The basics of the autism spectrum

As the statistics show, autism ? or at least the recognition and diagnosis of ? has been on the rise. Because studies show that the earlier it is diagnosed and therapies can begin, the better the results will be, we reached out to Children's Hospital of Pittsburgh of UPMC for an expert opinion. They put us in touch with Board Certified Behavior Analyst Alexandra Perryman, lead clinician at the Western Psychiatric Institute and Clinic of UPMC Theiss Early Autism Program.How many children are diagnosed with autism each year?The Centers for Disease Control currently reports that approximately 1 in 68 children are diagnosed with autism each year. However, other organizations have estimated the number to be as high as 1 in 45 children.How do these numbers compare to 10 years ago? Twenty-five years ago? Fifty years ago?The prevalence of autism has continued to increase each year. Fifty years ago, the prevalence was approximately 1 in 2,500. It then rose to about 1 in 150 in the early 2000s and has continued to gradually rise since then. It is now 1 in 68 children. However, the CDC notes that the number has not increased since 2014 and may be starting to plateau.What can we attribute that change to?No one is completely certain why the prevalence has increased so much. The criteria for diagnosing autism has changed significantly over the years and there are now more specific criteria in place which makes diagnosing autism easier. There is also an increased awareness about autism and many professionals (pediatricians, teachers, etc.) are now more aware of the symptoms, which may lead to more children being referred for evaluations, which in turn could lead to more diagnoses.Are there any particular children that are at higher risk for autism?Boys are 4.5 times more likely to be diagnosed than girls. Siblings of children with autism are also at higher risk, due to a genetic component to the disorder. Currently, white children are slightly more likely to be diagnosed than minority children. However, this may be due to a lack of resources for minority children, not a lower risk for autism.Can you describe the spectrum?Each individual with autism can present differently, with a wide range of abilities and behaviors. This is why autism is referred to as a spectrum. Individuals with autism typically display social impairments, but this could range from preferring to be alone all of the time and not initiating any social interactions or struggling with things like eye contact or reading facial expressions. Individuals with autism also typically engage in some type of repetitive behaviors or restricted interests. This could be hand flapping, body rocking, lining up toys or objects, only talking about one topic, repeating lines from movies or television shows, or any behavior that is done over and over again without a social function. Many individuals with autism also struggle with communication. Some may be non-vocal and communicate in other ways such as sign language or a voice output device. Other may communicate vocally, but struggle with more complex parts of language such using the correct pronouns or verb tense. Each individual with autism is different and that is why individualized treatment is also important.What are early signs of autism?Some of the early signs of autism include a lack of smiling and joyful expressions by 6 months old, a lack of eye contact, lack of babbling by 12 months, lack of gestures such as pointing or waving by 12 months, a lack of imitation skills, lack of play skills, and a lack of meaningful two-word phrases by 24 months. Parents who notice these warning signs can ask their pediatrician for an evaluation.What are the benefits of early intervention? How early can a child be diagnosed?Early intervention has significant benefits for children with autism. Research has shown that the earlier a child begins treatment, the more gains are made in communication skills and social skills. Autism can be diagnosed as early as 18 months, although it is more commonly diagnosed around 24 months. It is important for parents and professionals to be aware of the early warning signs and refer the child for a diagnosis as soon as warning signs are noticed. After a diagnosis is made, it is important to enroll the child in evidence-based services as soon as possible.What types of therapies are available for those with autism?Applied Behavior Analysis (ABA) is the only therapy for individuals with autism with a strong evidence base that has been developed over many years. It focuses on identifying why the individual is engaging in challenging behaviors and teaching them appropriate replacement behaviors instead. There is also a strong focus on the development of communication skills. The guiding principles behind ABA remain the same, but the way it is implemented is very individualized and focused on developing each individual's strengths. Individuals with autism may also qualify for speech therapy, occupational therapy or physical therapy depending on their specific needs. There are also many other therapies available for children with autism, but they do not have scientific evidence to show that they are effective. That does not mean they are ineffective, it only means that more research is required. These therapies include things like floortime, the Early Start Denver model, art therapy, music therapy, sensory integration therapy and auditory integration, among many others.What are the latest advances in terms of therapies for those with autism? How should we expect that to change in the next five to 10 years?There are many other types of therapies available for those with autism, but there is not yet wide-spread research that indicates that they produce significant, positive changes for individuals with autism with the exception of Applied Behavior Analysis. With the recent spotlight on autism and growing prevalence, I think we will see research increasing and aiming to provide the most comprehensive and most effective therapy packages for individuals with autism. ABA has proven to be a very effective therapy for individuals with autism, but I think with more research, we could see other types of therapies that might be combined with ABA to make an even more effective treatment package.