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Changes to Autism Diagnostic Criteria - What Does this Mean for Families?

By Yvette Vignando - 19th September 2012

Benison O"Reilly, co-author of the Australian Autism Handbook, and Yvette Vignando appeared on Mornings on Channel 9 to talk about the changes to diagnostic criteria for children with autism - and more generally, about what is known of risk factors for autism.

You can view the full video here.

Below is some more detailed information about the topic of the interview, with acknowledgement to Benison O'Reilly who provided the majority of the information below.

There is some concern under the new diagnostic criteria for autism (in the DSM-5) that some children in desperate need of care  will miss out on funding?

Because there are no blood tests to diagnose autism, doctors and psychologists can only diagnose it by observing behaviours. The manual most doctors and psychologists use, called the DSM-5 (a manual) , is being revised. The new version comes out in 2013, and there has been a tightening in the way autism will be diagnosed. There is concern that some children with real problems will no longer qualify for an Autism Spectrum Disorder (ASD) diagnosis under the new manual and will instead be given a new and different diagnosis, called a Social Communication Disorder.  The Australian Federal government has said it is not yet able to answer how this new diagnostic regime may affect families. It is thought that up to 20% of children currently diagnosed with an ASD may fall outside the new criteria. Children already diagnosed with an ASD under the old system will not lose their funding.

Do We Know What Causes Autism?

We know that there is a strong genetic element. If you have one child with an ASD you have a 10-20% chance of having another.  However, many genes are involved and scientists do not yet know enough to tell parents that there are certain things to do to reduce the likelihood of autism.

There is some evidence that older parents (that is the over 40s)  have a slightly increased chance of having a baby with an ASD – but there are many younger parents who have children with an ASD. Many events during pregnancy also seem to slightly increase your risk of having a child with an ASD, these include:

  • stress during pregnancy (including stress due to natural disasters),
  • premature and low-birth weight babies,
  • oxygen deprivation at birth,
  • infections and diabetes during pregnancy and
  • possible exposure to pesticides during pregnancy. 

Parents should not be concerned that these factors actually cause their child to have an ASD but researchers believe these experiences may tip a genetically vulnerable child the wrong way. The vast majority of babies born to older parents will not be affected by autism. 

There is also no scientific evidence at all that Measles, mumps, rubella (MMR) vaccines are linked to autism in children. In fact very large studies, including one for example in Finland of 1.8 million children followed for 14 years found absolutely no link between vaccinations and autism in children. This is also the position of the World Health Organisation.

A New Genetic Test for Autism Spectrum Disorders Developed in Australia

Researchers in Australia have developedIt a blood test to predict the chances of a child developing autism symptoms – a scientist tests for certain genetic markers that are present in people with ASDs. This is promising development but researchers only claim that it is correct in two-thirds of cases and we need more trials to see how reliable it is. It is only a test for the risk of developing an ASD and still requires a diagnosis by an ASD expert.

The potential benefit of this is that we know that early intervention for children who do have an ASD can make huge differences to social, educational and wellbeing outcomes for those children – the earlier a diagnosis is made, the more potential there is to improve outcomes for a child with an ASD.

So far the test has only be trialled on people from a European background and now other trials are continuing for people from different ethnic groups also. There will probably be good commercial genetic tests available in the future but they’re a few years away yet.

As Early intervention for Autism is so Important - What Signs Should Parents Look Out For?

There are many signs but the main red flags for ASDs are:

  • If your child is not babbling, pointing at objects or waving by 12 months
  • If you child is not smiling or showing obvious affection to their main caregiver by 12 months
  • If your child seems to have no interest in sharing toys (play) or activities with other people, especially if there is no sign of this by 24 months onwards
  • If your child does not say any single words by the age of 16 months, or no two-word phrases on his or her own by 24 months
  • If you notice any loss of language or social skills at any age.

If this describes your child you should go to your doctor or early childhood nurse as soon as possible to organise a proper assessment.

Some high functioning children may elude diagnosis until preschool or school  and it’s only when they are placed in a socially challenging environment that their problems become obvious.

Why is Autism is More Prevalent in Boys?

ASDs are about 4 to 5 times more common in boys.  Although scientists cannot say exactly why boys are more vulnerable to developing an ASD, we do know that a lot of medical problems are more common in boys, due to our genetics.  Males only have one X chromosome (they are X:Y) so if there is a problem with that X chromosome they are often more vulnerable to disorders than girls, who have two X chromosomes. For example, scientists have found that some particular risk genes for autism are more common in boys than girls – having those particular genes are one of many factors that increase the chances of someone developing an ASD. In girls one X chromosome may protect against problems with the other X chromosome. Other theories include hormonal differences between boys and girls or that girls may be better at compensating for their social problems and may just miss out on being diagnosed in the first place.

The Australian Autism Handbook is available on this site and in most Australian bookstores.

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