At the Child Development Clinic at Children’s Hospital of Richmond at VCU, children walk into the office of Chitra Pidaparti, Ph.D., greeted by an array of games and toys. Dr. Pidaparti observes children as they play, watching for important social, communicational and developmental cues. She looks to see if the child shows her their favorite toy, talks about the games or switches attention to another toy after a period of time, all the while searching for any developmental signs which could indicate a child is on the autism spectrum.Approximately 1 in 88 children in the U.S. have an autism spectrum disorder. Chances are, among the children in your child’s school grade, at least one has an autism spectrum disorder. And with an estimated 1 out of 54 boys and 1 in 252 girls diagnosed with autism in the United States, autism is currently four to five times more common among boys than girls.Rooted in early brain development, Autism is characterized by social-interaction difficulties, non-verbal and verbal communication challenges, and repetitive behavior. These signs and symptoms tend to emerge around the age of two, with a diagnosis typically being made by the age of three. Symptoms can vary from mild to very severe depending on the child and their place on the spectrum. To asses a child’s development and determine their diagnosis, Dr. Pidaparti, a psychologist at the Child Development Clinic, uses the Autism Diagnostic Observation Schedule (ADOS). Considered the gold standard in evaluation, ADOS uses play based assessment to identify any issues with socialization, communication or repetitive or restricted behaviors, such as inflexible routines, rigid adherence to rules, resistance to change or strong interests that consume much of the child’s attention.“By watching how the child interacts with me, and even their parent, in a natural play setting, I’m able to determine where they are developmentally,” said Dr. Pidaparti. “For example, if a child seems fixated on a certain toy, or avoids connection with myself or the parent, those could be signs the child is on the spectrum. Since the exact cause of autism is unknown, and diagnosis is purely based on behavior, there is no single test that can be performed.”Looking at everything from medical history and behavior ratings from the child’s parents, to notes from teachers and the ADOS assessment results, the clinic team takes a comprehensive approach towards diagnosis. With nurses, physicians, social workers, psychologists and even educational consultants working together to assess the patient, the team based approach allows for a more thorough and accurate examination.
“The autism spectrum is so complex, that a team based approach is really crucial for bouncing ideas off each other,” said Dr. Pidapatri. “Having a team to discuss this with transforms the checklist of factors and brings each child’s case to life.”
After an evaluation is completed, a social worker sits down with the parents to discuss the various intervention options. For infants and toddlers this might mean an early intervention program, for school aged children it may mean working with the school system to develop a special education program, and others may require occupational, speech, physical or other types of therapies. Applied behavior analysis (ABA) therapy is also available to help address and improve challenging behaviors. In some cases patients may be referred for additional genetic testing to identify abnormalities, which could eventually help researchers at Children’s Hospital of Richmond at VCU use gene sequencing to develop therapies for autistic children.Beyond developmental and behavioral challenges, children on the autism spectrum may experience other symptoms, such as difficulty sleeping or paying attention, and even seizures. Fortunately, while there is no treatment for autism, prescriptions are available to treat specific symptoms. Since supporting a child’s family is an important aspect of care at CHoR, the clinic social worker is available to connect families with resources to help them cope and learn more about their child’s diagnosis. Connecting them with the VCU Autism Center for Excellence, Commonwealth Autism Service or even the Parent to Parent support groups, CHoR helps families deal with the difficult realizations that often come with a spectrum diagnosis.
“I really appreciate that one of our main roles is offering the family support,” said Dr. Pidaparti. “The Spanish-speaking mother of one of my patients on the spectrum was unable to advocate for her son with the school system due to a language barrier. We connected her with the Center for Family Involvement and they were able to step in on her behalf to support the child’s educational needs. That kind of help really improves the lives of our patients.”
April marks Autism Awareness Month in the United States, offering an opportunity to educate the public about autism and remind parents of the importance of early detection. Early intervention is key to helping children on the spectrum live full and successful lives. Beginning at two months old, parents should look for certain milestones like smiling, cooing or eye contact, all important clues about your child’s development, but remember children develop different skills at their own rate. If you are concerned your child’s behavioral development might be delayed, it’s important to consult with your pediatrician.What’s something new you have learned about autism from reading this post? Please share with us in the comments!