7 Questions Answered about Autism

In 2007, April 2nd was designated as World Autism Awareness Day by the United Nations General Assembly to help raise awareness for autism as a growing global health priority. 

In celebration of World Autism Awareness Day, we caught up with our Clinical Director, Dr. Nancy Freeman, to learn more about autism spectrum disorder. 

1. Surrey Place: What is autism? And why is it sometimes referred to as autism spectrum disorder? 

Dr. Freeman: Autism is a neurodevelopmental disorder that begins early in a child’s development, with impairments in social interaction, communication and behaviour. There are three areas of social communication differences. The first area is difficulties in what is called social-emotional reciprocity, which means things like conversational turn-taking might be difficult, not sharing in the interests of others, or not initiating interaction with or responding to others.  Second, people with autism have differences in communication skills. These differences might include unusual, reduced, or absent eye contact, reduced or absent gestures (e.g., not pointing out things of interest, shaking head no or nodding yes), to individuals more significantly affected who don’t show facial expressions. The third area of social difference is in relationships. People with autism have difficulties developing and understanding relationships. For some, this might mean not knowing that you need to behave differently in different situations, difficulties making friends, or not being interested in having friends. 

People with autism also have behavioural differences that are restricted and repetitive.  For example, they may repeat movements (e.g. waving hands up and down) or speech (“echoing”), flip objects or line up toys. They may be much less flexible and become quite distressed if things are changed.  Interests may be restricted and quite intense. Finally, there may be oversensitivity or under-sensitivity to sensory input, including sounds, smells, textures, vision, pain and temperatures.  

The name autism spectrum disorder reflects the wide variety of characteristics and the variability of the severity of symptoms seen in people with autism. This is why you may hear the expression: “if you’ve met one person with autism, you’ve met one person with autism.” 

2. Surrey Place: Can you tell us more about the spectrum? 

Dr. Freeman: The spectrum ranges from people who speak in full sentences but struggle with conversations or friendships, to people who are very significantly affected by autism, do not speak or have any alternative system of communication and need very substantial support in many areas of their daily care.  To reflect the continuum of need for those on the spectrum, in 2013 the diagnostic system (DSM-5) moved to specify three levels of support needs: Level 1, “requiring support,” Level 2, “requiring substantial support,” and Level 3, “requiring very substantial support.”  A proportion of people on the autism spectrum also have an intellectual disability. As I mentioned earlier, recent Canadian research has reported an increased incidence of psychiatric diagnoses and mental health challenges compared to both the general population and relative to people with an intellectual disability. 

3. Surrey Place: How does someone get diagnosed? And at what age is a diagnosis possible? 

Dr. Freeman: A psychologist or physician with specialized training and knowledge about typical development and differences in development can make a diagnosis. A thorough assessment uses systematically administered tools and includes; evaluation of the child’s developmental, cognitive and adaptive levels and autism symptomatology; parent interview; developmental history including medical, hearing, and vision status; and direct observation and interaction with the child, preferable on more than one occasion and in more than one setting. All three social differences must be present, and at least two of the four behavioural differences. The differences must be present early in a child’s development, although some people are not diagnosed until later, sometimes much later. 

To receive a professional diagnosis, the symptoms must cause clinically significant impairment in social, occupational, or other important areas of functioning. There is also a specification of whether autism is or is not accompanied by intellectual impairments or other disorders. Characteristics of autism can often be detected between 12-18 months. Although the younger a child is, the more challenging it is, a reliable diagnosis may be made as early as two years, and Canadian research following infant siblings of children with autism has reported diagnosis between 18 to 36 months. 

4. Surrey Place: Do the signs and symptoms of autism change over time? And if so, how? 

Dr. Freeman: Yes, similar to many children, there can be maturational changes. The core social-communicative and behavioural features of autism remain but can appear different over time. As a child develops, differences may become more evident, as social interactions of peers become more sophisticated. For example, in young children, social differences may be seen in differences in play skills, but as children get older, difficulties in taking another’s perspective can be more evident. It’s important to emphasize that for children who receive evidence-based intervention early in development, there can be much better outcomes. Adolescence and young adulthood can result in added challenges. Canadian research suggests that young adults on the autism spectrum are five times more likely than the general population and almost twice as likely as same-age peers with other forms of developmental disability to receive at least one psychiatric diagnosis. 

5. Surrey Place: Are there any resources that you recommend for parents and families who have a child with autism? 

Dr. Freeman: Yes! We have many resources available on our website here, and we are always developing more. 

6. Surrey Place: There’s a lot of misunderstandings about an autism diagnosis, what’s one misconception that you’d like to clear up? 

Dr. Freeman: The single most important misconception to dispel is that vaccines cause autism. This is untrue and dangerous. The original research paper that spread this false information has been thoroughly discredited. The paper was also retracted by the journal which published it, and the author lost his medical license. Unfortunately, to this day, some parents have lingering concerns and may hesitate to vaccinate their children against life-threatening diseases.  

7. Surrey Place: And final question, what do you think is Surrey Place’s greatest strength as an autism service provider? 

Dr. Freeman: Surrey Place has a history of over 50 years of providing professional services across the lifespan to people on the autism spectrum. We offer a broad range of integrated, evidence-based services beginning with toddlers, through childhood, adolescence, and adulthood, and are here to support parents and families. Our vision is to help you live your potential – all your life. 

Surrey Place: Thanks for answering our questions today! 

To learn more about our Autism Services, visit our autism page.

By 2 months

Has your baby had their hearing screened? YES NO

By 6 months

Does the child?

Startle in response to loud noises? YES NO
Turn to where a sound is coming from? YES NO
Make different cries for different needs (hungry, tired)? YES NO
Watch your face as you talk? YES NO
Smile/laugh in response to your smiles and laughs? YES NO
Imitate coughs or other sounds such as ah, eh, buh YES NO

By 9 months

Does the child?

Respond to their name? YES NO
Respond to the telephone ringing or a knock at the door? YES NO
Understand being told no? YES NO
Get what they want through using gestures (reaching to be picked up)? YES NO
Play social games with you (Peek-a-Boo)? YES NO
Enjoy being around people? YES NO
Babble and repeat sounds such as babababa or duhduhduh? YES NO

By 12 months

Does the child?

Follow simple one-step directions (sit down)? YES NO
Look across the room to a toy when adult points at it? YES NO
Consistently use three to five words? YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)? YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes? YES NO
Bring you toys to show you? YES NO
Perform for social attention and praise? YES NO
Combine lots of sounds together as though talking (abada baduh abee)? YES NO
Show an interest in simple picture books? YES NO

By 18 months

Does the child?

Understand the meaning of in and out, off and on? YES NO
Point to more than 2 body parts when asked? YES NO
Use at least 20 words consistently? YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)? YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)? YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)? YES NO
Enjoy being read to and sharing simple books with you? YES NO
Point to pictures using one finger? YES NO

By 2 years

Does the child?

Follow two-step directions (Go find your teddy bear and show it to Grandma.)? YES NO
Use 100 to 150 words? YES NO
Use at least two pronouns (you, me, mine)? YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)? YES NO
Enjoy being around other children? YES NO
Begin to offer toys to other children and imitate other children's actions and words? YES NO
Use words that are understood by others 50 to 60 per cent of the time? YES NO
Form words or sounds easily and without effort? YES NO
Hold books the right way up and turn the pages? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 30 months

Does the child?

Understand the concepts of size (big/little) and quantity (a little/a lot, more)? YES NO
Use some adult grammar (two cookies, bird flying, I jumped)? YES NO
Use over 350 words? YES NO
Use action words such as run, spill, fall? YES NO
Participate in some turn-taking activities with peers, using both words and toys? YES NO
Demonstrate concern when another child is hurt or sad? YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)? YES NO
Put sounds at the beginning of most words? YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)? YES NO
Recognize familiar logos and signs involving print (Stop sign)? YES NO
Remember and understand familiar stories? YES NO

By 3 years

Does the child?

Understand who, what, where and why questions? YES NO
Create long sentences using five to eight words? YES NO
Talk about past events (trip to grandparents house, day at child care)? YES NO
Tell simple stories? YES NO
Show affection for favourite playmates? YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)? YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time? YES NO
Have an understanding of the function of print (menus, lists, signs)? YES NO
Show interest in, and awareness of, rhyming words? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 4 years

Does the child?

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)? YES NO
Use adult type grammar? YES NO
Tell stories with a beginning, middle and end? YES NO
Talk to try and solve problems with adults and with other children? YES NO
Show increasingly complex imaginary play? YES NO
Talk in a way that is understood by strangers almost all the time? YES NO
Generate simple rhymes (cat-bat)? YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)? YES NO