Sunday, April 8, 2012

Autism Primer: Q & A with Dr. Lee A. Wilkinson

Dr. Lee A. Wilkinson, award-winning author and autism specialist, offers introductory answers to frequently asked questions about autism spectrum disorders (ASD). Resources are also provided that will guide you to further information. The content is intended to be informational only and does not constitute professional advice.

Question: What is an autism spectrum disorder (ASD)?

Answer:  The synonymous terms Autistic Spectrum Disorder (ASD) and Pervasive Developmental Disorder (PDD), including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), refer to disorders of childhood onset characterized by impairment in social interaction and communication, as well as restricted or stereotyped patterns of behavior or interests. These delays or atypicality in social development, communication, and behavior vary in severity of symptoms, age of onset, and association with other disorders. Deficits in social relatedness are the major source of impairment and defining feature of all autism spectrum disorders (ASD), regardless of cognitive or language ability. This includes difficulties in communicating with others, processing and integrating emotional information, establishing and maintaining reciprocal social relationships, taking another person's perspective, and inferring the interests of others.

Question: What are the reasons for the dramatic increase in children identified with ASD?

Answer: Contrary to popular reports of an autism “epidemic,” the increase in prevalence over the last 10 years is mostly due to better identification practices, broadening of the diagnostic criteria, diagnosis at an earlier age, and greater public awareness of the signs and symptoms of ASD. Although the number of children identified has clearly increased, it is unclear whether the actual number of children with ASD has increased dramatically.

Question: What is the cause of ASD?

Answer: Autism is a neurodevelopmental disorder of unknown cause. Current research links autism to biological or neurological differences in the brain. Unfortunately, there are no biological markers or laboratory tests that can reliably diagnose autism. Growing evidence suggests that genetic factors play a significant role in its etiology. Although autism may be associated with a variety of genetic mechanisms and no particular environmental factors have been scientifically validated, ongoing studies are examining a possible gene-environmental connection.

Question: At what age can children be identified with ASD?

Answer: Autism is a lifelong neurodevelopmental disorder that appears during the first three years of life. Although normally present from birth, the age at which symptoms become apparent varies significantly. Advances have been made in identifying behavioral indicators as well as atypical development in very young children who are later diagnosed with ASD. Common signs or “red flags” of autistic disorder include: • Does not smile by the age of six months • Does not respond to his name • Does not cry • Does not babble or use gestures by 12 months • Does not point to objects by 12 months • Does not use words by 16 months • Does not use two-word phrases by 24 months • Regresses after mastering skills/loses previously mastered skills • Delays in milestones like crawling and walking. Although there is some evidence that the features of autism can be identified very early in life, the most reliable diagnosis is generally made by trained professionals when a child reaches approximately 2 years of age.

Question: How does a family history of autism affect the risk of a child developing an autism spectrum disorder?

Answer: Researchers now recognize that there is a genetic vulnerability in the development of autism. For example, twin studies indicate that in identical twins, if one twin has autism, there is a 60-90% probability that the other twin will also be affected. A recent research study suggests that nearly 1 in 5 children who have an older sibling with autism will also develop the disorder at a rate much higher than previously thought. Earlier estimates put the risk at between 3 and 10%, but the study found a substantially higher risk rate of approximately 19%, on average. Boys were nearly three times as likely to develop autism as girls, with a recurrence rate of 26% versus 9%. Unfortunately, we do not know how to estimate an individual family’s actual risk.

Question: How early should intervention begin for children with ASD?

Answer: Researchers and practitioners suggest that children identified with autism begin intensive behavioral treatment and receive educational services as early as possible in order to achieve the best possible outcomes. Specialized instruction should occur in a setting in which ongoing interventions occur with typically developing children. There is evidence that the early initiation of services is associated with a greater response to intervention and positive changes in language, social, or cognitive outcomes.

Question: What intervention or treatment works best for children with ASD?

Answer: There is no single intervention or treatment that is right for every child with ASD and no specific program or model has been shown to be superior to another. According to the National Research Council (2001), research is not yet available to predict which intervention approaches work best with which children. As a result, no one approach or method is equally effective with all children, and not all children will make the same progress or gains. The most effective interventions and programs are those that are based on the individual child’s unique needs, strengths and weaknesses.

Question: What are the long term outcomes for children with ASD?

Answer: There is no cure for autism. A diagnosis of ASD remains fairly stable throughout adolescence and adulthood. Although research has demonstrated substantial progress in response to scientifically-based interventions over a relatively short period of time, few longitudinal studies have examined the long term outcomes for children with ASD. Outcomes tend to be variable, with some children making significant improvement and gains and others showing little progress. However, recent research suggests that there is a trend toward improved outcomes for individuals with ASD in general. Increased opportunities for early intervention, improved educational programs and services, and parent and family support substantially increase the possibility of a more favorable outcome.

Resources for Further Information

American Academy of Pediatrics. Understanding Autism Spectrum Disorders [pamphlet]. Elk Grove Village, IL: American Academy of Pediatrics; 2005. <>
Autism Society of America <> <>
First Signs. <>
May Institute <>
National Autism Center <>
National Institute of Child Health and Human Development Autism Site <>
Organization for Autism Research (OAR) <>

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

© Lee A. Wilkinson, PhD

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