Managing Behavioral Issues

By Gillian Feit

Managing behavioral issues can be a challenge; especially when you are dealing with a child with Autism Spectrum Disorder (ASD). All children, atypical or not, experience meltdown and tantrums at some points in their lives. Most times, these outburst result from not getting something their way or a build up of anger/ anxiety. Although meltdowns and tantrums may be startling for the caregiver and others around, there are some strategies for dealing with these emotional outbursts. 

First, it is vital to understand the cycle of tantrums, rages and meltdowns. There are typically three stages which are; 1) the rumbling stage, 2) the rage stage and 3) the recovery stage (Myles and Hubbard, 2005). The rumbling stage is the first stage of the event and this is when the individual begins to display behavioral changes such as; “clear their throats, lower their voices, tense their muscles, tap their foot, or grimace. Some students engage in behaviors that are more obvious, including emotional or physical withdrawal, or verbally or physically challenging another child or adult” (Myles and Hubbard, 2005). Next, the rage stage is when the  child “is disinhibited and acts impulsively, emotionally, and sometimes explosively. These behaviors may be externalized (i.e., screaming, biting, hitting, kicking, destroying property or self-injury) or internalized (i.e., withdrawal). Meltdowns are not purposeful, and once the rage stage begins, it most often must run its course” (Myles and Hubbard, 2005). Finally, the recovery stage occurs after the meltdown and this is when many children may deny that any inappropriate behavior occurred while others may be so exhausted that they need to sleep (Myles and Hubbard, 2005).

Although these emotional outbursts may be jarring, there are many strategies for dealing with them. Some common strategies are; antiseptic bouncing, redirecting, proximity control, signal interference, support from routine, just walk and don't talk, and home base. 

Antiseptic bouncing is when you remove a child from the environment where they are experiencing the difficulty. For example, if the child is in a classroom, the teacher may send them on an errand or to simply take a walk in the halls. At home, the parent may ask the child to bring them an object or check on something in another room. This encourages the child to focus on a new task which will take their mind off of the challenge. Antiseptic bouncing is also similar to redirecting which involves helping the child “to focus on something other than the task or acuity that appears to be upsetting to her” (Myles and Hubbard, 2005). 

Proximity control is another strategy to help a child who has become upset or angry at something. This is when the teacher moves near the students or the parents move near their child. Even just standing next to the child is calming and makes them feel more supported in the hard time. This strategy “can easily be accomplished without interrupting an ongoing activity” (Myles and Hubbard, 2005).

Signal interference is when the teacher or parent begins to notice initial behavioral changes in the rumbling stage. For example, the teacher may position himself in a location to make eye contact with the student in order to present “an agreed-upon ‘secret’ signal, such as tapping on a desk, to alert the child” (Myles and Hubbard, 2005). This will tell the child that the teacher understands that they are upset in order to show solitude to them. 

Support from routine is a technique that helps to provide security to the child so there are no surprises. This allows the child to mentally prepare themselves. Support from routine tends to prevent anxiety and reduce the likelihood of tantrums, rage and meltdowns (Myles and Hubbard, 2005). 

Just walk and don’t talk also helps children manage their emotions. This strategy is when an adult walks alongside a child without talking. The adult’s silence is important because a child who is dealing with an emotional battle will likely react to any adult statement and may take their statement wrongly. Instead, the adult is there and will be an active listener to the child if the child wishes to speak about their feelings (Myles and Hubbard, 2005).

Additionally home base is a tactic that is used to help children become calm in a time of trouble. “A home base is a place in school or at home where an individual can escape stress” (Myles and Hubbard, 2005). In school, this place may be the student’s guidance counselors office, while at home, “home base” may be the child’s bedroom “or an isolated area in the house”. The home base should always be viewed as a positive environment and it should be quiet with slim to none distractions (Myles and Hubbard, 2005). 

Additionally, when these children are in such a state that they experience an emotional outburst, some may display self-injurious behaviors (SIB). SIB are unfortunately fairly common however, having a caregiver or a more mentally controlled figure with the individual, helps loved ones feel more reassured that the individual is in good hands. It is important to note that “generally SIB starts in early childhood: 50% of individuals showed SIB before 3 years of age, 70% before 7 years of age up to 90% before 10 years of age” and the severity of SIB differs from person to person. The severity of SIB is based on the frequency, duration, form, localization and physical damage. Every child is different in terms of their emotional level and management so it is vital to work with the child and a trusted professional to learn how to diminish SIB (Huisman et al., 2018). 

When dealing with a child with SIB or frequent behavioral issues, it is vital to understand how to implement positive reinforcement and behavior management techniques. Caregivers can use positive reinforcement when encouraging good behavior to reoccur. For example, if a child has a meltdown every time broccoli is on their plate, their parents may say that if they do not have a meltdown when they see broccoli on their plate, they can play with their favorite toy for 10 minutes instead of 5 minutes. This gives the child more of their desired interest while also encouraging them to keep calm. Other behavior management techniques include; “physical restraint, ‘Tell-Show- Feel and Do technique’, verbal and non-verbal communication, parent present / absent” (Othman, 2017).

Another way to manage behavioral issues is to help the child to get all of their anger out prior to having a tantrum. Dr. Sherkow often uses “bang-a-ball” to help individuals to release aggression. Implementing combat sports to release aggression are extremely beneficial to the child because it helps them take their emotions out on an object rather than others or by engaging in SIB. “Bang-a-ball” which some may know as ‘pound/whack-a-ball’ is a method that helps children release their strong emotions by being instructed to hit the balls while simultaneously saying their thoughts. They may be instructed to change their force when banging the ball or change their yelling volume. Rather than having a tantrum, this encourages the individual to get their emotions and thoughts out by expressing themselves through their strength on a toy. Dr. Sherkow enjoys this method because it is unharmful and the child is still expressing their emotions which is valuable. 

Overall, managing behavioral issues can definitely be difficult but by seeking to implement different strategies and working with the child, emotional outbursts are much more manageable. 

References

Myles, B. S., & Hubbard, A. (2005). The cycle of tantrums, rage, and meltdowns in children and youth with Asperger syndrome, high-functioning autism, and related disabilities. In CDROM ISEC 2005 Inclusive and Supportive Education Congress (Vol. 10, p. 05). 

Huisman, S., Mulder, P., Kuijk, J., Kerstholt, M., Eeghen, A. v., Leenders, A., Balkom, I. v., Oliver, C., Piening, S., & Hennekam, R. (2018). Self-injurious behavior. Neuroscience and Biobehavioral Reviews, 483-491. https://ern-ithaca.eu/wp-content/uploads/2020/12/Huisman_SmithMagenis_SIB_NeurosciBiobehavRev2018.pdf 

Othman, B. A. (2017). Behavior Management of Children with Autism. Al-Kindy College Medical Journal, 13(1), 27-31. https://www.iasj.net/iasj/download/593b501fddd6fe8c 

ASD: Early Signs and Early Intervention

Autism Spectrum Disorder (ASD) is a serious neurodevelopmental disorder that affects 1 in 36 children in the United States, with boys being 4 times as likely as girls to be diagnosed (Centers for Disease Control and Prevention, 2024). A multitude of symptoms are associated with ASD, however its main impact is preventing normal behavioral, cognitive, and social development. The earlier a diagnosis is made, the easier it is to address symptoms and aid development. 

You may be asking yourself: What are the early signs of autism? How does one deal with them? When is the appropriate time to seek help? What are the current therapies and approaches to treating autism spectrum disorder? 

First, identifying the early signs of autism is crucial. The National Institute of Mental Health establishes that ASD symptoms generally appear in the first two years of life (2024). Additionally, parents need to pay special attention to their children’s development as symptoms can often go unnoticed (Ozonoff et al., 2010). In fact, Ozonoff et al. indicate the major signs to look out for in very young (first year of life) ASD children are “decline[s] in eye contact, social smiling, and examiner-rated social responsiveness” otherwise a general lack in responsiveness to inquiries (2010). Other symptoms to be aware of are very limited speech and speech development, little response to being called by name, and no exchange in small gestures such as waives (Autism speaks, 2019). Finally, motor signs can also be an indication that your young child may have autism. According to Poscar and Visconti, the major indications are delays in sitting without support and walking. If you feel that, in addition to motor impairments and delays, as well as communications difficulties are manifesting in your child, you may want to schedule an appointment with a psychiatrist to see if you are diagnosed?

The importance of early identification and diagnosis cannot be emphasized enough. In clinical settings, the earlier ASD can be addressed in children, the higher the likelihood that increased or normal development can occur. That is, however, not to say that beyond a certain age, treatment is ineffective. ASD is a lifelong condition where treatment will help at any age. 

Now, in the case of a very defiant autistic child, it can be incredibly difficult to manage their outburst and tantrums. At the Sherkow Center, we believe in an approach that seeks to identify and understand the emotions triggering said fits. If the child is in a safe space, we would urge a parent to take a break, to step away from their child, and acknowledge them being upset. Next, you should communicate and try to establish what exactly sets them off to get a better baseline for their behavior. Our method is not supportive of punitive methods to managing tantrums, as we believe that they do not help in understanding the complex emotional processes involved in autistic behaviors. It may be, if a child’s outbursts are severe, a certain amount of medication would be required to help them control themselves, though it is not our first recommendation. 

As of today, there are a variety of early intervention methods that can be used to help address the behavioral problems ASD children are confronted with. One of the most prominent is the Early Start Denver Model (ESDM) which aims to restore normal development. To do so, it reinforces developmental milestones in a neurotypical child’s developmental trajectory, in a neurotypical order. Studies have demonstrated that doing so promotes far more results than if behavioral skills were taught or reinforced in a miscellaneous order. Furthermore, this model takes a team approach to care, so that all aspects impacted by autism, including motor development, communication development, education, relationships, and applied behavior (Rogers, 2016). 

References

CDC. (2024, February 22). Data and Statistics on Autism Spectrum Disorder. Autism Spectrum Disorder (ASD). https://www.cdc.gov/autism/data-research/index.html

National Institute of Mental Health. (2024). Autism spectrum disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd

Ozonoff, S., Iosif, A.-M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., Rogers, S. J., Rozga, A., Sangha, S., Sigman, M., Steinfeld, M. B., & Young, G. S. (2010). A Prospective Study of the Emergence of Early Behavioral Signs of Autism. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 256-266.e2. https://doi.org/10.1016/j.jaac.2009.11.009

Posar, A., & Visconti, P. (2022). Early Motor Signs in Autism Spectrum Disorder. Children, 9(2), 294. https://doi.org/10.3390/children9020294

Rogers, S. (2016). Early Start Denver Model. Comprehensive Models of Autism Spectrum Disorder Treatment, 45–62. https://doi.org/10.1007/978-3-319-40904-7_3

Comorbidities and Co-occurring Conditions

By Gillian Feit

According to the American Psychological Association, “Autism spectrum disorder (ASD) can impact functioning across multiple domains (e.g., social, cognitive, adaptive), and individuals with ASD are also at an increased risk for comorbid disorders. Comorbidity refers to the co-occurrence of two or more disorders in the same individual. The co-occurrence of ASD and other disorders can further exacerbate impairments in functioning” (Matson & Burns, 2019). Additionally, in an article written by Mannion and Leader, they found from prior research that children diagnosed with ASD had more severe comorbid symptoms than atypically developing toddlers. Younger children had fewer problems, and there was an increasing trend as the older age groups displayed the most severe problems across all classes of behavior, demonstrating, that those with ASD face co-occuring conditions however, the earlier that you notice that your loved on may have comorbidities, the sooner you should seek treatment, which will make for a more manageable and successful individuals battling multiple conditions (Mannion & Leader, 2024).

Furthermore, in an article titled ‘Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review’ researchers found “Substantial heterogeneity in prevalence of co-morbidities was observed: ADHD (0.00–86.00%), anxiety (0.00–82.20%), depressive disorders (0.00–74.80%), epilepsy (2.80–77.50%), ID (0.00–91.70%), sleep disorders (2.08–72.50%), sight/hearing impairment/loss (0.00–14.90%/0.00–4.90%), and GI syndromes (0.00–67.80%). Studies were heterogeneous in terms of design and method to estimate prevalence. Gender appears to represent a risk factor for comorbid ADHD (higher in males) and epilepsy/seizure (higher in females) while age is also associated with ADHD and anxiety (increasing until adolescence)” which is extremely interesting (Bougeard et al., 2021). The statistics of which conditions the individuals have, suggest that there are high chances for any autistic individual to be diagnosed with such conditions. Also, the fact that gender and age play a role, in impacting the separate populations, should make loved ones more attentive to their autistic individuals’s symptoms. 

Although ASD impacts different domains of functioning, some common comorbid conditions include ADHD (attention-deficit hyperactivity disorder), anxiety, depression, OCD (obsessive-compulsive disorder), learning disabilities, and many more (Khachadourian et al., 2023). 

Specifically, individuals with ADHD may have trouble staying focused, following instructions, sitting still, or waiting their turn. When ADHD co-occurs with autism, these symptoms can exacerbate difficulties in communication and social interactions. 

Those with anxiety disorder encounter excessive fear, worry, or nervousness that can interfere with daily activities. In individuals with autism, anxiety can manifest as intense concern about changes in routine, social situations, or specific fears, contributing to heightened stress and avoidance. 

Next, depression, a common anxiety disorder that is characterized by persistent feelings of sadness, hopelessness, and lack of interest or pleasure in activities, makes it more difficult to recognize in individuals diagnosed with autism due to overlapping symptoms such as social withdrawal and difficulties in expressing emotions. Nevertheless, depression significantly impacts the quality of life. 

OCD, a disorder characterized by unwanted, intrusive thoughts and repetitive behaviors or mental acts, can be very disruptive to anyone’s daily lifestyle. In individuals with autism, OCD-like behaviors might include rigid routines, repeated checking, or specific rituals that can interfere with and be bothersome to daily functioning. 

Additionally, autism spectrum disorder is not a learning disability; however, it can significantly affect learning. Learning disabilities are neurological disorders that affect the ability to process and respond to information, which can impact skills. Those diagnosed with both autism and learning disabilities may face challenges in academic settings and require specialized educational support and interventions.

Next, there are multiple different types of tests to diagnose individuals for comorbidities. “The Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), Part II (Matson, Boisjoli & Wilkins, 2007) was developed to screen for comorbid psychopathology in infants aged 16-37 months and has been psychometrically validated (Matson, Fodstad, Mahan & Sevin, 2009). The Autism Spectrum Disorders Comorbidity-Child Version (ASD-CC) (Matson & González, 2007) is another instrument used to diagnose comorbid psychopathology in children. Leyfer, Folstein, Bacalman, Davis, Dinh, Morgan et al., (2006) modified the existing instrument The Kiddie Schedule for Affective Disorders and Schizophrenia for use with children and adolescents with ASD. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL) was used to research prevalence rates of specific disorders” (Mannion & Leader, 2024). Also, the individual's psychiatrist or specialist may diagnose them with other disorders. 

Although there are many different tests and resources, there are some challenges that come with having co-occurring conditions. “Symptoms of comorbidities in ASD may be atypical and are often difficult to recognize (14). A major culprit propitiating these diagnostic difficulties is communication problems. In ASD, 25–50% of individuals are unable to speak (15). Furthermore, 90% of ASD toddlers are unable to point protodeclaratively or protoimperative (16). Indeed, many individuals with ASD are incapable of pointing to the source of their discomfort, find it difficult to attend to or detect bodily sensations (17), have poor integration of body scheme representation, and have atypical sensory perceptions or reports of pain (18). This inability to communicate pain or discomfort to other people may propitiate the enactment of inappropriate behaviors as a way for patients to express themselves and attract attention to their plight” (Casanova et al., 2020). Furthermore, many of these disorders have been largely ignored, due to the challenges involved in conducting a meaningful medical history and physical examination in a frequently nonverbal patient whose behavior may interfere with a lengthy assessment (Bauman, 2010). 

Managing ASD comorbidities may be challenging at first but, there are many ways to help individuals deal with multiple diagnoses. To begin, understanding the importance of medication is crucial. “Although pharmacological intervention is not intended to reverse ASD-related disabilities, medications can treat symptoms of ASD and co-occurring conditions, including intellectual disabilities, language delays, attention-deficit/ hyperactivity disorder (ADHD), anxiety, depression, agitation, irritability, disruptive behavior, and sleep disorders” which can make a significant difference in the individual’s everyday life (Feroe et al., 2021). Despite medication being an extremely effective way to help individuals manage co-occuring conditions with ASD, other ways to make the situation easier include, “engaging in shared decision-making with patients and families to develop the medical home and support” (Feroe et al., 2021). Having a secure support system will make individuals feel more comfortable, at ease and better cared for. 

Ultimately, it is vital to identify comorbid, health-related medical conditions associated with ASD. First, many of these medical conditions are treatable, and if identified and managed, will result in an improved sense of well being, more engagement in educational and therapeutic programs, and improved quality of life for the patient and his family. Second, identification of medical disorders involving specific organ systems may help us to identify phenotypic and genetic clusters of ASD persons, which may possibly define meaningful subtypes that may result in a better understanding of subsets of causative and biological mechanisms (Bauman, 2010).

Understanding your loved one’s ASD and their co-occuring conditions, helps to make a successful ASD individual that will receive the support and help needed.

References

Matson, J. L., & Burns, C. O. (2019). Comorbidity and the need for interdisciplinary treatments. In R. D. Rieske (Ed.), Handbook of interdisciplinary treatments for autism spectrum disorder (pp. 29–47). Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-030-13027-5_3

Mannion, A., & Leader, G. (2024). Comorbidity in autism spectrum disorder: A literature review. Research in Autism Spectrum Disorders. https://www.lenus.ie/bitstream/handle/10147/559386/MannionLeader2013b.pdf?sequence=1 

Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021). Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review. Insights in Autism: 2021, 12. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.744709/full 

Khachadourian, V., Mahjani, B., Sandin, S., Kolevzon, A., Buxbaum, J. D., Reichenberg, A., & Janecka, M. (2023). Comorbidities in autism spectrum disorder and their etiologies. Translational Psychiatry, 13. https://www.nature.com/articles/s41398-023-02374-w

Casanova, M. F., Frye, R. E., Gillberg, C., & Casanova, E. L. (2020). Editorial: Comorbidity and Autism Spectrum Disorder. Comorbidity and Autism Spectrum Disorder, 11. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.617395/full 

Feroe, A. G., Uppal, N., Gutierrez-Sacristan, A., Mousavi, S., Greenspun, P., Surati, R., Kohane, I. S., & Avillach, P. (2021). Medication Use in the Management of Comorbidities Among Individuals With Autism Spectrum Disorder From a Large Nationwide Insurance Database. JAMA Pediatrics, 175(9), 957-965. https://watermark.silverchair.com/jamapediatrics_feroe_2021_oi_210029_1630088716.57398.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAzQwggMwBgkqhkiG9w0BBwagggMhMIIDHQIBADCCAxYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMOdkmOqpWVWKGcmniAgEQgIIC57K 

Bauman, M. L. (2010). Medical Comorbidities in Autism: Challenges to Diagnosis and Treatment. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 10(3). https://link.springer.com/content/pdf/10.1016/j.nurt.2010.06.001.pdf 

What is Autism Spectrum Disorder?

By Gillian Feit

Autism Spectrum Disorder (ASD) is a complex heterogeneous neurodevelopmental disorder. Specifically, “Autism spectrum disorder is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviors, highly restricted interests and/or sensory behaviors beginning early in life” (Lord et al., 2020). According to the World Health Organization, as of their most recent data (November, 2023), approximately 1 in 100 children have autism (Autism, 2023). Moreover, ASD diagnoses have been increasing for years, but researchers cannot determine whether the trend is a result of increased awareness, improved detection, expanding definition, or an actual increase in incidence or a combination of these factors (Yasmin, 2014). Understanding the disorder correctly, receiving the correct diagnoses and implementing important interventions are vital to a successful trajectory for an individual with ASD.

Autism could be diagnosed at any age; however, it is described as a ‘developmental disorder’ because symptoms generally appear around 12 months and become more pronounced at 18 months. “By age 2, developmental precursors of autism symptoms can be used to diagnose children reliably, and by age 3, the diagnosis is thought to be relatively stable” (Webb & Jones, 2009). There are a significant number of different types of doctors that families seek for the diagnoses; however, the most popular doctors who diagnose ASD are neurologists, neuropsychologists, and developmental pediatricians followed by psychologists and psychiatrists (Goin-Kochel et al., 2006). A family will begin to seek a diagnosis when they first notice early onset observable markers. Some of the early onset symptoms include; “subtle disruptions in social interest and attention, communication, temperament, and head circumference growth that occur prior to the onset of clinical symptoms” (Webb & Jones, 2009). Other markers are; “socio-emotional responding, such as a failure to engage in shared positive affect; social attention, such as a failure to orient to social signals, such a child’s own name being called; social interaction, such as failing to maintain interactions with other children; and social gestures, such as a failure to wave hello or engage in other greeting responses” (Pierce et al., 2009). 

When you begin to have a suspicion about an individual due to developmental delays or abnormal behavior, you should seek to get them tested for autism. Although there is no singular test, brain scan, or blood work that entirely says whether an individual is autistic or not, professionals diagnose individuals according to the Diagnostic and Statistical Manual of Mental Disorders handbook. It is understood in both DSM-IV and DSM-5 that those who meet the criteria for autism often have symptoms of other disorders (anxiety disorders, affective disorders, attention deficit hyperactivity disorder, specific language disorders, and intellectual disability in particular). The presence of these other symptoms should be noted, and, if necessary, the patient should be treated. If the symptoms are sufficient to meet criteria for other disorders, then the patient should be diagnosed with comorbidities (Tanguay, 2011). ASD comorbidity is significant and can impact occupational, academic, autonomy, and other important areas of functioning. “Attention deficit hyperactivity disorder (ADHD) was the most common comorbidity, affecting more than 1 in every 3 children with ASD (35.3%), much higher than 1 in 6 (16.8%) among non-ASD siblings. Learning disability (23.5%) and intellectual disability (21.7%) were the next most-common comorbid conditions among children with ASD” (Khachadourian et al., 2023). Moreover, psychometric tools include ADOS, CARS, ADI-R, M-CHAT-R, Cognitive and developmental tests (Mullen Scales of Early Learning and The Wechsler Intelligence Scale for Children (WISC). Considering ASD can have profound impacts on different domains of functioning, more comprehensive evaluations also include speech and language exams as well as occupational therapy assessments. Furthermore, the children that are most affected are those with a delayed diagnosis, many of them only being diagnosed after visiting several different professionals. Only a small percentage of children are diagnosed before age three, and in most cases it is their teacher who identifies difficulties in school (Rey et al., 2019). When you begin to see abnormalities, it is crucial to get your loved one assessed.

Once the individual has been diagnosed with autism, after reaching out to specialists and receiving the correct tests, post-diagnosis support and interventions come into play. Children may have an Individualized Education Plan (IEP) and continued support by parents and loved ones, as well as, evidence-based therapeutic approaches (early intensive behavioral interventions (EIBI), developmental interventions (DEV), naturalistic developmental behavioral interventions (NDBI) and parent-mediated interventions (PMI) in preschool). Specifically, a recent meta-review noted that “the efficacy of many of these psychosocial interventions was supposed by highly suggestive or suggestive evidence depending on the age of the participants and the outcome under consideration. In preschool children EIBI, NDBI, DEV and PMI were supported by suggestive evidence: on social communication impairment, adaptive behaviors and IQ for EIBI, and on social communication for NDBI, PMI and DEV. In early school-aged children, highly suggestive evidence was found for the efficacy of PMI on disruptive behaviors. In late school-aged children and in adolescents, suggestive evidence was found for SSG on social communication and overall ASD symptoms” (Gosling et al., 2022). Early interventions make a significant difference in how a child with autism develops, and the earlier the help, the better. 

Not only are evidence based therapeutic approaches vital to ensuring an individual with the most effective approaches but, the role of parent and play are also crucial. “Parents are especially important because the time they spend with the child can lead to teaching opportunities (Symon), and they can provide information regarding important family values and routines and the child's strengths and preferences (Buschbacher, Fox, & Clarke, 2004). Furthermore, research has shown that parents can implement continuous treatment and can be effective interventionists (Koegel, Bimbela, & Schreibman, 1996). When parents are included in treatment, they can continue to teach children with ASD skills in the home environment, which improves the parent-child interactions and increases the amount of intervention they receive (Girolametto & Tannock, 1994). This is critical because research suggests that children who receive intensive treatment show significantly more improvement than those receiving less treatment (Anderson, Avery, DiPietro, Edwards, & Glynnis, 1987; Lovaas, 1987)” (Burrell & Borrego, 2012). 

Psychosocial interventions in children may improve specific behaviors, such as joint attention, language and social engagement, that can affect future development and may reduce symptom severity; however, many question about the identification of children, their needs, and the qualities of appropriate services (Lord et al., 2020). For example, “controversial issues include the use of widely criticized methods for (a) identifying the needs of young children, (b) diagnosing and labeling childhood disorders, and (c) placing children into potentially ineffective programs. Thus, enthusiasm must be tempered by potential risks, including the possibility that children may be misidentified and that interventions may result in either inconsequential or even harmful” (Barnett et al., 1992).

Myths and misconceptions are vital to debunk for anything, especially when it comes to developmental disorders. In the more recent years, people are believing that screens cause autism. An article written by Waldman et al., (2006) says “our precipitation tests indicate that just under forty percent of autism diagnoses in the three states studied is the result of television watching due to precipitation, while our cable tests indicate that approximately seventeen percent of the growth in autism in California and Pennsylvania during the 1970s and 1980s is due to the growth of cable television. These findings are consistent with early childhood television viewing being an important trigger for autism”. Ultimately, these researchers are claiming that early exposure to screens can result in developmental delays across language, cognitive and relational domains in which case children’s skills begin to mimic ASD symptomatology. The children then receive a misdiagnosis and parents begin to interact with the child as if they have ASD. Overall, this is an example of correlation not equalling causation rather than screens genuinely leading to ASD. 

Overall, ASD is a complex neurological and developmental condition that significantly impacts individuals. Despite the ability to diagnose autism at any age, symptoms typically emerge within the first two years of life, and early identification and intervention are crucial; they can profoundly influence the developmental trajectory of individuals diagnosed with the disorder. Given the rising rate of autism diagnoses, understanding the disorders’ characteristics and recognizing the variability among those affected are more crucial than ever.

References

Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900942/#R43 

Autism. (2023, November 15). World Health Organization (WHO). Retrieved July 3, 2024, from https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders 

Yasmin, N. H. (2014). Increasing Prevalence, Changes in Diagnostic Criteria, and Nutritional Risk Factors for Autism Spectrum Disorders. ISRN Nutrition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045304/

Webb, S. J., & Jones, E. J. H. (2009). Early Identification of Autism Early Characteristics, Onset of Symptoms, and Diagnostic Stability. Infants & Young Children, 22(2), 100-118. https://journals.lww.com/iycjournal/abstract/2009/04000/early_identification_of_autism__early.4.aspx 

Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2006). How many doctors does it take to make an autism spectrum diagnosis?. Autism, 10(5), 439-451. https://journals.sagepub.com/doi/10.1177/1362361306066601 

Pierce, K., Glatt, S. J., Liptak, G. S., & McIntyre, L. L. (2009). The power and promise of identifying autism early: Insights from the search for clinical and biological markers. Ann Clin Psychiatry, 21(3), 132-147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872627/ 

Tanguay, P. E. (2011). Autism in DSM-5. The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2011.11071024

Khachadourian, V., Mahjani, B., Sandin, S., Kolevzon, A., Buxbaum, J. D., Reichenberg, A., & Janecka, M. (2023). Comorbidities in autism spectrum disorder and their etiologies. Translational Psychiatry, 13. https://www.nature.com/articles/s41398-023-02374-w

Rey, F., Rodriguez, S., Linares, L., Vives, V., Vives, C., Vives, T., & Vives, M. (2019). A Systematic Review of Instruments for Early Detection of Autism Spectrum Disorders. International Journal of Psychology & Psychological Therapy, 19(1). https://dialnet.unirioja.es/servlet/articulo?codigo=6887337   

Gosling, C. J., Cartigny, A., Mellier, B. C., Solanes, A., Radua, J., & Delorme, R. (2022). Efficacy of psychosocial interventions for Autism spectrum disorder: An umbrella review. Molecular Psychiatry, 27(9), 3647-3656. https://www.nature.com/articles/s41380-022-01670-z  

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