Autism is one of those common conditions which remain unidentified or undiagnosed until very late into the developmental or formative years of a child. The reasons behind this are limited awareness of parents as well as denial or hesitancy in accepting their child’s problems.
Why do we need a team?
Diagnosing a child with Autism becomes difficult as they do not display any obvious physical problems. A developmental pediatrician or a pediatric neurologist or pediatric psychiatrist or child psychologist is better equipped to diagnose Autism. They are able to assess the delays in the child’s development across various milestones. This helps narrow down to the diagnosis of an Autism Spectrum Disorder.
The assessment of children with Autism requires multiple evaluators, using multiple methods of gathering information. Apart from pediatric neurologist/psychiatrist, a formal evaluation is best done by a team of professionals comprising of
- developmental pediatrician,
- child psychologist,
- occupational therapist,
- speech and language pathologist.
This team carries out several assessments and tests, which pinpoint the exact areas in which the child has a problem. For example, CARS, ISAA, CGI, etc. This assessment will aid in establishing a diagnosis as well as severity of ASD. These details will help to formulate a focused personalized treatment plan for your child.
What tests are required?
Prior to diagnosis based on clinical observations and standardized assessment tools, you may be requested to perform one or more of the following investigative procedures for your child. These will help in ruling out other possible problems.
Neuro-imaging studies (MRI/CT/PET-CT):
Magnetic Resonance Imaging (MRI) or Computer Tomography (CT) scan of the brain reveals its structure in different views as well as any gross developmental defects. Your child’s doctor may order any one of these to rule out underlying causes. However, in many cases of Autism, the MRI of the brain may be near normal, as Autism is a functional problem and not structural. Hence, studies are exploring the Positron Emission Tomography – Computed Tomography (PET-CT) scan in Autism, to figure out which areas have functional abnormalities and contribute to the deficits/problems.
A typical MRI Machine: It is a non- invasive method which uses a powerful magnetic field and radio frequency impulses. A computer is used to produce detailed images of internal structures like bones, soft tissue, organs, etc.
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PET-CT Scan: This is a nuclear imaging technique which reveals both structural and functional details of cells and tissues, in a single imaging session.
Image courtesy: Commons
Research has implied that there could be problems related to the functioning of the temporal lobes of the brain, including hippocampus and amygdala. These areas are responsible for organizing sensory input, auditory perception, language and speech production, memory association formation and emotional expression etc. These co-relate to the kind of issues seen in Autism. Another area, which appears to be affected, is the cerebellum, which is important for information processing, balance and coordination.
Brain Stem Evoked Response Audiometry (BERA):
In children with Autism it is seen that there is a delay in speech or failure to respond to name-call. It is then that your doctor may recommend a BERA test to rule out any hearing problems. BERA is an objective method of picking up brain stem (part that connects brain and spine) potentials in response to audiological click sounds. These waves are recorded by electrodes placed over the scalp. This test helps in ruling out hearing deficits.
Approximately 30% of ASD patients without clinical seizures are found to have epileptiform abnormalities in the brain. Epilepsy can be associated with Autism in early childhood and adolescent years. An EEG is a test that records the electrical activity of the brain using sensors across many different areas on the scalp. Depending upon the EEG report your child’s neurologist may/may not prescribe medicines for prevention of seizures.