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Physician Advocacy for ASD (Autism spectrum disorder)

Good diagnosis is more than just a DSM checklist. A good clinician may incorporate some bedside testing in the mix. To this end, recall that the three general categories of impairment in autism are social understanding, symbolic play, and social communication. There are a few concrete things you can do in your office to help determine if these three things are in fact impaired, which you can add to a focused history and observation.

To assess social understanding, the Sally/Anne test makes for a nice, short, “bedside” test. In it, you set up a scenario where two dolls, Sally and Anne, are playing together. Each has a box or basket. Anne needs to leave for a bit, and before she goes, she puts a specific toy in her basket. While she is gone, Sally moves the toy to her own basket. Then Anne comes back. You ask the child, “Where does Anne look for the toy?” “Where is the toy now?” “Where was the toy before?” Children on the autism spectrum think that Anne will look in the new location, Sally’s basket, because of their difficulty understanding others’ perspectives—they can only imagine Anne looking where they know the toy is located, not where she would believe it to be. (Details of the research behind this, known as the “theory of mind,” can be found at Baron-Cohen S et al, Cognition 1985;21(1):37-46.)

To test symbolic or pretend play, the trick is merely to get the child to substitute one thing for a completely unrelated thing. For example, can a block be used as a train in play? Can you play tea party and make a baby bottle into a salt shaker?

Assessing social communication is the hardest task, but a test of prosody is sometimes helpful. Try this: Hide your face from the child, then make a neutral statement such as, “I’m going to the movies” using a variety of emotional tones. Ask the child to identify which emotion was which. Normal kids get this right most, but not all, of the time, whereas kids with ASD often do not.

Engaging Children in Therapy

Identifying children with ASD is essential, but it’s only the beginning. Engaging these children in therapy can start the process of improving development and social skills, raising cognitive ability, and dampening detrimental behaviors. There are many types of therapy programs and each has variable levels of evidence. Behavioral programs, such as the Lovaas method, target multiple deficits, and many studies show significant symptom improvement (Howlin P, Am J Intellect Dev Disabil 2009;114(1):23-41).

On the other hand, environmental programs such as the Training and Education of Autistic and Related Communication Handicapped Children (TEACCH) focus less on changing communication or social skills and more on embracing each child’s specific characteristics. There are also programs created specifically for ASD children with limited language abilities. (For a thorough review of many programs, see Maglione MA et al, Pediatrics 2012;130(Suppl 2):S169- 78.) While it may seem hard to know which method is best for your patients and their families, helping identify a program individualized for each patient’s needs may be the best form of advocacy.

Involving Home and School

While therapy can start in our office, most of the work is done in the home and school settings. For children with ASD, school becomes the place that encourages change or allows retreat into stereotyped behaviors. Research suggests that effective school programs begin with the principal and ultimately involve the environment, teachers, and classmates.

Why the principal? Horrocks et al found that the principal’s belief in the ability of autistic students to integrate led to a higher rate of successful inclusion (Horrocks JL et al, J Autism Devel Dis 2008;38(8):1462-1473). Even simple changes like sound-absorbing walls and halogen lighting lead to improvements in mood, comfort, and performance in autistic children (Kinnealey M et al, Am J Occup Ther 2012;66(5):511-519).

Creating the ideal environment isn’t just a physical process; it also involves teachers setting the stage for success. Intervention techniques focusing too much on the child with ASD run the risk of separating children into two distinct groups, whereas classwide intervention techniques can help meet the needs of all students with minimal disruption. Ultimately, teachers not only help ASD students integrate, but also provide an example for other classmates to learn how to respond appropriately to the autistic child (Weiss MJ & Harris SL, Behav Modif 2001;25(5):785- 802). Select peers can go beyond just basic acceptance and volunteer for activities like peer play during recess to help improve social skills (Harper CB et al, J Autism Dev Disord 2008;38(5):815- 826). Lastly, encouraging parents to stay involved in school leads to higher satisfaction with school efforts (Zablotsky B et al, Am J Intellect Dev Disabil 2012;117(4):316-330).

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Physician Advocacy for ASD (Autism spectrum disorder)

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This article was published in print 1 & 2/2013 in Volume:Issue 4:1.


 

APA Reference
Kurtz,, K. (2016). Physician Advocacy for ASD (Autism spectrum disorder). Psych Central. Retrieved on October 15, 2019, from https://pro.psychcentral.com/physician-advocacy-for-asd-autism-spectrum-disorder/

 

Scientifically Reviewed
Last updated: 8 Mar 2016
Last reviewed: By John M. Grohol, Psy.D. on 8 Mar 2016
Published on PsychCentral.com. All rights reserved.