Autism Spectrum Disorder

Signs of autism spectrum disorder often manifest in early childhood and often before a child is one year old. Symptoms become consistently noticeable by the time the child is 2 or 3 years old. In some cases, people have such mild symptoms they may not get diagnosed until they start school, and some people don’t get diagnosed until they are in their teen years or adulthood when social deficits become more obvious.

A neurodevelopmental evaluation is required to get an official diagnosis of autism spectrum disorder. However, a parent, teacher, or child therapist can make a referral to a psychiatrist for children or adolescents, a developmental pediatrician, a pediatric psychologist, and/or a child neurologist for a formal evaluation.

The evaluation may involve interviewing the parents or caregivers, and/or teachers, observing and interacting with the child or teen in a controlled and structured setting. Sometimes other tests are administered to rule out other disorders.

A child often fares better in life if diagnosed at a younger age as the child and the family are more likely to receive support services and have better access to community and school resources.

Common Deficits and Symptoms of Autism Spectrum Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders and the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) the following are standardized criteria used to diagnose a person with autism: Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):

• Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
• Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
• Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life). Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur. To make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for the general developmental level.

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

Social communication deficits may include:

• Difficulty maintaining eye contact
• Decreased shared interests with others
• Difficulty empathizing with others’ emotions
• Difficulty reading the social or emotional cues of others
• Interpreting abstract ideas as literal
• Difficulty making and keeping friends
• Possibly non-verbal
• Poor insight into their own emotions
• Easily overwhelmed in social situations
• Difficulty expressing emotions
• Difficulty with taking turns in conversation
• Difficulty discerning personal space
• Difficulty seeking comfort from others
• Hyperfocus on topics or hobbies and expecting others to be equally interested
• Difficulty understanding or appropriately using tone of voice
• Difficulty understanding or appropriately using facial expressions
• Hyperverbal (talking too much without taking notice of people’s reactions)

Restricted and repetitive behaviors may include:

• Continuously repeating words/phrases
• Obsessive-compulsive behaviors (placing objects in a certain order and becoming upset if the order is changed, always playing with an object in a certain manner, having to follow a certain routine without deterring from it)
• Difficulty adjusting to or tolerating changes in routine and new experiences
• Stimming (repetitive body movements or noises, i.e., flapping hands, rocking back and forth, clicking noises with the mouth, etc.)
• Reacting in unexpected ways to certain sensory stimuli
• Hypersensitivity to certain sensory stimuli such as loud noises
• Ritualistic behaviors such as arranging items such as toys, books, or other objects in a particular way or repetitively touching objects in a certain order
• Rigid and inflexible thinking and behavior and extreme difficulty coping with change

Symptoms That Can Be Beneficial

• Hyperfocusing (remaining focused for an extended time) on certain topics or activities of specific interest
• Thinking outside the box, which allows for innovative solutions
• Strong attention to detail and observation skills
• Advanced skills in pattern recognition such as in codes and behaviors
• Strong artistic skills, especially in art, technology, and science

While autism spectrum disorder does not have a cure, many positive and hopeful treatment options exist to improve a person’s functioning and social/communication skills.

Some of these interventions include:

Applied Behavioral Analysis (ABA): This intervention is evidence-based and the gold standard for treating people with autism. Treatment goals focus on improving language and communication skills, attention and focus, self-care, motor skills, play, social skills, memory, and learning/academic skills.

ABA also teaches everyday life skills and helps with decreasing problem behaviors by helping a child with ASD understand the connection between behaviors and consequences. Each child is given a personalized plan which is adapted to individual needs. ABA also utilizes positive reinforcement to encourage positive behavior change. This may not be the best treatment option for someone with less severe symptoms but can be adapted.

Social Skills Training: This is usually implemented in either a group setting or individually with a trained professional. The goal is to assist children, teens, and adults with autism to understand social skills and cues and how to help improve their ability to interact socially.

Occupational Therapy: This intervention focuses on assisting a person with autism with improving daily living skills, motor skills deficits, and adaptive life skills.

Speech and Language Therapy: This intervention helps improve a child’s speech (nonverbal and verbal) patterns and language understanding.

Medication: People with ASD often have comorbid or co-occurring conditions such as attention deficit hyperactivity disorder (ADHD), depression, and/or anxiety which appropriate medication can treat. A qualified child psychiatrist or psychologist can evaluate your child for co-occurring conditions and determine whether medication is appropriate.

Educational and School-Based Therapies: Many school districts offer classes, social skills training, and educational support services for those with autism.

Behavioral Therapy: This is provided by a trained child psychiatrist, psychologist, or licensed therapist who specializes in working with individuals with an autism spectrum disorder. The focus is on social skills training, parent and family support, and cognitive behavioral therapy (CBT).

At Spokane Christian Counseling, a trained therapist will create a tailored care plan that meets your needs or those of your child. The plan will be focused on the uniqueness of each individual that is supportive of their strengths and abilities. The following are some of the treatment options provided by trained therapists at Spokane Christian Counseling:

• Cognitive Behavioral Therapy (CBT): CBT focuses on the connection between thoughts, feelings, and behaviors. People with autism often struggle with depression, anxiety, fear, obsessive-compulsive disorder, stress, anger, aggression, bullying, social skills deficits, and limited social support. CBT is often modified to suit the individual needs and functioning level of people with autism.The goal of CBT is to help people with autism move toward their goals, strengthen healthy behaviors and thoughts, and teach and help implement helpful ways to prevent or decrease co-occurring conditions such as anxiety and depression. Family counseling and parent coaching are also helpful interventions to offer education, support, and help for family members to recognize how they may be helping or hindering the person with autism.

• Advocacy: A trained therapist will help a client advocate for him or herself. This ensures the person’s needs are supported. The goal is not to fix the person with autism but instead to offer support and advocacy. They work to teach and strengthen healthy coping skills, improve social skills, assist with meeting goals, and encourage healthier emotion regulation.
• Referrals: Our trained therapists may refer you or your child to a trained psychologist or psychiatrist for a full evaluation if you or the therapist suspect a diagnosis of autism spectrum disorder. Therapists can also refer you to a psychiatrist or psychiatric Nurse Practitioner for a medication evaluation to rule out other co-occurring diagnoses and prescribe appropriate medication to treat these. 

Your Child Matters

At Spokane Christian Counseling, we believe God created all people in His image and believe everyone is unconditionally loved and seen as unique, worthy, and valued by God. We know firsthand that God mends broken hearts and heals wounded souls. We will offer support and encouragement while striving to show God’s love and treat you or your child with dignity and respect.