Archive of ‘Autism’ category
Hello, my name is Felisha Thomas and I work as a behavior therapist in a public school.
Therapists and teachers use ABA to help work with children. ABA stands for Applied Behavioral Analyst. This means the science of behavior. ABA is not just for children with autism. ABA is used to help all children with their behaviors.
Therapists and teachers learn ABA in school. They learn about the 3 ABCs of behavior.
- Antecedent: what are they doing before the behavior?
- Behavior: what are they doing?
- Consequence: what are they doing after the behavior?
Therapists and teachers use ABA for lots of things.
Help children make better choices throughout the day.
- Help children who are sad.
- Help children who are mad.
- Play with children at the playground.
- Keep children safe.
- Help children follow directions in class.
- Help teach children the rules.
- Help children learn the class lessons.
Therapists and teachers go other places outside of school to help children too.
- We go to museums.
- We go to zoos.
- We go to parks.
- We go to the pool.
- We try to help children anytime there is a need.
Therapists and teachers are friendly. We let children know that we are their friends who like to help.
For more information on ABA therapy, see ABA in Classroom Settings.
SKEPTICAL CHILD BY ARIESA66 LICENCED UNDER CREATIVE COMMONS CCO
I am a developmental-behavioral pediatrician in training. I am often asked to see children for concern about autism spectrum disorder (ASD). During my visit, I watch how children behave. I then decide if ASD is the diagnosis that best fits their behavior. I see children of all ages. This is about children less than age 3.
Why Toddlers are Different
Children with ASD tend to respond better to treatment when they are diagnosed early. (National Research Counsel, 2001). Many children can be diagnosed as young as 18 months of age. But most children are diagnosed between 3-4 years of age (Filipek, 1999).
One reason is because the early symptoms are hard to see. Some of the best-known symptoms may not show up until a child is older. These include flapping their hands and repeating parts of TV shows.
Toddlers with ASD often don’t learn the skills they need to interact with others. Children who are behind in just their ability to use language still try to interact. They will often use eye contact and gestures to work around their struggles. Children with ASD have trouble with this.
Here are some free websites and videos to help anyone who cares for young children. This information shows what we call the “red flag signs” for ASD.
Symptoms of Autism Spectrum Disorder
The website Autism Navigator talks about the early signs of autism. There is a free course with videos about toddlers with ASD. You have to register to use the site. They also have a list of red flag signs for toddlers. These include:
- not looking at someone when their name is called;
- not showing others objects they like;
- not sharing their interests with the ones they love;
- not making eye contact; and/or
- not using gestures to let people know what they want.
There are other resources on this website. However, not all of them are free.
How a Toddler with ASD Might Look
Here are some videos from the Centers for Disease Control (CDC) showing how a toddler with autism spectrum might look. There are also toddlers that do not have the warning signs of autism. This enables you to see how they differ. All the videos are on the CDC video library. Some of the videos are linked below.
Looking at someone when their name is called
Here is a video of a 12-month-old who responds to his name by looking at his mother and smiling. He also points at her. This is what we expect a toddler to do when their name is called.
12-month-old looking when called
Here is a video of an 18-month-old not looking at his mother when his name is called. A toddler who can hear should look when his name is called.
18-month-old child not looking when called
This video shows a 13-month-old stacking cups. He involves his father and gives him the cups. Many toddlers seek out their loved ones when playing.
13-month-old toddler playing with father
Here is a 17-month-old toddler who is not showing pretend play with a phone. He also does not copy the adult when she tries to show him how to use it. These are both warning signs of ASD.
17-month-old toddler not showing pretend play
Twins and a train
The last video shows a set of twins, who are 19 months old.
- The first one does not have signs of ASD. He likes to push the train back and forth with his mother.
- The second twin does have signs of ASD. He needs to be asked to push the train. He also does not seem to enjoy playing with his mother.
19-month-old twins pushing train
The Importance of Those Who Care for Children
Parents and early-childhood workers interact with young children the most. They often are the first to know something is wrong. They can be important to get a child with ASD the help they need. These links and videos can help anyone who is interested better know the warning signs for ASD.
Filipek, P. e. (1999). The screening and diagnosis of autism spectrum disorders. Journal of Autism and Developmental Disorders, 439-484.
National Research Counsel. (2001). Educating children with autism. Washington, DC: National Academy Press.
As of 2012, autism can be found in 1 in 68 children. 1 It was noticed that boys are more diagnosed than girls (1 girl to every 4-5 boys). 1 Is autism really more common in boys than girls? Or are we missing autism in girls?
Autism in girls can be hard to see. Girls with problems dealing with people can be seen as shy. They may live for years without knowing they have autism. This delays diagnosis and treatment. Boys are noted earlier than girls by 2 years.
Most of the time, a child with autism has problems dealing with people, and has repetitive behavior. Girls are aware of these problems but they are good at hiding them. Girls with autism want to deal with people, but don’t know how. They may start copying what others do. ‘They pretend to be normal’. 2 Girls with autism get tired from copying. “It is like math all the time”.2
Unlike boys, girls don’t flap their hands or jump all the time. They may not play with wheels of cars or trucks. These are other reasons for the delay in diagnosis.
Some teen girls love numbers and focus on their weight. They start counting every food they eat. This may end up having an eating problem. An eating problem may be a ‘face’ of autism in girls. Girls with an eating problem and girls with autism have similarities. They are both rigid, love details, and hate changes. Some children with autism are picky eaters with a strict diet.
Autistics can’t read between lines. Girls miss that someone is creepy. They are more at risk for abuse and taken advantage of.
Girls with autism want to make friends. They play with regular toys (dolls or Barbie). They have fewer behavioral problems. They have fewer repetitive moves. They are more at risk for feeling down or worried. They are more at risk for abuse
Girl with autism will need special help. Girls benefit from social groups that teach them how to:
- take care of themselves;
- be appropriate when dealing with people;
- make friends; and
- protect themselves from abuse. 3
If you would like to read more about this topic:
- Journal of Autism and Developmental Disorders October 2016, Volume 46, Issue 10, pp 3281–3294, The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype Authors: Sarah Bargiela, Robyn Steward, William Mandy , http://link.springer.com/article/10.1007/s10803-016-2872-8
- Autism—It’s Different in Girls. New research suggests the disorder often looks different in females, many of whom are being misdiagnosed and missing out on the support they need by Maia Szalavitz on March 2016, https://www.scientificamerican.com/article/autism-it-s-different-in-girls/
- Attention Finally Being Paid to Girls at Risk of AutismSomer L. Bishop, PhDa, Jeremy Veenstra-Vander Weele, MDb, , , Stephan J. Sanders, MD, PhDa, http://www.jaacap.com/article/S0890-8567(16)00008-3/abstract
- Autism Behaviors May Differ in Boys and Girls. Study also found gender differences in brain of children with the disorder. By Tara Haelle, https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/autism-behaviors-may-be-different-in-boys-and-girls-702957.html
Hey, my name is Sara. I’m Autistic. I have other Disabilities too. I like to say a laundry list of them. I’m going to talk about Autism and grad school here. And why I’m going. And how long it took me to get a regular college degree, and why.
I’m scared. I feel like graduate school will be a next level to regular college. I have trouble with organization. I have trouble with time management. Depression makes me tired and low energy.
I have already been talked to about going off topic in class in the first week. It wasn’t really off topic. The rest of the class and the teacher can’t see the patterns I see and how all of it was connected. I think another Autistic would have. The teacher was nice about it.
A classmate talked to me too. I thought she was being nice, then I wasn’t sure. I took it as I heard it, and then I started to wonder. Was it about my ‘lack of social cues’ or about their lack of comfort? The thing about Autism is I can’t know which it is. If I asked, would people tell me the truth or not? Thinking about this kind of tiny little social lie makes me crazy. It feels like betrayal to tell them. But people do it all the time. I can’t tell them or know when to tell them or when not to. Wouldn’t it be better if we all just didn’t? How is it polite? Makes me feel even more apart.
When I get in to school early, I take time to separate off and play simple games on the iPad or iPod to relax my mind and be less affected by lights and sound. So I can have enough energy reserved for getting through classes.
The next week, I got things said to me I’ve heard before, but are never easy to hear and are never cool. I hate hearing them. They make me feel not.
- Not Autistic enough.
- Not Disabled enough.
- I don’t need help.
- I don’t need support.
- I don’t
- Not as much as others, so it doesn’t
Life isn’t a competition. It hurts even more because my mother always compared my and my brother’s levels and types of Disabilities. If you don’t ‘look Disabled’ or ‘act Disabled’ then you always seem to get doubted, and people get mad at you. Like there’s a pot of Disability to reach into and smear across your face.
- I wish my child was able to do all you can.
- You need to understand not everyone is like you.
- My child is so much more
- My child is much lower
- If my children could just sit there, their lives would be amazing.
Way to suck the worth from my life. I am not here to be compared to. I am a person all on my own. This needs to be. I need to be. I am made less human if not. I wrote a poem about all this.
Here. This video will help. It’s called “Shit Ignorant People Say to Autistics.” Maybe you can relate. I love this video. It always makes me laugh and nod along.
Cultural beliefs may play a part in diagnostic disparities.
I try to remember when my son began to lose words. It seemed like I always knew how to reach him. I mean, yes, he had tantrums. He was a baby; you know? Besides, he was a boy, aren’t boys a little slower to develop? And his older brothers are quiet…we all are.
When my sister-in-law approached me about his development, I was stunned. Of course he talks. He talks all the time. At least that is what I heard myself say. Didn’t he? The more attention I began to pay, the fewer “I love yous” I heard. I know he used to call me Mommy. When did he begin to just stare out into… nothing? Joshua was moving backward, regressing. A well-check visit with his doctor sent my world into a tailspin. Just one word: Autism. That was almost seventeen years ago.
I have worked as a behavior therapist for nearly three years now. In that time, I can count the number of African American children I have serviced on one hand. That is not to say that autism does not affect African American children. It is just to say that I serve a larger population of non-African American clients. As a mother of an African American young man diagnosed with autism, this is concerning. Why are we not seeing more African American families seeking therapy? Is it because of barriers to quality medical care? Is it because of lack of financial resources? Or could it be cultural beliefs? Statistics bear out one fact…African American children are being diagnosed later than their counterparts.
National statistics state that Autism Spectrum Disorder (ASD) affects 1 in 68 children today. This diagnosis affects boys nearly five times as often as girls. It is not determined by race. It is not determined by where you live. It is not determined by how much money you make. It is an equal opportunity disorder being diagnosed across these factors. However, when you get diagnosed is a factor that can have a profound impact on a child’s development. Early diagnosis and therapies to support language, communication, and social-skill development are important. These have been shown to strengthen speech, relationship building, and interaction with others in a meaningful way.
African American children statistically are diagnosed later than their counterparts. Because of this, they often miss opportunities for early intervention. The failure to access services during early childhood can require more intensive and extended therapies later in life.
Statistics show African American families often have fewer resources. These could be financial, access to care, or social supports. Education about this diagnosis can be a powerful tool in closing the diagnostic gap. Recognizing early signs of autism can help parents identify possible red flags. The Centers for Disease Control “Know the Signs Act Early” campaign provides important information. Their brochures highlight developmental milestones as well as developmental delays to watch from birth to age five.
Below are some red flags from the CDC that parents should know. For more information, visit “Facts About ASD” on the Centers for Disease Control web site.
Some signs about children with ASD include the following.
- They may not point at objects they are interested in. (for example, not point at an airplane flying over).
- They may not look when you point at objects.
- They may show no interest in others.
- They may not look at you when you speak.
- They may like to be alone instead of with others.
- They may have a hard time understanding emotions. (for example; sad, happy, scared, angry, etc.)
- They may have a hard time saying what they feel. (for example; they are sad, happy, scared, angry, etc.)
- They may not like being hugged.
- They may look as if they are not paying attention when people talk to them.
- They may have a hard time talking to others.
- They may have a hard time playing with others.
- They may say the same thing over and over.
- They may have a hard time letting others know what they need.
- They may not play “pretend” games. (for example, not pretend to “feed” a doll)
- They may do the same thing over, and over again
- They may need to have things done the same way every time.
- They may have a hard time when things change.
- They may act unusual to the way things smell, taste, look, feel, or sound.
- They may stop doing things they once did. (for example, stop talking, playing with others, etc.)
Source: Centers for Disease Control and Prevention, 2016 – See footnote.
The information above does not address potential factors for diagnostic disparities suffered by African Americans. It can, however, bring awareness of potential signs of autism. This awareness can help families bring concerns to their pediatrician’s attention. Knowledge is power. Early detection and intervention can make a significant difference.
Today, my son is preparing for adulthood. We are working on vocational training with hopes of transitioning to college with educational supports. Is his story typical? Who knows? But shouldn’t it be?
For more information, see the resources below.
Centers for Disease Control and Prevention. (2016, March 28). Autism Spectrum Disorders (ASD)/Facts about ASD. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/autism/facts.html
I work with families who have young children with autism spectrum disorder (ASD). Parents interface with Early Intervention, public schools, and pediatrics. For a person with autism, age 22 marks the end of many childhood services. But autism doesn’t go away at age 22. One transition is the switch from child doctor to adult doctor. This can be a difficult task. Adult doctors often have little training in ASD. As a result, they may not be familiar with autism-related issues.
ASD service systems reflect the idea that it is a childhood disorder. Yet autism is lifelong. The rate of autism diagnosis is increasing. Children with ASD grow up to become adults with ASD. Our service systems need to catch up. We need to advocate for systems that better serve people throughout their lives. This includes better training for adult doctors. Recent studies show that adult doctors don’t have enough autism knowledge. The good news is that they seem interested in learning.1
Why is this important?:
- Some health conditions maybe related to autism, or they may not It is important for the doctor to know the difference.
- People with autism may require unique needs for doctor’s visits.
- Primary care doctors should be familiar with ASD services. This way, they can make referrals as needed.
- Primary care doctors need to look at the big picture to provide good care. This includes things like housing, social life, family, and job. The doctor needs to understand how ASD impacts a person’s life.
- A good primary care doctor can be an important advocate. He or she can help a patient access services.
How to find an adult doctor who understands autism:
- Sarris, Marina. The Challenge: Finding Health Care Providers For Adults with Autism. Interactive Autism Network at Kennedy Krieger
Institute. 8 April 2016. https://iancommunity.org/ssc/finding-health-care-providers-adults-autism
A Shopping Trip
Joshua and I enjoying a trip to Ellis Island. Being in crowds can be hard for Josh for lots of reasons, but practice is making it easier!
At age fourteen, my son had begun to express a desire to show his individuality. It is something that most teenagers go through. Suddenly, they want to pick out their own clothes. They want to try new hairstyles.They want to explore their own individual taste in music. In short, they want to try all things cringe-worthy to parents. My son is autistic. Up until that point, he had shown very little interest in things most preteens and teens do. He wasn’t into the current fashions other than what I bought. He wasn’t into confusing adults with slang. He wasn’t into blasting Richter scale registering music. So, when he asked me to take him shopping, I was excited and somewhat scared. He was becoming… a typical teenager. This was something I had not thought would happen. Not because I did not believe he would grow up and become a teenager, I did. But because looking at him through a lens of autism, I was not sure what to expect. I could not read his social cues; I did not know what would be next. I did not know whether he would continue to show delays in certain areas. I did not know if he would suddenly show interests that were not there before. That may sound simple, but trust me, it’s not. Like a lot of parents, I stood ever alert. I was the self-professed playground police. I was the guard always at the ready to protect him from the world. I squared my shoulders, grabbed my purse and keys, slid on my sunglasses, and said…let’s bounce!
Into Uncharted Territories
My son, Joshua, had always avoided the mall as if it were a punishment. I often wondered if this were a boy thing or an autism thing. With Josh, it was probably more of an “I don’t want to follow mom through endless stores” thing. I admit, I was a true mall warrior and had shopped with the best of them. But shopping with Joshua was different. He would lag behind no matter how often I prompted him to keep up. He seemed to have a hard time trying to walk beside me. Forget about him trying to focus on my witty banter. After finding that I was talking to thin air for the fifth time, I stopped dead. Frustrated, I looked back to yell for him to catch up. That’s when I saw that he was tracking my footsteps with his eyes.
Fascial expression recognition was hard
For Josh to understand, but after a few
hundred selfies with mom, he’s getting it!
Anticipating my movement by social cues was hard for him. He had a hard time understanding that I would stop unexpectedly to ooh and aah over a sweater in a store window. He couldn’t understand that my deep exhale was a signal of impatience towards teenagers stopping directly in front of us to talk. He couldn’t follow these social cues. He was too busy watching my feet so that
he could move with certainty through the crowded mall full of holiday shoppers. I stopped in front of what I thought was an age appropriate clothing store for him. I knew I would never fit into any of these styles again. As we went inside, I watched my son suddenly come to life. He circled the racks of clothes like a prize fighter. I held up a camouflage pair of pants. Wait, was that a smirk? I held my breath and reached for a pair of cargo pants. “Mom those are skinny jeans” he responded. Now that was almost with an attitude! Oh happy day. Was he acting like…hell, like I did at fourteen shopping with my mom? I approached who I thought must be the store manager. I owned shoes older than this kid.
A Mother’s Fear….
“Tell me, are there any colors that my son should not wear?” I asked. I was trying to look cool and confident. “Excuse me?” he answered, looking confused and bored. How do they do that? I repeated my question. “Are there any colors my son should not wear?” His gaze followed mine to the front of the store where my son stood. He was examining a pair of bandana-printed sweatpants as if he would be quizzed on them later. “My son has autism. He wants to shop for himself. I need to know if there are any colors he should not wear. Gang related colors?” The manager smiled. He suddenly looked old enough to buy a beer. “That’s a good question” he replied. We spent the next few minutes discussing this. He explained that, where we lived, gangs were identified by sports teams, not colors. He ran them down to me by pointing out baseball caps hanging behind the register. I made mental notes. My son bought a pair of sweat pants and a sweat shirt. They matched. He paid with his own money at the register from his own wallet. As we exited the store, I asked if he wanted to visit the food court.
“I’m good” he replied. That day my son joined the ranks of “teenagedom” while I continued to protect him from the sidelines. It was a good day.
Understanding the Dangers of the Unfamiliar Paths
Individuals with autism may have difficulties understanding social cues in their environment. This inability could place them at risk. Wandering; victimization from others; as well as having their movements or interactions misunderstood; are real dangers for those diagnosed on the spectrum. Autistics, parents, and caregivers need tools to help protect them when they are in the community. Autism Speaks offers several tools to help gain insight into societal dangers. They provide suggestions on how a community can help to safeguard their loved ones. While my concerns may not be shared by everyone, for me they are real. Pretending not to see the elephant in the room does not make it go away.
See Autism Speaks safety plans and strategies for safety while in the community. Topics
Social gatherings are great practice for Joshua. Everyone dressed up for a formal dinner. Ok, maybe this was one selfie too many!
range from cell phone use, avoiding victimization, and asking for help, to interactions with law enforcement. You may need to practice these plans many times with your loved one. Knowing what can possibly happen and being able to anticipate it is power. Safety is being prepared, not dealing with the aftermath. Remember, like fashion, nothing is usually one size fits all. But can we afford to not try it on?
I am a public health researcher. My interest is in how disability affects people all over the world. In the U.S., many doctors and teachers know a lot about autism. Every day we learn more about how to care for people with autism. We are learning to value their strengths. Many students with autism learn in regular classrooms. Many movies and books discuss autism. In the United States, autism is seen, heard, and talked about.
People with autism live all over the world. In many places, there is little known about it. In some cultures, there is not even a word for autism. Molly Ola Pinney started the Global Autism Project (GAP) to spread global awareness. She started it when she lived in Ghana, a country in West Africa. In Ghana, people often believe that evil spirits cause autism. Because of these beliefs, families often keep autism a secret. These families feel very alone. GAP aims to provide people with accurate facts.
Almost 60 million people with autism live in developing countries. GAP is building a global network of people who understand autism. It trains therapists, teachers, and families all over the world. It helps people create autism programs in their own cities and towns. The goal is to integrate people with autism in their own communities. Here are some real life examples of GAP’s work:
- Partnership with an autism center in the Dominican Republic – GAP in Dominican Republic
- Skill Corps in Kenya, January, 2016
- Teaching ABA Skills in India – What a difference a year makes: ABA in India
To learn more, see the Global Autism Project web site.
Butterflies. Anxiety. Sigh… What will their response be? Will they be extremely upset and not agree? Or will it make sense to them?
…Another not so clear-cut diagnosis of autism spectrum disorder (ASD). Yes, I agree that his behavior was not typical for his age, but does it really fulfill diagnostic criteria? Let’s see. He has language delay… check. He takes a long while to respond to his name… check. Yes, but he does respond after the 6th time and was usually distracted with a toy. I had to work to make eye contact… check. Yes, but he was so interested in all our toys. He would look at me when I got on his level. Oh, he did point to request! Yea, but my colleague says that it was to meet his needs only. Ok, so he may have some delays in his social communication.
Repetitive behaviors? Well, he did flap and jump a few times when we brought out the bubbles. Does that count? Yes… check. What about his restricted interests? He did play with the cars, but what toddler boy doesn’t like cars? Sometimes I did even get him to play with something else. Well, he needed a lot of prompting for pretend play; he really only pushed the car and crashed it into other cars. Repetitive play and restricted interests… check. No reported or observed sensory concerns… no check.
Ok, so he was referred for evaluation for possible Autism Spectrum Disorder (ASD). His Early Intervention (EI) team is concerned, but his parents aren’t so much. However, he did score high on his Autism Diagnostic Observation Schedule (ADOS) and meets DSM-5 criteria. Then why are you questioning it?
“Why are you questioning it?” This is a common query in my head. Sometimes it is clear, but other times it is not. Sometimes when you speak to his EI team, they may convince you that he has ASD. However, the child may show interest in you and others that makes you question it. Sometimes, he just seems like a busy kid that makes you work for his attention. This may make you more concerned for early signs of ADHD. Or you may wonder if it is just delays in all his skills, especially his intelligence. If we really think about it, a child whose brain is younger than he is, may appear younger socially and need a lot of effort to get his attention. The reasoning often becomes circular.
As a new Developmental-Behavioral Pediatrician, I have struggled with this worry. With each child, I find myself asking: “Are all toddlers who flap, toe walk, and take just a little too long to respond to your request really autistic? Or could it be something else?” I have relied on my colleagues to help me answer these questions, but the question has not gone away.
Most recently, I read an article about some children incorrectly being called autistic. Although the article suggested that “these children were less likely to be diagnosed by a specialist,” it did make me wonder if I am not the only one with these questions. It also made me ask, could children that live in this gray-zone be called something else that we may or may not yet know about?
As the amount of children who are called autistic increased over the past 2 years, I began to wonder how many of those children fall into this gray-zone. I wonder how many people are still in the gray-zone without any label. I also wonder if I will ever be able to answer these questions without any doubt.
For more information about the article, please see: Autism May Be Over diagnosed in the United States
Experts are learning more each day about the role genetics plays in Autism. Sometimes Autism is caused by changes in a child’s genes or DNA. These changes can run in a family. Or, these changes can be new to your child. A genetic test can help you learn more about these changes.
Why should children with Autism receive Genetic Testing?
• Genetic testing can explain why a child developed Autism.
• The test can help decide which services are best for the child.
• A genetic test can help reveal other health problems in the child.
• This test can help parents decide if they want to have more kids.
Genetic Testing does not tell you:
• how a child will develop;
• how well your child’s treatments will work;
• who the parent of your child is; or
• if you have HIV or have used drugs
It is not legal for your health insurance to change based on the results of this test.
A genetic test is often a blood test. There are different kinds of tests. Your doctor decides which tests are best for your child.
To get Genetic Testing, a doctor can:
1. order the genetic test; or
2. refer a child to a genetics team
The genetics team are experts in genes. They can explain in more detail the genetic test and its results. Meeting with a genetics team is often helpful, even if testing is not done.
Many insurance plans cover genetic testing. But, you should talk to your child’s doctor and insurance company before having the test.
Genetic testing can help children and their families. Talk to your doctor to see if it is a good option for your child.
To learn more:
Guidelines for Genetic Testing
What is Genetic Testing?