The Signs of Autism in Children

The signs associated with autism fall into two broad areas:

1. Impaired social interaction and communication

2. Restricted and repetitive behaviors and interests

As autism is a spectrum disorder, the signs of autism vary in different individuals. The common signs and symptoms of autism are:

• Lack of social or emotional exchanges like pointing, smiling, showing you things

• Lack of non-verbal communication such as nodding and shaking head, using hand gestures

• Difficulty developing and maintaining relationships appropriate to the age, such as peer play, lack of close friends

• Delayed expressed speech and understanding of speech

• Lack of eye contact when speaking

• Loss of language skills at any age

• Excessively following routines, patterns of behavior, and becoming distressed at changes

• Stereotyped or repetitive speech, movements or use of objects, such as rolling wheels before eyes, flapping hands, toe walking

• Strongly reacting to sensory input such as sound, pain or textures

• Restricted or fixated interests such as only playing with certain toys or discussing specific topics

• Being aggressive toward other people or self

What causes autism?

We know that there’s no one cause of autism. Research suggests that autism develops from a combination of genetic and nongenetic or environmental influences.

Research tells us that autism tends to run in families. Changes in specific genes increase the risk that a child will develop autism. Other factors that increase the risk of autism are advanced parental age and pregnancy and birth complications.

It is important to remember that increased risk is not the same as cause. For example, some gene changes associated with autism can also be found in people who don’t have the disorder. Similarly, not everyone exposed to an environmental risk factor for autism will develop the disorder. In fact, most will not.

Referral process

Manor Clinic provides autism assessment services for children, adolescents and adults. We accept referrals for autism diagnosis from a wide range of professionals, including the child’s pediatrician, family physician, psychiatrist, psychologist or social worker. We prefer to have a referral so that the important professionals involved in the child’s care can be roped in to offer multi-disciplinary support. We also accept direct referrals from families for the autism assessment.

How is Autism diagnosed?

There is no single test or examination for diagnosis; instead, a broad range of information is considered. This condition is diagnosed clinically based on information gathered from a comprehensive psychiatric evaluation, physical examination (if needed), and the observation of specific characteristic behaviors.

Manor clinic provides comprehensive multidisciplinary autism assessments using standardized gold standard assessment tools like the Autism Diagnostic Interview-Revised (ADI-R) or Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Our experienced multidisciplinary autism assessment team includes a psychiatrist and an autism consultant/psychologist.

Manor clinic will provide screening questionnaires to the parents. These screening questionnaires need to be completed before the ASD assessment meeting.

The assessment is completed over two to three appointments.

Meeting with autism consultant/psychologist:

This meeting could happen over one or two sessions. This assessment focuses on eliciting core symptoms of autism and observing specific characteristic behaviors by using one of the comprehensive interview tools like the ADI-R or ADOS-2.

1st Interview: Depending on the child’s age, this interview is arranged with or without parents.

2nd Interview: The second meeting is arranged with parents without the child.

Each appointment could last for up to 120 minutes.

Psychiatrist interview:

This interview is for comprehensive psychiatric evaluation. One or both the parents and the child will meet the psychiatrist. Parents can invite anyone else (e.g. other family members) to this meeting. Each evaluation is different, as each child's symptoms and behaviors vary. When making an ASD diagnosis, a psychiatrist will consider and assess the child for other disorders that might overlap or mimic ASD symptoms. The evaluation depends on the child’s age and may include (where relevant) child’s:

• mental health symptoms and experiences

• previous diagnosis

• prescribed medications

• blood or radiological investigations

• feelings, thoughts and actions

• physical health and wellbeing

• housing and financial circumstances

• schooling and training needs

• employment

• social and family relationships

• culture and ethnic background

• gender and sexuality

• use of drugs or alcohol

• safety and safety of others

Parents and children only have to talk about what they want to talk about.

In this meeting, the psychiatrist will also discuss the outcome of the assessment with the parents and child to explain whether the child has autism or not. A written copy of the report will be provided to identify any inaccuracies. Once the parents accept the report, the assessors will send a copy of the finalized report to the referrer.

If the child has autism, you will be provided:

• Information about what autism is and what it might mean for the child and their family, now and in the future.

• Information about supports available for the child and their family.

If the team does not think the child has autism, the psychiatrist will explain how the team reached this decision. The psychiatrist can provide information about any other mental health conditions that the child could have and where the family can get the necessary support.

Supports and treatments for individuals with autism

While there is no cure for autism, there are a wide variety of interventions, treatments, and therapies that have shown success in reducing symptoms and improving the quality of life for children who live with this disorder and their families. A treatment plan depends on the child’s needs, given the spectrum of the disorder.

Typically, interventions address one or more core areas of functioning:

• Social skills

• Communication skills

• Cognitive skills

• Academic skills

• Behavioral skills

Interventions to address comorbid mental health problems (like anxiety, depression, ADHD, behavioral problems/temper tantrums, trauma-related symptoms etc.):

• Psychological therapies like Cognitive-behavioral therapy (CBT), Family Therapy (FT), Eye Movement Desensitization and Reprocessing (EMDR), Social Skills Training, Anger Management training and Emotional Regulation Skills training can be offered after the assessment.

• Pharmacological interventions: No Biomedical (pharmacological, physical and dietary) interventions have been effective in treating the core symptoms of autism. After the assessment, pharmacological interventions (medications) informed by existing standardized guidance (like CANMAT or NICE) for the specific disorder will be discussed for children with comorbid mental disorders.