Basic Autism Q & A

We sat down with Dr. Rachel Loftin and asked her some basic question about autism identification and treatment. We found her answers to be particularly helpful for parents or loved ones who are just beginning to learn about autism.

What is autism?

Autism is a developmental condition that affects brain development. The primary signs of autism are in the areas of social-communication and atypical behaviors (restricted interests, repetitive behaviors, sensory seeking or avoiding behaviors). 

What causes autism?

There is no single answer to this question, as the autism spectrum is not a single disorder. Even though we refer to everyone with autism as having “autism spectrum disorder,” researchers are still figuring out how to define the different types of autism. In a small percentage of cases, autism results from a known genetic cause. In most cases, multiple genes are involved in a complex interaction that results in autism. This does not mean that a parent of a child with autism also must have autism (although they may). There are also some non-genetic factors that increase risk of autism. These include in utero complications (maternal illness, multiple births), birth complications (extreme prematurity, oxygen deprivation) and advanced parental age. 

Parenting style and vaccinations do not cause autism. 

What are the symptoms of autism?

The hallmark signs of autism are impairments in communication and socialization. However, the way these difficulties present is different for everyone. A person may not be able to speak or may be an eloquent speaker but have difficulty with the social aspects of communication. Nonverbal communication is normally an area of challenge, meaning that the use of eye gaze, gestures and body language is affected. Social relationships are challenging, although people with ASD may have friends. In addition to social and communication deficits, atypical behaviors are often present. These may include differences in sensory responses (under or over-responsiveness to sensory stimuli), insistence on certain routines and resistance to change, preoccupation with particular topics, or repetitive motor movements.

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Diagnosis

I think my child might have autism. What should I do next?

Talk to his/her pediatrician first. If the doctor doesn’t address your concerns, and you’re still worried, ask another. For children under age 3, if your child demonstrates developmental delays, you should get referred to the early intervention system for an evaluation. If your child is over age 3, you can request an evaluation through the school district to see if your child qualifies for a special education plan. Schools do not provide a medical diagnosis but this step is a good start!

You can also reach out to an autism specialist at any point. When seen by more general providers, some children with autism may first be diagnosed with developmental delays or other diagnoses. An autism specialist may be in the best position to rule autism in or out.   

What happens during the diagnosis? How can I best prepare?

It depends on which specialist(s) you see. For any provider, a thorough history including lots of questions about developmental milestones (even for adults who are getting diagnosed!) and social behavior is important. Your provider should spend a long time talking with you and fully understand your concerns, as well as spending time directly evaluating your child. 

One of the best ways to prepare for a diagnostic evaluation is to review your baby book or early videos to refresh your memory of your child’s early development. Make a list of your primary concerns or questions.

What is the difference between a diagnosis from a MD vs. Clinical Psychologist?

An evaluation from a clinical psychologist will include a parent interview and, typically, standardized measures of intelligence, adaptive behavior, autism symptoms, and other areas. Most medical evaluations will rely on parent history and medical evaluation only. In many autism specialty clinics, both physicians and psychologists often work together on evaluations and may include other specialties, such as speech therapists or occupational therapists. 

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Treatment

How is autism treated?

There is no single treatment for all people with ASD. Treatment is specific to skills that need to be addressed. Below are several examples of the most common treatments and the skills they target:

Speech and language Therapy

All aspects of communication (verbal, nonverbal, written):

  • Expressive language

  • Receptive language

  • Social-Pragmatic language

Occupational therapy

  • Fine motor skills

  • Regulation of internal state

Physical Therapy

  • Gross motor skill

  • Motor coordination

  • Motor planning

Applied Behavior Analysis (ABA) Therapy

  • Teaching of skills or content

  • Correction of problem behavior

Pharmocotherapy (Psychiatric Medication)

There is no “autism medicine,” but medicines can be helpful to treat specific difficulties that people with autism may experience:

  • Inattention, impulsivity, hyperactivity

  • Anxiety

  • Depression

  • Irritability

  • Sleep problems

Psychotherapy (talk therapy)

Can be used to address symptoms, including anxiety and depression, through approaches like cognitive behavioral therapy (CBT).

Participants need to have adequate means of expressive and receptive language, as well as some insight into their own behaviors and emotions.

Some therapists can also work with parents to help create behavior plans and teach parents how to use certain strategies at home.

Educational or developmental therapies

Therapies that teach specific content or skills, such as reading comprehension.
Or, for younger children, are focused on the child’s development.

Social skills therapies

Organized and structured social opportunities, usually facilitated by a clinician such as a speech therapist, social worker or clinical psychologist.

May be in individual or group settings.

What should I look for in an effective Therapy provider?

Like other professionals, the quality of work done by autism specialists can vary, and there may be personality factors that affect the success of a therapeutic relationship. As caregiver or a person seeking services, it is important that you feel comfortable and: 

  • Provider has expertise in the area you need

  • Provider listens to your concerns and seems to understand the problem

  • The provider demonstrates a willingness to understand the unique presentation of the person with autism. (Doesn’t treat all people with autism as being exactly the same)

  • The interaction between the person with autism and the provider is comfortable

  • The provider can discuss with you how you will tell if the treatment is working. This usually involves collecting data through observation or reporting from the person receiving treatment, caregiver or teacher

With so many treatment options, how do I find the best fit for my child?

You are an expert in your child’s needs and your own, but you are not expected to know everything about treatment options! Develop a list of areas that you see as most limiting to your child/adult child’s future and use it to help guide discussions with professionals. 

It usually helps to focus on treatments that will have the most impact on multiple areas. For instance, improving communication will, obviously, help communication, but it is also likely to have a positive impact by reducing problem behaviors that your child was previously using to communicate.  For that reason, speech and language therapy is often the best first line treatment. In some older children, anxiety or depression may be the most prominent feature and can interfere with social interaction and performance at school. In that case, psychotherapy and a medication evaluation may be the most appropriate first line interventions. Talk with other parents (link to parent support groups here), specialists you trust, and your child’s teacher to help prioritize interventions. 

What about nontraditional or experimental treatments?

There are many types of services available that either have no evidence of being helpful and even some that may put a child at risk of serious harm. When considering non-traditional treatments, consider the following:

  • What is the risk/benefit ratio for safety? How likely is it to help versus how dangerous may it be? 

  • How much financial, time and stress burden will it place on the family?

  • Will it interfere with pursuit of traditional treatments (e.g., behavioral therapy, speech, etc.)?

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