all around them. Severe difficulties understanding language can make your child’s environment unpredictable and stressful. They may try to control their surroundings to make them feel more secure, e.g. organise their toys, have set routines and responses. These can look like behaviours of a child who is on the spectrum, but we cannot know the reasons until the child has been assessed.
Other causes of behaviour that present like traits of Autism Spectrum Disorder include, to name a few:
- severe attention and listening difficulties,
- hearing difficulties,
- learning difficulties and global delay
- sensory difficulties
So, if you are concerned that your child might be on the Autism Spectrum, keep an open mind until you have had an assessment done.
What to do if you are worried about your child’s behaviour
Talk to your child’s key workers at nursery or other professionals who work with him. Share your thoughts, and evidence, with them and ask for their opinions and experience. You want to get as wide a picture as possible of your child’s communication in different settings. Does your child play with other children? Does he enjoy interactions? Does he copy what other people say or repeat language he has heard on telly and in films? Find out as much as you can about your child’s attention and listening, motivation to communicate, social interactions and enjoyment of interactions, use of language, play, eating habits and sensory issues, etc.
Referrals for Assessment
The nursery might have ideas about referrals they would like to make to support your child, e.g. if they are worried about understanding and use of language, they might want to refer to the local Speech and Language Therapy Service, if they are worried about sensory issues, they might want to refer to the local Occupational Therapy service. If they, and you feel that you need more investigation and assessment, you can take all of this information to the GP. The GP can refer your child for assessment with a Paediatrician, who will gather evidence from everyone involved with your child, discuss all of this information with you and assess your child.
The next step will depend on assessment findings. If the Paediatrician thinks that there is evidence of traits of Autism Spectrum Disorder, he will refer your child for assessment at a Social Communication Clinic.
Assessment and Diagnosis
A multi-disciplinary team is involved in assessment at Social Communication Clinics. This will be a Consultant Paediatrician and a Speech and Language Therapist or Educational or Clinical Psychologist. They will use an assessment called the ADOS (Autism Diagnosis Observation Schedule). It is a really thorough assessment that provides information on a wide range of areas. For example:
- Play skills: does the child use toy objects to mirror what people do with these objects in real life, e.g. drink from toy cups, give teddy a bath in a toy bath, etc. (functional play)? Does the child use objects to represent other objects, e.g. use a toy banana as a phone (symbolic play)? Does the child engage in sensory play with items, e.g. spin them, tap them, etc. (sensory play)?
- Use of language: does the child repeat what you said or repeat language from films (echolalia)? Does the child sound unusual when they speak?
- Desire to interact and engage with others.
- Non verbal communication, e.g. use of gesture, facial expressions, eye contact
- Stereotypical behaviours, such as hand flapping.
- Imagination and creativity
It will take between an hour and an hour and a half to carry out the assessment and then the team will go through the findings with you, either at the same appointment or at a later date. They will make a diagnosis based on the assessment findings, consider and information gathered from everyone involved with your child. The ADOS can be carried out more than once and children are assessed again at a later date if there are strong enough reasons to do this.
The ADOS is a fantastic assessment and although it can take a long time to administer, it is not unpleasant for children or for families, so do not be put off by the time or the fact that it is carried out by a multi-disciplinary team. Autism Spectrum Disorder is so complex that it is extremely helpful to have more than one professional involved in diagnosis.
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