Answers to Questions about Autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that leads to characteristic differences in socialization and communication as well as characteristic behaviors (as defined by DSM-5). It is a spectrum disorder meaning that there is a highly varied set of symptoms among people with autism and varying degrees of severity.

Asperger’s syndrome used to be a separate diagnosis from autism, but has been brought under the umbrella of Autism Spectrum Disorder (ASD) in recent definitions of ASD in the DSM-5. Asperger’s tends to refer to people on the less severe side of the autism spectrum, and though the term is no longer used in health care settings, some people may still use it from time to time to describe more mild forms of autism.

The underlying biology in the brains of people with autism is not fully understood by researchers and scientists, and a single underlying process in the brain has not been found. The general consensus among scientists is that genetic factors cause changes in brain structure and connectivity, which in turn affects socialization and communication skills and causes the characteristic behaviors in people with autism. A significant amount of research time and funding is ongoing to better understand the biology of autism. We have additional details on the biology of autism and links to research in our new parent kit.

It’s important to note that the initial signs of autism in children can vary significantly for each child. Different children will often show different signs — some children may show many signs and other children may show few signs. The time course can also vary by child, with some children showing signs at a very young age (first few months of life), others showing signs after 1-2 years of life, and still other children appearing to have a normal development for their first couple of years and then appearing to regress and lose abilities they used to have (such as losing communication skills). And it is also possible to have some of the symptoms of autism but not have autism spectrum disorder. Because of this complexity, a specialized health care provider is needed to establish a diagnosis of autism.

The severity level is intended to capture the level of support and services required by a person with autism. The severity level can also change over time. The three levels are:

• Level 1: Requiring support
• Level 2: Requiring substantial support
• Level 3: Requiring very substantial support

The time course varies by child. Some children show signs at a very young age (first few months of life), others show signs after 1-2 years of life, and still other children appearing to have a normal development for their first couple of years and then appearing to regress and lose abilities they used to have (such as losing communication skills).

For the majority of people, autism is a lifelong condition. Said otherwise, children with autism become adults with autism. There are some reports of children who have received early intensive services and later no longer meet the diagnostic criteria of autism spectrum disorder. Such children may still need additional support (e.g., educational supports) relative to their neurotypical peers.

Autism is more common in boys. For instance, in Colorado, boys were 4.5 times as likely to be identified with autism than girls based on data from the CDC.

There are a wide range of causes of a speech delay. Some children may have only a delay in language, for which many children “catch up” as they get older and undergo therapy. Other children may have a more general developmental condition where speech delay is one sign of a broader condition, such as autism. Still other children could have other issues such as a hearing impairment. If you notice speech delay in your toddler, you should speak to your pediatrician or a specialized health care provider about your concerns.

Possibly, but not necessarily. About 10% of preschool children have a language delay, but only 2% of children have autism. This means that the majority of children with delayed speech do not have autism. Autism is often accompanied by other signs beyond speech delay. See this infographic for more on the signs of autism and a broader list of potential signs of autism.

If your child is not meeting common developmental milestones, you should mention this to your pediatrician or another specialized healthcare provider like Soar. Examples of common milestones by age-related to language are shown above on our website. You can also check out the CDC’s website on Milestones in Action to see a complete set of videos related to developmental milestones. For those families interested in an assessment or testing for a child, you can read more about our child psychologist Dr. Wischkaemper on the Testing page or reach out to us at 720-706-3396 to schedule an appointment.

A wide body of scientific research supports that early detection of speech delays and early intervention is beneficial to young children. Indeed, the CDC has a campaign called Learn the Signs, Act Early to encourage early detection of potential delays in young children.

Try listening to your partner’s reactions without judgment – these feelings are completely normal and everyone processes a developmental concern differently. Remember that seeking services early for your child is the most impactful way you can help them.

Seek to understand your partner’s perspective and see if there is common ground – everyone processes a developmental concern differently. You can also consider seeking therapy services and support from a licensed counselor if needed.

Some providers may have been trained during a time when a “watch and wait” approach for developmental concerns was used. Today, leading medical societies including the CDC strongly advocate for early intervention to support a child’s long-term health. If you are in this situation, talk to your provider about your concerns and see if they can be addressed. You can also consider switching to another provider or asking for a second opinion. You are the ultimate advocate for your child!

Early Intervention (EI) is a government-run program focused on helping young children under the age of 3. EI programs and services covered by health insurance offer complementary approaches to helping a child. Some families access only EI services, other families access only health insurance-based services, and some access both. If you think your child needs more than what they are getting in EI, talk to your provider or pediatrician about ways to supplement that care.

It typically involves a test or assessment from a child psychologist or clinician who specializes in autism. If you are concerned that your child may have autism or have been told by a health care professional to seek out an autism assessment, call us at Soar Autism Center at 720-706-3396 or ask your pediatrician for a recommendation.

Typically a child psychologist or other clinician who specializes in autism testing and assessments can perform an evaluation. We offer this service at Soar Autism Center with our psychologist Dr. Abby Wischkaemper. We also have a list of other diagnostic providers in the greater Denver area for parents in our new parent kit.

Usually a standardized assessment or test is used in combination with a clinician’s independent judgment. During the assessment, the clinician will play with the child and watch for certain characteristics seen in children with autism. Assessments should be fun, and a child shouldn’t know they are being tested. The specific assessment used will vary depending on who evaluates your child, but examples of common assessments used in the US include the Autism Diagnostic Observation Schedule-2nd edition (ADOS-2), Autism Diagnostic Interview-Revised (ADI-R), Childhood Autism Rating Scale-2nd edition (CARS-2), and Gilliam Autism Rating Scale (GARS).

Autism tests are typically covered by most health insurance plans, including Medicaid. The specific cost will vary based on the details of your health insurance plan (e.g., co-pays, deductibles). If you are wondering about the cost of an assessment with us, call us at 720-706-3396 and we can check your insurance benefits for you.

Call us at 720-706-3396 and talk to one of our intake specialists who can help assess if an evaluation with Dr. Abby is a good fit for your child. You can also talk to your pediatrician or other health care provider for their recommendations.

Check out the signs of autism infographic that is on our Screening page. It shows different signs and symptoms of autism by age, as well as symptoms that can show at many different ages. We also have videos of neurotypical development from the CDC.

The M-CHAT is also known as the Modified Checklist of Autism in Toddlers. It is a screening test used to identify children who may be at risk for autism, and is focused on toddlers (typically 16 to 30 months of age). It consists of a series of questions that the parent answers about their child and is often done at a well-child visit with a pediatrician. It does not officially diagnose a child with autism but indicates possible risk of autism and that a diagnostic assessment may be beneficial for the child. You can take it online on our website here.

You should consult a health care provider, including your pediatrician and/or a specialized provider who can evaluate for an autism assessment. We offer this service at Soar Autism Center, and we also have a list of other Colorado providers who perform diagnostic testing in our new parent kit.

Conceptually, there are 3 broad categories of treatment modalities used to support children with autism: 1) behavior and communication approaches, 2) medications, and 3) complementary and alternative medicines, including dietary approaches. What is needed for each individual child will vary and should be based on a consultation with an expert provider in autism.

In our view, the overarching goal is to help a child with autism reach their fullest potential and improve their long-term quality of life. This often means helping them develop new skills to navigate the modern world, for instance by helping with speech and communication skills. But this is an important question to ask any provider you may consider.

There is a strong evidence base for early intervention on outcomes, and early intervention is supported by leading U.S. medical societies. Parents should, in consultation with a provider, strongly consider services at a young age to support a child’s long-term growth and development. Research studies have even found physiologic improvements in children who receive early intervention therapy, such as changes on brain wave tests (EEG) when viewing faces and objects.

Behavior therapy for children with autism is typically based on the principles of applied behavioral analysis, or ABA. Simply put, ABA focuses on the use of reinforcement to develop new skills or increase the use of certain positive behaviors. For instance, in a child with delayed speech who likes cars, a therapist might work with the child to say the word “car” and then provide reinforcement for the child saying “car” by giving him or her a toy car. There has been a tremendous amount written about ABA online and it’s easy to get lost, confused, and overwhelmed in the sea of information. Additional detail on ABA and how to evaluate providers is available in our new parent kit that you can download from our website.

ABA is not one therapy—rather, it is a family or umbrella of overlapping therapies. Several different models may be used with your child that, while based on the same underlying principles of ABA, in practice look quite different from one another. We’ve created an infographic on our Learning Center page to talk more about the differences between the different sub-types of ABA therapy, and additional detail is available in our new parent kit.

ABA is not the only evidence-based therapy used in children with autism. For instance, children often benefit from speech therapy and occupational therapy, among other types of therapy. But ABA has been shown in multiple studies to support the development of children with autism, particularly at an early age. The therapies tend to be complementary with one another and high-quality programs will focus on a comprehensive and individualized approach across modalities for a child.

Speech therapy is a type of communication therapy typically performed by a Speech-Language Pathologist, a Master’s- or Doctorate-level clinician who specializes in speech and communication. There are many different approaches that a speech therapist may use to support communication in children with autism.

Occupational therapy is a type of therapy typically performed by an Occupational Therapist, a Master’s- or Doctorate-level clinician. Specific approaches will vary by clinician and by child, but can include enhancing sensory processing, supporting self-care and daily living skills (e.g., getting dressed), and assisting with fine motor and gross motor delays.

There are no medicines that have been shown to cure autism or treat its core symptoms. However, a health care provider may prescribe medication to support the well-being and functioning of a child with autism, such as medicines to help manage anxiety or help with sleep.

There is a wide variety of types of autism providers available for families in Colorado. You can download our new parent guide which goes into detail on questions to ask when evaluating different providers. Some questions you may want to ask of potential providers include:

• What types of services will my child need, and who offers them? (e.g., ABA only or an integrated program of ABA, speech therapy, occupational therapy, and other supporting therapies)
• If ABA is recommended for my child, what sub-type of ABA do I want him or her to receive? (e.g., discrete trial training, naturalistic developmental behavior interventions, a hybrid)
• Do I want my child to receive services in a home- or clinic-based setting?
• What is the training and retention for staff? How much staff turnover do they see?
• Is the provider using evidence-based services?
• What are the treatment goals?
• What support will I get as a parent?
• What is their track record of success and outcomes?
• What is the clinic leadership like? Who are they? What do they value?
• Is my insurance accepted?

Yes. If you’d prefer to receive treatment at another provider, we are happy to refer you to another provider or coordinate with another provider on a care plan.

Early Intervention (EI) is a program that provides free services to children under the age of 3 who have a developmental delay or disability, including but not limited to children with autism. Our Learning Center has information on how to access Early Intervention services. Early Intervention services and health insurance-based services can be viewed as complementary approaches to helping a child. EI services tend to be of lower intensity and free to families, focusing on a smaller number of hours (e.g., 1 hour a week) and training of parents. In contrast, health insurance-based services tend to cover more hours of therapy (varies by child but could be 20-30 hours a week) and are paid for by health insurance.