Autism/Developmental Delay 
Autism is a group of neurodevelopmental disorders characterized by impaired social and communication skills, and behaviors which are usually recognized in the first three years of life.
A range of symptoms may occur in different combinations of varying severity:
Social Skills:
- Withdrawal from social situations, avoiding eye contact or smiling, difficulty responding to their name and sometimes a lack of empathy
- Difficulty making friends due to their inability to sustain conversation or pick up on social cues, such as facial expressions or changes in voice tone
Communication:
- Delay in speech development
- Speech may be characterized by a sing-song voice
- Lack of speech in severe forms
- Cognitive Delay
Behavior:
- Focus on one object for a long time
- Engage in repetitive acts such as twirling or rocking
- Self abusive behavior, such as banging their head or biting
- Develop rituals or routines
Leo Kanner, a Johns Hopkins Child Psychiatrist wrote his sentinel paper on Autism in the 1940’s. Of the three areas above noted he stated lack of social interest and social reciprocity were key to the diagnosis.
Autism may sometimes coexist with other conditions, such as ADHD, learning disorders, or epileptic seizures. Your child may develop anxiety or depression as a result of the condition. Autism is thought to be caused by genetic and environmental influences that affect normal brain development. Siblings of autistic children are at a higher risk of developing the disease or developmental problems, especially speech/language issues.
If you recognize any developmental difficulties in your child, it is important to seek assistance as early as possible. Your child’s doctor will review their symptoms and history with a questionnaire. A multidisciplinary team consisting of a pediatrician, child psychiatrist and other specialists will perform an evaluation to further understand a child's risk factors, stregnths and weaknesses to move towards a diagnostic formulation and treatment plan
Although there is no formal cure for autism, your child has the potential to improve with various therapies. Early diagnosis and treatment enhances outcomes. Intensive training sessions designed to develop your child’s social and language skills may be recommended. Your doctor may prescribe medication to treat coexisting conditions such as anxiety or depression as well as attentional issues. Your family may require counseling to help cope with caring for an autistic child. Dr. Kothari, who practices in Boca Raton, and serves many South Florida areas including Delray Beach, Parkland, and Coral Springs, has much experience in diagnosing and treating autistic children, and can refer the children and their families to local specialists and child and adult psychologists as well as social skills groups, speech and occupational therapists and learning specialists.
Applied Behavioral Analysis
Behavior analysts began working with children and adults with autism and autism spectrum disorders back in the 1960’s. Behavior analysis focuses on the principles of how learning takes place, and is aimed at increasing useful behaviors and reducing those behaviors that interfere with the learning process. Applied Behavioral Analysis (ABA) is widely accepted as a safe and effective treatment for autism and many studies support its effectiveness in improving communication, self care, play, social relationships, school and employment. Applied Behavior Analysis should be performed by qualified professionals. Dr. Kothari can refer patients to local specialists with experience in this form of therapy.
Support Groups
Local support groups are available for both children with autism and for their caregivers. Dr. Kothari can refer children with autism to specialized small groups for skill development and social interaction. Parents and caregivers may also benefit from interaction with other caregivers in local support groups. Several support groups can be found in the South Florida area, including in Boca Raton, Fort Lauderdale, Coral Springs and Delray Beach. Dr. Kothari can refer her patients and their families when appropriate.
Occupational Therapy
Occupational therapists (OTs) can be an invaluable part of the interdisciplinary treatment team for those with autism. Occupational therapists can evaluate for age appropriate skills and provide structured, individualized therapy to help the autistic child achieve age appropriate independence both at school and at home. Some skills an OT may foster include: daily living skills (grooming and hygiene), fine motor skills, gross motor skills, perceptual skills, visual skills for reading and writing, play, coping skills, social interactions, problem solving, and communication. Occupational therapists can also help if the autistic child also has a sensory processing disorder.
Speech Therapy
Many people with autism have difficulty with speech, language, or communication, making speech therapy an integral part of the treatment plan for those with autism or an autism spectrum disorder. An initial evaluation is essential to determine the child’s strengths and weaknesses in both verbal and nonverbal communication. After the initial evaluation, the speech therapist sets goals, and formulates an individualized treatment plan to help the autistic child communicate in more useful and functional ways, which may include written and expressive language, or nonverbal communication skills. Children who are nonverbal may be taught to use augmentative and alternative communication through various devices.
Early Intervention
The Individuals with Disabilities Education Improvement Act (referred to as IDEA) provides states with federal grants to provide early intervention. Children under the age of three who have a developmental delay, or a physical or mental condition most likely to result in a delay, are eligible to receive early intervention services through this program. While programs may vary from region to region, early intervention programs should assess the child’s current level of functioning and create an Individual Family Service Program (IFSA) or a similar plan perhaps with a different title based on region. These services may include speech therapy, occupational therapy, physical therapy, Applied Behavior Analysis, and psychological evaluation. While navigating the system to obtain the necessary evaluations to qualify for early intervention services can be daunting for parents, the possible benefits of the early intervention programs are important. Studies show early intervention services can improve IQ, language ability, and social interaction.
Transition to Early Adulthood
A child with a disability who is eligible for special education services in the United States is guaranteed to receive those services until he or she graduates high school or turns 21. Similar services are not guaranteed after that time, making the transition to adulthood challenging for those with autism and their family. Services vary from state to state and often depend on available funding, with many programs having waiting lists. In order to have a smooth transition to early adulthood, parents and children should start transition planning early. The transition to early adulthood for those with autism can be filled with challenges, including finding employment, post secondary education, housing, vocational training, and health care. Those with autism and their parents often seek the guidance and support of a psychiatrist and/or psychologist to help them through this challenging time. Many parents and self help groups are an excellent resource for this transition.
Dr. Kothari is sensitive to and understands the various struggles families go through with their children into the young adulthood transitional period and is both a support, treatment provider and resourse during this sensitive period.
