Pathways in Autism Spectrum Disorder: Early Recognition, Diagnosis, and Intervention

“If you meet a child with autism,
you meet one child with autism.”
– Steve Silberman

What is autism?

Autism spectrum disorder is a complex neurodevelopmental disorder. Children and adolescents diagnosed with autism typically have sensory sensitivities (i.e. cover their ear to loud noises, dislike certain tastes), difficulties with social communication (i.e. talking with same-aged peers), transitioning between activities, and repetitive behaviours (i.e. hand flapping, body rocking). However, as the quote by Steve Silberman points out, every child diagnosed with autism is unique, and each individual tends to vary in their symptom severity (thus, we call it a spectrum). For example, one child with autism may have great verbal skills, but have difficulties with transitioning between leaving daycare and going home; another child with autism may have poor social communication skills, but have no sensory sensitivities.

What kind of behaviours should I be concerned about?

Early recognition of behavioural difficulties is important. Typically, parents are the first to recognize abnormalities in their children’s behaviour. For example, research has shown that parents of children who are eventually diagnosed with autism noticed that within the first year of life, their child had consistently made poor direct eye contact, showed language delays (i.e. said their first words after 24 months), had motor-coordination problems (i.e. crawled and/or walked later), were less socially responsive (i.e. less smiles and laughs), and were either over-reactive (i.e. sensitive to sounds, touch, tastes) or under-reactive (i.e. not responsive at all). Parents also reported that their children had difficulty sleeping and were often hard to soothe when upset. It is important to note that these behaviours do not necessarily reflect autism, but further assessment would be needed to determine if there are developmental concerns.

Okay, I have concerns about my child’s behaviour. What should I do now?

Parents with these concerns often consult with developmental experts (i.e. clinical psychologists, paediatricians, family doctors) and request an assessment for autism or other developmental concerns. Children as young as 18-24 months old can receive a diagnosis from a developmental healthcare professional. A formal diagnosis is based on the results of a full developmental assessment. A full assessment includes an interview with the parents about their child’s developmental history and milestones. The assessment will also include tests focused on identifying symptoms of autism (i.e. language, social skills, play skills, repetitive behaviours, etc.). At the end of the assessment, parents are given a full report of the findings, and if a diagnosis is given, a list of recommendations for interventions.

If my child gets a diagnosis of autism spectrum disorder, where do I go now?

Starting intervention as early as possible is crucial to better outcomes for children diagnosed with autism. For example, research has demonstrated that children with autism who received early applied behavioural analysis (ABA) intervention and when the intervention was developed in partnership with the parents showed better outcomes in language ability, social interactions, and a decrease in symptom severity. There are a number of provincially funded service providers (i.e. ErinoaksKids Centre for Treatment and Development in Milton, and Ron Joyce Children’s Health Centre in Hamilton) that offer interventions to parents and children with autism. Families also have the option of paying out of pocket for private ABA therapists. Although many of the wait-lists for these programs are long, it is important to note that programs do offer parent support programs that coach parents on the principles of ABA prior to starting early intervention. In this way, parents can start components of the intervention before they start formal therapy.

This article was written by Vivian Lee, Ph.D., Psychometrist with New Leaf Psychology Centre. Vivian conducts psychoeducational and developmental assessments, including assessments for autism spectrum disorder. Vivian is also a postdoctoral student at the Offord Centre for Child Studies with McMaster University and the Ontario Ministry of Children and Youth Services.
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