Physicians notice rise in pediatric autistic cases, more awareness than in the past

Aug. 7—A better understanding of autism spectrum disorders has led to an increase in the number of children diagnosed with the condition, but it has also improved treatment and resources for students like 15-year-old Brooks Givens.

Diagnosed with Asperger's syndrome when he was 3, Givens will have resources that include sensory rooms and psychotherapy when he begins his freshman year at Athens High on Wednesday.

Givens is high functioning but has certain obstacles that his mother Stacey says he can work through by using therapy and the sensory rooms, which allow him to calm down. Asperger's syndrome is a social developmental disorder that is a form of autism spectrum disorder. Sensory rooms are designed to reduce students' anxieties and sharpen their focus, and Stacey said any student is welcome to use them.

"His struggles have changed over the years. When he was in elementary school, it was most certainly over-stimulation," Stacey Givens said. "When you look at the classic kindergarten and first grade room, there are bright colors and lots of things that jump out at you and excite you and for a neurotypical child, that's wonderful. For an autistic child, that's overwhelming."

Autistic individuals may have sensory sensitivities to certain images, sounds, smells, tastes and touch. According to Autism Speaks, an organization involved in research and education, autism has many subtypes, so there are those with autism who are highly functioning with little to no sensory issues and then there are those who are severely challenged and may require significant support in their daily lives.

Some autistic individuals also have unusual speech patterns or late development of speech as a child. They also may develop repetitive or obsessive behaviors. According to Autism Research Institute, if autistic children do not receive treatment, they won't develop effective social skills and "may speak or behave in ways that create challenges."

An autistic student's learning abilities in school could be affected depending on the severity of the autism, such as the inability to focus for a length of time and refusing to learn new things because of those repetitive behaviors.

The 2019-2020 National Survey of Children's Health reported approximately 2.9% of children ages 3-17 were autistic nationally, which is about 1.79 million children. In Alabama, the survey reported in 2020 that 3.1% of children aged 3-17 were autistic, which is about 28,410. This was an increase in the state of about 40% from 2016, when the survey reported that 2.2% of children in Alabama were diagnosed with autism.

"Over time, research has shown that there has been an increased number of children that have been diagnosed with autism," said Dr. Wes Stubblefield, Alabama Department of Public Health district director.

Area physicians say an increase in autism diagnoses over the past decade is likely due to better detection and more uniform guidelines on when the diagnosis is appropriate.

"People have more guidance about who meets that criteria," said child neurologist Dr. Martina Bebin. "The explosion of genetics and the association with autism and autism spectrum disorders within those people with genetic mutations, we didn't understand that link before."

Bebin has been a child neurologist with Children's of Alabama hospital since 1994 and has a practice in Huntsville. She can now detect autistic traits in children as young as 18 months old, which she said would have been impossible more than 20 years ago.

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Providing assistance

The resources local school systems provide for students with autism spectrum disorders continue to evolve.

Katie Black, special services coordinator for Hartselle City Schools, said each individual with autism is unique and so there is not a single, definitive approach to assisting them.

"There's a saying in the world of special education and especially in the world of autism: If you've met one person with autism, then you've met one person with autism," Black said. "It's so diverse and so that's why it's very important for the child to have a team and we take it from a team approach to assess the child's current skills."

Stubblefield said autism is "a disorder of what we call social reciprocity, meaning that autistic children have trouble going back and forth in conversations."

Black said her schools utilize applied behavior analysis, an interpersonal therapy designed to improve social skills, to understand autistic students' behaviors, especially if they become agitated or violent.

"An autistic child having a sensory overload and having a complete meltdown in the hall and accidentally hitting a teacher, that's different than a neurotypical (non-autistic) child who hits a teacher out of malice," Black said. "The way that we approach that is through functional behavior analysis."

Black said applied behavioral analysis is "working with a student through discreet trials, a lot of positive reinforcement to see how they respond, and what kind of stimuli that person is more responsive to."

Black and Morgan County technology director Lee Willis said their schools are dealing with a shortage of teachers going into special education.

"I've got a classroom right now and every student in that classroom is autistic so we could definitely use more special education teachers," Willis said.

However, Black said she believes more individuals will eventually enter the field because of recent government funding.

"Now, I will say that with the stimulus and ESSER funds, for the past couple of years we're really getting some good programs," Black said. "I feel really good about where we're at right now."

ESSER funds, Elementary and Secondary School Emergency Relief, was signed into federal law in December 2020 to help elementary and secondary schools across the nation who were suffering from the impact of the COVID-19 virus.

In 2012, Hartselle City Schools had 11 students with diagnosed autism cases. Now the system has 62, Black said.

Decatur schools special services coordinator Stefanie Underwood said it was important to note that not every student with autism is involved in special education.

"There are those who are very high-functioning and can stay in a regular classroom, then there are those who need help and cannot stay in the classroom all day," Underwood said.

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Still much to learn

Stacey Givens' organization, Make-A-Way Foundation, was responsible for having sensory rooms installed 11 years ago in all Athens City schools and 12 Limestone County schools. She said her foundation led the effort to have the sensory rooms built so Brooks and other students who need time to themselves could have somewhere to go away from the classroom.

Stacey said she had to take Brooks out of kindergarten because being in a classroom full of children all day was too much stimuli, which would make him upset and cause him to panic.

During a recent interview, Brooks spun around on a spin disc, which is like a miniature merry-go-round, in the Athens Middle sensory room to release some pent-up energy. When talking, he looked at his cellphone frequently, didn't make eye contact, and spoke in a sort of monotone, but he was able to carry on a conversation about roller coasters.

"My favorite roller coaster is the Lightning Rod at Dollywood. It goes real fast and makes real sharp turns," Brooks said.

He smiled and said, "I never get sick on the rides. I can handle anything."

Brooks is also an avid fan of the Golden State Warriors and the Atlanta Braves.

When he was a young child, Stacey said, Brooks could not speak properly, but now after taking speech therapy, he has announced baseball games at Athens Middle School and the Athens Dixie Youth League.

Bebin said because of the focus on autism awareness in the last decade, parents, teachers and physicians are starting to come forward more often with concerns about children who they suspect may be on the spectrum.

There are only two FDA-approved medications for children with severe autism: Abilify and Risperdal. Both are antipsychotic medications that help with irritability and aggression that result from sensory sensitivities associated with autism, like bright lights or loud noises.

Autism Speaks said the many types of autism result from a "combination of genetic and environmental factors," and Stubblefield said there is no definite cure.

"That's still an area of active research," Stubblefield said. "There have been many hypotheses; there is an underlying genetic predisposition, because the rate in identical twins is higher than in non-identical twins, which would make you think that if they had the same genes, then they have a higher predisposition. So, there is a genetic background, but there's really not an understanding of why or what triggers the autistic cascade of effects."

— wesley.tomlinson@decaturdaily.com or 256-340-2438.

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