Autism Spectrum Disorder, or what people commonly call autism, is a developmental neurological condition. Contrary to the myths circulating about this disease, autism does not affect a person’s intelligence. It impacts the way they interact with others and their social standing.
This condition can be a little complicated to detect. While some children as young as 18 months old are given a reliable diagnosis, others remain undiagnosed until they’re adolescents or adults. According to the National Library of Medicine, autism is a dynamic and complex condition characterized by unusual genetic combinations, poor neural connectivity, and disruptive speech development.
But there’s one topic that has been a matter of heated debate – can an individual (child or otherwise) be mildly or slightly autistic as opposed to having a full-blown disorder? This article attempts to explore the origins of this idea as well as its veracity.
How Easy Is It to Diagnose Autism? Challenges Involved
Since autism is a complex developmental disorder affecting social interactions, individuals with the condition often require interventions by speech-language pathologists (SLPs). However, these interventions are not a routine practice in many healthcare facilities. This may make an accurate diagnosis a big challenge.
Only a multidisciplinary approach while evaluation can yield good results. But the disease does go undetected due to the following reasons –
1. Heterogeneity of Symptoms
One major problem with an autism diagnosis is that there is currently no specific genetic or medical test, even though the disorder is considered to be heritable (in many cases). Its symptoms often look similar to those of other learning disorders, such as Down Syndrome and Fragile X Syndrome (FXS).
ASD diagnosis is still largely based on behavioral observations. If the social and cognitive assessment of children during this stage overlaps with other disorders, an accurate diagnosis may become challenging.
2. Differentiation Issues
As per the Environmental Protection Agency, the most common childhood developmental disorders include dyslexia, Attention Deficit Hyperactivity Disorder (ADHD), and dyspraxia. These conditions often affect children between the ages of three and 17.
Their differentiation is a challenge because each of these conditions (along with ASD) has complex etiologies where symptoms vastly vary among individuals. Another issue is the high degree of comorbidity, which may be more of a rule than an exception.
3. Problem of Gender Phenotypes
Many therapists observe that an accurate ASD diagnosis in verbal girls often goes undetected. As for non-verbal children, no major discrepancies were observed in terms of adaptive skills.
In general, autism seems to affect more boys than girls. However, verbal girls with autism displayed lower adaptive skills than their male counterparts. Conversely, other verbal girls displayed similar or better adaptive skills than boys. This makes it difficult to determine accurate gender phenotypes.
4. Coping Mechanisms
Some language-speech therapists have observed that children with high stress or anxiety levels may display ASD-like symptoms. This is because of childhood trauma and the resulting insecure attachment patterns that a child develops as a coping mechanism.
The child may actively avoid social interactions and eye contact in order to feel secure in their environment. These behaviors are also present in children with other learning disabilities, such as dyslexia.
Earmarking the Most Distinguished Symptoms of the Disorder
Before a decision regarding mild autism can be made, it is important to identify the most distinctive signs of the disorder. Evaluators and healthcare practitioners can then use these distinguished symptoms to measure how closely a child matches these criteria for an accurate diagnosis.
According to the National Library of Medicine, autism is marked by three core symptoms –
- Impairments in Communication
Children and adults with autism face difficulties in understanding verbal cues from others. They may not be able to make sense of hand gestures, eye contact, and other facial expressions.
When interacted with, these individuals may continue to give a blank stare or stay oblivious to their immediate environment.
- Restricted Repetitive Behavioral Patterns
One of the hallmarks of ASD is the prevalence of repetitive behaviors or interests in those affected by it. For example – a child may continue to line up items in a specific order or flap their hands without rest.
This repetition may also show itself in their speech, also known as echolalia.
- Reciprocal Social Interactions
Another distinctive symptom of those who have ASD is that they find it difficult to reciprocate social and emotional conversations. For instance – you could narrate an emotional story to a person with ASD, and all they could respond with is a blank, confused stare.
In some cases, abnormal social approaches are observed, such as responding in a rude manner in sensitive matters.
Factors Affecting an Accurate Diagnosis
Over the years, formal autism assessments have become much more reliable. For instance – the Autism Diagnostic Observation Schedule (ADOS) is a specialized ASD diagnosis test conducted for a span of 30 to 60 minutes. During the assessment, the evaluator will offer the child a series of chances to display their interaction and communication abilities.
These may include small tasks like responding to their name being called, commenting on another person’s emotions, etc. While this does wonders to standardize the entire diagnostic process, its accuracy may depend upon a number of factors, including –
1. The Knowledge of the Condition
Every evaluator must thoroughly know what autism entails and how it may manifest in different individuals. This knowledge must go beyond ASD symptoms in children.
Evaluators need to be aware of autism symptoms in adults, the latest theories surrounding the disorder, discoveries, gender differences, available treatments, how the disorder changes over an individual’s lifespan, and more.
Only when they have thorough knowledge can they assess on a case-to-case basis and offer affected individuals and their families the necessary support.
2. Training and Experience
An interesting aspect of ASD diagnosis is that it is highly dependent upon an evaluator’s training and experience. Since there is no specific medical test, evaluators need to refine their diagnostic abilities through real-life experiences.
Over the past two decades, the Early Intervention Program for Autism has expanded throughout the US. However, supervised training is still lacking among psychologists. Without a clear idea of what the different faces of autism look like, evaluators may find it difficult to provide an accurate diagnosis.
3. Variability in the Child’s Performance
Young children do not display singular behavioral patterns like adults. Their behavior might change on a moment-to-moment basis. It’s common to find a child hysterically laughing one moment, followed by profuse crying the next.
This is also a challenge for evaluators. Different variables come into play, including the time of the assessment, the place, the child’s present mood, their comfort level with the evaluator, the person accompanying the child, etc. Experienced evaluators will take all these factors into account before offering a concrete diagnosis.
4. Validation of Parent-Child Interactions
Despite all efforts, a one-time test may fail to offer accurate results because the child’s performance may differ. The evaluator can schedule multiple assessment sessions.
In any case, they must compare their one-on-one assessments with the child-parent report. Was the child’s behavior on the day of testing typical, or did they act differently? Since a parent spends a lot more quality time with their child as opposed to the evaluator, their interactions also provide a solid basis for an accurate diagnosis.
The Validity of Being “On the Spectrum”
Keeping the above factors in mind, it makes perfect sense that autism may be described as a ‘spectrum’ of disorders. This is because its symptoms not only vary among individuals but may present themselves differently, too.
The most distinctive cases are where an individual showcase significant speech and interaction struggles. In other cases, evaluators and parents need to rely on occasional ‘atypical’ outcomes. The latter mostly goes undiagnosed until the adolescent or adulthood stages.
The child may sit on the most subtle end of the ‘spectrum’ where their behaviors do not call for an immediate healthcare evaluation. This is why autism awareness and education are so vital among parents and teachers. Since they play a direct role in the child’s lives, they have a better chance of picking up on the ‘subtle’ symptoms.
Possible Causes and Symptoms of Mild Autism
According to the Centers for Disease Control (CDC), most autistic cases are genetic or complications experienced during pregnancy. The latter may include certain medications known to cause ASD in children. One such medication that has received much criticism is Tylenol, a drug used to treat headaches and muscle aches.
Affected mothers are filing a consolidated Tylenol lawsuit after their child was diagnosed with ASD, ADHD, and other speech-language disorders. More courts are pushing the Tylenol litigation forward after proven reports on the in-utero connection between the drug and autism.
According to the observations of TorHoerman Law attorneys, most cases are filed against big companies like Johnson & Johnson. Parents are enraged that these companies failed to warn them of the possibility of the condition. A class-action lawsuit may be housed in hopes of global settlements for the affected children and their families.
Both genetic and drug-related autism may present itself through mild symptoms. The most important thing to look out for is the consistency of the signs. Evaluators and parents can keep an eye on common behaviors that make an ASD diagnosis possible. As per the CDC, these symptoms include –
- A fixation on specific activities or ideas
- An unwillingness to participate in new experiences
- A lack of verbal expressiveness
- Aversion to cuddling or hugging
- Difficulty engaging in a conversation or avoiding eye contact
- Unable to catch on verbal cues, such as not responding to one’s name being called
- Difficulty in grasping other people’s feelings and emotions
- Affinity for isolation
- Inability to express one’s needs
- Aggressive behaviors or sudden tantrums
The Therapeutic Approach to a Better Life
Even today, there is no cure for autism. Most forms of the disorder, full-blown or mild, respond well to therapeutic approaches. The goal of these treatments is to ensure a child is able to function well and adjust to their surroundings.
Some of these therapies include behavioral management therapy, nutritional therapy, cognitive behavior therapy, and parent-mediated therapy. Still, the best possible approach is early intervention.
A recent research conducted by Rutgers University found that the Auditory Brainstem Response (ABR) test shows promise in the early detection of autism. This test uses the individual’s brain waves to understand their socio-emotional behaviors. The test results can give answers for abnormal motor control, sensory processing, and language disabilities.
The alpha waves as autism’s neuro-marker may call healthcare practitioners to rethink all about the condition.
