Diagnosing autism

From Autism Wiki

Every diagnostic appointment with a specialist represents the convergence of three stories: 1)the child, who comes to the appointment with a certain history and in a certain frame of mind, more or less willing to interact; 2)the parents, who come with their own story and their own willingness or ability to relate that story; and 3) the diagnostician, who may be a physician, child psychologist or special educator, who also comes with their own training and experience, and the willingness or ability to listen to or elicit that story. Autism is a clinical diagnosis, based on history and observations. It cannot be confirmed with the certainty of disorders like juvenile diabetes or Down syndrome. There are autism-specific diagnostic tests, but they, too, rely on excellent observations of a child's behaviors at a particular point in time.

Physicians use the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as listed below.

Educators may use different criteria in order to diagnose "educational autism."

[edit] DSM definition

Autism is defined in section 299.00 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

1. 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:
      1. 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
      2. failure to develop peer relationships appropriate to developmental level
      3. 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)
      4. lack of social or emotional reciprocity
   2. qualitative impairments in communication as manifested by at least one of the following:
      1. 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)
      2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
      3. stereotyped and repetitive use of language or idiosyncratic language
      4. 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 one of the following:
      1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
      2. apparently inflexible adherence to specific, nonfunctional routines or rituals
      3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
      4. persistent preoccupation with parts of objects
2. 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.
3. The disturbance is not better accounted for by Rett syndrome or Childhood Disintegrative Disorder.

These are rules of thumb and may not necessarily apply to all diagnosed autistics.