Ask the experts: Autism

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Q: What is autism?

 A: Autistic disorder is classified as a “pervasive developmental disorder,” which means the disorder’s symptoms affect many areas of development. Symptom presentation and severity can vary widely from one individual to the next, but a diagnosis of autistic disorder requires impairments in social interaction, communication and behaviour.

Social impairments may include absent or infrequent eye contact and failure to develop age-appropriate relationships with peers. A delay or absence of language development and a failure to develop mentally appropriate play skills are examples of communication impairments. Preoccupation with particular interests that are unusual in their intensity or focus, and rigidity regarding non-functional routines are behavioural symptoms that may be seen in an individual diagnosed with autism.

Autistic disorder is a lifelong condition. Those with autistic disorder may appear to have no interest in socialising with others, they may have extremely limited functional communication skills, and they may engage in behaviours that require them to be constantly supervised. However, there are some individuals who, after receiving proper treatment, may become indistinguishable from their typical peers.

Q: At what age can a child be reliably diagnosed?

A: A reliable diagnosis of autism should be made following a comprehensive evaluation by a trained professional such as a psychologist or physician. Interviews with caregivers will be an important piece of the diagnostic process, as will an assessment of developmental milestones. Another crucial evaluation component is a specialised measure, such as the Autism Diagnostic Observation Schedule (ADOS) or the Autism Diagnostic Interview-Revised (ADI-R). Additionally, other instruments may be included in a comprehensive assessment.

Diagnosis before 12 months of age is unusual. In fact, diagnosis before 18 months is currently unreliable. Developmental delays and behavioural differences become more apparent shortly thereafter and, in most cases, a reliable diagnosis can be made before a child turns three years old. It is critical for parents to bring any concerns they have regarding their child’s development to the attention of their paediatrician as soon as possible. Research has clearly demonstrated that treatment for autistic disorder is more effective the earlier it begins.

Q: What is the treatment for autism?

A: The most effective research-supported treatment for autistic disorder is applied behaviour analysis (ABA). ABA techniques, such as reinforcement, are used to teach various skills, and reduce challenging and other socially significant behaviours. ABA has been shown to be effective for a multitude of individuals, addressing any number of needs (self-care, making friends, learning to talk), and in all sorts of settings (one-to-one instruction, typical classrooms, everyday settings).

Effective ABA intervention is characterised by detailed assessment, objective measurement, skills broken down into small steps, and fun for the learner! Importantly, ABA should be delivered by qualified professionals. Unfortunately, effective treatment requires a substantial number of hours, which makes the treatment quite expensive.

Dr David Fischer, who provided this information, is a behavioural consultant at Autism Partnership Limited. Autism Partnership is a worldwide authority and one of the largest applied behavioural analysis service providers for the treatment of autism. Founded in the US in 1994, Autism Partnership now has more than 200 full-time staff working throughout offices in the US, Canada, the UK, Australia, Singapore and Hong Kong.


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