What are the signs of Autism Spectrum Disorder?

Do you worry constantly about your child’s behavior? Is your baby behind on speech? Do you think something is wrong with your child’s development but can’t quite pinpoint the problem? Is your child the pickiest eater you have ever seen?…If you answered yes to any of the above questions, keep on reading.

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What is Autism Spectrum Disorder?

Autism Spectrum Disorder (ASD) is a developmental disability that typically affects behavior, communication, and social skills. It can present with a broad range of symptoms and severity. ASD now includes several disorders that were previously diagnosed separately like autistic disorder, pervasive developmental disorder and Asperger Syndrome.

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How common is Autism Spectrum Disorder (ASD)?

According to the Centers for Disease Control and Prevention (CDC), 1 in 59 children are affected with Autism Spectrum Disorder; and according to the American Academy of Pediatrics (AAP), ASD can affect any child, regardless of his/her racial, ethnic, or socioeconomic background.

Is my child going to be screened for ASD?

Yes! Every child should be screened at the ages of 18 and 24 months during their well checkup visit. Your pediatrician will most likely provide a questionnaire for you to fill out and ask specific questions regarding all aspects of your child’s development. This questionnaire is a standardized screening that will help your pediatrician understand your child’s development and pick up any potential delays. It is imperative that you bring up any and all concerns you might have about your child’s speech, social interactions, or behavior. Once a problem has been identified with the screening, your pediatrician will refer your child for a comprehensive diagnostic evaluation by a developmental  behavioral specialist, child neurologist, child psychiatrist, or child psychologist depending on the resources available where you live. A hearing test, lead level, and referrals for interventions like speech therapy and occupational therapy are probably going to be ordered as well. Other referrals might be necessary depending on the family history and the specific symptoms your child is exhibiting.

Before you child’s next well-visit please check out the CDC’S Developmental Milestones  by age and print out the age appropriate check list . This is a great resource for parents to have prior to discussing any concerns they might have with the pediatrician.

Remember, you know your child better than anyone else, so bring up your concerns and request a screening if it hasn’t been done. Early diagnosis and intervention are extremely important to improve the outcome.

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Tell me again…how does ASD affect children?

The key components of Autism Spectrum Disorder are:

  1. Impaired Effective Communication
  2. Impaired social interactions
  3. Presence of stereotypical patterns of behaviors and interests

Ok…Let’s go over these components in more detail.

Impaired Effective Communication

For someone to communicate effectively, it is necessary to be able to use and interpret verbal (spoken) and nonverbal (non-spoken) language. Verbal communication refers to the use of spoken language (words, sentences, stories) in the correct context and timing to communicate with others. Nonverbal communication refers to the understanding and use of gestures, facial expressions, body posture, and head/body orientation to convey a message.

A child with ASD typically has delays acquiring language, has difficulty with the use of language in the appropriate context and timing, and/or has challenges understanding nonverbal cues related to language and communication.  Some children with ASD may completely lack the intent or desire to communicate.

Impaired social interactions

Social skills refer to the ability a person has to interact and communicate with others. In order to have appropriate social interactions, one must have the motivation, attention, and behaviors necessary to be successful. For example, making eye contact, smiling, or using the proper word or gesture to start a conversation. Another important aspect of social interactions is to have the ability to share interests or emotions. For example, when a toddler brings and shows a toy to his parent or caregiver, or points to an object that is interesting to him/her.

In order to develop and sustain friendships a child must master more than just good social skills. It requires processing, interpreting, remembering, integrating, and internalizing social interactions with others which they can mimic later in similar social situations. It requires lots of attention and interpretation of both verbal and nonverbal language.

In children with ASD, social interactions are generally infrequent or atypical. They generally do not demand attention from parents or siblings, except when they must fulfill a need. For the most part they are not interested in peers and prefer to play by themselves. They usually have a hard time interpreting social situations.

Presence of stereotypical patterns of behaviors and interests

Children with ASD often exhibit a stereotypical pattern of repetitive behaviors, restricted activities or interests, resistance to change, and hyper- or hyposensitivity to sensory stimulation. These symptoms could be present during early childhood and are especially obvious when they persist into school age.

When should I worry about my child’s communication skills?

Concerning signs for younger children:   

  • Absence of babbling or cooing by 9-12  months
  • Doesn’t mimic/imitate sounds by 9 months
  • Absence of single words by 16 months
  • Regression or slowing down of new language development by 15 to 24 months (or at any age). About 1/3 of patients with ASD present with this problem.
  • Failure to acquire language by age 2. This is the most common parental concern, and roughly 2/3 of patients with ASD present with this problem.
  • Absence of meaningful two-word phrases by 24 months
  • Does not use language as a means for communication (simply repeats word)

Concerning signs for older children:

  • Has a hard time initiating or continuing a conversation with family or peers
  • Has trouble expressing needs with the right word or phrases
  • Repeats words or phrases (known as parroting or echoing), but doesn’t understand how to use them correctly or in context
  • Often speak in a monotone voice that seems to lack expression or emotion (robot-like voice)
  • Often has a hard time taking turns to talk and dialogue is over-focus on personal interests.
  • Difficulty understanding the context of what is said (for example; gives unrelated answers to questions)
  • Has trouble understanding sarcasm, jokes, and teasing
  • Often very literal, unable to understand metaphors
  • Unable to understand nonverbal signs (for example; doesn’t get that the listener is rolling his eyes or looking at his watch because it’s annoyed by the conversation)

When should I worry about my child’s social skills?

Concerning signs for younger children:

  • Doesn’t mimic/imitate parent’s facial expressions by 9 months
  • Child does not respond or alert to name by 12 months
  • Child does not point to objects to show interest by 12-15 months
  • Regression of social skills by 15 to 24 months, or at any age
  • Child does not pretend play by 18 months
  • Child doesn’t bring objects of personal interest to show a parent or caregiver by 24 months
  • Does not appear interested at what a parent is pointing to or looking at
  • Child resists cuddling and holding
  • Does not appear to be easily comforted by parent

Concerning signs for older children:

  • Child appears not to hear you most of the time
  • Lack of empathy or concern
  • No interest in peers/family
  • Doesn’t make eye contact or has a hard time keeping eye contact
  • Has a hard time understanding others facial expressions
  • Often lacks facial expression, and has difficulty expressing emotions or feelings
  • Has a hard time making friends or does not care about making friends
  • Prefers to be alone
  • Often has difficulty understanding other people’s feelings
  • Inappropriately respond to social interaction with indifference or aversion
  • Plays alone and often performs scripted activities like repeating word by word a dialogue that has been seen on television or a movie previously
  • Avoids hugs and physical contact
  • Often does not understand others personal space and tends to get too close to family and peers not noticing that this makes them uncomfortable

When should I worry about my child’s behavior?

Concerning signs for younger children:

  • Often exhibits repetitive motor mannerisms like hand or finger flapping, head-banging, face or body slapping, self-biting, spinning, rocking, swaying, walks on toes most of the time
  • Has unusual sleeping habits or appears to not need sleep
  • Often lines up the same number of objects in the exact same manner, but does not understand what the toy or object represents
  • Difficulty transitioning from one activity to another or exhibits intolerance to change
  • Has frequent tantrums, is always fussy
  • Extremely picky eater, only eats a particular food or very few food items. Often only eats one brand of a certain food, and refuses to eat the same food if it is a different brand because can tell the difference (for example if likes Juicy Juice Apple juice, would refuse any other brands of apple juice)
  • Excessive preoccupation with unusual objects like ceiling fans, vacuum cleaners, or toilets

Concerning signs for older children:

  • Restricted interests despite appropriate motivation and exposure
  • Becomes obsessed over a certain topic and is always talking about it, or repetitive questioning about a certain topic
  • Likes specific routines, and does not do well with change
  • Often obsesses with a few or unusual activities, doing them multiple times during the day
  • Plays with parts of toys instead of the whole toy (for example, spinning the blades of a helicopter toy), but doesn’t understand the overall purpose or function of the toy
  • Often appears to not feel pain or temperature
  • Often appears to be extremely sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
  • Gets overwhelmed easily
  • Appears to be uncoordinated and clumsy, falls frequently
  • Appears to be bothered by foods with particular tastes and textures, or obsesses over eating only certain foods.

 

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Is autism spectrum disorder caused by vaccines?

No!  This theory was disproved a long time ago, but many people still insist that vaccines, especially the MMR, can cause autism. There is no reliable study out there that links vaccines to Autism Spectrum Disorder. In fact, a study  published at Annals.org on  March 2019 has confirmed that the chances of developing autism were the same in children who received the MMR vaccine and those who did not. Interestingly, the study also revealed the results held true for vaccinated children who had a sibling with autism. Among girls, the risk of autism was lower in those who were vaccinated. According to the study,  the largest risk factors for autism were having an older mother or father, low birthweight, poor Apgar scores, preterm birth, large head, assisted birth and smoking in pregnancy.

Are boys and girls affected equally with ASD?

It is believed that boys are four times more likely to be diagnosed with Autism Spectrum Disorder than girls, but also the time of diagnosis in girls could be delayed because ASD presents with linguistic differences among both genders. A new study  done by researchers at Children’s Hospital of Philadelphia that was recently published in the journal Molecular Autism, found that school-aged girls with ASD use considerably more cognitive process words (for example; think, know, or feel) than boys allowing them to communicate more like a neurotypical  child.  In general, cognitive process words, also known as internal state words, help convey a thought, a feeling, or emotion and its proper use allows the listener to perceive that the speaker can understand the thoughts and feelings of others.

At what age is Autism Spectrum Disorder typically diagnosed?

The current recommendation is for children to be screened for ASD during their routine well checkup appointments at 18 and 24 months, so many children get diagnosed successfully by around age 2; however there are still a big number of children being diagnosed after age of 3 or 4.  A  new study published in April 2019 in the medical journal Jama Pediatrics, proposed that children can be responsibly diagnosed with autism at an earlier age if formal screening starts earlier than what is currently recommended. The toddlers involved in the study were screened around 12 to 14 months of age and 84% of the kids who were diagnosed retained their ASD diagnosis when a follow up was done at age 3.   Earlier diagnosis would be ideal as it would allow children with the disease to initiate therapies and interventions at a younger age.

Among all children, minority groups are usually diagnosed later and less often, probably due to less exposure to proper medical care and/or less parental awareness that there might be a delay.

World Autism Awareness Day.

Tools/Resources for parents

This book– Autism Spectrum Disorder: What Every Parent Needs To Know  is a vital resource for parents. It can help the parent learn more about the ASD diagnosis and current modalities of treatment.

CDC’s Milestone Tracker App -With this app you can track your child’s milestones from age 2 months to 5 years.

Before your child’s next well visit, check out the CDC’s developmental Milestones page , and print and fill out the CDC developmental milestone checklist

Not sure how to talk to your pediatrician about your concerns? Check out these tips from the CDC.

Resources (click on the links to read more)

https://www.uptodate.com/autism-spectrum-disorder-clinical-features

https://www.uptodate.com/autism-spectrum-disorder-surveillance-and-screening-in-primary-care

https://www.healthychildren.org/How-Doctors-Screen-for-Autism

https://www.healthychildren.org/Early-Signs-of-Autism-Spectrum-Disorders

https://www.mayoclinic.org/autism-spectrum-disorder/symptoms-causes

https://www.cdc.gov/autism/signs

https://www.aappublications.org/news/

https://annals.org/mmr-vaccine-associated-risk-autism 

https://www.cdc.gov/milestones/checklist

https://www.autismspeaks.org/what-autism

https://www.philly.com/autism-girls-childrens-hospital-of-philadelphia

https://molecularautism.biomedcentral.com

https://www.autismspeaks.org/autism-facts-and-figures

https://www.cnn.com/2019/04/29/autism-screening-recommendation-study

https://jamanetwork.com/jamapediatrics

Disclaimer: The content in this blog is not to be considered medical advice and it is not intended to replace the relationship you have with your primary care provider. If you have specific questions, please contact your physician.

¿Cuáles son los signos del Trastorno del Espectro Autista?

¿Te preocupas constantemente por el comportamiento de tu hijo? ¿Consideras que tu bebé está atrasado en el habla? ¿Crees que algo está mal con el desarrollo de tu hijo, pero no puedes identificar el problema? ¿Es tu hijo exageradamente selectivo para las comidas?

Read in English

Si respondió afirmativamente a cualquiera de las preguntas anteriores, por favor siga leyendo.

 ¿Qué es el trastorno del espectro autista (Autism spectrum disorder)?

El autismo, o trastorno de espectro autista (ASD por sus siglas en inglés), es una discapacidad del neurodesarrollo que típicamente afecta el comportamiento, la comunicación y las habilidades sociales. Este trastorno puede presentarse con una amplia gama de síntomas y diferentes niveles de severidad. El ASD ahora incluye varios trastornos que previamente se diagnosticaban por separado como trastorno autista, trastorno generalizado del desarrollo y síndrome de Asperger.

 

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¿Qué tan común es el trastorno del espectro autista (ASD)?

Según el Centro Para El Control y La Prevención De Enfermedades (CDC por sus siglas en inglés), 1 de cada 59 niños se ve afectado por el trastorno del espectro autista. Según la Academia Americana de Pediatría, este trastorno puede afectar a cualquier niño, independientemente de su origen racial, étnico o socioeconómico.

¿Mi hijo va a ser evaluado para descartar el trastorno del espectro autista (ASD)?

¡Sí! Cada niño debe ser examinado durante su visita de niño sano a las edades de 18 y 24 meses. Lo más probable es que su pediatra le proporcione un cuestionario para que llene y le haga preguntas sobre todos los aspectos del desarrollo de su hijo. Este cuestionario es un examen estandarizado que ayudará a su pediatra a entender el estadio del desarrollo de su hijo y a detectar posibles retrasos. Es imperativo que usted presente todas y cada una de las inquietudes que pueda tener sobre el habla, el desarrollo o el comportamiento de su hijo. Una vez que se ha identificado un problema, su pediatra remitirá a su hijo para una evaluación diagnóstica integral por un especialista en desarrollo/comportamiento, un neurólogo infantil, un psiquiatra o un psicólogo infantil dependiendo de los recursos disponibles donde vives. Es muy probable que tu pediatra también ordene una prueba de audición, una prueba de sangre para detectar el nivel de plomo, y haga referidos para intervenciones como la terapia del habla y la terapia ocupacional. Otros referidos pueden ser necesarias dependiendo de la historia familiar y los síntomas específicos que su hijo está exhibiendo.

Antes de la próxima visita de su hijo, consulte los parámetros del desarrollo que ofrece el CDC e imprima la lista de verificación apropiada para la edad. Este es un gran recurso que puedes utilizar para verificar como va el desarrollo de tu bebe antes de discutir cualquier inquietud con el pediatra.

Recuerde, usted conoce a su hijo mejor que nadie, así que no dude en discutir sus inquietudes y solicite una evaluación a cualquier edad si usted lo cree necesario. El diagnóstico apropiado e intervención temprana son extremadamente importantes para mejorar la prognosis.

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Dime otra vez… ¿Cómo afecta el trastorno del espectro autista a los niños?

Los componentes clave del trastorno del espectro autista son:

  1. Falta de comunicación efectiva
  2. Falta de interacciones sociales adecuadas
  3. Presencia de patrones de comportamientos e intereses estereotípicos

Ok…Déjame explicarte un poquito más sobre estos tres aspectos del espectro autista:

Falta de comunicación efectiva

Para que alguien se comunique eficazmente, es necesario poder usar e interpretar el lenguaje verbal (hablado) y no verbal (no hablado). La comunicación verbal se refiere al uso del lenguaje hablado (palabras, oraciones, historias) en el contexto y el tiempo correctos para comunicarse con los demás. Comunicación no verbal se refiere a la comprensión y el uso de gestos, expresiones faciales, postura del cuerpo, y la orientación de la cabeza/cuerpo para transmitir o recibir un mensaje.

El niño con trastorno del espectro autista (ASD) típicamente tiene retrasos en la adquisición de lenguaje, tiene dificultades con el uso del lenguaje en el contexto y el tiempo apropiados, y/o tiene dificultades para entender señales no verbales relacionadas con el lenguaje y la comunicación.  Algunos niños con ASD pueden carecer por completo la intención o el deseo de comunicarse.

Falta de interacciones sociales adecuadas

Las habilidades sociales se refieren a la capacidad que una persona tiene para interactuar y comunicarse con los demás. Para tener éxito con las interacciones sociales, se requiere poseer la motivación, la atención y los comportamientos necesarios. Por ejemplo, hacer contacto visual, sonreír, o usar la palabra o gesto adecuado para iniciar una conversación. Otro aspecto importante de las interacciones sociales es tener la capacidad de compartir interesess o emociones. Por ejemplo, cuando un niño pequeño trae y muestra un juguete a su padre o hermano, o apunta a un objeto que es interesante para él.

Para un niño desarrollar y sostener amistades se requiere más que poseer buenas habilidades sociales. Es requerido procesar, interpretar, recordar, integrar e internalizar las interacciones sociales pasadas para luego imitar estos comportamientos en situaciones sociales similares en el futuro. También es necesario tener la habilidad de prestar atención e interpretar el lenguaje verbal y no verbal.

En los niños con ASD, las interacciones sociales generalmente son poco frecuentes o atípicas. Estos niños generalmente no exigen atención de los padres o hermanos, excepto cuando deben satisfacer una necesidad como comer o ir al baño. Usualmente no están interesados en jugar con otros niños y prefieren jugar solos. Por lo general, tienen dificultad para interpretar situaciones sociales.

Presencia de patrones de comportamientos e intereses estereotípicos

Los niños con ASD a menudo exhiben un patrón estereotípico de comportamientos repetitivos, actividades e intereses restringidos, resistencia al cambio, e hiper-o hipo sensibilidad a estimulación sensorial. Estos síntomas podrían estar presentes durante la niñez temprana y son especialmente evidentes cuando persisten en la edad escolar.

¿Cuándo debo preocuparme por las habilidades de comunicación de mi hijo?

 Signos preocupantes para niños pequeños:

  • Ausencia de balbuceo a los 9-12 meses
  • No imita sonidos a los 9- 12 meses
  • Ausencia de palabras individuales a los 16 meses
  • Regresión del lenguaje entre las edades de 15 a 24 meses. Alrededor de 1/3 de pacientes con ASD se presentan con este problema.
  • Incapacidad para adquirir el idioma a los 2 años. Esta es la preocupación más común de los padres, y aproximadamente 2/3 de los pacientes con ASD se presentan con este problema.
  • Ausencia de frases de dos palabras a los 24 meses
  • No utiliza el lenguaje como medio de comunicación (simplemente repite las palabras).

Signos preocupantes para niños mayores:

  • Tiene dificultades para iniciar o continuar una conversación con familiares o compañeros
  • Tiene problemas para expresar las necesidades con la palabra o frase correctas
  • Repite palabras o frases (conocidas como repetición o eco), pero no entiende cómo usarlas correctamente o en contexto
  • A menudo habla en una voz monótono que parece carecer de expresión o emoción (voz de robot)
  • A menudo le cuesta tomar turnos para hablar y el diálogo se centra en sus intereses personales
  • Dificultad para entender el contexto de lo que se dice (por ejemplo; da respuestas no relacionadas a las preguntas)
  • Tiene problemas para entender el sarcasmo, bromas y burlas
  • A menudo es muy literal, incapaz de entender las metáforas
  • Incapaz de entender los signos no verbales (por ejemplo; no entiende que el oyente está girando los ojos o mirando su reloj porque está aburrido con su conversación)

¿Cuándo debo preocuparme por las habilidades sociales de mi hijo?

Signos preocupantes para niños pequeños:

  • No responde al padre o madre con una sonrisa o expresión facial a los 6-9 meses
  • No imita las expresiones faciales de los padres a los 9 meses
  • El niño no responde o se alerta cuando escucha su nombre a los 12 meses
  • El niño no señala a objetos para mostrar interés a los 12-15 meses
  • Regresión de las habilidades sociales entre las edades de 15 a 24 meses
  • El niño no hace juegos de pretender (pretend play) a los 18 meses
  • No trae objetos de interés personal para mostrar al padre o madre a los 24 meses
  • No parece interesado en mirar a lo que el padre o madre está señalando o mirando
  • El niño resiste o evita los abrazos y no le gusta que lo carguen
  • No es consolado fácilmente por sus padres

Signos preocupantes para niños mayores:

  • El niño parece no escucharte la mayor parte del tiempo
  • Demuestra falta de empatía o preocupación por otros
  • No tiene interés en compañeros y familia
  • No hace contacto visual o tiene dificultad para mantener el contacto visual
  • Le cuesta entender la expresión facial de otros
  • A menudo carece de expresión facial, y tiene dificultad para expresar emociones o sentimientos
  • Le resulta difícil hacer amigos o no se preocupa por hacer amigos
  • Prefiere estar solo
  • A menudo tiene dificultad para entender los sentimientos de otras personas
  • Responde inapropiadamente en una situación social con indiferencia o aversión
  • Prefiere jugar solo y recita oraciones como en forma de guión (por ejemplo, imita un diálogo que ha visto en la televisión o una película)
  • Evita los abrazos y el contacto físico
  • A menudo no entiende el espacio personal de otros y tiende a acercarse demasiado a la familia y los compañeros sin entender o darse cuenta de que esto los pone incómodos

¿Cuándo debo preocuparme por el comportamiento de mi hijo?

Signos preocupantes para niños pequeños

  • A menudo exhibe manerismos motores repetitivo como el aleteo de las manos o los dedos, golpearse la cabeza o la cara, morderse frecuentemente, girar en círculos, balancearse, caminar en los dedos de los pies la mayor parte del tiempo
  • Tiene hábitos de sueño inusuales, o parece que no necesita dormir
  • A menudo coloca en línea el mismo número de objetos de la misma manera, pero no entiende lo que el juguete o el objeto representa
  • Dificultad para la transición de una actividad a otra, o exhibe intolerancia al cambio
  • Tiene rabietas frecuentes, siempre parece estar irritable
  • Muy selectivo para comer, sólo come unos pocos alimentos (puede reconocer la diferencia entre los mismos alimentos que son de diferentes marcas)
  • Excesiva preocupación con objetos inusuales como ventiladores de techo, aspiradoras o inodoros

 Signos preocupantes para niños mayores:

  • Tiene intereses restringidos a pesar de la motivación y la exposición adecuada
  • Se obsesiona con un tema determinado y siempre está hablando de ello
  • Hace preguntas repetitivas sobre un tema
  • Le gustan las rutinas específicas, y no tolera el cambio
  • A menudo se obsesiona con actividades inusuales, haciéndolos varias veces durante el día
  • Juega con partes de juguetes en lugar de todo el juguete (por ejemplo, girando las cuchillas de un helicóptero de juguete), pero no entiende el propósito general o la función del juguete
  • A menudo parece no sentir dolor
  • A menudo parece ser extremadamente sensible o no sensible en absoluto a los olores, sonidos, luces, texturas, y el tacto (estímulos sensoriales)
  • Se abruma fácilmente
  • Parece ser descoordinado y torpe, se cae con frecuencia
  • No soporta alimentos con ciertos sabores y texturas, o se obsesiona con comer sólo ciertos alimentos con determinados sabores y texturas

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¿Es el trastorno del espectro autista causado por vacunas?

¡No!  Esta teoría fue refutada hace mucho tiempo, pero muchas personas aun insisten en que las vacunas, especialmente el MMR, pueden causar autismo. No existe un estudio fiable que vincule las vacunas con el trastorno del espectro autista. De hecho, un nuevo estudio publicado en Annals.org en Marzo del 2019, ha confirmado que las probabilidades de desarrollar autismo son las mismas en niños que recibieron la vacuna MMR y aquellos que no la recibieron. Interesantemente, este estudio también reveló que no existe un aumento de riesgo de desarrollar la enfermedad para aquellos niños vacunados que tienen un hermano que padece de autismo. Entre las niñas, el riesgo de autismo fue menor en aquellas que fueron vacunados. Según el estudio, los mayores factores de riesgo para desarrollar autismo fueron: tener una madre o padre mayor, bajo peso al nacer, baja puntuación de Apgar, parto prematuro, cabeza grande, parto asistido y que la madre fumara durante el embarazo.

¿Se ven afectados igualmente los niños y niñas con el espectro autista?

Se cree que los niños son cuatro veces más propensos a ser diagnosticados con el trastorno del espectro autista en comparación con las niñas, pero también el tiempo de diagnóstico en las niñas podría retrasarse porque el ASD (trastorno del espectro autista) presenta diferencias lingüísticas entre ambos sexos. Un nuevo estudio por investigadores del Hospital De Niños de Filadelfia que se publicó recientemente en la revista Molecular Autism, encontró que las niñas de edad escolar con ASD utilizan considerablemente más palabras de proceso cognitivo (por ejemplo; pensar, saber o sentir) ayudándolas a  comunicarse de manera más similar a un niño neurotípico.  En general, las palabras del proceso cognitivo, también conocidas como lenguaje del estado interno, transmiten un pensamiento, un sentimiento o una emoción y su uso adecuado permite que el oyente perciba que el orador puede entender los pensamientos y sentimientos de los demás.

¿A qué edad se diagnostica típicamente el trastorno del espectro autista (ASD)?

La recomendación actual es que los niños sean evaluados durante sus citas de chequeo de rutina a los 18 y 24 meses, por lo que muchos niños reciben un diagnóstico con éxito alrededor de los 2 años; sin embargo, todavía hay un gran número de niños que se diagnostican después de la edad de 3 o 4.  Un nuevo estudio publicado en Abril del 2019 en la revista médica Jama Pediatrics, propuso que los niños pueden ser diagnosticados responsablemente con autismo a una edad más temprana si las evaluaciones formales comienza antes de lo que se recomienda actualmente. Los niños pequeños involucrados en el estudio fueron evaluados y diagnosticados alrededor de 12 a 14 meses de edad y el 84% de los niños conservaron su diagnóstico de ASD cuando se realizó un seguimiento a la edad de 3 años.   El diagnóstico a una edad más temprana sería ideal, ya que les permitiría a los niños con la enfermedad iniciar terapias e intervenciones antes de lo que las reciben ahora.

Entre todos los niños, los grupos minoritarios generalmente se diagnostican más tarde y con menor frecuencia, probablemente debido a una menor exposición a la atención médica adecuada y/o a menos conciencia de los padres de que su niño podría tener un retraso en el desarrollo.

World Autism Awareness Day.

Herramientas/recursos para padres

Este libro–Trastorno Del Espectro Autista: Lo Que Cada Padre Necesita Saber es un recurso vital para los padres. Puede ayudar a los padres a aprender más sobre el diagnóstico de ASD y de las modalidades actuales de tratamiento.

La aplicación de seguimiento de los patrones de desarrollo del CDC- con esta aplicación puede rastrear los parámetros de desarrollo de su hijo desde los 2 meses hasta los 5 años.

Verifique los parámetros de desarrollo del CDC

Imprima y llene una lista de verificación de hitos del desarrollo del CDC

¿No está seguro de cómo hablar con su pediatra? Echa un vistazo a estos consejos del CDC.

Recursos:

https://www.uptodate.com/autism-spectrum-disorder-clinical-features

https://www.uptodate.com/autism-spectrum-disorder-surveillance-and-screening-in-primary-care

https://www.healthychildren.org/How-Doctors-Screen-for-Autism

https://www.healthychildren.org/Early-Signs-of-Autism-Spectrum-Disorders

https://www.mayoclinic.org/autism-spectrum-disorder/symptoms-causes

https://www.cdc.gov/autism/signs

https://www.aappublications.org/news/

https://annals.org/mmr-vaccine-associated-risk-autism 

https://www.cdc.gov/milestones/checklist

https://www.autismspeaks.org/what-autism

https://www.philly.com/autism-girls-childrens-hospital-of-philadelphia

https://molecularautism.biomedcentral.com

https://www.autismspeaks.org/autism-facts-and-figures

Descargo de responsabilidad: El contenido en este portal no debe ser considerado como asesoramiento médico y no intenta reemplazar la relación que usted tiene con su pediatra. Si usted tienes preguntas específicas, por favor llame a su doctor.

Everything you need to know about seasonal allergies.

If you or your children are experiencing itchy eyes or nose, sneezing, nasal congestion, or cough… please continue reading. 

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Allergic rhinitis, also known as hay fever (nasal allergies), mimics the symptoms of a chronic cold, but is in fact a very complex immune reaction to specific allergens. Hay fever is very common and affects up to 30% of children in the United States. 

Nasal allergies could be seasonal or perennial (last all year-long). Seasonal allergy symptoms occur only during specific parts of the year and are usually caused by pollen from trees, grasses, and weeds. On the other hand, perennial allergy symptoms are present year-round and are usually caused by indoor allergens like dust mites, cockroaches, mold spores, and animal dander. 

Most people can self diagnose themselves and buy over the counter medication to alleviate their symptoms; however, many times hay fever/seasonal allergies will occur in association with a number of other disorders that require medical attention. Some associated conditions include allergic conjunctivitis, sinusitis, asthma, and eczema. 

What are the symptoms?

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Head: headache, sinus pressure, and facial pain
Eyes: itchy, watery, and red eyes; crusting of eyes, burning sensation to eyes, eyelid swelling (puffy eyes) and dark circles under the eyes
Nose: nasal congestion and obstruction, runny nose, sneezing, clear nasal secretions, loss of smell, and itchy nose
Throat: post nasal drip, hoarse voice, cough, scratchy throat, sore throat
Other: headache, general fatigue (usually associated to lack of sleep or poor quality of sleep due to nasal obstruction), itching of the palate and inner ear, snoring, popping of the ears, mouth breathing

Why do we get allergies? 

An allergen is a harmless air particle that is capable of producing an immune response that results in an allergic reaction.  However, it is not allergens themselves that cause your allergy symptoms. Whenever an allergen enters your nose, it interacts with cells called mast cells. If you are allergic to that particular allergen or particle, your mast cells in response will release histamines. It’s due to the release of histamines that you get to experience a runny nose or sneezing. Many allergy medicines use an “antihistamine” in an attempt to control the symptoms histamines cause.

The most common allergens are pollen, dust mites, animal dander, and mold. In children, clinical allergy develops first to allergens that are continually present in the environment (like dust mites or animal dander) and then to pollen and other seasonal allergens. Allergic rhinitis requires a few years of allergen exposure to develop, it is uncommon in children under two years of age.

Did you know? Allergic rhinitis (seasonal allergies) accounts for about 2 million lost school days per year for kids. It is associated with cognitive and psychiatric issues in children and adolescents, including attention deficit hyperactivity disorder, lower exam scores during peak pollen seasons, poor concentration, impaired athletic performance, and low self-esteem.

Allergic rhinitis risk factors: family history, male sex, birth during pollen season, early use of antibiotics, cigarette smoke exposure during the first year of life, early exposure to indoor allergen

Overview of nasal allergies treatment

Non medical

The non medical approach to treatment focuses on avoiding allergens that trigger your allergies. For a lot of people this method alone is enough to control their symptoms.

  • Avoid pollen exposure by keeping your house and car windows closed. In general pollen counts are higher in the evening during spring and early summer, and in the morning during late summer and fall. Consider taking a shower, washing your hair, and changing clothes after spending time outside.

 

  • It is extremely hard to get rid of dust mites, you can limit contact by using physical barriers like dust-proof covers on pillows and mattresses, controlling humidity, and reducing areas that harbor dust mites. Washing bed linens and blankets weekly (or more frequently) in hot water will reduce dust mite counts. Steam treatments can eradicate dust mites, so carpet steam cleaning is recommended. Also, minimizing the presence of carpets, upholstered furniture, drapes, and stuffed animals would help by decreasing the places that can be colonized by dust mites.

 

  • If you think you have a pet allergy, consider keeping the pet outside or restrict it to just a few rooms in the house. Ideally keep the pet outside of your bedroom. Wash your hands after petting your pet and bathe your pet at least once a week to reduce dander. Aggressive cleaning and the use of a vacuum cleaner with HEPA filters is useful as well.

 

  • To prevent or control mold in your house, clean bathrooms and kitchen frequently and avoid the use of humidifiers.

 

  • In order to avoid irritants, do not smoke and do not allow anyone to smoke in your house or car. Stay away from strong odors like perfumes, paint, burning candles, cleaning products, room air fresheners and oils. Also, stay away from wood burning stoves and fireplaces.

Over the counter medication 

Over the counter treatment has become quite popular as most allergy medications are now available without a prescription. Therefore, standing on the allergy aisle at your local pharmacy or grocery store can be absolutely overwhelming since there are more options than ever. It can be confusing to figure out what medicine to pick for your symptoms, so I will break them into classes to make it easier next time you go pick up your allergy meds. 

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Oral Antihistamines – Antihistamines are typically used for itching, sneezing, and runny nose symptoms, but are not as effective for nasal congestion.

First generation antihistamines like diphenhydramine (Benadryl), chlorpheniramine, brompheniramine, and doxylamine are commonly found over the counter. You can find these antihistamines as single agents and in combination with other medications (frequently used in cold medications). First generation antihistamines are troublesome in children because they can produce significant sedation and somnolence . Also, young children may experience paradoxical agitation characterized by fussiness, excessive movement, hyperactivity, and crying spells after taking it. The use of over the counter cold medications containing this class of antihistamines has been linked to several deaths in children younger than 2 years of age. In general, dosing is more frequent than the newer antihistamines, about every 6 hours. Children’s Benadryl Allergy– dosing is 2.5 ml every 6 hours for children 2-5 years old; 5-10 ml every 6 hours for children 6-11 years old; 10-15 ml every 6 hours for children older than 12 years of age. 

Some examples of first generation antihistamine that you can find over the counter:

  • brompheniramine (Childrén’s Dimetapp Cold)
  • chlorpheniramina (Chlor-Trimeton y Actifed Cold)
  • dimenhydrinate (Dramamine)
  • diphenhydramine (Benadryl, Nytol o Sominex)
  • doxylamine (Vicks NyQuil, Tylenol Cold and Cough Nighttime)

 

Second and third generation antihistamines like cetirizine (Zyrtec), loratadine (Claritin), levocetirizine (Xyzal), fexofenadine (Allegra) are long acting, thus they are dosed once or twice a day. Overall, these have less side effects than first generation antihistamines and are non-sedating. 

  • Cetirizine (Zyrtec) is available as tablets and liquid gels ( 10 mg), orally disintegrating tablets(10 mg) and liquid formulation. It is dosed once a day.

6 to 11 months old:  dose is 1.25 ml (1/4 tsp) to 2.5 ml (1/2 tsp) of the liquid once a day; max dose is 2.5 ml in 24 hours

12 to 23 months old: dose is 2.5 ml ( 1/2 tsp) of the liquid once a day; could use 2.5 ml twice a day if needed; max is be 5 ml (1 tsp) per 24 hours

2 to 5 years old: dose is 5 mg (1/2 of a disintegrating tablet), or 5 ml (1 tsp) of the liquid once a day

6 years and older: dose is one 10 mg tablet or 10 ml (2 tsp) of the liquid once a day 

  • Loratadine (Claritin) is available as tablets and liquid gels (10 mg), orally disintegrating tablets (5 mg and 10 mg), and liquid formulations. It is dosed once a day. 

2 to 5 years old: dose is one 5 mg orally disintegrating tablet or 5 ml (1 tsp) of the liquid once a day 

6 years and older: dose is one 10 mg tablet or 10 ml (2 tsp) of the liquid once a day 

  • Levocetirizine (Xyzal) is available as tablets (5 mg) and liquid formulation ( 2.5 mg per 5 ml). It is dosed once daily.

2 to 5 years: dose is 1.25 mg , which would be  2.5 ml (1/2 tsp) of the liquid once a day 

6 to 11 years old: dose is 2.5 mg, which would be 1/2 a tablet or 5 ml (1 tsp) of the liquid once a day 

12 years and older: one 5 mg tablet or 10 ml (2 tsp) of the liquid once a day 

  • Fexofenadine (Allegra) is available in tablets (30, 60, 180 mg) and liquid formulation

6 months to 2 years old: dose is 2.5 ml (1/2 tsp) twice daily of the liquid 

2 to 11 years old: dose is one 30 mg tablet twice a day or 5 ml (1 tsp) twice a day of the liquid 

12 years and older: dose is one 60 mg tablet twice a day or 10 ml (2 tsp) twice daily; alternatively you can use one 180 mg tablet once a day 

Oral Antihistamine-Decongestant Combinations- The use of non sedating, second generation antihistamines in combination with the decongestant pseudoephedrine has  become popular since it results in better symptom relief than antihistamines alone. Some common formulations are loratadine-pseudoephedrine (Claritin-D, Alavert Allergy and Sinus), fexofenadine- pseudoephedrine (Allegra D), and cetirizine-pseudoephedrine (Zyrtec D). All are approved for children 12 years of age and older. Side effects include high blood pressure, difficulty falling asleep, and headaches. 

  • Loratadine 5 mg/Pseudoephedrine 120 mg: dose is one tablet every 12 hours
  • Loratadine 10 mg/Pseudoephedrine 240 mg: dose is one tablet daily
  • Fexofenadine 60 mg/Pseudoephedrine 120 mg: dose is one tablet every 12 hours
  • Fexofenadine 180 mg/Pseudoephedrine 240 mg: dose is one tablet daily
  • Cetirizine 5 mg/Pseudoephedrine 120 mg: dose is one tablet every 12 hours or two tablets daily

Nasal Sprays

Glucocorticoid nasal sprays are the most effective single therapy for patients with persistent nasal congestion due to it’s anti inflammatory properties.  They are superior to oral antihistamines for symptoms such as nasal blockage, post nasal drip and  nasal discharge. Some available over the counter are fluticasone (Flonase), budesonide (Rhinocort), triamcinolone (Nasacort).

The proper technique is important when using a nasal spray. I always tell my patients to look at their toes when spraying their nose, then to insert the spray pump tip in the nostril aiming towards that side’s eye and spray, lastly sniff gently to move the medication to the higher parts of their nose. Repeat on the other nostril. Make sure not to spray your nasal septum. Side effects include nasal burning and discomfort, sore throat, and nose bleeds. Usually young kids don’t like the taste of the medicine as it trickles down their throats

  • Fluticasone (Flonase, ClariSpray) & triamcinolone (Nasacort) nasal sprays are approved for use in children age 2 and older. The dose for each of these medications  is one spray per nostril once a day, but two sprays per nostril can be tried for a limited period (about two weeks ). Fluticasone is considered safer than the other over the counter nasal sprays. 
  • Budesonide (Rhinocort) nasal spray is approved for patients 6 years and older. The dose is 1-2 sprays per nostril once daily for ages 6 to 11 years of age and up to 4 sprays per nostril for patients older than 12 years of age. 

Cromolyn Sodium nasal spray is available over the counter as NasalCrom. It prevents allergy symptoms by maintaining the nasal mast cell’s integrity, minimizing the release of histamines and avoiding the nasal allergy symptoms even before they start. It is recommended for runny, itchy nose and sneezing. It is safe to use and non-sedating, but requires frequent dosing. Dose is one spray per nostril up to four times per day. Approved for use in children 2 years of age and older. 

Nasal decongestant sprays Also known as topical nasal vasoconstrictors, are typically recommended only for short-term treatment of nasal congestion since their use past three to seven days has been associated with rebound nasal congestion. I would not recommend its use for more than 3 days.  These are not approved for kids younger than 2 years of age.

Common over the counter formulations are:

  • Phenylephrine (Afrin Children’s, Neo-synephrine, Little Noses Decongestant Drops)

2 to 6 years: Find the pediatric formulation (0.125% solution) dose is 1 drop in each nostril every 4 hours as needed. *Little Noses Decongestant- may use 1-3 drops in each nostril every 4 hours as needed  

6 to 12 years: can use the 0.25% solution, dose is 1 to 3 sprays every 4 hours as needed

12 years and older: may use the 0.25%-1% solution, dose is 1 to 3 sprays every 4 hours as needed

  • Oxymetazoline (different Afrin and Mucinex formulations available, Vicks Sinex, Neo-Synephrine 12 hr)– mostly available as a 0.05% solution. Not recommended for children younger than 6 years old. 

6 year and older: dose is 1 to 3 sprays into each nostril twice daily

Eye drops

Antihistamine/vasoconstrictor eye drops like Naphcon-A and Visine-A are available for red, itchy eye symptoms. Not for use beyond two weeks. For kids older than 6 years of age. Dosing is 1 drop up to 4 times a day. 

Antihistamine eye drops like Zaditor and Alaway are approved for children 3 years and up. Dose is 1 drop in eyes twice daily. May use for prolonged periods of time

Just a little bit more on treatment…

Oral decongestants – phenylephrine and pseudoephedrine are the most commonly used oral decongestants. There are serious side effects associated with the improper use of these agents including excessive sweating, agitation, high blood pressure, seizures, and cardiac rhythm abnormalities . Therefore, oral decongestants are not approved for use in children younger than 4 years of age. For children ages 4 to 6 years, they should be used exclusively if recommended by your child’s doctor. After the age of six, it is safe to use but make sure you are following the package instructions carefully. Always ask your pediatrician if your not sure what dose to use.

Other-Supportive therapy with nasal saline irrigation could be used alone for mild symptoms or prior to the use of medicated nasal sprays. Nasal irrigation has been shown to be beneficial and carries insignificant risks if performed properly. There are a variety of over the counter devices to be used for nasal irrigation. I recommended using a commercially prepared saline solution , but if you decide to make your own, please use distilled, sterilized, or previously boiled water. The use of tap water for nasal irrigation is not advised because of the risk of contracting an amebic infection. Although extremely rare, infection with the amoeba Naegleria Fowleri is usually fatal.

If your child’s symptoms are not improving despite the correct use of over the counter medication, it is time for a visit to the pediatrician. There are a vast array of prescription medications that can be extremely useful for controlling allergic rhinitis symptoms.

Resources: click on the links to read more

Allergic Rhinitis

Hay-fever-rhinitis

Conditions-and-treatments of allergic rhinitis

MayoClinic-conditions/hay-fever/symptoms-causes

MayoClinic/diseases-conditions/hay-fever/in-depth/seasonal-allergies

Disclaimer: The content in this blog is not to be considered medical advice and it is not intended to replace the relationship you have with your primary care provider. If you have specific questions, please contact your physician.