There has been confusion in the autism spectrum community about how a diagnosis is made, especially since the Diagnostic and Statistical Manual of Mental Disorders (DSM) changed the way autism is defined and diagnosed as of May 2013.
April is World Autism Awareness Month and presents a great opportunity to clarify how a diagnosis is made.
Instead of 3 different diagnoses (autism, Asperger’s disorder and pervasive developmental disorder not otherwise specified), we now use one diagnosis – autism spectrum disorder (ASD) and define where on the spectrum a child is at any point, based on how much support he needs.
Level 1 is considered the highest functioning. It indicates that a child requires support. Level 2 requires substantial support and Level 3 requires very substantial support.
To make an ASD diagnosis, a child must have significant difficulties in 2 areas of functioning: “social communication/interaction” and “restricted/repetitive behaviors.”
Rebecca Lieb, PhD
Difficulty with “social communication/interaction” means a child:
- Struggles with interacting and communicating for social purposes.
- Does not do well with back-and-forth social interactions (appropriate conversations, sharing interests, initiating social interaction).
- Lacks understanding and use of non-language strategies to communicate (maintaining eye contact, recognizing facial expressions/body language, using gestures).
- Has trouble developing and keeping relationships beyond the family (making/keeping friends, playing creatively/imaginatively with others, and showing interest in other children).
A child who demonstrates “restricted/repetitive behaviors” may:
- Flap his hands, repeat lines from TV shows, line up toys in a certain order or display other repetitive actions.
- Have a strict need for routine and rituals. For example, the child may insist on doing the same things in the same order every day, need food prepared a very particular way, or ask questions repetitively despite knowing the answer. She may have a meltdown when transiting between activities and have greeting rituals.
- Have highly restricted, fixated interest in particular topics or objects. For example, the child may only want to talk about, play with or watch TV shows about dinosaurs. He may be obsessed about collecting found items. Sometimes, the object of interest may be unusual, such as the child who is very focused on smoke detectors.
- Be extremely sensitive to certain noises or textures or indifferent to pain, heat or cold. He may be excessive about smelling or touching objects or have a fascination with things that light up or spin.
As you can see, there is a lot we look at when considering an ASD diagnosis and ASD can look very different depending on the child. Keep in mind that having just one of the symptoms noted above doesn’t automatically mean your child has ASD.
A child with sensory sensitivities doesn’t always receive an ASD diagnosis. Also, a child who doesn’t have good eye contact could have ASD, but could also be inattentive/distractible or anxious.
The most important thing to do if you’re concerned your child may be demonstrating signs of ASD is to talk to your pediatrician.
For families of younger children, you can fill out the Modified Checklist for Autism in Toddlers (M-CHAT), a free 20-item checklist that will help your pediatrician decide if further evaluation for ASD is appropriate.
You can find information about appropriate developmental milestones on the CDC’s Learn the Signs. Act Early campaign website.
Autism Speaks also has information about signs and symptoms of ASD on its website.
Increased awareness and understanding means more support and advocacy for children with ASD and their families.
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