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By Expert ID: 05067, Ph.D.

Autism and other autism spectrum disorders (ASDs) are increasingly common diagnoses for children throughout the world. A growing number of legal matters, including child custody cases, involve at least one child with such a diagnosis. Children with autism experience a wide range of symptoms that can not only complicate the legal process, but can also be impacted by the outcome of that case.

ASDs include a cluster of disorders with similar patterns of symptoms, including Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).

Many children with an ASD display markedly impaired language skills, making it difficult to use standard interviewing practices. Likewise, a common symptom of autism is distress due to changes to routine or environment.

Autism, or Autistic Disorder, affects multiple facets of an individual’s life. Impairment in social interaction is common, as is disordered communication and limited imaginative play.

Today, it is widely accepted that autism spectrum disorders are genetically influenced, biologically-based disorders. Many believe that environmental factors may play a key role as well. Recent epidemiological studies suggest that 1 of every 110 children (1 in 70 boys) is affected by an ASD.

In autism, children often seem aloof, withdrawn, and isolated. There is a high degree of self-absorption and inward focus; understanding the emotions and perspectives of others will tend to be quite limited. Children may not seek to share attention, interests, or enjoyment and often lack a sense of empathy. They often fail to form developmentally appropriate peer relationships; some may exhibit no interest in forming friendships at all. Use and recognition of nonverbal social cues, such as eye contact and gestures, are also frequently impaired.

Another key facet of autism is disordered communication. The degree varies greatly; some individuals fail to develop any language and are essentially mute while others display more subtle deficits in the ability to participate in a reciprocal conversation. Some children use highly stereotyped forms of language. Stereotyped language can include echolalia (the rote repetition of heard sounds and words) and the recitation of preferred phrases.

Those who do develop age-appropriate vocabulary and syntax often continue to have significant difficulty with many aspects of verbal communication. The pragmatic, or social use of language may be significantly impaired. Grammar, organization, and language comprehension are often notably immature. Difficulties are frequently noted in initiating conversation, taking turns speaking and following another’s topic of interest. Language is often used quite literally; any nonliteral statements, such as humor and irony, are generally misunderstood. Finally, symbolic play, a key early building block of language skills, is often absent or abnormal in children with an ASD.

Many repetitive behaviors are closely associated with a diagnosis of autism. For instance, children with autism often are highly interested in one topic or object (e.g., fire trucks, vampires) to an extent that it interferes with overall functioning. It is also common to see inflexible adherence to nonfunctional routines. Some of the repetitive behaviors exhibited by children with ASDs involve unusual motor behaviors, such as spinning, rocking, hand-flapping, and body posturing. Others, like odd, close inspection of objects, relate to obsession with parts of objects. It is also common for children on the autism spectrum to display a variety of sensory aversions or sensory-seeking behaviors. For instance, some children have auditory sensitivities and become easily overwhelmed in “over-stimulating” social settings.

Although autism is considered to be an enduring, life-long disorder, a wide of range of treatment options exist to help affected individuals manage symptoms and gain needed skills. Some interventions (such as applied behavior analysis) have been rigorously evaluated and validated. Given the significant cost of many interventions, an increasing number of families turn to insurance providers but are often denied coverage of autism-related services. A growing number of such cases have resulted in litigation.

The family court system is another arena encountering an increasing number of cases involving children with an ASD. Custody determinations can become complicated when a child diagnosed with an autism spectrum disorder is involved. Conversely, custody arrangements can exacerbate symptoms of autism.

Children with autism are generally anxious, rigid and have difficulty relating to significant people in their lives. Each of these issues can be negatively impacted by parental divorce and disruptions to custody arrangements, such as sporadic overnight visits with the non-custodial parent. Poor communication skills and difficulty understanding social dynamics make it more difficult for children with autism to express their needs and wishes, as well as understand the nature of the change in their custody arrangement.

When individuals with an ASD interact with the court system (whether for insurance-related litigation, child custody disputes, or criminal/civil cases), unique complications often arise. Children are likely to be difficult to question using standard interviewing techniques. An adult with autism may be competent and quite intelligent, yet still have trouble participating collaboratively in a case.

With these and other related challenges, it is often beneficial to enlist the services of a psychologist or other mental health professional well-versed in the nature of autism. A thorough evaluation can address issues around diagnosis, intelligence, communication skills and other aspects of daily functioning. These clinicians can also make recommendations for appropriate, effective interventions and aid in determining the needs and wishes of those affected by autism.

By Expert ID: 05067, Ph.D.