How Is Autism Diagnosed? (Part One)

So, how is Autism diagnosed?

Psychological therapy

Until recently, autism spectrum disorders (ASD), including Aspergers Syndrome, have been understood as a range of complex neurodevelopment disorders—characterized by social impairments, difficulties in verbal and non-verbal communication, and restricted, repetitive, and stereotyped patterns of behavior.

Changes in definition have been proposed and accepted by different organizations and groups in the United States and other parts of the world. The changes have been discussed in other posts; meanwhile, I will address how autism is diagnosed.

At the present time, a single test to diagnose autism does not exist. We do know that a biological or single genetic marker has not been identified, thus, autism cannot be diagnosed with a blood test or imaging studies. It is rather a diagnosis that is primarily identified by behavioral and developmental differences.

How to Expand A Picky Eater’s Diet: Feeding and Food Chaining

Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face. Feeding issues are especially common in children with autism, including those with Aspergers, because of difficulties with sensory processing. In many cases, this leads to eating challenges at mealtimes.

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“Food chaining,” from the book by the same name, is based on the child’s natural preferences and successful eating experiences—specifically the idea that we eat what we like. Food chaining introduces new foods that have the same flavors or sensory features as foods that are already preferred by the child, increasing the likelihood that the child will like the food.

What Are School Accommodations and Modifications for Students with Asperger’s?

Some students with disabilities require accommodations or modifications to their educational program in order to participate in the general curriculum and be successful in school. Each child with autism or Asperger’s Syndrome is different and has their own unique needs. Parents will meet with school personnel in an ARD/IEP meeting to determine what accommodations and modifications should be implemented to best assist their child. It is imperative that parents and educators understand the difference between the two.

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For many students with Asperger’s Syndrome, accommodations will be needed to access the curriculum and remain in the least restrictive environment. Accommodations (the HOW) can be made for any student. Students do not need to have a 504 plan or an IEP.

Accommodations do not alter what the student is expected to learn but rather make learning accessible to the student. They allow the student to demonstrate what they know without being impeded by their disability. Students are required to complete the same assignment or test as other students, but with a change in the timing, formatting, setting, scheduling, response and/or presentation. They do not alter in any way what the assignment or test measures.

How to Use Visual Supports for Social Skills Training

Many school students carrying the diagnosis of Asperger’s Syndrome exhibit challenges in the area of social interactions and social skills. These social difficulties are worrisome for parents and family members who look for supports to address these challenges. Struggles in the school setting often center on their child’s inability to “fit in” with other students or an inability to grasp social expectations from their teachers and peers. Additionally, their child’s feelings of high anxiety and stress can make the learning environment challenging for them and the people around.

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Over time, I’ve listened to concerns from parents and teachers regarding a student’s lack of understanding when it comes to social situations in the classroom environment. This often leads to isolation and the need for behavior support.

There is information in the literature that suggests both adult and peer mediated techniques to teach and build social skills in children with autism.  Strategies that are directed by an adult include reinforcement of shaped social skills where the child is reinforced when he or she demonstrates closer and closer approximations of a desired behavior. Peer mediated strategies incorporate the use of proximity, prompts with reinforcement and teaching peer initiation. The literature also supports using social scripts to capitalize on visual learning methods (Krantz and McClannahan 1993).

In my experience, I’ve observed how visual supports can be very beneficial in producing non-transient messages for the student to follow and use during social situations.  When paired with direct instruction using applied behavioral analysis techniques like shaping and reinforcement, social skills training can be accomplished.

The Pathways to Diagnosis

Interdisciplinary Autism Assessments

For individuals on the autism spectrum, a diagnosis from a medical professional is necessary in order to qualify for medical services. One main difference in the assessment is in how the child is evaluated and whether the evaluation is done by an individual or a team.

Interdisciplinary Autism Assessments at ACN

At ACN, we conduct interdisciplinary autism assessments where a number of specialists participate in the evaluation and all of them are present at the same time from start to end.

The team consists of a developmental pediatrician or psychologist, a behavior analyst, a speech-language pathologist, and an occupational therapist. We believe that a comprehensive evaluation gives parents a clearer sense of the skills and deficits in their child and a clearer direction for seeking therapies.

The following is an illustration of the pathway to a diagnosis at ACN:

Are People with Aspergers as “Logical” as They Think?

Balancing the left and right brain: the role of emotion and mood

One of the hallmarks of Asperger’s Syndrome (AS) is that individuals often have strong points of view, and they have trouble seeing other points of view as equally valid. Most see themselves as extremely logical and therefore right in their conclusions; for them, the points of view of others can seem illogical. This is often perceived by neurotypicals as being oppositional, stubborn or lacking empathy.

Brain hemispheres sketch

What’s interesting is that often when people think they’re being logical, research shows that their emotions can be driving their cognition. Emotions are frequently substantial influences in people’s thinking without their knowing it. In his eloquent writing for Linked In, Kristopher Jones makes clear what is my experience as well: people with AS can have very strong feelings.

How to Deal with Sensory Processing Difficulties in School

Many children with sensory processing disorder or related issues can have difficulties in the school setting. Problems can arise anywhere: in the classroom, cafeteria, gymnasium, hallway, playground, and even the bus. Some of these issues can be as subtle as not eating lunch, or as difficult as destroying a classroom.

Knowing what causes these problems and how to prevent them is important for both the school and the child. This is where parents can be the best advocate for their child with Aspergers or HFA and sensory issues.

Preparing a child for school is important, but it is equally important to prepare the school for the child. Sharing their sensory concerns with the teachers, para-professionals, principals, and others is imperative to limiting sensory difficulties in the classroom.

Aspergers is Not the Same as ODD (Oppositional Defiant Disorder)!

People with Asperger’s usually collect labels like ADHD, anxiety disorders, or bipolar disorder before they’re diagnosed with AS. The label that annoys me is Oppositional Defiant Disorder. Is there a difference between people whose Asperger’s-related behavior is misunderstood and ODD? I find that ODD is sometimes simply a description of behavior without a cause.

Insurers ask for diagnoses based on ICD 10, the “handbook” of diagnoses. One of the official ICD 10 descriptions of AS is that it’s a “neuropsychiatric disorder whose major manifestations is an inability to interact socially; other features include poor verbal and motor skills, single mindedness, and social withdrawal.”

ICD 10 describes ODD as a behavior disorder and a psychopathological disorder. It’s described as a “recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures.”  The criteria include “frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with requests or rules of adults, deliberately annoying others, blaming others for own mistakes, and being easily annoyed, angry or resentful.”

ICD 10 is right in my experience in describing those with Asperger’s Syndrome as “single minded.” This is a real strength when doing tasks, following rules and being honest. However, single mindedness can also include inflexibility or even severe rigidity in sticking to a point of view.

Transitioning to Adulthood with Aspergers

Individuals diagnosed with Aspergers or another autism spectrum disorder (ASD) may be presented with many challenges throughout their lives—especially during the transitional periods.

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As the individuals age and learn to use different skills in various environments, families, educators, medical professionals and the individuals themselves begin to anticipate the transition to adolescence and, eventually, to adulthood. Given the differences in abilities and behaviors that many individuals with Aspergers or HFA experience, it can often be overwhelming to plan for tomorrow much less several years later.

Living in the Gray Area: Using FLoortime as ABA Tactic

Once a child is becomes more competent in his or her ability to think multi-causally, the next focus of higher level social-emotional thinking is the capacity to understand the gray areas of life.

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Adolescents and young adults with Aspergers or HFA are especially prone to hitting an emotional rut when speaking in terms of “never” and “always”—hallmark terms associated with “black and white” thinking. “He never calls on me during class” or “She always gets to play the game first” are common phrases that parents or peers hear when the speaker’s ability to think and feel in more varied degrees is constricted. Not only is this harder to negotiate socially for the interactive partner, but it’s not a very fun state for the black and white thinker either.