Princeton's Ask The Doctor September/October 2019

A Psychiatrist Reflects on 20 Years of Treating Children with Autism By Ankur Desai, MD

The number of people diagnosed with autism has grown in the 20 years that I’ve been a child and adoles- cent psychiatrist, and so has my understanding of the disorder. I first learned about autism in my Growth and Development Course when I was a medical student 20 years ago. The classic presentation of the disorder was described then as “an individual with pervasive social and communication skills deficits and a history of lim- ited, circumscribed interests and repetitive, stereotypical mannerisms.” I’ll admit: Back then, I was uncertain how to interact with patients with autism and didn’t understand how they would be able to grow and thrive in society. How- ever, I had the opportunity to work with children with

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autism as a medical student, psychiatry resident, and in more depth as a child and adolescent psychiatry fellow. During those six years of training, I learned more about the subtle nuances of autism. I realized that the disorder wasn’t the narrow outlook described above. Instead, I saw first-hand that the autism community encompasses a broad variety of individuals from different walks of life, each with their own strengths and challenges; a true spectrum of abilities and deficits. The Number of Patients Diagnosed with Autism Is Growing The prevalence of autism over the last 15 to 20 years has grown exponentially. When I started medical school, about 1 in 1,000 people were diagnosed with the disorder, and it affected four times as many males than females. In 2000 when I was a resident, autism affected about 1 in 155. Now, the condition affects 1 in 59 children, according to the Centers for Disease Control and Prevention (CDC). Startlingly, in New Jersey, autism affects 1 in 34 children, and more specifically, 1 in 22 boys. I’m frequently asked why the number of children diagnosed with autism continues to increase. The answer is complex. There are multiple reasons for this increase: • Our awareness of autism and our ability to identify its signs and symptoms has improved, leading to a higher rate of diagnosis • It’s likely that people with milder forms of autism who weren’t diagnosed had children of their own who meet the cur- rent definition • Environmental factors, such as exposure to chemicals, medications, alcohol, and other substances and conditions that we only partially understand Redefining Autism In 2015, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the standard reference guide that health care providers use to diagnose mental and behavioral conditions, including autism. In this updated version of the manual, the condition Asperger’s syndrome was removed, and its symptoms were folded into a broader category of autism spectrum disorders (ASD). To be diagnosed with autism spec- trum disorder, patients must have three symptoms (called criteria) regarding socialization and communication and two symptoms of restrictive or repetitive behaviors. With improved awareness of the diagnostic criteria and assessment tools that can identify potential signs of autism at younger ages, children can be referred to the appropriate therapeutic services at earlier stages of their development. This enables us to improve the overall trajectory of their development and progress Over the last 15 to 20 years, there’s been a concerted effort nationwide to integrate behavioral health services to address treatment needs related to ASD and other intellectual and developmental disabilities. There is a growing focus on linking children who exhibit developmental delays involving social skills and speech and language skills with early intervention services and, if appropriate, transition them to specialized preschool programs. These services can provide critical, evi- denced-based services, such as social skills training, applied behavioral analysis, and speech and language therapy, which are important for optimizing their progress in school and in the community. As a parent, it’s only natural to want the best for your child, and it can sometimes be difficult to understand the recom- mendations and “take home” points from an autism evaluation. If your medical provider indicates that your child may meet in school and their long-term prognosis for life. More Services for Better Treatment

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ASK THE DOCTOR

SEPTEMBER/OCTOBER 2019