Autism Assessments in Edmonton | Myths Symptoms and The Truth About an Autism Diagnosis
Hi there, my name is Dr Kelly Clark, and today I wanted to talk about autism spectrum disorder, and autism assessments in Edmonton. There’s three things that I wanted to bring up about it. A, I wanted to talk about defining what it is so that we have an understanding of what it is. Secondly, I want to talk to you about some resources that you might be able to get if you do have a child you’re concerned might have autism or is diagnosed with autism. And then also, I would like to talk about how to get assessed for this condition.
What Autism Is and Updated Diagnostic Terms
What I wanted to bring up is that there used to be previous terms for autism that you might have heard of. So, it used to be called autistic spectrum or autistic disorder or aspers disorder—you might have heard of that one before, which would be high functioning autism. Or you might have also heard that there was a term called pervasive developmental disorder other not otherwise stated, and that would be an old term that we used to use for autism. But it’s changed a little bit, and I’m going to talk about some of the new diagnostic terms for it.
Diagnosing autism, or if you’re concerned that your child—or, say, even yourself as an adolescent or an adult—might have autism, it needs to fit some of these criteria. Generally, it does fit a lot of them, but sometimes it doesn’t of course meet all of the criteria. I’ll also talk about, just because there’s one that might fit—for example lining up toys, you know, when a child is young, a lot of parents will be concerned: “Oh, there was a lot of rigid kind of lining up.” That doesn’t mean that they have autism; it could just be one of the features and could reflect something else or just a personality trait. So I wanted to talk about the general criteria for autism and for you to reflect on, to think about, and if you fit a lot of these—your child, yourself, or your adolescent—you may want to consider getting an autism assessment.
The first criterion is a persistent deficit in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history. The first area I want to look at are deficits in social and emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation to reduced sharing of interest or emotions—like flat affect, does not ask for things they want, does not celebrate or share other people’s interests, or show emotion around play activity and things where there might be interest together with somebody else. Kids that struggle in these areas struggle with “hello”—they don’t initiate conversations that well; they don’t respond that well. So even though a child or somebody or an adult might say, “Hello, how are you doing today, Johnny?” they don’t reciprocate. Also, they don’t necessarily share interest or share joy or emotion around activities. So even if you might be doing something with your child, you’re both into this activity—they clearly have this as a preferred activity—and you go, “That’s fantastic,” and there’s just a flat affect. When you see these kinds of things, those are some of the indicators for deficits in social-emotional reciprocity, and some of those examples are there for you to think about.
Also moving on to: they may resist physical contact; they don’t like emotion, they don’t like being touched, sometimes withdrawing, remaining aloof, and/or they just don’t like hugs, don’t like affection in general. Some of those things you want to consider when you’re thinking about that reciprocal kind of emotional and social type of interaction, and a failure to initiate or respond to social interactions—as I was saying earlier, saying hello back or initiating is something we want to watch for as well.
Social Communication and Interaction Criteria
The second area under that persistent deficit in social communication and social interaction is deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication to abnormal eye contact or body language, or deficits in understanding and use of gestures while talking. For example, very little hand movements: these kids, adolescents, or even adults, when they’re telling a story, they’re not doing what I’m doing right now, which is moving arms or articulating facial features while they’re speaking. These things are common traits and struggles for them. So there’s a lack of that kind of reciprocity in nonverbal communicative behaviors. A classic one that some parents or people will think of is the lack of eye contact—that’s certainly one—but again, we don’t want to just go “that one indicates autism.” My own children when I’m speaking to them sometimes don’t respond when I call their name or when I ask them questions because they might be distracted or whatnot, but we just want to notice this kind of behavior: it must be a significant departure from typical kids or adolescents or adults in this area of nonverbal communication—eye contact, those kinds of things, facial expressions that affect. We want to be thinking about those things.
The third area in that criterion—again, persistent deficits in social communication and social interaction across numerous settings—is deficits in developing, maintaining, and understanding relationships. For example, difficulty adjusting behavior to suit various social contexts, deficits in sharing imaginative play or making friends, or the absence of interactions with peers. This might be the student that is constantly by themselves or constantly fixated on, you know, Lego or some kind of stereotyped interest that they might have, or an interest that they have over in the room—they lack that ability or interest in interacting with peers. So there again is that interaction and communication lack that we should be seeing, or that you might see in somebody who might have autism. So that’s the first area we want to highlight: a persistent deficit in social communication and social interaction across multiple contexts.
Restricted and Repetitive Behaviors and Sensory Differences
The second criterion—and again probably a lot of you may know this—is restricted, repetitive patterns of behavior, interest, or activities, as manifested by at least two of the following, or by their history. We’re going to go into stereotyped or repetitive motor movements. Sometimes these kids, adolescents, adults have stereotyped repetitive behaviors: rubbing their arms, rubbing their ears, their faces. These repetitive behaviors might be occurring. Use of objects: simple stereotyped motor stereotypes—like again, lining up toys or flipping objects. Verbal repetitive behaviors—like echolalia, which is almost this parent-parting type of quality where you might say, “I had a good day,” “Good day,” “Had a good day,” “Good day,” and they’ll repeat or echo what you’ve said. Or they might have a stereotyped phrase that they say on their own, but they say it in no context of the conversation—while they’re just playing with something or walking around they go, “Good day,” and so there’s no person there, there’s no interaction, and the phrase just comes out. So stereotyped repetitive movements and/or speech.
The second area under restricted repetitive behaviors, interests, or activities is insistence on sameness, inflexibility, adherence to routines or ritualized patterns of behavior, well, and verbal behavior as well. For example, extreme distress at small changes: kids, adolescents, and adults that when there’s a change in their setting or in their environment or to a routine or ritual, they get very upset, way over the top. It doesn’t typically meet most kids’ or individuals’ type of behaviors; there’s a big reaction to that. Difficulties with transitions: kids with autism have significant difficulties with change but also transitions—moving from one activity to another. So maybe they’re playing with some Lego and now they’ve got to move to go brush their teeth—they can get very disturbed by a transition like that. Rigid thinking pattern: very black-and-white thinking. Oftentimes with these individuals greeting rituals can be difficult for them in that, you know, they may not wave; I’m talking about kind of more visual things—they may not do those typical things like looking at people, those kinds of things. For example, another is needing to take the same route to school or eat the same food every day. The difference between a ritual and a routine: an individual with autism can like both. A ritual is a series of behaviors that have to follow an invariant sequence: “I brushed my teeth, I wiped my face, then I went downstairs and ate some more food or a snack.” They really like not moving any of that ritual out of order; it has to be invariant, and if that ritual is changed, they get very upset. A routine is a bit different: “I might like drinking my coffee in the morning and then looking at the paper and then talking to somebody.” That’s kind of a routine; I like to flow—it doesn’t necessarily have to go out in that exact order; I could read my paper first, I could drink my coffee—but I do like that routine to be consistent. So ritual is more rigid, and routine has features that are consistent. Any changes in those can cause a lot of duress for autistic kids, adolescents, or adults.
The third area under that second criterion (restricted, repetitive patterns of behavior, interest, or activities) is highly restricted, fixated interests that are abnormal in intensity or focus. For example, a strong attachment to or preoccupation with unusual objects—excessively circumscribed behavior, which means highly restricted and fixated with abnormal intensity. They can really want to have an object—say maybe it’s a Lego piece—and if it’s that they really like touching it or they obsess on it; they want to talk about Lego all the time; they want to deal with Lego all the time; they insist on having Lego. That kind of high rigid intensity towards it clearly doesn’t fit for most people and can be an indicator of autism. There’s also almost an obsessive quality or rumination on it, both in interest and intensity.
Another quality is hyper- or hypo-reactivity to sensory stimuli. Kids on the autistic spectrum can sometimes be highly sensory-stimulated: they might hear a door close or, a good example, in the bathroom when somebody’s washing their hands and then they use the dryer: that high-pitch dryer can send them, and you might even see them grabbing their ears and really getting a lot of duress over that high sensitivity to sensory stimuli. Or under-stimulation: they don’t actually respond much to anything; they may have an incredibly high tolerance to pain, not seem to react to many things. So that can also be an indicator to watch for. Then also fixating on things that have to do with smelling, tantruming behaviors, visual fixations—like maybe really staring at or overly fixated on lights. Again, this really high intensity and high demand of certain sensory stimuli is characteristic for some kids on the autistic spectrum, adolescents, or adults.
Another important thing about this is that these qualities that I’ve talked about—the characteristics, the symptoms—must be present in the early childhood development period. For it to just happen in, say, adolescence, it needs to have been sustained earlier. Another important thing is symptoms have to have clinical impairment; in other words, a significant impairment in social, occupational, or other important areas of functioning. It has to create some difficulties at school, emotional life, social life with peers; and, say, if it’s an adult or an adolescent, significant difficulty with jobs—keeping jobs, maintaining jobs, finding jobs. These disturbances should also not be better under-explained by an intellectual developmental disorder or a global developmental delay.
That’s kind of a breakdown of some of the symptoms that outline autism spectrum disorder. Of course there’s more, but I wanted to give you a bit of a breakdown there.
The other thing I wanted to talk about is if your child is, say, between six and sixteen years, six and eighteen years old, a great resource in the Edmonton area is the Glenrose Rehabilitation Clinic. There’s a hospital program called SNAC: School Age Neurodevelopmental Assessment Clinic. That clinic has availability for a multimodal approach for assessment: you have speech, occupational therapists, pediatric physicians who will take a look at these developmental challenges, and there’s a multimodal approach to assessing your child if they fall in that age. It’s a fantastic program; I would encourage you, if you have some of these symptoms that you’re observing in your kids, you may want to access this program through your family doctor. But it’s important to know that you need a referral from a mental health provider or physician, and there should be a letter provided. You’re also going to probably need a psychoeducational assessment—somebody who does psychoeducational assessments, a psychologist, would be somebody you’d need to get that report from—and then you can proceed with that assessment. The challenge with those assessments, although they’re very good and there’s a lot of expertise there, in the Edmonton area I just was phoning the Glenrose the other day and the wait list is two years. So it’s a long duration waiting for those assessments. Various organizations and people that have expertise—like pediatricians who might have this expertise—can do the assessments, and also some psychologists who have the training in autism assessment, such as myself and others, would be a great source for you to consider when you’re doing the autism assessment.
Assessment Pathways and Supports in Edmonton
For determinations of autism spectrum, you may be wondering, “Well, what age can we start looking at this?” You can look before thirty months old. So say the child is not speaking—which is again one of the symptoms of autism: nonverbal, can struggle with developing speech—if your child is below thirty months, there are assessment services for that. Also between thirty-one months and beyond: if the child is not speaking, there still can be an assessment of autism for those children as well. And adolescents that maybe have just kind of phrase speech right through to adolescence or adulthood: the assessment for autism can proceed with them. So really, you can look at getting assessed quite young for your child’s needs in this area, and if you’re an adult: programs like I talked about, except SNAC, for example—you can’t access it after eighteen—but you could look at specialists, like at Clark Psychological Services. There are people, psychologists at my practice, including me, who do this, as well as other psychologists that have this expertise. I want to let you know that those are some of the ways that you can get the assessment done.
The last would be: well, okay, so if you find somebody, you determine that your child or an adolescent or adult has autism, what’s next? When they’re young, you can consider FCSS, which is Family and Community Support Services, or FSSD (Family Support for Children with Disabilities), so when the child is under eighteen years old, you can go to a government website where you take a look at this service or this provider, and they provide counseling even speech and occupational therapy—these are some of the services that you can possibly connect through the FCSS program. There are other various agencies that help out, including pediatricians that you could look at for sources of information. The Glenrose Hospital as well has a navigation connection to help parents who are querying about these things; if you call their general line, they can also give some guidance there.
So those are some of the things that I wanted to bring up today around autism spectrum disorder and autism assessments in Edmonton. My name is Dr Kelly Clark. Thank you for listening.