If You’ve Seen One Person with Autism, You’ve Seen One Person with Autism: Diagnosing Autism and Its Varied Presentations

In this episode, I speak with Celine Saulnier, PhD, a clinical psychologist and co-author of the Vineland Adaptive Behavior Scales, Third Edition, about the evolving science and clinical practice of autism assessment and diagnosis. Celine shares her path from training with M-CHAT developer Deborah Fein, to nearly a decade at the Yale Child Study Center, to directing clinical research at Emory University and the Marcus Autism Center, and finally to founding her own practice. We discuss the two hallmark domains of autism, social communication differences and restricted or repetitive behaviors, and why no single measure can capture the conditions variability across verbal ability, cognitive functioning, and presentation. She describes groundbreaking eye-tracking research showing that divergence from typical social attention emerges as early as six months of age, and research has led to FDA approval of a diagnostic technology called EarliPoint to identify autism in child from this young age up to eight years old. We also discuss the genetics of autism in children, including recurrence risk for siblings and the concept of the “broader autism phenotype,” where family members show subthreshold traits (or shadow traits) that still warrant support. We discussed aspects of autism, including theory of mind, sensory processing differences, and repetitive behaviors, as well as the chronic anxiety, dysregulation, and burnout that can result from navigating a world not built for neurodivergent processing. Celine distinguishes between camouflaging and masking, and discusses how these coping strategies, while adaptive in the short term sense, can be associated with poor mental health outcomes over time. Finally, we explore the range of interventions available across the lifespan, from parent coaching and skill building in early childhood to social skills groups, executive functioning coaching, and life coaching in adulthood.

Celine Saulnier, Ph.D., obtained her doctorate in Clinical Psychology from the University of Connecticut, after which she completed a postdoctoral fellowship and then joined the faculty at the Yale Child Study Center, Yale University School of Medicine. At Yale, Celine worked closely with Drs. Sara Sparrow and Domenic Cicchetti investigating adaptive behavior profiles in Autism Spectrum Disorders. She became the Training Director and then Clinical Director for the Yale Autism Program, specializing in diagnostic evaluations of individuals with autism