What is Autism? Part III
As parents, what can we do? ‘Screening and Evaluation’
Parents are often suggested by relatives, neighbors, elders in the family, general physicians, pediatricians to wait and watch. “He will come out of this”, “He is a boy, boys talk late”, “This is his/her personality trait, he likes being alone”, You just need to give him more time, he stays alone and thus has gotten used to that” “There is nothing wrong with the child for you to take him/her to a psychiatrist”; are comments often heard thus leading to a delay in diagnosis and subsequent intervention.
Early intervention is the
key to helping a child with Autism and thus the parents should seek help
as soon as they “feel” something is wrong the child. All parents’ esp.
mothers have a gut feeling that tells her “Something is not right with my
child” and leads her to the most important questions- “What do I do?””,
“Who will tell me, what exactly is the problem with my child?”
In clinical terms, there are a few “absolute indicators,” often referred
to as “red flags,” that indicate that a child should be evaluated.
Red Flags
The following red flags may indicate a child is at risk for atypical
development (not developing normally), and is in need of an immediate
evaluation.
Social/Communication Red Flags:
• No big smiles or other
warm, joyful expressions by six months or thereafter.
• No back-and-forth sharing of sounds, smiles, or other facial expressions
by nine months or thereafter
• No babbling by 12 months.
• No back-and-forth gestures, such as pointing, showing, reaching, or
waving by 12 months.
• No words by 16 months.
• No two-word meaningful phrases (without imitating or repeating) by 24
months.
• Any loss of speech or babbling or social skills at any age.
If your baby shows any of these signs, please ask your pediatrician/ psychologist/ psychiatrist/ Developmental Pediatrician for an immediate evaluation.
Red Flags were compiled from the following sources: Greenspan, S.I. (1999) Building Healthy Minds, Perseus Books; Filipek, P.A. et al. Practice parameter: Screening and Diagnosis of autism. Neurology 2000, 55: 468-79.
To help you make better observations of your child, here is a list of 12 questions that you as a parent can answer about your child’s behavior. These 12 questions correspond to the 12 symptoms of Autism from the DSM-IV (refer to last post “What is Autism- part II for details on DSM-IV). Your answers to these questions will help you ask specific questions to your child’s GP/Pediatrician
Try to be as detailed and objective in your answers and not just a simple “yes”/”no”.
1. How does your child
communicate with you nonverbally? That is, how does he get your attention,
does he look you in the eye, does he respond to your nonverbal
communication? How does he respond to tickling, hugging and holding?
2. How does your child react to other children? Does he play with them?
Does he have friends?
3. How does your child show you that he is interested in something? Does
he show you things he likes? Does he bring things to you to show you or to
share with you? Does he point to things in the environment that interest
him?
4. How does your child react to the social approaches of others? If
someone is happy, does he act happy too? If someone is sad, does he
respond appropriately? If someone hits him, how does he respond?
5. How well does your child communicate verbally? Is your child delayed in
his speech? Do you feel he talks much lesser than other children of his
age?
6. How well does your child converse with others? Can your child begin a
conversation appropriately? Can your child continue a conversation about a
particular subject fairly well? How does your child end a conversation?
7. How does your child talk? Does he repeat words or phrases that seem
unrelated to what is going on? Does he use words or phrases that only you
would fully understand and seem not so sensible to others?
8. How well does your child pretend? Can he play make-believe games where
he pretends to be an animal or pretends to be doing some action? Can he
imitate your actions?
9. Does your child have very strong interests in certain toys, things, or
topics that seem out of the ordinary? How easy is it for you to redirect
his attention from this interest?
10. Does your child have to do things a certain way? Does he have a
routine that must be followed? If you do things to interrupt his routine,
how does he react?
11. Does your child engage in odd movements with his body or parts of his
body? Does he rock, bang his head, flick his fingers, wave his arms or
hands in the air, or make other repetitive movements?
12. Is your child fascinated with or strongly attracted to parts of
objects? (Has been discussed in the last paper- What is Autism-Part II)
A few other screening tools* for health professionals/parents that one
hears of are-
• CHAT (Checklist for
Autism in Toddlers)
• M-CHAT (Modified Checklist for Autism in Toddlers)
• M-CHAT Online (M-CHAT Online is administered following the PEDS when the
child being screened is between 18 and 59 months)
• PEDS (Parents’ Evaluation of Developmental Status) - also available is a
PEDS Online Screening Test. For further details visit the link-
http://www.forepath.org/
*Screening DOES NOT provide a diagnosis; it is the first important step in
the diagnostic process.
Screening tools are brief
measures that differentiate children who are at risk for atypical
development from those who are not. They come in the form of
questionnaires given to parents, or purposeful dialogues and observations
between the parent and the physician/General Practitioner. A screening
tool can help eliminate parental worries of developmental delays, by
screening children “out,” rather than “in.”
Children who are flagged “at risk” during the screening process are to be
then referred to diagnostic specialists (psychologists, psychiatrists,
Developmental Pediatricians) for more extensive diagnostic evaluation and
subsequent referral for appropriate intervention services/therapy.
To recapitulate, this is what you, as a parent need to do if you feel
something is amiss in your child-
• Note down your
observation about your child. Write down all that comes to your mind when
you say “he is not doing this/that”!
• Discuss these notes with your GP/Pediatrician and request for a
screening.
• If your GP/pediatrician seems to dismiss your concerns every time you
raise them, says things like “oh, you are worrying unnecessarily ”, give
him some time”, “you are just being over overprotective” ;try and contact
other professionals such as Occupational Therapists, Special Educators and
Speech Therapists. These professionals may not ‘diagnose’ autism but would
be able to screen the child and would assist you in a referral to the
professionals concerned.
• Become a member of organization and internet groups that will give you a
chance to interact with many more parents of children with Autism and
access resources and referrals.
What is
By: Birinder Kalra Consultant & Special
Educator
New Delhi, INDIA
magex123@yahoo.co.in
Disclaimer: The views expressed in this health article are strictly those of the writer and 123oye does not take any responsibility for them. Kindly consult a Doctor before following any advice.
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