Welcome to the April edition of Ask Dr. Emily! We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights here, on the last Friday of each month, in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month.  Send your questions to theautismblog@seattlechildrens.org.

Q: My 16-year-old son was diagnosed with Asperger’s when he was very young. My friends and other people have told me that “Asperger’s” is no longer the term used to describe his level of functioning. What is the correct term to use when talking about him to teachers and other parents so they understand?

A: A new version of the Diagnostic Statistics Manual-5th Edition (DSM-5) was released in 2013. The previous version of the DSM (DSM-IV-TR) described three diagnoses: Autistic disorder, Asperger’s disorder, and pervasive developmental disorder, not otherwise specified [PDD, NOS]. All three of these disorders were considered “autism spectrum disorders.” The current DSM-5 discontinued the use of the three specific diagnoses and, at present, provides only one diagnosis: Autism spectrum disorder (ASD). The way we now describe “functioning” is to qualify whether an individual presents with intellectual impairment and/or language impairment.

Many individuals historically diagnosed with Asperger’s could be described by today’s DSM-5 standards as “autism spectrum disorder without intellectual impairment and without language impairment.” Because the term “Asperger’s” was used for so long, and so many understand it well, it is not uncommon for individuals, families, and providers to continue using the term in conversation to describe presentation and/or functioning. Bottom line: Keep using the term, if it helps you communicate with educators and others, but know that there are new official terms out there.

 

Q: What is the thinking about the impact of screens on kids with autism?  I know that limiting screen time for typical kids can impact their brain and social development.  Screen time seems to be a form of comfort for my autistic teenager after a long day at school, etc…   Texting has provided a great way for her to socialize with her friends but more on her own terms.  And texting seems to be a great tool for she and I to have a difficult conversation – it seems to be less charged and conflictual that way.   Is there any research and/or guidance for the healthy way to reap these benefits without affecting brain development in a negative way?

A: This is such a great question and one that I hear often. Research tells us that screen use (i.e., T.V., video games, computer games) in typically developing children is correlated with several negative effects on development. Specifically, increased screen use in typically developing children is correlated with delays in language development, reduced social interaction, less sleep, poorer school performance, higher rates of obesity, social skills challenges, impulse control challenges, and inattention/lack of focus. Earlier start age has been correlated with language delays and executive functioning delays (like attending, planning, and resisting impulses). These results make sense, right? Time spent on media is time NOT spent interacting with and being active participants in the world and people around them.

Research regarding media use in individuals with autism spectrum disorder (ASD) tells us that children with ASD spend more time using screens on a daily basis compared to their typically developing counterparts. Bottom line, kids with ASD are getting more exposure, which puts them at potentially higher risk for experiencing the deleterious effects of media mentioned above.

Regarding recommendations, the American Academy of Pediatrics (AAP) offered their recommendations in 2011 regarding recreational screen time use. Specifically, the AAP recommends that children under age two not engage in screen time at all. Between the ages of 2 and 18, the recommendation is between 1-2 hours, with no more than two hours per day. Yes, children these days are more and more engaging in screens as a way of staying socially connected. And many kids with ASD, specifically, endorse media/screen time as their most preferred activity. Thankfully, nothing out there is saying that we cannot use screens, however, moderation is the key. Thus, setting limits, creating balance, and providing alternative activities can teach kids how to set healthy boundaries for themselves as they grow into adulthood.