A diagnosis of ASD is made by a medical doctor or psychologist. Other professionals (speech-language pathologists, occupational therapists, teachers) often are among the first to suspect ASD but cannot make a formal diagnosis. Rather, we can collect information to help the doctor make a diagnosis.
Ultimately, to have a diagnosis of ASD, an individual needs to meet the criteria outlined in the Diagnostic and Statistical Manual. The DSM-V criteria is available on numerous sites, with credit being given to www.autismspeaks.org for the following summary:
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper-or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
|Severity Level||Social Communication||Restricted, repetitive behaviours|
“Requiring very substantial support”
|Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches||Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.|
“Requiring substantial support”
|Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.||Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.|
|Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.||Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.|
You may be wondering how the DSM-V criteria translate into everyday life and everyday English!
Here are features that we look for during assessments, which might be helpful if you are suspecting your child has autism or some features of it:
Behaviour or Sensory-Based Concerns:
- Gets upset very easily, or tantrums seem to be worse than expected for his age, or gets upset over unusual things or needing things to be a certain way
- Difficult to console
- Has odd hand movements or posturing, such as flapping, holding objects to look at them out of the corner of his eye
- Does not play with toys in a typical way (carries them around, lines them up, focused on letters or numbers rather than playing with a toy)
- Is busy, always on the go; seems to crave movement
- Oversensitive to light, sound or texture
- Not a great sleeper
- Only eats a few foods
- Inconsistently responds when you talk to him; seems to have ‘selective hearing’
- Prefers to play alone, or prefers to engage in gross motor play with others
- Less interested in sitting to listen to books or engage in other activities on someone else’s terms
- Doesn’t look at people as much as other people and might look at objects for a long time
- Not interested in other children, or may approach them and then not know what to do
- Doesn’t point and look at items or share with others
- Quiet as a baby and did not babble much
- Words and sentences are behind (no words by 16 -18 months or short sentences by 24 months)
- Has words and then stops using them or seems to not be learning new words
- Repeats or echoes words or might repeat full scripts from movies or shows
- Has a different tone of voice or prosody when speaking
- Parents feel that something is ‘different’ but can’t identify what it is
If you have concerns regarding your child’s development, do not wait to get a professional opinion. It is better to be overly cautious and have your fears allayed if your child’s development is fine, than to lose valuable time. We can help.