Autism
Autism Spectrum Disorder is a neurodevelopmental disorder, meaning symptoms begin during early childhood development, typically by 2-3 years of age, though there can be signs even in the first year of life. The diagnostic criteria for autism is described in the Diagnostic and Statistical Manual of Mental Disorders, (DSM) with its most recent version in 2022 (DSM-5-TR) that describe the types of challenges that kids can face. Dr. Jamie Lee Palaganas spent much of her training and her early years in practice working closely with leaders in the field of behavioral neurology to hone her skills of diagnosing these challenging cases and connecting with a multidisciplinary team to help you and your child reach and surpass their goals.
What is Autism?
The first years of development are dynamic and face paced. While development in the first year of life is heavily focused on building motor skills, these motor skills are then put to use in the development of speech, social skills and interactions with others and their environment. For some children, the development of social skills can be delayed or abnormal and may raise concern for autism, also known as Autism Spectrum Disorder (ASD). Autism is a complex condition where children have a disorder that can involve challenges with social skills, communication, and restricted or repetitive interests or behaviors. Autism has a broad spectrum of presentations with different combinations of symptoms and levels of severity. This variety can make recognition and diagnosis of an autism spectrum disorder challenging. At Pediatric Neurology of NYC, we value taking the time to learn about each child’s unique combination of strengths and challenges in order to provide the proper diagnosis and guide treatment.
Some children with autism may have no verbal language, where others may have an exceptional vocabulary. Some children may do well with interactions with other adults, but struggle with connecting to their peers. Others may have significant restrictions to their interests, difficulty with transitioning between activities, and while some may seek out bright lights or sounds as sensory stimulation, others may be very sensitive and overwhelmed by these same sensory inputs.
What causes Autism?
Just as autism is complex in its symptoms and presentation, the causes of autism can be complex including genetics, perinatal factors and events, environmental factors and social determinants.
Genetics may predispose individuals to abnormalities in the development of the brain from a structural perspective or in how the brain functions. While sometimes single genetic abnormalities can cause autism (such as in Rett Syndrome, Fragile X syndrome), there are other times where a combination of genetic factors that alone may not cause autism but when they occur together can lead to autism.
There is also a significant role for environmental and social factors in the development of autism such as the health and age of the parents, exposure to chemicals, prematurity or complications during pregnancy or delivery.
Overall, the development of autism is not necessarily predictable or something that can be prevented or avoided. While we are constantly building our understanding about autism, there are many factors we do not yet fully understand.
How do we diagnose and treat autism?
Early in life, there are screening questionnaires such as the M-CHAT, which is often performed at pediatric well visits between 16 and 30 months that can help identify concerns about if autism is a possibility. It is important to realize that screening tools are not diagnostic tests in and of themselves! They are only meant to help determine if a child may benefit from a more detailed evaluation.
Autism has varied presentations and symptoms and as a result, diagnostic evaluations may require multiple different specialists including physicians like neurologists, developmental pediatricians and/or geneticists, psychologists, speech and language pathologists, occupational therapists or other developmental specialists. Each specialist will perform their evaluation and obtain a detailed history about the child’s development to best determine if they meet the criteria for a diagnosis of an autism spectrum disorder.
Sometimes bloodwork, genetic testing, imaging of the brain (such as MRI) or looking at the brainwaves (with an EEG) may also be part of the evaluation.
At Pediatric Neurology of NYC, we have developed an incredible network of professionals across each of these areas of expertise to best address this important diagnostic process. The collaboration between different disciplines and specialties can be very valuable in coming to an appropriate diagnosis and Dr. Jamie is careful to ensure a thorough approach.
Can children overcome autism?
- As mentioned throughout this page, autism is a spectrum disorder and in the most recent version of the DSM 5 TR, there is emphasis on assigning the level of support needed for an individual for both social communication and their restricted and repetitive behaviors. There are 3 levels of severity with level 1 being the least severe, (requiring support), level 2 the intermediate level of severity (requiring substantial support) and level 3 the most severe, requiring very substantial support.
- What those supports may vary from person to person and may include physical therapy, occupational therapy, speech therapy and behavioral therapies like ABA. Using a variety of approaches that address a children’s developmental and cognitive strengths and weaknesses, children can make significant progress and develop skills and coping mechanisms to improve their functioning and quality of life.
- It is also important to realize that there are sometimes other conditions occurring simultaneously with autism, for example epilepsy, intellectual disability, sleep difficulties, ADHD, mood disorders and other psychiatric conditions. Careful assessment to best understand all aspects of a child’s life is valuable in building a team and treatment approach.
Can these conditions be treated successfully?
While there are significant challenges that can come with a diagnosis of autism, there are also times when children with autism will have incredible talents and interests that lead them to be amazing artists, scientists, musicians, engineers. The ability to think in a unique way leads to a different perspective that can lead to novel and exceptional outcomes.
Dr. Jamie and Pediatric Neurology of NYC always focus on their unique values, goals, strengths and weaknesses which are of utmost importance for children with autism and their families. If you want to discuss your child’s development, concerns for social development or autism, contact Pediatric Neurology of NYC to set up your consultation.