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Episode 1

What are the signs of autism?

Jane Howard & Coleen Sparkman

How can I tell if my child has autism? What are the earliest signs of autism in children?

There are several early signs your child might have autism. In this episode, we talk to two leading experts about the earliest signs of autism and how to respond to them. Autism can present itself before a child turns two, and the best outcomes come from early diagnosis and treatment.

Dr. Jane Howard:

One of the things that the research has shown is that parents are aware, much sooner than their child is diagnosed, that things are not progressing exactly like they thought they should be. And so most parents have some concerns, even before the child’s first birthday.  

Gene Gates: 

That’s Dr. Jane Howard from Therapeutic Pathways. And it’s hard to find someone who knows more about autism and the best modern treatments that she and her business partner Coleen. If you want to know what the first signs of autism are, you’re in the right place, because this is an Introduction to Autism. A show dedicated to helping parents who wonder if their child is showing signs of autism. An introduction to autism is a compassionate evidence based series that provides solid information, guidance, and hope. You learn about the signs that your child might have autism, and how early diagnosis and treatment leads to the best outcomes. You’ll also hear from some of today’s best experts in the field, whose mission it is to help families with autism. Plus, we’ll talk to some young adults who will share what their life looks like living with autism. I’m your host, Gene Gates. And this show is produced by Dr. Jane Howard and Coleen Sparkman from Therapeutic Pathways. So Jane, let’s start with the basics. What concerns might a parent notice?

Dr. Jane Howard: 

The concerns could be in any number of different areas, but they’re often around the infant’s lack of interest in looking at other people’s faces, looking at their eyes when things are going on, tracking what’s happening in the environment. And they may not be thinking, “Hmm, is this autism?” But they do have some concerns. And interestingly enough, they will bring those concerns often to the pediatrician or whoever the primary care person is. But because autism happens much more frequently in boys than girls, four to one actually, many times they’re sort of counselled “Oh, be patient.” You know, sometimes boys are a little bit more slow to develop in some of these social kinds of areas like interest in people.

Gene Gates:

I’m interested in this four to one scenario? Do we have any idea why it’s more prevalent in boys? And we’re talking young boys? So you’re talking about these things starting to show up in 10, 11 months?

Dr. Jane Howard:

Absolutely. There’s been a large amount of research that’s been devoted to trying to figure out the genetics, but we really don’t have a lot of clarity as to why the ratio of four to one exists. People have put out different ideas about social expectations or things like that. But I think the people who do the research think that there really is a genetic component here. And that things are in motion, if you will, in utero. Well, before. 

Gene Gates: 

Are parents thinking what’s wrong? Is there something in the food? Is it the vaccine? Is it in the water? Am I living close to something that’s toxic? You must have a lot of compassion for these parents who wonder: “Why me? What did I do? What’s happening?” I know the vaccine thing is highly controversial. But from a strictly clinical standpoint, is there any possibility at all, that something in the vaccine, mercury or otherwise, before or now might have been a contributing factor in the US?

Coleen Sparkman:

What we know is that there is a wealth of research that does not support vaccines being a causative factor. And that’s probably all we know about that. 

Gene Gates:

I think that the American public won’t hear that. It seems to me that you can say that all you want, but “Darn it, my kid was fine, then they had this vaccine.” And normally, it’s the one that has multiple vaccines. And then they behave differently after the shot. And I believe that for these people, it’s hard to shake them out of that tree of belief. So weird thoughts on that. Have you heard this thing, too- that it’s not any one of the vaccines, but it’s when they all come together, that there’s something in the mass that’s greater than the sum of the parts?

Coleen Sparkman:

Sure. My background is as a speech and language pathologist. So what brought me to this point in terms of working with Jane and in our program with Therapeutic Pathways is that I was often one of the first diagnosticians to see these children. And so what happens is there’s some correlational but not causative things that happen, meaning that around the age that parents are noticing concerns, and oftentimes, the earlier signs that Jane was talking about, may be in the back of their mind, but what they could see is their child wasn’t talking. And they’re not talking the same as their peers. And they just got their shot. But that really was not causative. The earlier signs are there, their language development isn’t happening. All of that comes together to build this profile of what we would typically see in a young child with autism.

Gene Gates: 

So that certainly makes sense. It’s like saying, my kid never got in any accidents in the car before they turned 16. It’s like, well, yeah, they didn’t drive before they were 16. So, I can understand that. The other thing that I hear a lot, and I don’t know if this is true, but I know one of you or both of you know the answer to this question. And that is that autism is much more prevalent in the United States than it is elsewhere. What do we know from international studies? Are there places that have lower instances of autism? 

Dr. Jane Howard: 

I actually think that we have a lot of information about the instances of autism in the United States and other countries. And of course, the culture and the healthcare that’s available is going to have some influence on what age children are diagnosed or how they are receiving services. But to the best of our knowledge, when we really have looked across the world and been able to do good epidemiological studies, what we know is that it seems to be pretty constant across the world. I mean, the United States stands out in a good way. Because the age at which children are getting diagnosed is getting younger and younger, especially compared to places like the UK, where you think, “Oh, they’ve got very good child find and good healthcare services.” But we think that it really is a pretty stable prevalence across the country. But when you start looking at the age at which children are diagnosed, and how good the testing is that’s available. Those things are going to be influenced by that country’s resources and the openness with which they have to identify individuals with some sort of delays, and then bring in the services that are going to make a difference.

Gene Gates:

So to be clear, I want to make sure that I understand this correctly- If in America, we go to the doctor at younger ages, and we go more frequently than some other countries, then of course, we’re going to have greater instances of diagnosis, because we’re going there earlier and more frequently. Is that what you’re saying, Jane?

Dr. Jane Howard:

Yeah, and I would say one of the examples of that is that the American Academy of Pediatrics counsels all of their healthcare providers to do screening for autism twice before the age of two. And it’s not the case that everybody is doing that religiously with their patients. But that’s the recommendation. And really, the emphasis in our healthcare system is early diagnosis, these early treatment and better outcomes.

Gene Gates: 

When I asked you another question that I hear a lot of chatter about, and that is that autism is on the rise, because we have broadened the description of what qualifies as autism. Is that true? Is this spectrum now more generous than it was, say 20 years ago? And that’s why we’re seeing more children with autism is because we’ve opened up the funnel, if you will, in terms of how we describe what autism is- can either of you speak to that? 

Coleen Sparkman: 

It’s actually two different questions, I think. What we find is that, yes, we have a new DSM-5 Diagnostic and Statistical Manual, which is a compilation of all the different diagnoses that the medical community… 

Gene Gates:

So this is like the book that says, here’s the stuff you’re looking for, if you think they might have autism, if they have these things then they probably do, essentially.

Coleen Sparkman:

So that has taken it and put it all under one umbrella called Autism Spectrum Disorder. We refer to it as a spectrum frequently. It’s interesting because Jane and I together have a combined many years, probably eighty years between the two of us. But across that time, when I started as a speech pathologist in 1979, the incidence was one in 10,000 births. Now it’s one in 57. So what I would say is given experience and what we know from watching the different types of children that we’ve worked with is, it is a combination. There are more kids. Absolutely. These children may have been given a slightly different diagnosis that we don’t use anymore right now. At that time, we would have seen more children diagnosed as maybe with an intellectual disability only, but probably were on the spectrum. But there are more children with autism.

Gene Gates: 

You said usually one in 10,000. And now it’s one in 57. That’s enormous. So would you say beyond a shadow of a doubt, diagnosis/ disease, whatever you want to call it, it sounds like it’s a runaway train right now. That’s an enormous change.

Dr. Jane Howard:

Yeah. And I would just add to what Colleen was sharing. We think that there actually has been an increase. But there’s so many factors that are coming into that, making that number one in 57. One, certainly as the way in which we’re describing, defining, identifying autism. That has changed, and that’s going to change who gets put into that particular category or received that diagnosis. It’s also the case that the awareness has just become so much greater in the general community, but also with the pediatricians and the healthcare community. I think it would be safe to say that when individuals go through medical school, they go through their rotation. Their opportunity, certainly in the past, to even have any face time with a patient with autism was very limited. Now, it’s more likely because it’s much more in the forefront. 

The American Academy of Pediatrics has been very active in that. But still, here’s the challenge. Autism in very young children, as we were talking about earlier, less than two years of age looks so different than when you start talking about identifying individuals with autism, who are 5, or 8, or 10, or 16. And we certainly have also seen that there are many more cases just because the knowledge is there. And the resources are now there to be able to identify autism in individuals who may have gone through school, may have gone through college, may be out in the community, who actually meet the diagnostic criteria. So those are folks that were never really included or counted before. So there are a lot of factors going into this. But when all is said and done, I think there’s a general agreement that despite all of the things that I just mentioned, there are more cases, the reason for that is not clear.

Gene Gates:

I’ve heard people described as having Asperger’s. And they say, “Oh, they’re on the spectrum.” People often say, “Oh, that’s Bill Gates. He’s never been diagnosed, but we can look at the research and we can listen to the way he speaks and say, ‘Okay, he’s got Asperger’s that means he’s on the autism spectrum.’” Can you help me understand a little bit more from a clinical point of view? Rather than a YouTube point of view. How do you see that playing into this whole conversation?

Dr. Jane Howard:

I want to be very careful, it’s almost become sort of a pastime hobby to look at folks that are out in the public and then say, “Oh, I think this person must be on the spectrum, or have autism.” But with regards to that question, Asperger’s is a diagnostic category that was in force at one time. So Coleen was talking about the DSM, which is the Diagnostic Statistical Manual that classifies different kinds of conditions. So in that older version, Asperger’s did appear, it doesn’t appear anymore. That doesn’t mean that individuals who would show the signs of Asperger’s don’t exist. Clearly they do. But now they’re being represented in that sort of bigger category, that spectrum of Autism Spectrum Disorder. And it’s really one of those situations where autism is clearly a spectrum. And you will see folks who look very different from one another, that both may have that same diagnosis. I mean, the old saying is, and it’s still true, if you meet one person with autism, you’ve met one person with autism. So individuals who might be very competent in many areas, but have some social difficulties may fall into that category that previously people said, “Oh, that’s Asperger’s.” 

Gene Gates:

I’d love to know more about what does a full life look like living with autism? And what are the best practices for treatment? Can we talk about that in our next episode?

Dr. Jane Howard:

Absolutely, those are two really important topics that we would like to be able to share what we’ve learned and what we’ve experienced in our years of providing services to families. And these are topics that are really important. 

Coleen Sparkman: 

What I would add is that there is a lot of positive and optimism around that topic, as well.

Gene Gates: 

I can’t wait for that conversation again. Coleen Sparkman and Jane Howard, thank you so much. I look forward to our next conversation. 

 

1. How old is your child or dependent?

2. What are your goals for your child?

3. Has your child been given a formal diagnosis of autism?

4. What types of behavior is your child demonstrating?





Please select a value.

Readiness

Your answers indicate that your child may be best treated in the Readiness program. This individualized, evidence-based program teaches young children skills they need to accelerate their learning and gain independence. Using imitation and naturalistic learning techniques, your child will develop useful skills in the areas of speech and language, cognition, and self-awareness. A program for children ages 0-3. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Foundations

Your answers indicate that your child may be best treated in the Foundations program. This program gives preschool and school-age children the structure to achieve important social, emotional, and intellectual milestones, helping them test within their peers’ range. With 25+ hours of applied behavior analysis (ABA) therapy per week, your child will develop social skills and better self-awareness for school and home. A program for children ages 4-7. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Breakthroughs

Your answers indicate that your child may be best treated in the Breakthroughs program. Specifically designed for children who have limited hours due to school schedules, this program removes life barriers by developing communication, social, and self-help skills. We teach your child to engage in appropriate behaviors, helping them interact with peers and develop relationships. A program for children ages 8-11.

Interactions

Your answers indicate that your child may be best treated in the Interactions program. Through guided social skills groups twice a week, this program helps improve social functioning in children ages 5 to 16. Parent or caregiver participation is crucial to this program; our certified staff provides training for successful participation.

Independence

Your answers indicate that your child may be best suited for the Independence program. Geared toward older children, this program includes more in-depth skills that will help your child function independently. Taught skills include functional communication, self-management, and financial literacy. A program for individuals ages 12-25. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Your Child My Be Suited to Multiple Programs

Independence

Your answers indicate that your child may be best suited for the Independence program. Geared toward older children, this program includes more in-depth skills that will help your child function independently. Taught skills include functional communication, self-management, and financial literacy. A program for individuals ages 12-25. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Strategies

Your answers indicate that your child may be best suited for the Strategies program. The most age-encompassing of our programs, the goal of Strategies is to reduce challenging behaviors and issues with aggression. These behaviors interfere with independence and community participation, so we work to mitigate those challenges and encourage safe, appropriate behavior for individuals of any age. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Strategies

Your answers indicate that your child may be best suited for the Strategies program. The most age-encompassing of our programs, the goal of Strategies is to reduce challenging behaviors and issues with aggression. These behaviors interfere with independence and community participation, so we work to mitigate those challenges and encourage safe, appropriate behavior for individuals of any age. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Breakthroughs and/or Interactions

Your answers indicate that your child may be best suited to the Breakthroughs or Interactions programs. These programs treat similar symptoms, so Therapeutic Pathways will need to meet with you and your child before we can place them within the appropriate program.

Specifically designed for children who have limited hours due to school schedules, Breakthroughs removes life barriers by developing communication, social, and self-help skills. We teach your child to engage in appropriate behaviors, helping them interact with peers and develop relationships.

Through guided social skills groups twice a week, Interactions helps improve social functioning in children. Parent or caregiver participation is crucial to this program; our certified staff provides training for successful participation.

*This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Your Child My Be Suited to Multiple Programs

Breakthroughs and/or Interactions

Your answers indicate that your child may be best suited to the Breakthroughs or Interactions programs. These programs treat similar symptoms, so Therapeutic Pathways will need to meet with you and your child before we can place them within the appropriate program.

Specifically designed for children who have limited hours due to school schedules, Breakthroughs removes life barriers by developing communication, social, and self-help skills. We teach your child to engage in appropriate behaviors, helping them interact with peers and develop relationships.

Through guided social skills groups twice a week, Interactions helps improve social functioning in children. Parent or caregiver participation is crucial to this program; our certified staff provides training for successful participation.

*This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.

Strategies

Your answers indicate that your child may be best suited for the Strategies program. The most age-encompassing of our programs, the goal of Strategies is to reduce challenging behaviors and issues with aggression. These behaviors interfere with independence and community participation, so we work to mitigate those challenges and encourage safe, appropriate behavior for individuals of any age. *This is a suggestion based on the answers you submitted. Please contact Therapeutic Pathways at (209) 422-3280 to discuss which program would best suit your child.