What Should Parents Know About Autism Spectrum Disorder?

In this episode of "Mom Doc Talk," host Kristen Cook, a general pediatrician, focuses on Autism Awareness Month. Kristen discusses autism spectrum disorder (ASD), covering its definition, history, early warning signs, diagnostic process, and treatment approaches. She emphasizes the importance of a multidisciplinary team for diagnosis and the crucial role of parents in advocating for their children. Kristen highlights effective interventions like Applied Behavioral Analysis (ABA) therapy and other supportive therapies. The episode aims to provide valuable information and support to parents, caregivers, and anyone interested in understanding autism better.

• Definition and history of autism spectrum disorder (ASD)
• Early warning signs of autism
• Diagnostic process for autism, including criteria from the DSM-5
• Role of parents in noticing signs and advocating for their children
• Importance of a multidisciplinary team in diagnosis and treatment
• Overview of effective treatment approaches, including Applied Behavioral Analysis (ABA) therapy
• Other treatment modalities such as speech therapy, occupational therapy, and social skills training
• Co-occurring medical conditions associated with autism and their management
• Advocacy strategies for parents in educational and medical settings
• Support resources and community for parents of children with autism

www.autismspeaks.org

www.autismsociety.org

www.cdc.gov/NCBDDD/autism

www.nationalautismassociation.org

The information in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical issues. All the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

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Welcome back to mom Doc talk with doctor Kristen Cook. April is Autism Awareness Month. It is a dedicated time to encourage understanding, acceptance, and advocacy regarding autism Spectrum disorder. In this episode, we'll explore what autism is, its history, early warning signs, the diagnostic process, and the best treatment approaches. So whether you're a parent navigating a new diagnosis, a caregiver looking for support, or someone who just wants to understand autism better, this episode is for you. Before we dive in, I need you to understand that I am not an expert in neuro divergence. As a general pediatrician, I never diagnose a patient with autism. Ever. I believe that an appropriate evaluation of autism requires a multidisciplinary team, and I believe that the role of a general pediatrician is to pay attention to developmental milestones and refer patients for appropriate testing when One indicated. Autism spectrum disorder is a neurodevelopmental condition that affects communication behavior and social interaction. It's called the spectrum because the severity and presentations of symptoms can vary widely from person to person. Some individuals may require significant support in daily life, while others may be highly independent. Autism was first described in 1943 by Doctor Leo Kanner, a child psychiatrist. In an academic article called Autistic Disturbances of Affective Contact. Around the same time, Austrian pediatrician Hans Asperger also described similar traits in children who had strong language skills but struggled with social interaction. In fact, Hans Asperger is the namesake of Asperger's syndrome, which initially was a term to describe people who had difficulties with social interaction, repetitive behaviors, and communication, but lacked other developmental delays. Over time, our understanding of autism has evolved, and today we use the term autism spectrum disorder to encompass a broad range of traits and abilities, including the previously described Asperger's syndrome. Again, autism spectrum disorder is a neurodevelopmental condition that develops prior to three years of age. To diagnose autism, we rely on the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, also known as the DSM five. The key criteria include persistent difficulties in social communication and interaction, including challenges with nonverbal communication, difficulty understanding relationships and deficits in emotional reciprocity. Restricted repetitive patterns of behavior, interest, or activities such as repetitive movements like hand flapping or rocking, insistence on sameness. Intense fixations on specific topic or objects, or unusual responses to sensory input. These symptoms must be present from early childhood, even if they become more noticeable later. And these symptoms must cause significant impairment in daily functioning. These criteria help professionals determine if a child meets the threshold for an autism diagnosis. I'm providing this information for completeness. Under no circumstance do I want you to use this information in attempts to diagnose any child with autism spectrum disorder. Parents are often the first to notice signs that something might be different about their child's development. Some early red flags that may indicate autism include limited or no eye contact. Lack of a social smile. By 6 to 9 months of age, not responding to their name by 9 to 12 months of age. Lack of interest in social games like peekaboo after nine months of age. delayed speech or lack of babbling by 12 months of age, and dislike of physical comfort when upset or scared. If you notice these signs, it's important to bring them up with your pediatrician as soon as possible. It's equally important to note that none of these red flags in isolation should cause anyone to panic. Children develop on their own unique timeline. Not every failed developmental milestone is an issue of concern. As a pediatrician, part of my job is to help parents understand certain behaviors that are developmentally appropriate based on a child's age. Certain typical toddler behaviors can sometimes resemble features of autism spectrum disorder. For example, many toddlers have moments where they don't respond to their name because they're deeply engaged in play. Young toddlers often engage in solitary play, meaning that they prefer to play alone instead of engaging in cooperative play with other children. For a toddler, this is completely normal from a developmental perspective. It's common for toddlers to have repetitive behaviors like spinning or organizing toys. This alone does not mean that they have autism. Speech delays can occur for various reasons, including hearing issues or a family history of late talkers. So what's the key difference? In autism, these behaviors tend to be more persistent. They impact social engagement and occur alongside other developmental differences. Diagnosing autism is a multi-step process. It typically involves some type of developmental screening. Pediatricians use tools like the Mychart Modified Checklist for Autism and toddlers, usually at 18 or 24 month well-child visits to assess for early signs. This is the key tool that I use in my medical practice. If the screening indicates concern, I refer for evaluation. Diagnosis also involves a comprehensive diagnostic evaluation. This is conducted by specialists such as developmental pediatricians, child psychologists, or neuropsychologists. It includes observing the child's behavior, taking a thorough developmental history, and using standardized assessments like autism diagnostic Observation Schedule two depending on the child's needs. Evaluations may include speech language assessments, audiology evaluation, occupational therapy screenings, and genetic testings. While there is no cure for autism, early intervention and individualized therapies can make a huge difference. Some of the most effective interventions include applied behavioral analysis or ABA therapy. This is a structured approach that focuses on improving specific behaviors and skills through reinforcement. ABA is the standard of care when it comes to the treatment of autism spectrum disorder. ABA therapy is a structured, evidence based intervention used to support individuals with autism by improving social communication and behavioral skills. It is based on principles of learning and reinforcement to encourage positive behaviors while reducing challenging ones. The key principles of ABA therapy include. Positive reinforcement. Desired behaviors are rewarded with praise tokens or access to preferred activities, making them more likely to be repeated. Behavioral modification. Undesired behaviors are addressed by identifying their triggers and teaching alternative, more appropriate behaviors. Individualized approach. Each child receives a customized treatment plan based on their strengths, challenges, and goals. Breaking skills into small steps. Complex skills such as brushing teeth, making eye contact are broken into smaller teachable components. Data driven methods. That's progress is continuously tracked and analyzed to adjust strategies as needed. The benefits of ABA therapy include improved communication and social interaction. The development of daily living skills such as dressing and eating. The reduction of disruptive or self-injurious behaviors and the enhancement of independence and adaptability. While ABA is widely recognized and has helped many children develop essential skills. It has also been criticized for being too rigid or repetitive in some programs focusing on compliance over autonomy if not implemented thoughtfully, and not addressing emotional regulation in some cases. Modern ABA has evolved to be more child led and play based, ensuring it aligns with the child's well-being. Other treatment modalities include speech and language therapy to help with communication challenges, from verbal speech to alternative communication methods like picture exchange systems. Occupational therapy, which focuses on sensory processing and fine motor skills to help children navigate their environments more comfortably. Social skills Training teaches children how to engage with peers and understand social cues. Parent training and support equipping families with strategies to support their child's development at home and medications. I want to be very clear there are no medications that treat autism spectrum disorder. However, children with autism may be prone to other medical conditions. It's not uncommon for children with autism to have aggressive behavior. It can be very frustrating to a child when they are unable to communicate wants and needs. Sometimes atypical antipsychotic medications can be helpful. Children with autism spectrum disorder are more prone to certain medical conditions compared to neurotypical children. It's not that autism causes these conditions Directly, but there's a higher co-occurrence. This is something that both pediatricians and parents should be mindful of, because it can impact quality of life and require a more comprehensive care approach. Children with autism spectrum disorder often have gastrointestinal issues. Constipation, reflux, and abdominal pain are much more common in children with autism, and there are some studies that suggest that gastrointestinal symptoms occur in up to 70% of children with autism spectrum disorder. In addition to GI issues, sleep issues are a common co-occurrence. Difficulty falling asleep or staying asleep is reported in 40 to 80% of children with autism. The causes can include sensory sensitivities, anxiety, or circadian rhythm disruptions. About 20 to 30% of individuals with autism spectrum disorder will develop epilepsy. Seizures can emerge at any age, but are often present in early childhood or adolescence. In addition, there's a significant overlap between autism and attention deficit hyperactivity disorder. Around 30 to 60% of kids who have autism spectrum disorder also meet criteria for ADHD. Children with autism are at higher risk for anxiety, depression, and obsessive compulsive behaviors. These can be harder to identify if a child has limited expressive language, so it takes a careful look at behavioral changes. Certain syndromes, like fragile X syndrome and tuberous sclerosis are more common in children with autism spectrum disorder. So what does this mean for parents and providers? A child with autism should be monitored with a wide lens, not just for behavioral or developmental milestones, but also for medical red flags. It's important to note that parents are often the first to notice subtle shifts in sleep, bowel habits, and mood, and that their instincts should be trusted. Collaborative care with pediatricians, developmental specialists, neurologists, and therapists is often essential. The best treatment plans are individualized, addressing each child's unique strengths and challenges. Now let's switch gears and talk about advocacy. Advocacy means actively supporting, speaking up for, and securing resources for your child in educational, medical, and community settings. It's about ensuring their unique needs are met while fostering an environment where they can thrive. Parents are their child's first and most powerful advocates, shaping how schools, health care providers, and society at large support neurodivergent children. Here are some advocacy strategies for parents in the school setting. It's important for parents to research and understand the IEP and 504 process. Know your child's legal rights and collaborate effectively with educators. Keep parent teacher communication positive and solution focused. Push for sensory friendly accommodations. Advocate for quiet spaces, movement breaks, and alternative learning methods. Encourage AI powered learning tools. Promote the use of speech to text apps and adaptive software to support learning at the doctor's office. Come prepared with information. Keep track of developmental milestones and therapy outcomes. Request comprehensive support. Don't hesitate to ask for referrals to speech therapy, occupational therapy, or behavioral interventions. Speaking from a personal experience as a general pediatrician, if you are concerned about your child's development, I want to know about it. You know your child best. Please speak up. It's also important to challenge dismissive responses. If a medical provider downplays concerns. Seek a second opinion in the community setting. Advocate for sensory friendly extracurricular activities and public spaces. Teach your children self-advocacy. Help children understand and communicate their needs. Consider joining parent advocacy groups. This way, you'll be able to work collectively for policy changes that benefit all autistic individuals. Finally, here are some internet resources for families with a child with autism. Autism speaks for. Autism. NCB. Didi. Backslash. Autism and National Autism Association for. If your child has recently been diagnosed with autism, or if you're still in the process of getting answers, please know this. You are not alone. There is a vibrant, supportive community out there, and with early intervention in the right resources, autistic children can thrive. Thank you for joining me today. Keep parenting the child you have with love and confidence, and I'll see you next time on mom. Talk with Doctor Kristen Cook. The information in this podcast is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your health care provider for medical issues. All of the opinions are those of Doctor Kristen Cook and do not reflect the opinions of her employer, nor the hospital she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.