Diagnosis of Autism

Parents are usually the first to notice unusual behaviors in their child. Their baby seemed "different" from birth. The first signs of autism may appear in children who had been developing normally. When an affectionate, babbling toddler suddenly becomes silent, withdrawn, violent, or self-abusive, something is wrong. Unfortunately, friends and relatives can delay the parents in seeking help. Statements such as "He'll grow out of it," or "Every child is different," can assure parents that there is nothing really wrong with their child.

Autism is a type of Pervasive Developmental Disorder. A diagnosis of autistic disorder is made when an individual displays 6 or more of 12 symptoms across three major areas: social interaction, communication, and behavior. When children display similar behaviors but do not meet the criteria for autistic disorder, they may receive a diagnosis of Pervasive Developmental Disorder-NOS (PDD not otherwise specified).

The following are the diagnostic criteria for Autistic Disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV):

A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3).

• Qualitative impairment in social interaction, as manifested by at least two of the following:

  • Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction.
  • Failure to develop peer relationships appropriate to developmental level.
  • A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people).
  • Lack of social or emotional reciprocity ( not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids ).
• Qualitative impairments in communication as manifested by at least one of the following:
  • Delay in or total lack of the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime.
  • In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
  • Stereotyped and repetitive use of language or idiosyncratic language.
  • Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
• Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least two of the following:
  • Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
  • Apparently inflexible adherence to specific, nonfunctional routines or rituals.
  • Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements).
  • Persistent preoccupation with parts of objects.

Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

1. Social interaction
2. Language as used in social communication
3. Symbolic or imaginative play

The disturbance is not better accounted for by Rett Syndrome or Childhood Disintegrative Disorder.