Expert Blog - Understanding ASD with Caint!

What is Autism Spectrum Disorder(ASD)?

Autism Spectrum Disorder (ASD) or Autism is a neurodevelopmental condition whereby a person has notable delays or difficulties in their development. The term “spectrum” in Autism Spectrum Disorder is used because the symptoms of ASD can vary from person to person, and each individual will require different levels of support ranging from some supports to others requiring higher levels of support or intervention. Where a person is situated on the spectrum can help determine what supports the individual may need at any given time. Characteristics of ASD can include (but are not limited to) :

• communication (expression and/or understanding) difficulties or delay - social communication difficulties are common
• repetitive speech and/or motor movements and/or restrictive behaviours
• Social interaction difficulties
• Differences in play development
• food refusal or rigid selectivity
• strong interests
• adherence to routine, resistance to change
• sensory processing difficulties (under or over reaction to sensory input)
• some children can have compulsions and rituals

It is important to note that people with ASD are as diverse as any other group of people with their own strengths and challenges. The amount of support people with ASD need varies greatly between individuals.

How is it Diagnosed?

ASD is diagnosed through an interdisciplinary team assessment comprising of a Speech and Language Therapist /Occupational Therapist, and a Psychologist. The child’s parents or caregivers are also vital members of the team as experts on their own child. The interdisciplinary team works with the child’s parents or caregivers throughout the assessment process to gain a concrete understanding of the child’s development and medical history as well as the families main concerns. The team uses a standardized assessment tool called the ADOS-2 and natural observation, along with parent discussion, to form a diagnosis. The parent interview is usually and ADIR standardized interview or a DISCO interview. It is important that the team liaise with your creche, preschool or school to see what functional difficulties your child is having and to look at their play and interaction with their peers.

At Caint we:

• build strong bonds and connections with families, children and teachers
• acknowledge the power and importance of early intervention
• provide evidence based treatment approaches that are individualized
• support families in a kind, caring and compassionate environment
• always remember to incorporate fun and laughter into our therapy

Assessment Pathway at Caint

Step 1:

If you call our head office number, our administrator Geraldine will talk you through the assessment process.

• She will book each part of the assessment process with you individually and send you an email confirming the dates and times of all the appointments in the clinic.
• She will send out forms so information about your child can be gained from a variety of sources to ensure a holistic assessment process. One form will be filled out by you, the parent, and another your child’s school or preschool. These forms were designed by Caint to ensure we get parents detailed current concerns and developmental history of their child. We also get information on how the child is functioning in the school environment and the teacher’s observations of behaviour and social interactions.

The assessment process then involves 3 clinic appointments as follows:

Step 2:

• The first clinic appointment will be a structured interview with a Speech and Language Therapist using the Autism Diagnostic Interview- Revised. This is one of the best practice guidelines interviews in the assessment of autism. This appointment is attended by parents only. One or both parents can attend. The appointment takes approximately 1.5 – 2 hours.

Step 3:

• The second clinic appointment is a play-based assessment with your child carried out using the Autism Diagnostic Observation Schedule (ADOS-2). This is completed by two clinicians, a Psychologist and a Speech and Language Therapist in line with best practice guidelines. They will observe a one-to one interactive session with the child. This takes approximately 1 hour. The observations of the child are discussed and analysed by both the SLT and Psychologist.

Step 4:

• All the information from the above, including reports from teachers, reports from you, the parent, as well as information gained by the professionals when interacting with your child during the ADOS-2 assessment, is discussed and analysed holistically to determine if enough evidence is present to give a diagnosis of ASD at this time. Further information may be sought to support this process if necessary. Occasionally a school observation is needed or a full cognitive assessment is needed in addition to the ASD assessment if we need a more comprehensive picture of your child.
• A multidisciplinary report on your child is compiled based on the above.

Step 5:

• Your final appointment will be a feedback session with the Psychologist. They will outline the findings from the assessment process as a whole, letting you know whether a diagnosis has been reached and a clear explanation as to the factors that indicated whether a diagnosis was reached. They will outline strengths and areas of need in your child’s profile and give recommendations on how to support your child’s needs going forward. This may involve onward referral to other therapists (Speech and Language Therapy, Occupational Therapy, etc.) as well as recommending specific educational supports your child may need (access to a Special Needs Assessment, advice on suitable school placement, etc.).

If an ASD diagnosis is made, the team will discuss available services for the child with their parent(s) or caregiver(s) and devise a plan using a client and family-centred approach.

At what age can a child be tested for ASD?

Children may be diagnosed with ASD from as early as 2 years of age. In fact, many parents, or caregivers’, express concerns by the time their child reaches 18 months of age. An early diagnosis of ASD allows children and families to access supportive services.

Are there early signs to look for?

Signs for ASD are frequently observed in the early years of a child’s life. Your child may be a candidate for ASD assessment if they are showing the following signs:

• Excessive cries, whines, and screams
• By 4 months, does not imitate sounds and does not look towards new sounds
• By 4 – 6 months, isn’t using speech sounds “p”, “b”, “m”
• By 7 – 10 months, isn’t using canonical babbling (consonant – vowel repetition e.g. “bababa”) to get your attention
• At 10 months, doesn’t respond to name
• Shows no interest in engaging with you, limited to no eye contact
• At 12 months, doesn’t use gestures to communicate or doesn’t try to communicate to you when they need help
• By 15 months, doesn’t understand “no” and “bye-bye”
• By 15 months, can’t say at least one to three words
• At 18 months, isn’t saying at least 6 to 10 words
• By 18 – 20 months, isn’t’ pointing out things of interest
• At 21 months, doesn’t respond to simple directions
• At 24 months, can’t join two words together
• Limited play skills
• Lack of interest in other children
• Some repetitive play such as lining things up
• Sensory seeking behaviour such as looking closey at objects
• Hand flapping or stimming

Children with ASD are often delayed in developing communication however, some children develop normally in their first year, and then go through a period of regression between 18 and 24 months of age when they develop autistic symptoms.

If you concerned about your child’s development, you should arrange a consultation with your pediatrician.

How does it impact a child’s development?

Children who are on the autism spectrum develop differently and at a different rate to typically developing children. Children with ASD don’t necessarily develop skills in the same order as typically developing children. For example, children with ASD might not have the explosion of speech and language that typically developing children have between 1 and 3 years of age. However, they may communicate in different ways and can be supported through Speech and Language Therapy services.

How can I support a young child that shows signs of ASD before they can be diagnosed?

Early referral to speech and language therapy is important even if you don’t have a diagnosis as you can work together in building the foundations for language and communication

• Be Face to Face: Sometimes your child might find it hard to look at you, that mean’s he or she is missing out on seeing your facial expressions. If your child feels overwhelmed being face to face with you, start by getting down to their physical level.
• Model and Exaggerate the use of gestures during daily routines e.g waving and blowing a kiss when saying goodbye
• Imitate what your Child Does or Says: There are many ways to communicate, not just through speech. In fact, many non-verbal ways are as effective, if not more effective, than words.Be animated and imitate and sounds you child makes to encourage them to do it again - a fun response.  Vary your tone and intonation when interacting with your child and responding to their vocalisations
• Practice Vocalisations during daily routines your child enjoys. Model sounds and facial expressions to encourage back and forth interaction
• Allow Messy Play if your child is rigid or picky around food, get creative and allow your child to feel the food.
• Use real objects to help your child see what’s happening next: if your child gets upset when they have to change their activities you can prepare your child for changes by showing him or her objects to help anticipate what is going to happen next e.g hold up their pyjamas to let them know it is bedtime or show a rubber dickie to signal bath time

How does Occupational Therapy support your child with ASD?

Occupational therapy (OT) helps people develop independence skills, motor skills, and sensory processing strategies. OT can help support your child with ASD to participate in their daily lives, including self-care, leisure, and school. Your occupational therapist can help your child participate in self-care activities including dressing, feeding, toileting, sleep, and more. As well as self-care occupations, OT can support your child to engage in their own leisure occupations, whether it be developing skills to cycle a bike or learning play skills to support peer relationships. Finally, your child may need some OT support in regard to their school participation. An occupational therapist can help your child to develop skills for school, such as handwriting, as well as work with educators to modify the environment to support your child’s engagement. OT also addresses difficulties with sensory processing, which many children with ASD have. Your occupational therapist can help you and your child to identify when they need to be regulated and how to do so. Children with ASD often process sensory information in different ways. They may dislike certain textures or consistencies or may have difficulties with noises, lights, sounds, smells and touch. The OT can develop sensory diets and activities and strategies to help regulate your child too.

What is ABA and how does it support your child?

Applied Behaviour analysis (ABA) is therapy based on the science of learning and behavior. The goal of any ABA program is to help each person work on skills that will help them become more independent and successful in the short term as well as in the future. ABA therapy programmes have been shown to help:

• increase language and communication skills
• Improve attention, focus, social skills, memory, and academics
• Decrease problem behaviours

Are there any other therapies available?

Speech and Language Therapy

Speech and Language Therapy provides assessment, treatment, support and care for children and adults who have difficulties with communication (understanding and/or expression), or with eating, drinking and swallowing. The Speech and Language Therapist (SLT) supports children with ASD to improve their verbal, nonverbal, and social communication and interaction skills. They also support children with food aversion or “picky eaters” by providing treatment plans to improve feeding related challenges.

Clinical Psychology

Clinical Psychologists assess, diagnose, and treat mental, emotional, and behavioural disorders. The Clinical Psychologist uses a range of techniques including behavioural strategies, social skills training, and emotional regulation to help children with ASD cope better in their everyday lives.

Occupational Therapy

Occupational Therapy provides assessment and intervention for children and adults who have difficulties with their daily occupations relating to self-care, leisure, and productivity (school). The Occupational Therapist supports children with ASD to improve their independence skills and participation in their daily lives.

Is there treatment available to support my child?

There are many treatments available to support children with ASD. A multidisciplinary team approach is the gold standard for supporting children with ASD. The team usually includes a Speech and Language Therapist, an Occupational Therapist, and a Psychologist. However, as each child with ASD is uniquely different, the treatment and supports your child requires will vary depending on their own stage of development and needs.

Here are some examples of interventions/supports available to Children with ASD:

Picture Exchange Communication System (PECS)

PECS is a low-tech communication system which aims to teach functional communication to children with ASD through exchanging pictures with communication partners e.g. parents. PECS consists of six phases and begins by teaching the child to give a single picture of a desired item or action to a “communicative partner” who immediately honours the exchange as a request. PECS goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, children are taught to use modifiers, answer questions and comment. PECS has also been shown to develop speech in some children with ASD.

Lámh

Lámh is the manual sign system that is used by children and adults in Ireland with learning disability and communication needs, such as children with ASD, Lámh signs are based on natural gesture and many have been adapted from Irish Sign Language (ISL).  Lámh is used with speech and only key words in a sentence are signed. The signs support beginner communicators to communicate their wants, needs and build relationships with friends and family.

LEGO Therapy

LEGO therapy is a social development therapy for children with ASD. The program focuses on making social interaction fun and enjoyable for children with ASD. The structured workshops encourage communication between children as they work together to solve problems and build LEGO in groups.

Floor Time

Floor Time, also known as Developmental individual-difference relationship-based model (DIR), helps children with ASD work around processing difficulties to re-establish effective contact with caregivers or play partners and begin to master developmentally appropriate skills. It is designed to increase socialisation, improve language, and decrease repetitive behaviours. The intervention encourages parents to engage children at their physical level – by getting on the floor to play.

In Floor Time, therapists and parents engage children through the activities each child enjoys. They enter the child's games. They follow the child's lead. Therapists teach parents how to direct their children into increasingly complex interactions. It is based on the idea that adults can help children expand their circles of communication by meeting them at their developmental level and building on their strengths.

TEACCH Autism Program

TEACCH focuses on promoting engagement in activities, flexibility, independence and self-efficacy through strategies based on the learning strengths and difficulties of people with ASD.

Hanen More Than Words

Hanen More Than Words is a parent training program focused on parent use of communication strategies to facilitate child’s social communication development. Parent training is provided in group workshop sessions with some individual coaching video sessions.

If you want to learn more about the services that Catherine and her team at Caint offer check out https://www.cainttherapy.ie/

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Further Reading

Read another of our expert blogs - Expert Blog-Marc Weissbluth