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Katharine Button, MD (Host): Welcome to For Peds Sake, the podcast from Nicklaus Children's Hospital, where we provide expert insights to help families navigate a wide variety of pediatric health topics. I'm Dr. Karrie Button, and today we will be discussing autism spectrum disorder, what early signs to look for, when to seek a diagnosis, and the therapies and resources available to support children and families.

Joining me today is Dr. Abigail Ley, a Pediatric Neurologist at Nicklaus Children's Hospital who specializes in the early identification and treatment of autism. Dr. Ley, welcome to the podcast.

Abigail Ley, MD: Thank you, Dr. Button. I appreciate the opportunity to be here and share information that can help families better understand Autism Spectrum Disorder, or ASD. 

Host: Great. So let's begin with a foundational understanding of ASD. Can you explain what it is and how it affects children?  

Abigail Ley, MD: By DSM 5 criteria, all children or people who are on the autism spectrum have to have some level of social communication deficits for age and cognition, as well as engage in significant restrictive and repetitive behaviors. However, the level of severity of symptoms can vary. Autism Spectrum Disorder is a developmental condition that impacts communication, social interaction, and behavior.

This term spectrum, is important because autism presents differently in every child. Some children may have difficulties with speech and social interaction, while others may be highly verbal but struggle with sensory sensitivities or repetitive behaviors. The range of experiences vary widely, which is why early identification and individualized support are so critical.

Host: So these are such great points. So tell us, what are some of the early signs that parents should look out for? 

Abigail Ley, MD: Early signs can develop as soon as 12 to 18 months of age, but many children really don't become more noticeable with autism features until age 2 or 3. Some key indicators include limited eye contact, lack of response to name, delayed speech or language development, and repetitive behaviors such as hand flapping or lining up toys.

Strong reactions to sensory input and difficulty engaging in pretend play or understanding emotions can also occur. These signs do not necessarily confirm an autism diagnosis, but they do indicate that further evaluation could be helpful.

Host: Got it. So let me ask you this. If a parent notices some of the signs that you just mentioned, what should their next steps be?

Abigail Ley, MD: The first step is to speak with their child's pediatrician who can conduct an initial screening and if necessary, refer to a specialist for further evaluation. Early detection is key, as intervention at a young age can significantly improve outcomes for children with ASD.

Host: Perfect. So once a child is referred for evaluation, what does the diagnostic process involve and what should parents expect on that journey?

Abigail Ley, MD: Here at Nicklaus Children's Hospital in the Brain Institute, we do a comprehensive history and behavioral observation. And if the child is felt to meet clinical criteria for ASD, we do a diagnostic form called the CARS 2. We also will be implementing an early diagnostic tool that looks at eye gaze called EarlyPoint in our clinics in the very near future.

And that's FDA approved for children between 16 to 30 months of age. If autism cannot be diagnosed via this sort of evaluation, a comprehensive assessment through a psychologist typically includes parent questionnaires regarding the child's behavior and development, as well as the ADOS, which is a clinical behavioral observation tool.

These assessments help determine whether a child meets clinical criteria for autism and can help provide insight into their specific strengths and challenges.

Host: Great. Those insights are so helpful. So if a family does receive a diagnosis of autism for their child, what are the treatments that are available? 

Abigail Ley, MD: Early intervention is the most effective approach to supporting children with autism. Some of the most widely used therapies include speech therapy, which helps with verbal and nonverbal communication, occupational therapy, which addresses sensory processing and fine motor skills, as well as some children will require something called applied behavioral analysis or ABA therapy, which can help the child with their self life or adaptive skills, social interactions, and other maladaptive behaviors such as aggression or extreme hyperactivity or impulsivity.

Host: So there are treatment options out there and it's so helpful to hear about these. Let me ask you, are there any newer approaches or emerging therapies for families that they should be aware of?

Abigail Ley, MD: There is ongoing research into assistive communication devices for nonverbal children, as well as integration therapy and clinical trials exploring other interventions including other behavioral interventions. But while the research continues to advance, the most important factor remains, early intervention. The sooner a child receives support, the better their developmental outcomes.

Host: Thank you for that. So I can imagine that receiving an autism diagnosis can feel incredibly overwhelming for families. You see this every day. What resources would you recommend to help families navigate this journey?

Abigail Ley, MD: There are many excellent resources available. At Nicklaus Children's, we offer autism evaluation programs and therapy services designed to support both children and families, as well as connecting with local support groups within our community. We can also offer further guidance and give other families connections to each other.

Host: So before we wrap up today, Dr. Ley, for parents who know their children best, right? They do. What advice would you give to them if they're concerned about their child's development?

Abigail Ley, MD: My best advice is to trust your instincts. If something doesn't seem right, speak with your child's pediatrician. Early detection and intervention can make a significant difference in any child's development and there are many resources available to help families navigate this process.

Parents should know that they are not alone. Support is available every step of the way. 

Host: Dr. Ley, thank you for sharing your expertise and your insights today. This has been an incredibly informative discussion and I know it will be helpful to many families.

Abigail Ley, MD: Thank you so much for having me. I appreciate the opportunity to be a part of this important conversation.

Host: And thank you to our listeners for tuning into For Peds Sake. If you found this episode helpful, please share it with other parents and families and subscribe for more expert discussions on pediatric health topics. See you next time.