MANHATTAN, NYC AUTISM SPECTRUM DISORDER
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Autism Spectrum Disorder or ASD is estimated to affect one in 54 children in the United States alone, according to a 2020 finding by the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network. Yet despite its prevalence, autism is also often misunderstood.
One such misconception is about the nature of the disorder itself. Because autism affects social and communication skills, it is often assumed that it is a learning disability.
What is Autism Spectrum Disorder?
Autism is a neurodevelopmental disorder that affects social communication and interaction and involves restricted and repetitive behaviours. People with autism will often have trouble with joint attention, responding to social situations, and using verbal and nonverbal communication. However, children can be social and still have autism. They also manifest sensitivity to sensory input as well as restricted and repetitive actions or activities, such as repetitive speech, motor movement, and use of objects.
Autism is a lifelong condition, and its causes are not entirely known. It can sometimes run in families, but other possible reasons include:
- genetic differences or mutations
- differences in brain development and function
- exposure to harmful chemicals or materials in the environment (dietary factors, drugs, and toxic chemicals)
Common Challenges for People with Autism
Individuals with ASD often share the same behaviours and traits that lead to similar challenges. However many of these are not diagnostic features of autism (see below). These challenges include:
- Social skills difficulties: A person with ASD will often struggle to understand unwritten social rules and read and respond to nonverbal cues, such as body language and facial expressions.
- Sensory processing: Processing sensory information can be difficult for a person with autism. Some may seek out certain sensations, while others may have aversions and sensitivities to light, sound, touch, taste, and other senses. Difficulties with sensory processing often lead to sensory overload and meltdowns.
- Struggles with executive functioning: Executive functioning refers to the mental skills and processes that allow individuals to plan and execute tasks, focus, and follow and remember instructions within the context of getting something done.
- Trouble with motor skills or motor planning – Motor skills are a trouble spot for people with autism, making them seem uncoordinated. Children with ASD may be showing difficulties with handwriting and physical activities and exercises, such as riding a bike, running, or playing catch.
- Language and communication difficulties: In many instances, language development problems are among the early signs of autism. Individuals with autism typically struggle with self-expression and engaging in conversations.
Signs and Symptoms of Autism
Young children can exhibit signs and symptoms of autism. However, in some cases, these go unnoticed until they start attending school. As individuals age, the symptoms may change, but the core features of ASD remain. These are:
- impairments in social communication
- impairments in language and related cognitive skills
- behavioral and emotional challenges
According to the American Speech-Language-Hearing Association, these core features of ASD are heavily influenced by the severity of the disorder and developmental level of language acquisition. These include pre-symbolic, emerging language, and conversational language. A person with autism may also experience sensory and feeding challenges.
The signs and symptoms of autism fall under communication, social skills, and behavioral challenges. These include:
- trouble with understanding and using gestures (pointing, waving)
- difficulties with understanding and using words and following directions
- problems with reading or writing
- struggles with conversations (hard to understand, use a robotic or singsong speaking voice, barely talks or not at all)
- repeats words or phrases they have heard recently (echolalia)
- uses challenging behaviors to express what they want instead of speaking
- difficulties with sharing attention or focusing on the same object or event
- does not participate in group activities like playing or sharing toys
- unable to respond when invited to play or join conversations
- struggles to make and keep friends
- trouble with taking turns in play or conversation
- repetitive behaviours or actions, such as hand or body movements
- unexplained bursts of emotion (crying, laughing, or becoming angry for unknown reasons)
- reacts negatively to certain sounds, smells, or textures
- picky eating or chooses food based on the look, colour, or texture
- struggles to move on from one activity to the next
- shows interest in only a few objects or topics
Diagnosing Autism Spectrum Disorder
Diagnosing ASD requires interdisciplinary collaboration and the active involvement of the family. A speech-language pathologist (SLP) plays a key role during the assessment, together with a pediatrician, pediatric neurologist, and a developmental pediatrician. During the evaluation, the following must be identified before a diagnosis can be made:
- presence of co-occurring conditions or deficits, such as developmental disabilities, genetic syndromes, or hearing loss
- limitations in activity and participation, particularly with communication in everyday contexts
- contextual factors, which may be environmental or personal, that directly affect the child’s success in communication and life participation
- the impact of communication challenges on the child’s quality of life
During the evaluation process, the role of an SLP centres on observing and taking note of the child’s spoken and written language skills (when appropriate) and social communication. A speech-language pathologist then conducts a comprehensive speech-language assessment that includes speech and language skills testing, feeding and swallowing, and augmentative and alternative communication (AAC).
As a neurodevelopmental disorder, ASD is a lifelong condition with no known cure. But like many other disorders, an early and accurate diagnosis can make a significant difference in addressing the condition. Recognizing the disorder early on can help families access appropriate resources, such as special education services and learning programs. Early diagnosis can also help families and caregivers establish a system that allows them to understand and manage the child’s difficulties.
Treatment for Autism Spectrum Disorder
Besides special educators, psychologists, and pediatricians, an SLP plays a crucial role in the treatment and management of ASD. Primarily, SLPs can work with the child to improve social and communication skills to ensure their success at home, school, and later life.
Following the 2001 World Health Organization guidelines, autism treatment is designed to:
- build on the individual’s strengths and address weaknesses related to autism’s core features
- provide activities and encourage participation by introducing new communication skills and strategies and modifying existing skills and behaviours
- change contextual factors to reduce barriers, improve avenues for successful communication and participation, and identify appropriate accommodations.
For ASD, the primary goal of treatment is improving social communication and language skills as well as managing or modifying existing behaviors. These are all key in making sure the child is not hindered from developing and maintaining relationships, succeeding in social settings, and being actively involved in daily life.
More specifically, an SLP may work with the child to improve the following skills:
- understanding and using appropriate verbal and nonverbal communication behaviours
- social interaction in different settings or situations
- taking turns in conversation
- moving on and transitioning to the next task
- reading and writing
- adaptability to changes and expanding interests, such as trying new foods
Manhattan Letters ASD Diagnostic Assessment
At Manhattan Letters, we work with a team of licensed clinical psychologists and neuropsychologists who can provide you with a comprehensive ASD assessment for your child or family member. Here are some frequently asked questions regarding ASD assessment:
- Who should undergo a diagnostic assessment of Autism Spectrum Disorder (ASD)?
Individuals of any age and functioning level can be assessed if they or their parents are concerned they might be showing signs and symptoms of ASD.
- What does a diagnostic assessment involve?
A diagnostic assessment involves a detailed parent interview, during which the individual’s history of social behavior, language and communication, and interests and behavior are discussed. This is generally followed by an IQ test to determine intellectual strengths and weaknesses. Our licensed child psychologist, Dr. Kessler, will then administer the ADOS (Autism Diagnostic Observation Schedule), which is a semi-structured evaluation of characteristics of Autism Spectrum Disorder (ASD). Language testing and a school observation may also be conducted as part of the evaluation. Once these steps are completed, our specialist will meet with you to discuss the results and provide recommendations.
- How long does an assessment take?
A diagnostic assessment can be completed over the course of two to three office visits, each one to two hours in duration. For adults, an evaluation can often be completed during one day.
- What happens after the assessment is complete?
Doctor Kessler compiles the results into a confidential report. This report can be shared with any one of the parent’s choosing. The report will also include recommendations for treatment.
Dr. Kessler provides diagnostic evaluations for individuals of any age concerned about a possible autism spectrum disorder (ASD). Parents are initially interviewed regarding their child’s early developmental history, the history of the problem, and current concerns. The child is then administered a developmental or IQ test, depending on their age, and the Autism Diagnostic Observation Schedule (ADOS). In some cases, a school observation is also recommended. Dr. Kessler then meets with parents to discuss the results of the evaluation and make recommendations for how to proceed.
We provide social skills training.
SPEECH LANGUAGE THERAPY
PROVIDED BY LICENSED SPEECH LANGUAGE PATHOLOGISTS
One of the hallmarks of Autism Spectrum Disorders is difficulty with language and communication, negatively affecting the child’s social functioning. Our intervention primarily targets social speech in naturalistic settings: entertaining games, activities, and play. For toddlers and preschoolers, play is the most important teaching tool when targeting social speech. Improving the right play skills increases social attention, also known as joint attention, the building block for social reciprocity. For school age children, goals may include explicitly teaching social rules, e.g. conversation starters and killers, reading non-verbal communication, e.g. what does it mean when someone frowns and crosses their arms, teaching what others may be thinking, providing skills to deal with classmates etc., and ideally practicing these social skills in small groups. We also work with siblings and transfer goals from therapy into your home.
COGNITIVE BEHAVIORAL THERAPY
PROVIDED BY DR. KESSLER
Cognitive Behavioral Therapy, also known as CBT, is often helpful to individuals with ASD who are struggling with their social behavior and emotions. Individuals who have trouble knowing how to behave or managing their behavior in social situations can benefit from CBT, as can individuals who have difficulty managing intense emotions. CBT typically relies on parent involvement to allow the child to generalize what they learn in therapy to their everyday life.
PROVIDED BY DR. PATEL
Individuals with Autism Spectrum Disorders often have difficulty with sensory processing, self regulation, motor planning, and fine/visual motor skills. Occupational therapy intervention primarily focuses on assessing the child’s individual sensory processing skills in relation to everyday functional living skills. Assessment also involves assessing all other areas of occupational therapy s domain, including activities of daily living, play skills, social skills, and motor skills. For toddlers and preschoolers, intervention would include parent education, home programs, sensory diets if necessary, and targeting the individual needs of each child to develop foundational skills needed for the child’s everyday functioning whether that be in a sensory gym setting or in the home. For school age children, goals may include social skills, functional writing skills, or activities of daily living as it relates to school, home, and community performance. Individual occupational therapy sessions are also provided in a sensory gym for families who are interested in having access to specialized therapeutic equipment to target sensory processing skills. Consultation is also provided to families who currently are receiving services and would like strategies to be integrated in the home and community.