Autism spectrum disorder (ASD) is a developmental disorder. It often appears in the first three years of life and affects social communication and behavior.
Several different signs can prompt someone to seek out an autism evaluation. In this Q&A, Paige Siper, PhD, Chief Psychologist of the Seaver Autism Center for Research and Treatment at Mount Sinai, explains when you might want to seek an assessment, what that involves, and what a recent focus on sensory processing differences means.
What signs might prompt an evaluation for autism spectrum disorder (ASD)?
Several signs may prompt an autism evaluation. Concerns are commonly raised by a parent, family member, pediatrician, or teacher. Autism-specific screening should occur at the 18- and 24- or 30-month well visits and whenever a concern is expressed.
Autism is a constellation of difficulties with communication and reciprocal social interaction as well as repetitive and restricted behaviors and interests. Early signs may include delays in language or motor skills, although some individuals with autism achieve milestones on time.
Social communication signs include limited use of nonverbal communication such as eye contact, facial expression, pointing and other gestures and limited social interaction; for example, lack of showing objects of interest, minimal interest in peers or lack of shared enjoyment with others. Difficulty with imitation and pretend play are also common early signs. Repetitive behavior signs include repetitive speech, an intense focus on certain topics or parts of objects, insistence on sameness, lining up objects or toys, motor mannerisms such as hand flapping or body rocking, and unusual sensory behaviors.
Paige Siper, PhD
What are sensory processing differences?
In 2013 when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) came out, it was the first time sensory reactivity was included within the diagnostic criteria for autism. The DSM-5 describes three categories of sensory differences:
- Sensory hyperreacitivty is an overresponsiveness to sensory stimuli that may take the form of individuals covering their ears in response to sounds, squinting or avoiding the sight of certain objects, resisting the feel of certain textures or discomfort when touched by others.
- Sensory hyporeactivity is an underresponsiveness to sensory stimuli, which can result in significant safety concerns. For example, an individual who is hyporeactive may not respond to the sound of an alarm, the feel of pain or temperature, or the sight of a car passing by.
- Sensory seeking is an excessive interest in sensory stimuli. Individuals who are sensory seeking may repeatedly seek out the sight, feel or sound of certain objects.
Each of these examples can affect daily living and quality of life. Research suggests up to 90 percent of individuals with autism display sensory differences compared with people who do not have autism.
How do I know if my child needs a sensory assessment and what is involved?
If your child is displaying sensory hyperreactivities, hyporeactivities, or seeking behaviors that are affecting their daily functioning, a sensory assessment may be warranted. The goal of a sensory assessment is to identify personal sensory preferences. We all have our own sensory preferences, and by determining those preferences we can modify environments accordingly.
Over the past several years, the Seaver Autism Center at Mount Sinai developed a novel sensory assessment called the Sensory Assessment for Neurodevelopmental Disorders (SAND). The SAND combines a semi-structured, clinician-administered observation and a corresponding caregiver interview. We want to see, within an exam setting, how a child responds to stimuli that prompt sensory responses, and we also want to capture information from caregivers about their child’s daily experiences.
Following an assessment, parents will learn about their child’s unique sensory preferences and sensitivities, and then an individualized treatment plan can be developed and implemented. Adjustments in an individual’s sensory experiences can have a profound impact on adaptive behavior, social engagement, and learning.
Since autism is a lifelong diagnosis, how can parents and caregivers support their child as they develop?
Parents are their child’s greatest advocate and the true experts. Parents can support their children by helping them develop the skills necessary to become as independent as possible. A variety of interventions are commonly used to help individuals on the autism spectrum gain skills. These include:
- Applied behavior analysis, often referred to as ABA therapy, is one evidence-based treatment for core features of autism.
- Speech and language therapy is important to develop both functional and pragmatic communication skills.
- Occupational therapy can focus on sensory reactivity, fine motor skills, and activities of daily living.
- Physical therapy can target challenges such as low muscle tone, which is commonly observed in autistic individuals.
It is important for each child to have a personalized treatment plan that is reviewed and updated regularly to ensure individuals reach their optimal potential.
What programs and services does Mount Sinai offer at the Seaver Autism Center?
The Seaver Autism Center is a multidisciplinary program with a large research focus ranging from natural history studies that track change over time to clinical trials that test new treatments. All individuals participating in research at the Center receive an autism-focused research evaluation. We also offer neuropsychological and psychoeducational evaluations, individual psychotherapy for those on the autism spectrum and their siblings, parent training, and medication management through Mount Sinai’s Faculty Practice Associates. The Seaver Autism Center has a large community outreach program that offers social skills groups and training for both families and professionals. We have a variety of collaborations with local cultural institutions such as the American Museum of Natural History and the Guggenheim Museum. Finally, our training program is committed to training the next generation of autism experts.
What is the Seaver Autism Center at Mount Sinai doing to support patients’ sensory needs?
Over the past year, we made it a priority to improve care and better support individuals on the autism spectrum’s sensory needs within the Mount Sinai community. We developed Sensory Toolkits that are now available within our pediatric emergency departments. We are starting to disseminate the toolkits to other specialized practices within and outside of the Health System with the goal of improving the patient experience. Each kit has several sensory tools, as well as an information sheet that explains the intended use of each tool to satisfy sensory needs and ultimately to make each person’s experience more comfortable. Families get to take the kits home with them to continue using beyond their visit to Mount Sinai. Our team also developed a learning module, now available across the Mount Sinai Health System, to train physicians, clinicians, and staff members within different disciplines on how to best support neurodiverse patients. We are actively collecting data on both of these initiatives to ensure these new programs are serving their intended purpose. Finally, we are surveying caregivers of children on the autism spectrum to determine which sensory interventions and supports have and have not worked for their child. You can learn more here.