Autism Spectrum Disorder (ASD) refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. ASD includes autism as well as Asperger syndrome, childhood disintegrative disorder, and other disorders.
The Centers for Disease Control and Prevention (CDC) estimates that about 1 in 44 children has been identified with ASD. Rates have increased dramatically over the past 2 decades, but it is unclear how much of this increase is due to better detection and diagnosis.
Some key features of ASD include:
- Difficulties with communication and social interaction – For example, children with ASD may avoid eye contact, have trouble understanding other perspectives, or struggle to have back-and-forth conversations.
- Repetitive behaviors and restricted interests – These may include repetitive movements like flapping hands, attachments to unusual objects, obsessively following routines, or intensely focused interests.
- Sensory issues – Individuals with ASD may have heightened or reduced sensitivity to sound, touch, taste, smell, or other stimuli. They may find certain noises painful or be indifferent to temperature extremes.
- Cognitive delays – About 31% of children with ASD have an intellectual disability. Others have average or high intelligence, including “savants” with remarkable skills in areas like art, memory, or math.
The severity of ASD symptoms varies widely across individuals. With early intervention and support, many people with autism can lead happy and fulfilling lives.
Diagnosis of Autism
Receiving an autism diagnosis can be a challenging process, but it is an important step in getting access to supportive services and understanding a child’s needs.
The diagnostic process typically begins with developmental screening during regular pediatrician visits at 18 months and 24 months. If there are concerns after the screening, the doctor may refer the child for a more comprehensive evaluation by specialists like psychiatrists, psychologists, speech-language pathologists, and occupational therapists.
Autism spectrum disorder can be reliably diagnosed as early as age 2, but most children are not diagnosed until after age 4. Diagnosis becomes more stable after age 3, as certain behaviors like delayed speech become more evident.
Several diagnostic challenges can delay an autism diagnosis:
- Symptom overlap – Autism symptoms can overlap with other conditions like ADHD, anxiety, speech delays, and intellectual disability. Teasing apart exactly what is causing developmental delays can be difficult.
- Access to specialists – Getting an autism evaluation often requires referrals to multiple specialists like psychologists, pediatric neurologists, or developmental pediatricians. Waitlists to see these providers can be very long depending on location.
- Cost – A comprehensive autism evaluation can be expensive, especially if insurance does not cover it. The financial cost can prohibit families from getting a diagnosis.
- Awareness – Pediatricians and parents both need education on early signs of autism to make appropriate referrals for further testing. Cultural factors may also influence when families seek help.
- Testing limitations – There are no lab tests or brain imaging scans that can definitively diagnose autism. Diagnosis relies on clinical judgment. Test results must be used with care.
Getting an accurate, timely autism diagnosis allows families to start receiving supportive services as early as possible, which can greatly improve outcomes. Increased awareness and access to diagnostic services is key.
Treatment Options
There are many different treatment approaches for autism, as each individual may respond differently to interventions. Some common evidence-based therapies include:
1. Behavioral Therapy
Behavioral therapy aims to teach adaptive behaviors and skills while reducing problematic behaviors. Popular approaches include Applied Behavior Analysis (ABA) and Early Intensive Behavioral Intervention (EIBI). These therapies use techniques like positive reinforcement, prompting, shaping, and fading to teach everyday skills like speaking, self-care, social skills, and following instructions. Intensive ABA therapy is often begun early, during preschool ages.
2. Speech Therapy
Many children with autism have speech and communication challenges. A speech-language pathologist can work on language development, improving conversational skills, using alternative communication methods like pictures, and addressing articulation issues. Social skills groups are another option to develop pragmatic communication abilities.
3. Occupational Therapy
Occupational therapists help with sensory processing challenges, motor skills, and daily living activities like getting dressed or using utensils. Interventions may include sensory integration training, the use of assistive equipment, and modifying tasks, and environments to optimize independence and building skills.
In addition to these therapies, medications may be used to manage co-occurring conditions like anxiety, ADHD, or seizures. Though autism has no “cure”, early intensive therapy combined with supportive services and accommodations can significantly improve outcomes. An experienced team can develop an individualized treatment plan to meet each person’s needs.
Educational Support
For parents of children with autism, finding the right educational environment and support services is crucial. Under the Individuals with Disabilities Education Act (IDEA), public schools are required to provide special education services tailored to each child’s unique needs. An Individualized Education Program (IEP) will be developed to outline goals, accommodations, therapies, and other supports.
There are several options within public school systems:
- Mainstream classrooms with special education services are provided within the regular classroom setting. This may include an aide, modified lessons or testing, preferential seating, etc.
- A special needs classroom with a lower teacher-to-student ratio and staff trained in autism interventions. Students may attend specials and lunch with typical peers.
- Dedicated autism classrooms and schools are designed specifically for the needs of students on the spectrum. Highly structured environments with intensive therapy and low student-teacher ratios.
In addition to traditional public schools, some families opt for private special needs schools, homeschooling, or virtual school. Regardless of the setting, key tips for supporting autistic students include:
- Maintaining a structured and predictable daily routine with visual schedules. Minimizing transitions when possible.
- Using visual aids and manipulatives to supplement verbal instruction.
- Breaking larger tasks into smaller steps. Providing regular positive reinforcement.
- Teaching organization and study skills explicitly. Checklists and timers can help with task initiation and focus.
- Arranging preferential seating near the teacher and away from distractions. Noise-cancelling headphones may help some students.
- Allowing movement breaks, fidget toys, or exercise balls to accommodate sensory needs.
As students get older, transition planning becomes crucial to prepare for life after high school. IDEA requires transition plans to be incorporated into IEPs by age 16, outlining goals for future education, employment, and independent living skills. This process should involve the student, parents, teachers, vocational counselors, and representatives from any external support agencies. Steps include identifying strengths/interests, arranging job training or internships, researching college disability services, connecting with adult service providers, and more. A thoughtful transition plan can help set autistic students up for success as they embark on the next phase of life.
Financial Assistance
Navigating health insurance and government assistance programs can provide much-needed support for autism services. Many families face financial strain associated with caring for a child with autism. Accessing coverage and funding is crucial but can be complex to navigate.
Most private health insurance plans must cover autism treatments under federal mental health parity laws. Plans like Medicaid also cover autism services. To receive coverage, families should thoroughly understand their benefits and obtain needed referrals from healthcare providers. Documentation of a formal autism diagnosis is typically required.
Government assistance includes state Medicaid waiver programs, grants, vocational rehabilitation services, Supplemental Security Income for those meeting disability criteria, and tax benefits. Nonprofit organizations and disability advocates can help families identify and apply for suitable programs. Funding is often limited, so families should understand eligibility and be persistent in seeking support.
With proper documentation and perseverance, many families can obtain coverage and assistance to pay for costly autism therapies, education, vocational services, medical care, and more. Support groups and social workers can guide you in navigating complex systems. Financial help provides critical access to needed autism services.
Respite Care
Respite care provides short-term relief for caregivers of individuals with autism spectrum disorder (ASD). Caring for someone with ASD can be demanding and stressful, often resulting in caregiver burnout. Respite allows caregivers to take a break while knowing their loved one is in good hands.
Respite serves several important purposes:
- Provides caregivers time for self-care to prevent burnout
- Allows caregivers to focus on other responsibilities and relationships
- Gives the caregiver and care recipient a break from each other
- Provides social interaction and activities for the person with ASD
- Delivers care from someone specifically trained to work with ASD
There are several options for respite care:
- In-home respite: A trained provider comes to the home to care for the individual with ASD while the caregiver gets a break.
- Out-of-home respite: The person with ASD goes to a respite facility for care. This allows them to socialize with peers and engage in activities in a structured setting.
- Respite camps: Specialized camps provide respite care combined with fun activities adapted for those with ASD. Camps range from day camps to overnight camps.
- Host home respite: The individual stays with a trained host family who are experienced in caring for people with ASD. This provides a “home away from home” respite option.
- Adult day programs: Also known as day habilitation programs, these centers provide daily care and social/ recreational activities for adults with disabilities.
Respite provides caregivers with vital relief while allowing their loved one with ASD to grow socially and engage in enjoyable activities outside the home. Seeking appropriate respite services helps sustain caregiving while benefiting the whole family.
Housing Options
One of the most important services for autistic individuals is finding appropriate housing that meets their needs. There are several housing options specifically designed to support those with autism.
Supported Living Arrangements
Supported living provides those with autism the ability to live independently in their own home or apartment while still receiving care and support. This allows for more independence while also providing help with daily tasks like cooking, cleaning, and transportation when needed. Trained staff can assist autistic residents in a supported living environment.
Residential Care Facilities
Specialized residential facilities offer 24/7 structured care for those with autism who require more significant support. These facilities have staff trained in caring for those on the spectrum and programming tailored to their needs. Residential facilities provide housing, meals, therapy, medication management, and personalized care.
Housing Assistance Resources
There are also resources available to help adults with autism access and pay for housing. Nonprofit organizations like Autism Housing Network provide information and support in finding appropriate housing. Government rental assistance programs can help make housing more affordable. Some support coordinators can also assist in locating housing and obtaining housing subsidies when eligible.
Employment Support
Individuals with autism often need assistance finding and maintaining meaningful employment. There are several programs and services available to help people with autism succeed in the workplace.
Job Training Programs
Specialized job training programs exist to help people with autism gain the skills needed for employment. These vocational rehabilitation programs teach job skills, help build resumes, provide job coaching, and assist with the interview process. Some programs have partnerships with local businesses to facilitate hiring people with autism.
Workplace Accommodations
Under the Americans with Disabilities Act, people with autism are entitled to reasonable accommodations in the workplace. Common accommodations include modified training procedures, additional time to complete tasks, noise-canceling headphones, written job instructions, and a structured routine. Employers are required by law to provide reasonable accommodations.
Hiring Incentives for Employers
There are federal and state programs that provide financial incentives for employers who hire people with disabilities, including autism. These incentives come in the form of tax credits or wage reimbursement. For example, the federal Work Opportunity Tax Credit gives employers up to $2,400 back on their taxes for hiring an individual with a disability. There are also state vocational rehabilitation agencies that will reimburse wages or provide on-the-job support.
Employment support enables many people with autism to find meaningful work and be productive members of society. With the right training, accommodations, and hiring incentives, jobs can be successfully performed by individuals across the autism spectrum.
Community Resources
Local autism support groups can provide a sense of community and allow families to connect with others going through similar experiences. Support groups are often organized by age, type of autism, or special interests. Some groups meet in person, while others gather online. Families can get advice on accessing services, share experiences, and find emotional support.
Recreational and social programs tailored to those with autism allow opportunities to practice social skills, engage in physical activity, and enjoy arts, music, or outdoor adventures. Programs may be designed for specific age groups or capabilities. Some parks and recreation departments offer camps, classes, sports teams, or community outings adapted for those with developmental disabilities. Nonprofits may also provide programs for socialization, creative arts, or life skills development.
Lack of transportation can be a major barrier for people with autism, preventing access to jobs, services, friends, and community life. Some localities have transportation assistance programs or ride services adapted for special needs. Paratransit services, on-demand rideshares, volunteer drivers, or training on using public transit may be available. Support groups can be a good source of information on transportation options in the local area. Reliable transportation enables greater participation and independence.
Long-Term Planning
Planning for your autistic loved one’s long-term well-being is crucial. Here are some key considerations:
Guardianship
- Evaluate whether you need to establish legal guardianship once your child turns 18. Guardianship grants you continuing decision-making power when you reach adulthood.
- Consult with an attorney who specializes in guardianship and disabilities. They can advise you on your options and how to file for guardianship.
- The court will evaluate whether your child can make sound decisions independently. If not, guardianship allows you to remain involved in medical, financial, and other choices.
Letter of Intent
- Create a letter of intent detailing your wishes and instructions for your child’s care. While not legally binding, it can provide critical guidance to future caregivers.
- Include your child’s daily routine, calming strategies, preferred activities and foods, and other details about their needs and preferences.
- Share information on their behaviors, triggers, and how to best support them. Outline their skills, strengths, and challenges.
- Update the letter annually and provide copies to family, trustees, and your child’s support team.
Estate Planning
- Meet with an attorney to draft legal documents like a special needs trust, will, and power of attorney for finances and healthcare.
- A special needs trust provides assets for your child while allowing them to maintain eligibility for government benefits.
- Your will should name a trustee to manage assets and clearly state how you want your child cared for.
- Appoint someone through power of attorney who can make decisions if you’re unable to. Select people who know your child well.
- Review your plan regularly and communicate about future care with your child and their support network.
