AAAP Today

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TO SCREEN OR NOT TO SCREEN FOR AUTISM ?

3 Reasons why universal screening of children aged 1-3 years should be conducted.

By Lirio Sobrevinas-Covey, Ph.D.

The US Preventive Task Force recently published a statement that did not advocate universal screening of children up to the age of 3. The reason given was the lack of scientific evidence that early screening yielded benefits in terms of improving clinical outcomes for children eventually diagnosed with Autism Spectrum Disorder.

That statement was met with considerable disagreement from clinicians and autism advocates including the American Academy of Pediatricians. With reference to an editorial by Dr. Geraldine Dawson, Ph.D. from Duke University, here are 3 reasons why universal autism screening of young children aged 1-3 should be conducted.

1. Autism is a prevalent and high-cost condition. The most recent (2012) survey in the United States found that autism affects 1 in 68 children. It is associated with significant short- and long-term economic and emotional burdens to families and to society. The lifetime cost of supporting an individual with ASD has been placed at $1.4 million. For an individual with ASD and intellectual disability, the estimated lifetime cost almost doubled to $2.4 million.

2. Autism screening in young children can be done in timely manner and with adequate reliability.. The most commonly used tool is a parent questionnaire that requires little training by the health care professionals, can take 5 minutes and, if further questioning is warranted, can take only an additional 10 to 15 minutes. The measured ability of the screening tools to detect a positive diagnosis (sensitivity) and of detecting the absence of the diagnosis (specificity) is high.

3. When early screening does take place, this leads to early diagnosis, which leads to earlier referral and intervention. Professionals using the screening instruments may be able to detect ASD symptoms earlier than some parents. Further, much evidence has shown that early intervention can result in significant improvements in cognitive and language outcomes.

Reference: Dawson, Geraldine, JAMA Pediatrics, Editorial , February 16, 2016. Why It’s Important to Continue Universal Autism Screening While Research Fully Examines Its Impact.

Message of Dr. Lirio Covey, President of AAAP which co-chaired the April 2016 celebration of World Autism Awareness Day (WAAD).

Today’s event marks the celebration of increased awareness and recognition of the autism condition throughout the world. Many interventions and services to help this population – by addressing their deficits and strengthening their assets, have begun. These services have, overwhelmingly, been oriented to children and adolescents. There is a broader reality of the autism condition, however, that also needs to be recognized – the majority of living persons with autism are not children, they are adults.

Why is this attention necessary? In some ways, happily, for those of us with loved ones who are autistic, persons with autism have lifetimes that are not different from persons who are not autistic. They can live up to the age of 60 or more. As with non-autistic populations, transitioning from childhood to adulthood carries new life challenges.

Our association – the Association for Adults with Autism Philippines, is committed to improving the lives of adults with autism – throughout their adult lives, by recognizing those adult needs while still adapting to their demands of their atypical status – by encouraging their socialization, and. in line with the focus of this year’s WAAD event, by helping them transition into productive lives in ways befitting their abilities.

It is gratifying to have cooperative relationships with fellow advocates and organizers of today’s event who are devoted to adults with autism and others with special needs. Like Best Buddies, the Unilab Foundation’s Project Inclusion, and the Philippine government’s National Council on Disability Affairs. Our hearts are full of gratitude and inspiration from seeing the commitment and generosity displayed by your presence here today. AAAP is proud to be part of WAAD and the autism community in the Philippines.

Indeed, they are not less, but persons with autism may walk, sing, act, and, maybe, even dream in a different key. That different-ness raises special challenges. Let us work together with love, perseverance, and the joy of creativity to meet those challenges and bring about a better world for us all. Thank you. God bless.

​AUTISM AND ANXIETY

Social withdrawal and social skills deficits are common signs of autism spectrum disorder (ASD). But, are they also signs of a co-occurring anxiety disorder?

The most common form of anxiety is social anxiety, also known as social phobia. Signs of social phobia are fear or anxiety in relation to people (being near or having to interact with others); fear of judgment or criticism by others; dread and panic before certain situations and ruminating on the event afterwards, and physical symptoms such as shaking, nausea and increased heart rate.

Social anxiety often first appears in adolescence, when the young person becomes aware that their performance will have an impact on their ability to handle social relationships. Social anxiety can affect as many as 65% of teenagers with the high-functioning form of ASD.

Social anxiety can have reciprocal effects vis-à-vis social skills – poor social skills can lead to social anxiety, and conversely, social anxiety can lead to poor social skills.

Anxiety is not a central feature of ASD, is not necessarily life long, and does not affect the individual’s innate communication skills. It is a separate condition from ASD, but there can be similarities in behavioral outcomes – isolation, low self-esteem, and avoidance of social situations.

Anxiety has neurobiological and as well as psychological elements that can impact social and cognitive functioning. Professionals working with persons with ASD should check for the co-occurrence of anxiety. Parents’ and other family members’ help should be asked to detect the presence of any of the broad range of anxiety symptoms, including physical symptoms such as trembling hands and increased heart rate, or cognitive symptoms such as excessive fears and worry. Recognizing which specific anxiety symptoms are involved is important in order to design the specific type of treatment appropriate to the specific anxiety symptom.

Interventions for alleviating social skills deficits, a core feature in high functioning ASD, referred to as Asperger’s syndrome, should consider and assess the contribution of anxiety in the social difficulties of the patient.

Treatment options for anxiety include cognitive, behavioral, and psychopharmacological interventions.

Reference: Bellini, S (2004) Living in fear: Anxiety in adolescents with autism spectrum disorders. The Reporter, 9 (3), 1-2.