Autism Spectrum Disorder: Diagnosis and Treatment

How can we reach the diagnosis?

We must take into account the following aspects:

Family history: personal history of pregnancy and childbirth, presence of signs and other neurological conditions such as epileptic seizures, mental retardation, cerebral palsy or other diseases, as well as evidence of other medical illnesses or significant data on physical examination.

Characterization of the present clinical picture: manner of onset, whether there was an early developmental deviation or a period of regression, features of mental disorders, presence of stereotypies and severity of symptomatology, as well as evolution.

The diagnosis is clinical, since there is no specific test to determine it, although we can rely on some complementary tests.

Selective screening tests are the Social Communication Question air, the M-CHAT and others. We can also rely on the criteria of the Diagnostic Manual of Mental Disorders (DSM-IV-5) or ICD-10. Psychometric tests are difficult to apply in children with autism, but they perform better in skills tasks than in verbal ones.

An Electroencephalogram (EEG) and if necessary a Computerized Axial Tomography (CT) should be indicated. Stool in Sabouraud Glucose Agar medium, which is used for isolation, identification and preservation of pathogenic fungi, saprophytes and useful for yeast culture (rule out Candidiasis).

It should be noted that a positive diagnosis requires more than one first evaluation, sometimes in different contexts and must be confirmed by experts from a multidisciplinary team.

Will my child have normal intelligence?

We cannot give an absolute answer, because children with Autism Spectrum Disorders (ASD) are different in their abilities, intelligence and behaviors. As with everyone else, some have more ability than others do.

Approximately 1 in 4 have normal intelligence, and 1 in 10 people with ASD have extraordinary abilities in subjects such as art, music, arithmetic or memory and they develop at an early age.

Those with more language development do better. However, they tend to be interested in a limited number of subjects and have difficulty with abstract concepts. Generally, they all show difficulties in school, so their teaching must be individualized to meet the real needs of each child with ASD.

Is there a guide to what skills my child should be gaining so I know if something is wrong?

Yes, there are developmental milestones that all children reach as they age.

At 2 months: He/she tries to look at parents and pay attention to faces.

At 4 months: He/she copies facial movements, such as smiling or frowning, and responds to affection. He/she likes to play with people and may cry if play stops. He/she uses hands and eyes at the same time. He/she watches faces carefully and tries to reach for objects with one hand.

At 6 months: He/she likes to look in mirror and puts objects in mouth. He/she recognizes familiar faces. The child likes to play with other people, especially parents. He /she reacts when his name is mentioned and makes sounds to show joy or displeasure.

At 9 months: The baby has favorite toys and picks up small objects between thumb and forefinger. He/she may be afraid of strangers. He/she understands no. He/she makes different sounds such as momomomomo and fafafafafafa, points to objects and plays at finding things.

Around 12 months: the child extends arm or leg to help get dressed, follows simple directions, and tries to imitate words he/she hears.

By 18 months: The baby explores only if a parent is nearby, and knows and points to body parts. He/she shows affection for familiar people.

By 2 years: He/she begins to relate to colors and objects according to their shapes, and is excited by the presence of other children. The baby demonstrates increasing independence.

By age 3: Able to put together puzzles of three or four pieces. Able to dress self. Expresses a wide range of emotions. Walks up and down stairs.

By age 4: He/she enjoys doing new things. Increasingly creative. The child enjoys playing with other children more than playing alone, talks about likes and interests, tells stories, can say his/her first and last name.

At age 5: The baby wants to be like his friends and is able to draw a person with six body parts. Recognizes what gender people belong to, wants to please friends. He/she likes to sing, dance, act, can distinguish fantasy from reality and speaks very clearly.

This is a small guide to some of the skills your child should be gaining so that you can identify if there is a problem and seek help and guidance in a timely manner.

After the diagnosis is established, is there any treatment that can help a person with ASD?

There are varieties of treatments and interventions that will greatly help the patient with ASD and his or her family, where the main goal is to increase your child's ability to function and reduce disabling symptoms. Early intervention during the preschool years can greatly assist in the acquisition of fundamental behavioral, communication and social interaction skills.

A multimodal approach (a type of treatment that channels the cognitive-behavioral part) should be used. Behavioral Psychotherapy focused on behavioral analysis has proven to be very effective for parents and teachers.

Education with individualized programs according to their abilities and level of functioning show that greater learning can be achieved if their potential or strong areas such as perseverance, pleasure in routines and good memory are utilized.

Speech and Language Therapy is performed by Speech and Language Therapy specialists, which should begin as early as possible and utilize imagery, signaling, and verbal and nonverbal communication. Attention should also be given to motor rehabilitation, both fine and gross.

Psychopharmaceuticals are used to adjust the behavior so that better results can be obtained in their educational activity. In the beginning, Haloperidol, Thioridazine, Pimozide, etc. have been used. Selective Serotonin Reuptake Inhibitors, such as Risperidone and Fluoxetine can improve ritualistic behavior.

Carbazepine and Valproate as mood stabilizers and due to their antiepileptic effect can be effective in controlling aggressive behavior even if the EEG is normal.

Vitamin therapy, Vitamin B6 with magnesium and folic acid report improvement to the patient.

Other techniques used are: Music therapy, Pictotherapy, Zootherapy with dolphins or horses, among others.

Parents are excellent co-therapists in the treatments used and should be trained in these tasks. It is important to hold Parent Groups 1 or 2 times per month, to provide support and training in the skills to be achieved at home.

Do not believe in miraculous solutions or magical treatments because they do not exist, if someone promises you something like that, stay away, because you may be listening to a phony.

There is much to be discovered and much promising research in progress, do not be discouraged. We suggest you always bring and entrust your family member to specialized and legally trained personnel. All children with ASD have the ability to learn, so it is very important that they are properly diagnosed and treated as early as possible.

It is best for everyone to accept them and not compare them to other children. We must always take the positive side of every situation or bad time that happens, because they are not worse or better than other children are, they are just them and they have their good and bad things like everyone else. Take them by the hand and never leave them alone.