Autism is a behaviorally defined developmental disorder that begins in early childhood. Although the diagnosis of autism may not be made until a child reaches preschool or school age, the signs and symptoms of autism may be apparent by the time the child is aged 12-18 months, and the behavioral characteristics of autism are almost always evident by the time the child is aged 3 years.
According to DSM-IV-TR, a diagnosis of autism requires that a child show at least six of specific deficits across the three core areas, and delays in at least one area must be evident by 3 years of age.
The diagnosis of autism is typically made when impairment is significant in all three areas.
Child’s social interaction fit at least two of these descriptions.
- Impaired non verbal behavior such as poor eye contact, facial expressions that do not match the situation, and lack of communicative gestures. Child rarely looks at other people and rarely smiles.
- Remaining aloof, preferring to be alone. Failure to develop friendships which is typical for a child of same developmental level.
- Lacks spontaneous sharing of interests or enjoyment (i.e., joint attention).
Child’s ability to communicate fits at least one of these descriptions.
- Delay in, or the total lack of, the development of spoken language or speech and no attempts to use other modes of communication (e.g., gestures). Child doesn’t talk at all, rarely looks at other people and rarely smiles.
- Child has stereotyped and repetitive echolalic language.
- Lack of developmentally appropriate varied, spontaneous, make-believe or play involving imitation of others’ social behavior. Child doesn’t play pretend play with the toys. He/She just lines them up in the same way every time.
Child’s behavior, interests and activities are rigid, repetitive, and stereotyped and fit at least one of these descriptions.
- Child has an exceptionally intense or focused preoccupation with one or more areas of interest (e.g., trains, building towers with blocks). For example child can play with trains alone for hours. Yet he doesn’t seem to really understand that they are trains. He doesn’t pretend to make them go on the track or have crashes or imagine what the cars are carrying or talk, as he plays alone. He just lines them up in the same way every time.
- Need to follow specific, nonfunctional routines or rituals. For example child lines trains up in the same way every time. He gets very upset if anyone rearranges his trains.
- Child has a tendency to sustain odd play like for example sometimes child also carries a train around with him and rubs it against his chin or waves it in front of his eyes.
To receive the diagnosis
Early parental concerns about the developmental progress of their baby should always be heeded. If a mother expresses anxiety about her baby’s social and emotional responses and perceptual abilities, the professional must be alert to the possibility of autism. Appropriate referral to specialists in normal and abnormal child development may mean that a diagnosis is reached sooner than has been typical in the past. Parents might have to ask for a referral from the family physician who can immediately refer child to multidisciplinary child development clinic for assessment. The professionals who may be involved in the assessment probably include a neurologist, psychologist, developmental pediatrician, speech/language therapist, preschool education specialist. Parents will have to provide a review of the family history, the pregnancy and the child’s behavior and developmental progress.
The diagnosis of autism is unlikely to be made on the basis of one examination, especially if the child is very young. Child might be referred to an audiologist for hearing assessment, a speech or language therapist for assessment of communicative development, an educational psychologist for assessment of developmental level or intelligence or to preschool clinical psychology service or family therapy clinic if the GP suspected emotional problems related to difficulties within the family (which could, of course, resulted from the stresses centered on the child).
The most widely used diagnostic manual for autism spectrum disorders is the Diagnostic Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). However none of these assessments by themselves are sufficient for an authoritative diagnosis of Autism, and referring the child for a succession of specialist assessment can introduce undesirable delay.
Regardless of whether a definite diagnosis of autism is reached, children and their parents can be offered help. The main purpose of diagnosis is to achieve useful ends for people with ASDs themselves and their families and other carers. Diagnosis of Autism can be beneficial as
- It provides lever to parents with which to obtain appropriate education or other intervention for their child.
- Helps parents to make sense of his problems (so that’s why he never looks at anyone, that’s why he lines up the trains.
- It guides parent’s hopes and expectations for their child.
- It helps parents to share their problems and learn from others (by joining a parents’ group, reading, attending conferences, workshops or discussion groups.)
- Protect parents from negative reactions of others (He doesn’t mean to be rude – he is autistic and doesn’t like to smile).
- It helps to facilitate the access to services or funding.