Often as a paediatric occupational therapist, I get clients coming to me seeking clarification about their child’s state of development, especially in regards to Autism Spectrum Disorder (ASD). This may include answering a few questions, doing a formal assessment, and writing up a report. Or, it may be contributing to their journey to seek out a formal diagnosis of some sort.
In a similar fashion I often get parents asking ‘what their child has’, and at the end of an assessment I’ve been asked: “So, what do you think?…. is it Autism?”
Firstly, from a legal and formal perspective, Occupational Therapists cannot formally diagnose any disorder under the DSM. Secondly, if my report was contributing to the paediatrician’s (or other qualified health professionals) formal diagnosis, it is not my role to give my client a tentative “Well I am thinking it might be ASD” without strong evidence to suggest this.
Often this can leave clients confused and feeling helpless – why did they just spend all that time and money on an OT assessment not to get an answer?
My response to this is: we provide answers, simply in a different format!
We cannot provide a direct black and white diagnosis for your child. But we do provide a clear overview and summary of your child’s strengths and challenge areas.
SOME RED FLAGS TO LOOK OUT FOR
This following list is not exhaustive, but is loosely based on the DSM-5 Criteria for Autism Spectrum Disorder. This is by no means a diagnostic tool, rather a generalised guideline. The following list needs to be taken into account alongside the child’s environment and context. Similarly, not all children with autism have all of the following symptoms (i.e. I often see children with ASD provide me with eye contact on their terms).
Symptoms of ASD can be loosely grouped into three main sections – social skills, behaviours, and sensory reactions:
- Social: Communication and interactions: this may mean inabilities to have back and forth conversation or challenges with initiating interactions. Also to look out for:
- Abnormalities in eye contact
- Challenges understanding body language and facial expressions
- Difficulties in sharing imaginative play
- Behaviour: Look for restricted and repetitive patterns of behaviour or interests. This may mean stereotyped motor movements, speech, or toys. Also look for:
- Lining up toys
- Echolalia in speech
- Rigidity with routine and insistence on sameness
- Restricted or fixated interests
- Sensory: Be aware of Over or Under reactivity to sensory inputs or unusual interests in sensory aspects of the environment. Also look for:
- Very high pain threshold
- Excessive smelling or touching of objects
- Fascination with lights or movement
- Extreme adversity to certain textures or tastes
FACTORS TO CONSIDER WHEN SEEKING A DIAGNOSIS
- In the eyes of the government and certain funding bodies, a formal diagnosis is required to gain access to funding packages. Talk to your trusted health care professional about your options based on your location. Keep in mind also the roll out of the NDIS.
- Certain schools and educational facilities are unable to provide specialist help and assistance unless a formal diagnosis is provided. Talk to your school about what is needed to set up support for your child.
- Some parents and carers may see a diagnosis as a ‘negative label’ of which their child may be perceived negatively in social contexts. Alternatively, some parents may see this ‘label’ as a positive and empowering tool for their child to help them understand their uniqueness.
- Some parents and carers may be seeking a diagnosis for closure or better understanding. Some may feel a sense of relief after gaining a diagnosis.
- Some parents may feel fear, frustration and anxiety after receiving a diagnosis. Understand that it is a journey and to seek emotional support when required. Your health care professional should be equipped to help you better understand your child’s diagnosis and how to deal with the emotions associated with it.
Ultimately it is a very personal decision, and in general, not an easy one. It is best to talk to people who you trust and support you. This can be family, friends, partners or health professionals.