Identifying and diagnosing an autism spectrum disorder

What is Autism Spectrum Disorder (ASD?) Autism has become a lot more recognised in recent years, which has been a good thing. However, the term can be bandied around in the press and in conversation without necessarily being explained properly. This can lead to misconception and worry, especially if you suspect your child has ASD. 

So what is autism, how can you recognise it and how is it assessed? 

‘The term autism describes qualitative differences and impairments in reciprocal social interaction and social communication, combined with restricted interests and rigid and repetitive behaviours, often with a lifelong impact’ (NICE, 2013). 

Although all children with an ASD share certain difficulties, it is a spectrum condition, which means it affects people in different ways. That is why it is important to make sure that your child gets the right diagnosis so that they receive the right support to take part in the world around them.  

How to recognise ASD?

These may not be only things you notice but it is common for children with an ASD to have difficulties in the following areas:  

1) Spoken language: 

Uses made up words (e.g. babble you would expect from a younger child), appears to stop using words they were previously using, uses or repeats adult-type phrases (e.g. ‘time to do our teeth’, ‘no need to worry, it’s just a noise’).

2) Responding to others:

Does not always respond to their name being called or react when someone smiles at them.

3) Interacting with others: 

Finds it difficult to start social play with other children (e.g. playing alongside instead of with other children) and is mainly interested in interactions to get their needs met (e.g. naming all the animals/numbers in a book). 

4) Eye contact, pointing and other gestures:

Has limited or no social eye contact and/or facial expressions with others, does not point towards toys of interest to show you they like them.

5) Ideas and imagination:

Takes part in limited or no pretend play (e.g. bites toy food as if it was real food instead of pretending to give it to ‘teddy/dolly’), likes to play with toys in an unusual way (e.g. is more interested in moving/looking at the wheels than playing with the car), repeats back whole scenes from their favourite television programme but struggles to use the ideas in other play.

6) Unusual or restricted ideas and/or rigid and repetitive behaviours:

Tends to follow their own agenda (e.g. not noticing others or objects around them and might even try to walk over/through them), repeatedly flaps their hands or appears to enjoy spinning objects, struggles if routines change (e.g. likes to put the puzzle pieces in the board in the same order).

Difficulties in one or more of these areas does not automatically mean that your child has an ASD however they should be considered as part of the bigger picture. 

I think my child might have an ASD – what should I do?

First, try not to worry. With the right diagnosis, you and your child will be able to get the help and support that you both need.

It is important that you have a multidisciplinary team (MDT) - including you - to gather the right information about your child as no person alone, or single ‘autism-specific assessment tool’ should be used to diagnose autism.

NICE guidelines recommend every autism diagnostic assessment should include:

• a detailed case history including experiences in home life, social and educational settings.

• medical history and physical examination

• assessment of social and communication skills and behaviours

• a comprehensive assessment to support differential diagnosis and/or to identify other conditions that may co-exist with autism, such as a learning difficulty, ADHD or mental health issues.

Once this has been completed, the findings should be shared with you to help you understand your child’s underlying difficulties and to include you in the discussion about the right diagnosis for your child.

Who is involved in supporting an ASD diagnosis?

Your team should include a Paediatrician and/or child and adolescent Psychiatrist, Speech and Language Therapist, Clinical and/or Educational Psychologist and there should be regular access to a Paediatric Neurologist and Occupational Therapist .

The importance of differential diagnosis

ASD is a lifelong diagnosis so it is important to make sure that your child’s difficulties are not better explained by any of the following:

• Neurodevelopmental Disorders (e.g. developmental language disorder, learning difficulties, global developmental delay)

• mental and behavioural disorders (e.g. attachment disorders, ADHD, OCD, mood or anxiety disorders)

• conditions that present with developmental regression (e.g. Rett Syndrome or epileptic encephalopathy)

• other conditions (e.g. severe hearing/visual impairments or selective mutism)

Of course, your child is at the centre of all of this and it should not be a box-ticking exercise. Making sure that your child is assessed holistically (not just focusing on the difficulties) will ensure the appropriate multidisciplinary decision is made whatever the final diagnosis.