What is Autism?

Autism Spectrum Disorder (ASD) is a developmental disorder.  The characteristics or symptoms typically show in early childhood including social interaction (relating to other people, things, and events), communication (using and understanding language), and behavior (repetitive and challenging).   No two  individuals with ASD  are exactly alike, and they exhibit a wide range of functional abilities.  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013) outlines the criteria for diagnosis of autism spectrum disorder.  Under the prior DSM (DSM-IV) criteria, individuals could be diagnosed with one of four separate disorders that included autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or pervasive developmental disorder not otherwise specified.  The DSM-5 includes only autism spectrum disorder.  Anyone with one of the four diagnosis used under the DMS-IV should qualify for a diagnosis of autism spectrum disorder under the criteria used in the DSM-5. 

We do not know all the causes of ASD.  However, through research we have learned that there are likely multiple contributing factors, including biological, environmental, and genetic factors.  Currently no cure exists for ASD; however with effective intervention, individuals with ASD make progress and develop new skills.

Prevalence

The Centers for Disease Control and Prevention (CDC) estimated the prevalence of ASD among children aged 8 years was 1 in 68 in the U.S. (Christensen et al., 2016).  The CDC continues to work to find out how many children have ASD, discover the risk factors, and raise awareness of the signs (http://www.cdc.gov/ncbddd/autism/index.html). 

Currently, we do not know how many Oklahomans have ASD.  Our best guess is based on information the Oklahoma State Department of Education gathers about children receiving special education services through their annual child count.  Through the annual child count, children are identified in one of 13 categories, including Autism.  In 2014, 4,885 (4.6% of all children receiving special education) children aged 3-21 years were identified under the autism category.  This number does not include children with ASD who are served under another category, children with ASD who are not receiving special education services through the local public school, or those under age 3 or over age 21.

 

Children served under Autism Category in Oklahoma
Child Count by Age Group

 

98-99

11-Oct

12-Nov

13-Dec

13-14

14-15

Percent Change

Age 3-5

*

164

200

210

220

263

2,822

Age 6-11

305

1,405

1,674

1,923

1,899

1,997

555

Age 12-17

135

1,346

1,540

1,816

2,067

2,417

1,690

Age 18-21

14

147

172

172

203

208

1,386

TOTAL (Age 3-21)

454

3,062

3,586

4,121

4,389

4,885

976 

 * not reported

Signs and Symptoms

No two individuals with ASD are alike.  However, all individuals experience some differences with social development, communication, and behavior.  Some will exhibit all of the signs, while others might demonstrate only a few of the signs. The severity of the signs will range from one person to another.

The earliest signs of autism are the absence of behaviors that are typically seen in the first year of life and can be easy to miss such as an infant who does not respond to a parent's smile or does not respond as often as other infants.  Later signs of autism are the presence of behaviors that are not typical and can include things such as rocking, spinning or unusual use of vision or gaze.  These later signs are more observable when the child is around 18-24 months of age or older. 

Links to reliable information about the signs of autism:

The American Academy of Pediatrics: What are autism spectrum disorders and what are the symptoms?

Autism Speaks Inc., Florida State University, and First Signs Inc.: ASD video glossary 

The Centers for Disease Control, National Center on Birth Defects and Developmental Disabilities - Act Early, Learn the Signs

Sharing Concerns

How do I talk to a family member, friend, or parent if I have concerns their child demonstrates some of the signs of autism spectrum disorder?

 If you are a family member, friend, teacher or a physician and have concerns about a child and are not sure how to share your concerns, visit the following sites for ideas.  

Autism Speaks Inc.: Talking to Parents About Autism Action Kit 

First Signs Inc.: Sharing Concerns

Screening

If you are concerned that your child demonstrates some of the signs of autism, consider having a screening or a comprehensive diagnostic evaluation completed.  Talk with your child's pediatrician about your concerns.  Your pediatrician can complete a screening tool designed for autism and / or refer you to a specialist for a diagnostic evaluation.  

What is screening? 

Screening is a process of identifying children who need more extensive evaluation and assessment.  Screening involves the use of standardized tools to assess the risk of developmental delay.  Screening is not a process used to diagnose autism spectrum disorder (see diagnostic evaluation).  

Who can administer screening tools?  

Professionals that administer screening tools might include a physician, teacher, therapist, nurse, social worker, etc.  Professionals should have solid knowledge and understanding of typical child development and the signs of autism.  

At what ages can screening tools be administered? 

Each screening tool is designed for a specific age group.  Some tools can be used on children as young as 18 months.  The American Academy of Pediatrics (AAP) (2007) now recommends all children be screened for autism spectrum disorder at the 18-month and 24-month preventative visits.  

What should I know about screening tools?  

Screening tools:

  • should be standardized and designed for autism spectrum disorder;
  • focus on developmental and behavioral milestones;
  • use a parent interview format or a professional interacting with a child, or include both parent interview and professional interaction;
  • are typically quick to administer (5 - 20 minutes);
  • cost less and require fewer resources when compared to a comprehensive diagnostic evaluation; and
  • tend to over identify children as having a developmental delay or risk for autism spectrum disorder.

Screening tools are identified as Level 1 and Level 2.  Level 1 tools are designed to be administered to all children in the general population whether there is a concern about development or not (e.g., well-child visit at the pediatrician's office).  Level 1 tools tend to over-identify children and include a broad range of developmental delays.  Level 2 tools are designed to be administered to a high-risk population (children that have been identified as at risk of having a developmental delay or disability).  Level 2 screening tools specific to autism spectrum disorder help to identify children at risk of having ASD rather than other developmental disorders.  Early intervention programs (e.g., in Oklahoma the SoonerStart Early Intervention program) and developmental clinics are more likely to use Level 2 screening tools.  Level 2 screening tools in contrast to Level 1 tools take more time to administer and require more training for administration, scoring and interpretation.  

Screening tools for autism are not intended to indicate whether or not a child has autism; it only rules in or rules out the possibility of autism.  If the results of the screening indicate a chance of autism, the child needs to be evaluated and assessed by a professional who can diagnose.
 
Who can I contact in Oklahoma to obtain a screening?  

Contact:

For more information about screening and diagnostic evaluation see the American Academy of Pediatrics: Identification and Evaluation of Children with Autism Spectrum Disorders (Clinical Report).
 

Diagnostic Evaluation

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013) outlines the criteria for diagnosis of autism spectrum disorder.  Under the prior DSM (DSM-IV) criteria, individuals could be diagnosed with one of four separate disorders that included autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or pervasive developmental disorder not otherwise specified.  The DSM-5 includes only autism spectrum disorder.  Anyone with one of the four diagnosis used under the DMS-IV should qualify for a diagnosis of autism spectrum disorder under the criteria used in the DSM-5. 

What is a diagnostic evaluation? 

The purpose of a diagnostic evaluation is to determine whether or not a child has autism and to help identify strengths and weaknesses for planning the child's intervention program.  

Who can perform diagnostic evaluations?  

Professionals that can diagnose autism spectrum disorders must be either a licensed psychologist (PhD, PsyD) or a physician (MD or DO).  Many times other professionals with expertise in autism will assist in the diagnostic process (e.g. occupational therapist, speech language pathologist).  

A comprehensive diagnostic evaluation should include input from multiple sources and contexts:

  • Input and interviews of parents and teachers (if applicable);
  • Observation of the child in various settings (e.g. classroom, home, free time, structured time);
  • Cognitive and achievement assessment;
  • Adaptive behavior assessment - this looks at how the child is adapting to daily activities (e.g. behavior, self-care);
  • Clinical judgment - professionals who are on the team need to have training in diagnosing autism in order to make good clinical judgment about your child; and
  • Ideally more than one professional on the team (e.g. speech language pathologist, occupational therapist, social worker, physical therapist).


At what ages can a diagnostic evaluation be completed? 

A reliable diagnosis of autism spectrum disorder is possible by 2 to 3 years of age.

What should I know about diagnostic evaluations?  

A diagnostic evaluation:

  • is intended to indicate whether or not a child has autism;
  • should be standardized and designed for autism spectrum disorder. Two common tools used to diagnosis autism are the Autism Diagnostic Observation Scales (ADOS) and Autism Diagnostic Interview- Revised (ADI-R);
  • focus on the core challenges of autism spectrum disorder including communication, social skills, and overall behavior;
  • involve more time than administration of a screening tool;
  • cost more and require more trained and experienced professionals when compared to a screening; and
  • can be difficult for the child and family.


Who can I contact in Oklahoma to obtain a diagnostic evaluation? 

For a list of clinics in Oklahoma who perform diagnostic evaluations, visit our Provider data base or contact us to locate a professional in your area. 

For more information about screening and diagnostic evaluation see the American Academy of Pediatrics: Identification and Evaluation of Children with Autism Spectrum Disorders (Clinical Report).

Connecting with Other Parents

We strongly recommend that you connect with other families.  Many families have similar experiences and can be a source of help and support.  To connect with other parents, visit our Support Groups page.