Autism, which affects thought, perception and attention, is not just one disorder with a well defined set of symptoms.
Autism is a broad spectrum of disorders that ranges from mild to severe.
In addition, the behavior usually occurs across many different situations and is consistently inappropriate for their age.
In the diagnostic manual used to classify disabilities, the DSM-IV (American Psychiatric Association, 1994),
“autistic disorder” is listed as a category under the heading of:
“Pervasive Developmental Disorders.”
A diagnosis of autistic disorder is made when an individual displays:
6 or more of 12 symptoms listed 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).
Problems in social relatedness and communication. (Difficulty in mixing with other children; prefers to be alone; aloof manner; difficulty in expressing needs; uses gestures or pointing instead of words ).
Abnormal responses to one or a combination of senses; such as sight, hearing, touch, balance, smell, taste, reaction to pain.
Sustained odd play. Uneven gross/ fine motor skills. Not responsive to verbal cues; acts as deaf. Little or no eye contact.
Insistence on sameness; resist changes in routine.
Noticeable physical over activity or extreme under activity. Tantrums; displays extreme distress for no apparent reason.
Speech and language absence or delays. Inappropriate laughing and giggling. Echolalia (repeating words or phrases in place of normal language).
Abnormal ways of relating to people, objects and events. (Inappropriate attachment to objects; don't seek cuddling )
An aspect of language that tends to be disturbed in autistic people has to do with knowing how to use language appropriately and in context.
That includes knowing how to hold a conversation, thinking about what the other person in a conversation understands and believes, and tuning into the meta:
linguistic signals of the other person, such as facial expression, tone of voice and body language. It is important to remember that communication is as much nonverbal as it is verbal, and autistic people have great difficulty understanding nonverbal language
The following is from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV):
DIAGNOSTIC CRITERIA FOR 299.00 AUTISTIC DISORDER
A. 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)
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
a) 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
b) failure to develop peer relationships appropriate to developmental level
c) 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)
d) lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
(2) qualitative impairments in communication as manifested by at least one of the following:
a) 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)
b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
c) stereotyped and repetitive use of language or idiosyncratic language
d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(3) restricted repetitive and stereotyped patterns of behavior,interests and activities, as manifested by at least two of the following:
a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
b) apparently inflexible adherence to specific, nonfunctional routines or rituals
c) stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole body movements)
d) persistent preoccupation with parts of objects
B. 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
(2) symbolic or imaginative play
C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder
Diagnostic Criteria For 299.80 Asperger's Disorder Diagnosing and Evaluating Autism
Autism and related disabilities, such as PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified), and Asperger's Syndrome are difficult to diagnose, especially in young children where speech and reasoning skills are still developing.
It is essential that the process of diagnosing Autism & related disabilities include the assessment and evaluation of a child's development, communication, and social skills.
Evaluation and assessment are ongoing processes. Once a diagnosis has been reached, this process should be repeated periodically.
We included brief descriptions of some medical tests and evaluations that may be ordered for children suspected of having autism or a related disability.
The following medical tests may help with diagnosis and possibly suggest changes in the intervention or treatment strategy.
Hearing: Various tests such as an Audio gram and Typanogram can indicate whether a child has a hearing impairment. Audiologists, or hearing specialists, have methods to test the hearing of any individual by measuring responses such as turning their head, blinking, or staring when a sound is presented.
Electroencephalogram (EEG): An EEG measures brain waves that can show seizure disorders.In addition, an EEG may indicate tumors or other brain abnormalities. An electroencephalogram (EEG) is a recording which shows the variations in electrical potentials at a number of scalp sites.
Inside the brain, neurons produce their own electrical fields. The electric fields are measured in units of micro volts. It is thought that an unhealthy brain will have large changes in the electrical potential compared to the potentials produced by a healthy brain.
However, in order to observe an unhealthy brain it must be compared to the same brain when it was healthy. So, for example, to measure the difference between a brain undergoing a seizure, the EEG must last long enough for seizure to occur. Often a video EEG is done over a period of a day or a week. This form of measuring brain activity is noninvasive (doesn't require any surgical cuts) and it is relatively inexpensive. This method gives numerical results. The patterns of the numbers are then used to determine whether or not the brain is healthy. The results can also be used to determine which section of the brain is causing problems. Additional tests will likely be needed to make an accurate diagnosis of these conditions.
Metabolic Screening: Blood and urine lab tests measure how a child metabolizes food and its impact on growth and development. Some Autism spectrum disorders can be treated with special diets.
Magnetic Resonance Imaging (MRI): An MRI involves using magnetic sensing equipment to create an image of the brain in extremely fine detail. Sometimes children are sedated in order to complete the MRI.
Computer Assisted Axial Tomography (CAT SCAN): An X-Ray tube rotates around the child taking thousands of exposures that are sent to a computer where the X-rayed section of the body is reconstructed in great detail. CAT Scans are helpful in diagnosing structural problems with the brain.
Genetic Testing: Blood tests look for abnormalities in the genes which could cause a developmental disability.
Many children with Autism and related disabilities require some form of special therapy. Evaluation can help determine the potential benefits of therapy.
Speech - Language Therapy: It is recognized that autistic children have difficulties with language,but it is clear that traditional approaches emphasizing mastery of the formal properties of language are largely inappropriate: training children to speak is not going to bring about a transformation of their behavior. The autistic child needs to learn not so much how to speak as how to use language socially to communicate. Some autistic children are nonverbal, and some who are verbal may also have deficiencies or are unable to use language in a meaningful way.
A Speech Pathologist who specializes in the diagnosis and treatment of language and speech disorders,can help a child learn how to effectively communicate.
Occupational Therapy: Commonly focuses on improving fine motor skills, such as brushing teeth, feeding, and writing, or sensory motor skills that include balance (Vestibular System), awareness of body position (Proprioceptive System), and touch (Tactile System). After a therapist identifies a specific problem, therapy may include sensory integration activities such as: massage, firm touch, ex..
Physical Therapy: Specializes in developing strength, coordination and movement. Therapists work on improving gross motor skills. This therapy is concerned with improving function of the body's larger muscles through physical activities including exercise.
Direct observation, interaction, and interviews assessments: Information about a child's emotional, social, communication, and cognitive abilities is gathered through child directed interactions, observations in various situations, and interviews of parents and care givers. Parents and family members should be actively involved throughout these assessments. What actually occurs during a specific assessment depends on what information parents and evaluators want to know.
Functional assessments: Aim to discover why a challenging behavior (such as head banging) is occurring. Based on the premise that challenging behaviors are a way of communicating, functional assessment involves interviews, direct observations, and interactions to determine what a child with autism or a related disability is trying to communicate through their behavior. Once the purpose of the challenging behavior is determined, an alternative, more acceptable means for achieving that purpose can be developed. This helps eliminate the challenging behavior.
Play based assessments: Involve adult observation in structured and unstructured play situations that provide information about a child's social, emotional, cognitive, and communication development. By determining the child's learning style and interaction pattern through play based assessments, an individualized treatment plan can be developed.
Standardized instruments are formal methods used to determine different levels of cognitive development.
Rating Scales & Developmental Inventories: Vineland Adaptive Behavior Scales and Childhood Autism Rating Scale are examples of standardized tests that measure a child's general developmental skills, including socialization skills and coping skills. Scores are based on parent interviews and evaluator observations.
Intelligence Tests (IQ): Stanford-Binet Intelligence Scale and other intelligence tests attempt to determine an individual's intelligence based on standardized criteria. The results of educational tests are often provided in composite scores. On the Wechsler Intelligence Scale for Children , (WISC-III), three scores are usually provided:
Verbal IQ (VIQ), Performance IQ (PIQ), and a Full Scale IQ (FSIQ). Each of these tests provides a composite score. Both the Verbal and Performance IQ scores are composites of five different sub tests. Intelligence Tests (IQ) do not necessarily measure an autistic child true abilities and unique potential to develop.
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