How is Autism diagnosed?

Posted in: General- Sep 09, 2009 1 Comment
To qualify for a diagnosis, a person must have 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, manifest by at least two of the following:
A. Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures and gestures, to regulate social interaction
B. Failure to develop peer relationships appropriate to developmental level
C. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest)
D. Lack of social or emotional reciprocity
Qualitative impairment in communication, as manifest 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, or social imitative play appropriate to developmental level
3. Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one 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.
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 Retts Disorder or childhood disintegrative disorder.

Worried about your child?  The simplest way for a parent to determine whether their child may require further screening for autism  is to use the list of criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.  It is easy enough for even parents to be able to evaluate their children within a reasonable degree, allowing for further medical assessment and intervention.  The list of criteria is available at the end of this entry.

Additional methods of screening are available, the simplest for toddlers being the Checklist for Autism in Toddlers (CHAT) typically issued by a GP, family physician or pediatrician at the child’s 18 month checkup.  There is also the M-CHAT, or Modified Checklist for Autism in Toddlers. Both tools are freely available for use and are recommended standards by which to screen.

Beyond screening, the tools for proper assessment and diagnosis are to be used by a trained psychologist and preferably a BCBA- Board Certified Behavioural Analyst.  Some of these tools are the CARSGARS, and Vineland Adaptive Behavior Scale, and the ABLLS test to measure academic capabilities if applicable.

A proper behavioural, developmental, and psychological assessment takes a few hours with the child as well an interview with the parents to determine where the child’s weaknesses, strengths, and problem behaviours lie.  Following the assessment, parents should expect a detailed report as well as an explanation of the results by the clinical psychologist who conducted the assessment.

The American Psychiatric Association guidelines are as follows:

A. To qualify for a diagnosis, a person must have 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, manifest by at least two of the following:

  • A. Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures and gestures, to regulate social interaction
  • B. Failure to develop peer relationships appropriate to developmental level
  • C. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest)
  • D. Lack of social or emotional reciprocity

2. Qualitative impairment in communication, as manifest 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, or social imitative play appropriate to developmental level

3. Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one 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

3. Symbolic or imaginative play

C. The disturbance is not better accounted for by Retts Disorder or childhood disintegrative disorder.

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One Response to “How is Autism diagnosed?”

  1. Early Autism Recognition = Hope | MuslimMatters.org says:

    [...] both of our pediatricians should have done was use the MCHAT, or Modified Checklist for Autism in Toddlers, which is a tool for screening children and determining which ones should be directed towards [...]