Welcome to the October 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 [email protected]

Q: Do adults with autism experience the same traits as children with autism? For example, will an adult with autism take two hours to eat a pop tart while sitting at a table? Are they slow eaters?

A: Symptoms of autism that are identified in childhood often persist into adulthood. They may shift and change in presentation and/or intensity. It is not uncommon for individuals with autism (from childhood to adulthood) to experience “quirks” surrounding meals and eating, for a variety of reasons. For example, sensory sensitivities can impact food preferences and tolerance of variations in texture, temperature, or taste. Sometimes signals from the brain telling an individual whether they are hungry or full are not transmitted or received. Distractibility is also something that can prolong a task like eating. To sum it all up, while eating challenges are not among the diagnostic criteria for autism, it is not uncommon for them to present for varying reasons from as early as birth on into adulthood.

Q: My girlfriend’s 5-year-old daughter has all the symptoms of autism and I don’t know how to tell her. Can someone advise me? Thank you

A: There is no doubt that situations like these are tricky and difficult to navigate. On the one hand, we, as friends/partners/family members, feel a certain obligation to be truthful and open about our concerns. We worry that if we do not voice our concerns that our friends/loved ones may not get the help they need and/or that we are not doing our “duty.” On the other hand, these kinds of conversations are sensitive. We do not know how the feedback will be received (and this is very difficult feedback for any parent to receive). We worry that saying something may put strain on the relationship (which is a very real possibility). And there is a possibility that, after all of that stress and strain, we might be wrong.

Autism is an especially sensitive topic to broach, and receiving a diagnosis or feedback about suspicions of autism (even from a trusted autism expert) can be life-changing, stressful, and emotionally taxing. I took a random poll of ten providers (all autism experts) at the Seattle Children’s Autism Center, and this is what I learned: For most autism experts I polled, they agreed that they were most likely to give input and make recommendations, if a friend or family member approached them first. In other words, most were reluctant to give unsolicited advice. In my survey, the most frequently endorsed recommendation (again, when approached first by a friend or loved one) was to discuss concerns with the child’s primary care provider and/or to seek a diagnostic evaluation. The benefit of being an autism expert is that people often ask us for advice/input; it is less common that we have concerns that parents aren’t already talking to us about.

Now, what should you do if you’re NOT an autism expert? Well, it depends. For example, how well do you know the parent and for how long have you known them? How well do you know the child and for how long? How much trust is there between you and the parent? Did this parent approach you or are you approaching them first? Have you had conversations about developmental concerns with this parent in the past, or will this be “out of the blue?” What is your skill/knowledge base related to child development and/or autism symptoms, diagnosis, treatment, etc.?

To sum it all up, if you are thinking about voicing your concerns about autism to a friend or loved one, you have a lot of thinking to do, numerous questions to ask yourself, and plenty of pros and cons to weigh. Thankfully, the weight does not rest solely on your shoulders. Children interact on a regular basis with primary care providers, teachers, and care takers (baby sitters, nannies, daycare providers), whose job it is to continually observe and give feedback about development or concerns therein. Good luck to you.

Dr. Emily Rastall is a clinical psychologist at Seattle Children’s Autism Center, where she works to evaluate and treat children and families affected by autism spectrum disorder and related or co-morbid disorders. The information contained in this blog should not be used to replace the relationship that exists between you and your healthcare provider. Please contact your healthcare provider for specific medical advice and/or treatment recommendations.