April is Autism Awareness Month and our experts are answering questions about Autism Spectrum Disorder (ASD). From signs to treatment, Bianka Soria-Olmos, M.D. and Lee Mason, Ph.D. share what parents need to know about ASD. Dr. Soria-Olmos is a pediatrician at Cook Children’s office in Haslet and Dr. Mason is an Applied Behavior Analyst at the Child Study Center, which is part of Cook Children’s Health Care System.

What is ASD (Autism Spectrum Disorder)?

Autism, or ASD, is a neurodevelopmental condition that may include difficulties with social skills, behaviors of repetitive nature and difficulties with verbal and nonverbal communication. It’s estimated that 1 in 54 children are affected by autism in the United States. ASD is a complex disorder that presents with varying symptoms ranging from mild to severe. There is no single cause, and at this time, both genetic and environmental factors are thought to contribute. More importantly, no reliable studies to date have shown a link between ASD and vaccines.

What are the signs of ASD?

Signs of autism can vary depending on the child. The key to early diagnosis is a partnership between the parent and the child’s doctor. Parents should discuss any developmental concerns with their pediatrician. In some cases, concerns may arise after standard developmental screening, which occurs at each well-child visit. A standard autism screening should occur between 18-24 months of age.

Some early signs include:

• Delays in development like babbling or cooing
• Lack of social smile by 6 months of age
• No pointing or waving by 12-14 months of age
• No single words by 15 months of age

Having a pediatrician recognize these signs is one of the reasons it’s important to keep your child up to date with well-child visits. The visits typically include questionnaires about development and this is an opportunity to identify any of these delays early.

Some children may have delays only in one area and no other difficulties. Standard screening tools exist to help your doctor identify other problems, which may indicate autism as a possible diagnosis.

One of the most widely used screening tools is MCHAT-R (Modified Checklist for Autism in Toddlers, Revise). This checklist is a series of 20 yes/no questions. The scoring of this screening tool gives a low, medium or high risk for ASD. All children with medium/high-risk results should have appropriate follow up which may include referral to a developmental pediatrician or a trained psychologist for formal ASD testing.

What if the MCHAT-R screening is negative, but I still have concerns?

A detailed history regarding the concerns also may lead to a referral for further testing even if the screening is negative. The reason for this is because ASD has such a wide presentation of symptoms it may eventually be diagnosed when symptoms are more subtle.

Since every child with autism is different, the treatment recommendations will vary for every child depending on the difficulties they are having. The current evidence supports the following effective treatments for autism: ABA (Applied Behavior Analysis), speech therapy, occupational therapy and treatment of any other co-existing condition of course.

What happens after my child receives an ASD diagnosis?

Half a century of research has convincingly shown that early intensive behavioral intervention, along with other applications of behavior analysis, is the treatment of choice for individuals with ASD. Behavior analysis is a science that studies how the environment affects behavior, and how behavior changes over time. The goal of ABA is to change behavior in ways that are meaningful to the patient and their family. For families of children with ASD, this often means increasing communication and social skills, while reducing behavior that interferes with learning.

Just as every person with autism is different, every ABA intervention is individualized to meet the patient’s needs, cultural norms, and family values. Comprehensive intervention is typically recommended, and may consist of up to 40 hours of ABA per week. In addition to addressing communication and social skill deficits, early intensive behavioral intervention can help with feeding problems, toileting, elopement (running away), tantrums, and other challenging behavior.

Research suggests that children with ASD who receive comprehensive ABA treatment show large developmental gains, and a reduced need for special services later in life. Less-intensive ABA treatments may be appropriate for older individuals. These programs typically focus on specific skills like developing relationships or obtaining employment.

Despite the broad variety of treatment goals, all ABA interventions rely on reinforcement-based approaches to develop lasting behavior change. Working in collaboration with other professionals has advanced the treatment options for individuals with ASD. Speech and occupational therapies that incorporate evidence-based practices (e.g., augmentative communication systems) while avoiding unproven approaches (e.g., sensory integration) can be highly effective.

A final note from the experts

We know being a parent can be stressful whether you are a first-time parent or not. Often worries and questions can arise when a child starts missing developmental milestones. Rest assured that science is on your side, and advances in screening, diagnostics, and treatment are helping us understand more about autism every single day. We know early diagnosis leads to early intervention, which has been shown to improve behavior, skills and language development. Early intervention helps with the outcomes of children diagnosed with autism. It’s important to bring up any concerns to your child’s primary care doctor as soon as you have any worries or concerns.

This would be stressful for any mom, but Alexa's son has high-functioning autism. She was worried about who would be sitting next to him on the flight and would they be tolerable of her son. 

The story had such a happy ending because of a wonderful man named Ben Pedrazza, who even messaged Alexa with a photo of the two of them on the flight. 

"He did ask if we were there yet several times but he was a great travel buddy," he wrote. 

Isn't that awesome?

With this story in the news, I thought it would give us a chance to talk about autism. I often get asked about it in my office. Some parents want to know if their child should be tested or how they would know if their child has autism. So let's take a look at what pediatricians look for as far as the signs and symptoms of autism spectrum disorder.

Not one single test can diagnose autism. This is not surprising given the complexities of the neurodevelopmental condition, some of those we do not understand fully. What is known is that the earlier it is diagnosed the earlier interventions can be started and the outcomes tend to be more positive.

So what do you look for? What are the signs?

The real answer is it can vary depending on the child, key to early diagnosis requires a partnership between the parent and the child’s doctor. Any concerns a parent has about development should be looked into further. In other cases, concerns may arise after standard developmental screening which occur at each well-child visit. Standard autism screening should occur between 18-24 months of age.

Autism, or ASD (Autism Spectrum Disorder), is a neurodevelopmental condition that may include difficulties with social skills, behaviors of repetitive nature and difficulties with verbal and nonverbal communication. It’s estimated that 1 in 59 children are affected by autism in the United States today. ASD is a complex disorder that presents with varying degree symptoms ranging from mild to severe. There is no single cause, and at this time both genetic and environmental factors are thought to contribute. More importantly no reliable studies to date have shown a link between ASD and vaccines.

Some early signs include:

• Delays in development like delayed babbling or cooing
• Lack of social smile by age 6 months
• No pointing or waving by age 12-14 months
• No single words by age 15 months

Having a pediatrician recognize these signs is one of the reasons it’s important to keep your child up to date with well-child visits. The visits typically include questionnaires about development and this is an opportunity to identify any of these delays early.

Some children may have delays only in one area and no other difficulties. Standard screening tools exist to help your doctor identify other problems which may indicate autism as a possible diagnosis.

One of the most widely used screening tools is MCHAT-R (Modified Checklist for Autism in Toddlers, Revise). This checklist is a series of 20 yes/no questions. The scoring of this screening tool gives a low, medium or high risk for ASD. All children with medium/high risk results should have appropriate follow up which may include referral to a developmental pediatrician or a trained psychologist for formal ASD testing.

What if the screening is negative, but the parent has concerns?

A detailed history regarding the concerns also may lead to referral for further testing even if the screening is negative. The reason for this is because ASD has such a wide presentation of symptoms it may eventually be diagnosed when symptoms are more subtle.

Since every child with autism is different, the treatment recommendations will vary for every child depending on the difficulties they are having. The current evidence supports the following effective treatments for autism: ABA (Applied Behavior Analysis), speech therapy, occupational therapy and treatment of any other co-existing condition of course.

We know early diagnosis leads to early intervention, which has been shown to improve behavior, skills and language development. Early intervention helps with the outcomes of children diagnosed with autism. It’s important to bring up any concerns to your child’s primary care provider as soon as you have any worries or concerns.

An early diagnosis may also start you on an incredible journey with a child as interesting and amazing as Landon.

For more on this Topic:

• Autism
• Cook Children's Child Study Center
• New Self-Defense Class Empowers Teens with Intellectual Disabilities to be a 'Hard Target'
• The Autism Spectrum: A Pediatrician's Explanation
• Avery's Journey: An Autism Spectrum Disorder
• Autism Spectrum Disorder: The Need to Wander or Elope
• Julia Brings 'Sunny Days' to Kids with Autism
• Living with Autism
• What Is Autism?

Released earlier this year, the survey looked at more than 3,500 school-aged kids with either ASD, intellectual disability and or developmental delay; and found that children on the autism spectrum disorder were more prone to wander, or elope, from home. Of the parents surveyed, more than 26 percent had eloped in the previous year.

The number of kids who stray from the safety of their homes increases even more dramatically when you look at kids as young as 4 years old and up.

“Elopement is a common and dangerous behavior seen in about half of children with autism,” said Joyce Mauk, M.D., a Cook Children’s pediatrician/CEO and medical director of the Child Study. “It occurs more commonly in children with more severe developmental delays. When this happens it’s of great concern because children can face dangers of drowning or traffic injury when they run away.”

Dr. Mauk says children with ASD most frequently run away from the home, but can escape their caregivers in various community settings. Dr. Mauk says she has seen teen-aged patients run away and cross several busy urban intersections before finally being found. But even when someone tries to help, it may not guarantee safety for the children who have eloped.

“Because children with autism may have poor communication skills, they may not give reliable parental contact information when they are found,” Dr. Mauk said.

Dr. Mauk recommends the following for parents to safe-guard their children with ASD:

• Use a medic alert bracelet or tag for children who are known to elope.
• Look into GPS trackers that can be worn attached to shoes.
• In cases where this is a severe problem of the child bolting from his or her parents, the child may even need to be contained in large strollers when the family is out.
• At home closed and locked doors are helpful.

But in the end, Dr. Mauk stresses that nothing beats close care-giver supervision.