Tag Archives: autism spectrum disorder

DR. DR., Give Me The News: What is a Neuropsychological Evaluation?

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A neruo what?! Why does my child need this? Does that mean my child will have a diagnosis? What are they testing for? How long will it take? Will my child need medication? A neuropsychological evaluation can raise many questions and concerns for families. The information below can help provide some clarity about what a neuropsychological evaluation is and if your child would benefit from one.

What is a neuropsychological evaluation?

A neuropsychological evaluation is a test completed by a licensed clinical psychologist and may include additional providers, such as an occupational therapist or social worker, from a multi-disciplinary team approach. The team will interview the child’s parents, in addition to any other adults that may be able to provide feedback about the child (e.g. therapist, teacher). The evaluation is a series of tests, both written and verbal, which are completed over the course of several sessions and all appointments can vary in length of time. These tests help to better understand the brain development, strengths, and weaknesses of that individual.

What does/can it test?

The evaluation is recommended for children over the age of five. The initial and primary concerns will determine the exact tests administered throughout the evaluation. Generally, tests assess academic functioning, attention and executive functioning skills, and motor functioning. These skills are essential for children to establish and develop in order to fully function in a classroom setting independently. The evaluation also monitors the child’s sensory profile in addition to their social-emotional development.

What about the diagnosis?

It is possible that your child might receive a diagnosis after the evaluation (e.g. ADHD, anxiety, autism spectrum disorder). Any diagnosing information will come from the Diagnostic and Statistical Manual of Mental Disorders, 5ThEdition (DSM-5). This information can often be difficult for families to accept and understand what it actually means. Receiving a diagnosis does not always mean that your child will have that diagnosis forever; however, many neurological disorders are often influenced by brain structure. A diagnosis can provide answers, information, and recommendations for your child and family. The information can better support your child’s care team to provide an Individualized Educational Plan (IEP) within the classroom setting and additional therapeutic services which may only be available through insurance. If your child is recommended medication at the evaluation, talk with your current treatment team of providers and your child’s primary care doctor, to see if and when beginning medication is the right step for your child.

Who can it help?

These evaluations can help provide the child, family, and support teams with a detailed description or a “blue print” of how the child’s brain works. These reports include specific recommendations for each child at home, in the classroom, and within the community as needed. Sharing your child’s neuropsychological report with their school, doctor, and therapists will ensure your child’s care team is working collaboratively to achieve the targeted goals.

Questions or concerns?

If you have questions or concerns about your child’s diagnosis, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Photo Credit: Berzin via pixabay.com

Teaching Play Skills to Children with ASD

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Pretend play can often be very difficult for children with autism spectrum disorder (ASD) because it directly impacts their ability to develop and understand social skills along with communication skills. Play skills are necessary for children to establish and create meaningful relationships with peers and understand the world around them. This blog will help provide some information to help engage your child with ASD while learning new foundational and essential play skills.

Where do I start?

Just like every child is different, every child with autism is different. It is important to understand your child’s strengths and weaknesses. Before introducing new unfamiliar activities with your child, make sure your child is at a ready-to-learn and regulated state. This means your child is demonstrating a calm body and is ready to play. It is important to reinforce eye contact and joint attention while playing with your child to help increase their engagement skills. Your child’s skill level, attention span, and interests will determine and help guide you in the right direction to begin introducing new unfamiliar play. Begin where your child is at and remember to slowly build on their current level of understanding and skill. If your child resists the new play, begin new play schemes with some of your child’s favorite games or toys. Remember, all children learn by repetition and benefit from having a model or demonstration with how to the use objects appropriately.

Sensory Play

Sensory activities include activities that stimulate our senses, whether in a positive way or a negative way using all our senses: taste, sound, visual, tactile, and smell. These different textures, colors, smells, taste, and experiences impact the way you experience the world around you. Sensory-based activities help children become engaged and focus on the activity presented. These activities can improve attention span, increase flexibility and exposure to new items, and help self-regulation. Please use caution when implementing new sensory items with your child and notice for any aversive or negative reactions.

  • Music is a great way to engage any child! Fingerplays (e.g. “Wheels on the bus”) and dancing improve your child’s attention span, imitation skills, and gross-motor coordination.
  • Water, whether it’s outside when weather appropriate or in the bathtub all year round.
  • Play-Doh (roll, squish, animal shapes)
  • Waterbeads (fill and dump, have animals swim)
  • Sand

Functional Play

Functional play is the child’s ability to use objects as they are intended and expected (e.g. block to build). Use cups to fill up and dump the water/waterbeads in the bathtub or a car to drive across the sand. Use the blocks to build a tower and crash them. Provide hands-on assistance and a demonstration if your child does not use the object functionally.

Pretend Play

Pretend play or symbolic play is when a child uses a realistic item or non-realistic item as something else (i.e. using play food or a spoon as a toothbrush). Use animals in the bathtub to walk across the tub and use the sounds associated with each animal. Once your child has mastered the play imitation skills, expand upon this play and encourage your child to have the animals go down the slide in the bathtub. Use their favorite stuffed animal during meal times and encourage your child to “feed” their animal. Continue the child’s bedtime routine with their favorite animal, while you demonstrate and explain what you are doing with your child and their animal.

Questions or concerns?

If you have questions or concerns about your child’s play skills, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Reference: The Australian Parenting Website (2017). Play and children with autism spectrum disorder.

Retrieved from: raisingchildren.net.au/autism/school-play-work/play-learning/play-asd.

Photo Credit: rawpixel via Unsplash.com

Gender Differences in Autism Spectrum Disorder (ASD)

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Are girls with autism being missed?

A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.

First, an overview of autism spectrum disorder.

What is ASD?

ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.

Red Flags:

Potential signs of ASD that you might notice in your child are outlined below.

  • Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
  • Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
  • Your child has a delay in speech and language skills
  • Your child does not imitate actions, sounds, or words that they overhear
  • Your child does not respond when you say their name
  • Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
  • Your child has unusual ways of moving their hands or bodies
  • Your child has significant difficulty with transitions
  • Your child does not play with, or similarly to, other children their own age

The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.

So, Girls:

Why are they being missed?

As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.

What does it look like?

A few more specific signs of ASD that you might notice in girls are outlined below.

  • Your child has interests that are age-appropriate but very intense
  • Your child plays with toys in a “pretend” but repetitive manner
  • Your child displays sensory differences, but might begin to hide these as they get older
  • Your child has extreme reactions to change or transitions
  • Your child is exhausted after social interactions
  • Your child has difficulty making or keeping friends
  • Your child has difficulty with conversational skills, such as topic maintenance and turn taking
  • Your child may internalize their emotions, resulting in anxiety

How does this affect your child?

The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.

What can I do? 

If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.

Questions or concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

References:

Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.

Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .

Volkers, N. (2018, April). Invisible Girls. The ASHA Leader, 23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash

The Function of Echolalia

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Echolalia is the repetition or “echoing” of sounds, spoken words, phrases, or sentences. Echolalia is a typical function of early language development seen in young children as they begin to learn spoken language. Echolalia can also be a symptom of various disorders including aphasia, dementia, traumatic brain injury, schizophrenia, or Tourette’s Syndrome; however, it is most often associated with autism spectrum disorder (ASD). It may be difficult to discern typical versus atypical echolalia and whether or not it is a functional part of your child’s language skills, but there are specific qualities to look out for in order to differentiate the underlying causes.

Types of echolalia:

There are two types of echolalia: immediate and delayed. Immediate echolalia is when a child repeats what they just heard. For example, if a parent asks a question, “Do you want a cookie?” and the child responds with, “You want a cookie?” rather than responding to the question. Delayed echolalia is when a child repeats something they heard hours, days, months, or even years prior. For example, the child may repeat a line from a video they saw earlier that day or a phrase heard at the park the week before.

Functional versus non-functional echolalia:

For some children, echolalia is just a meaningless imitation of sounds or words strung together. These children may imitate things they’ve heard recently or in the past with no communicative intent. For other children, echolalia serves a purpose to express wants and needs when they are unable to produce novel statements of their own.  When a child “scripts” (i.e. recites exact lines) from shows or movies, it may appear that they are producing long, meaningful utterances, when in fact they have no comprehension of what they are actually saying. In these instances, they may be using the familiar and memorized words and cadence as a calming strategy, but not to convey a specific message. Functional echolalia, however, is the use of learned words or phrases to make requests and otherwise express wants and needs. Some children will use exact words and intonation in order to get their needs met in a functional way even though they may not yet be able to produce their own novel word combinations. For example, they may say “Are you hungry?” to request food, as opposed to simply stating they are hungry or requesting specific food items. It is significant to note, the child who is “scripting” lines from a movie, may also be using those words as a way to request that movie at that time.

When is echolalia considered typical?

Echolalia is seen in typically developing children during early language development between one and two years of age. While we will continue to see some repetition of overheard language between two and three years of age, we also expect to see a consistent increase in novel words and phrases as well. By three years of age, echolalia should be observed minimally in a child’s spontaneous language, and by four and five, a child is expected to engage in conversations using completely novel language. Children with a language delay or autism spectrum disorder may demonstrate these echolalic characteristics beyond three years of age depending on the severity of the delay or disorder.

While first instinct may be to try to stop the echolalia altogether, it is important to recognize it as either a functional communication tool your child has developed, or as a stepping stone into functional expressive communication skills that can be further developed with the help of a speech therapist. If your child’s echolalia has continued past an age considered part of typical language development or appears “non-functional,” it may be helpful to consult a speech and language pathologist. They can help identify the underlying causes and use these emerging verbal skills to target and build functional communication.

Questions or concerns?

If you have questions or concerns about your child’s echolalic language, please contact us at info@playworkschicago.com or 773-332-9439.

Therese Brown, MS, CCC-SLP
Speech-Language Pathologist
Photo Credit: Echolalia Autism (repetitive speech)-Causes, Symptoms, and Treatment via hearingsol.com