Autism Spectrum Disorder (ASD) Diagnosis

As a Speech Pathologist, I often see children who are not learning to talk as well as they should. Sometimes it quickly becomes apparent that these children can be diagnosed to be somewhere on the "autism spectrum". A specific definition could be Autism Spectrum Disorder (ASD).
At some point, as I get to know a child, the idea needs to be raised. Sometimes parents come to therapy and ask, "Do you think my child has autism?" Other parents may have never considered the possibility and find it extremely difficult to begin to talk about this issue.
Parents may have developed their understanding of autism from the media. Very often, movies and books depict people with autism as having ALL the possible autistic symptoms. These symptoms have become a stereotype of autism. This can be very misleading. When parents look at their child, they say, "That doesn't look like my child!"
As a Speech Pathologist I work with many children with autism or who are "on the autism spectrum" somewhere. They are all different. They have different symptoms and learn differently and at different rates. Many clinicians working with children "on the spectrum" find that they can quickly identify that this is the case by seeing a pattern of symptoms, rather than seeing a child exhibiting all of the 'classic' signs of autism.
Usually children arrive at Speech Pathology because they are not talking like their peers. A child may not be talking at all, or may be talking in a limited way. Children with autism often repeat exactly what they have heard, a kind of speech called echolalia. It may be what you have just said to them (like, "hello Olly") or lines repeated verbatim from a movie. Sometimes the children may sound like they are talking in sentences but it may be their own language or the tune of speech without clear words.
From a Speech Pathologist's perspective, there will be differences to normal development in the way a child communicates, not just talking. Eye contact is usually limited, and your child may not automatically turn to you when you try to attract his attention.
When children are learning to talk following the usual pattern, they learn to copy most of the adult purposes for communicating. So they will ask for things, protest and refuse, use polite language, make comments about things they see or hear, and ask and answer questions. They want to communicate because they want to interact with others. If a child is having difficulty getting their message across they can work out a range of strategies to get what they want.
Usually children with autism communicate only for a limited range of purposes and don't tend to seek interaction just for the sake of communicating. They can become very upset when they are unable to have their needs met or when something upsets them. It is not always easy to work out why they are upset. Children with autism can be upset more easily than other children if they have sensory difficulties, also, such as being too sensitive to sound or touch.
They can also be less sensitive to senses such as sound and touch and seek out stimulation, by pushing against people or mirrors, for example, or spinning around or flapping their hands.
Children tend to want to socialise with others, and learn to take turns in conversations and with toys (although this part can take a long time!). Children with autism usually don't seek to play with peers and are happier left to do their own thing. Often they even limit physical contact, such as hugging, with parents and brothers and sisters.
A diagnosis can be a very difficult thing for parents to accept, particularly if their understanding of a disorder is influenced by media. The media has certainly picked up on autism in the last decade or so, and there are almost limitless books and films depicting people with autism.
Please do not be daunted by these portrayals. Children are all individuals with their own personalities and skills. If a child has autism, it is probably better to know than not to know, for a number of reasons. Other people are likely to be more understanding of the difficulties you are facing and treatment can be planned and managed.
Most children with autism can be shown how to communicate with others. They participate in school and lots of other activities in which they show an interest. Some children with autism are exceptionally clever with things that interest them. They learn social skills and how to interact successfully with other people.
If you have concerns, find a Speech Pathologist who works with children with autism, to support you and guide you through the issues, and set your child off on a lifetime of communicating.

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Early Warning Signs of Childhood Apraxia of Speech

Childhood Apraxia of Speech (often abbreviated as CAS) is a somewhat rare speech disorder. It is estimated that 1 in 1,000 children will be diagnosed with apraxia. In comparison, 1 in 150 will be diagnosed with an Autism Spectrum Disorder. Many parents, and indeed doctors, are not aware of what apraxia is, and thus the early warning signs may go unnoticed. Like many other neurological disorders, early treatment is the key to helping your child overcome the difficulties this speech disorder can present.

In medical terms, Childhood Apraxia of Speech is a motor-planning disorder that is characterized by difficulty sequencing the speech movements necessary for volitional speech. In layman's terms, the messages sent by the brain to the muscles and nerves that control voluntary speech get scrambled and the muscles and nerves can't decode them to understand what to do. This is not a speech delay, but a true neurological disorder. It is unclear what causes apraxia, but it appears to be related to immature neurological development, rather than caused by an injury to the brain, such as is seen in stroke patients with apraxia. Though it has been named "childhood" apraxia of speech, it is not strictly a childhood disease. A child diagnosed with apraxia will struggle their entire lives with their speech, though it will probably get easier to speak as they get older.

Many children with Autism, Down Syndrome, and Cerebral Palsy have been diagnosed with CAS, though apraxia does appear in children who have no other disabilities. Common co-morbid conditions include hypotonia (low muscle tone), sensory integrations problems, and language delay. Many older children with apraxia have trouble with reading, writing, and spelling. Because of this, early intervention with speech therapy and occupational therapy is very important for a child's future at school.

While there are some warning signs that are commonly seen in apraxic children, many parents are told by well meaning friends, family, and even pediatricians to "just wait and see." If your child shows several of the warning signs listed below, don't take the wait it out approach. As your pediatrician to refer you to a speech-language pathologist for an evaluation. Early detection and intervention is key for a bright future for your apraxia child. If your child is older and has speech problems, it's never too late to get them evaluated.

Early warning signs:

• little or no babbling during infancy
• difficulty with nursing or feeding during infancy
• few consonants
• slow, effortful or halting speech
• poor speech intelligibility
• difficulty imitating sounds or words
• late onset of first words (or "losing" words)
• inconsistent or unpredictable speech errors
• groping during speech attempts
• high frequency of vowel and voicing errors
• high receptive language, but low or no expressive language (child understand everything being said, but can't say anything back)
• "soft" neurological signs, such as sensory problems, sensitivity to touch, fine motor problems
• slow or no progress with traditional speech therapy (apraxic kids benefit from specialized, intensive therapy that isn't necessarily know by all speech-language pathologists)

As the mother of a severely apraxic child, I understand the fear that hearing such a diagnosis can bring. My son is not on the spectrum, nor does he have any other disability (well, he does have minor sensory issues and minor hypotonia). Unless you hear him talk, you would never know that he can't talk. My first thought upon hearing the diagnosis was "Will he ever speak?" You are probably wondering the same thing about your recently diagnosed child. The answer is yes, more than likely your child will speak, especially with early intervention. You child may not speak "normally," he may need to use ASL (as mine does) or a communication device, but he will be able to communicate and lead a pretty typical life. The most important thing a parent can do is recognize the early warnings signs, push your pediatrician or other professional for help, and get involved in your child's treatment. With hard work, and possibly years of therapy, most people will never even know that your child has childhood apraxia of speech.

When my son was diagnosed with Apraxia, he was also diagnosed with Sensory Processing Disorder. I found that having a variety of fidget toys on hand helps his attention and focus tremendously. I've reviewed a variety of sensory toys to help others pick the best fidgets for their kids.

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