Because there are no biological markers for autism, screening must focus on behavior. The diagnosis is made by an autism specialist (typically a physician or a psychologist) who takes into account the child's complete medical and behavioral history, observation of the child's behavior in different settings, and ruling out other problems that may present the same symptoms. To learn more about the most common coexisting disorders with ASD, click here.
It is also recommended that the formal diagnosis of autism is made by a physician or clinician who has extensive experience with, or specializes in, Autism Spectrum Disorders, such as a pediatric neurologist, a developmental pediatrician, a child psychologist or child psychiatrist. To read more about diagnosis, click here.
If you, as a parent, suspect that something is wrong with your child's development, don't wait: speak to your pediatrician about getting your child screened for autism.
The main diagnostic reference of mental health professionals in the U.S is Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV, 1994).
1. Autistic Disorder (299.00 DSM-IV)
2. Asperger's Disorder (299.80 DSM-IV)
5. Rett's Disorder (299.80 DSM-IV)
4. Childhood Disintegrative Disorder (299.10 DSM-IV)
Autistic Disorder (299.00 DSM-IV)
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 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) 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)
(d) Lack of social or emotional reciprocity
(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 gestures 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 one of the following:
(a) Encompassing preoccupation with one or more stereotyped 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 object
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(a) Social interaction
(b) Language as used in social communication
(c) Symbolic or imaginative play
C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
Asperger’s Disorder (299.80 DSM-IV)
A. 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 to other people)
(4) Lack of social or emotional reciprocity
B. 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, non-functional 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
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
Rett’s Disorder (299.80 DSM-IV)
A. All of the following:
(1) Apparently normal prenatal and prenatal development.
(2) Apparently normal psychomotor development through the first 5 months after birth.
(3) Normal head circumference at birth
B. Onset of all of the following after the period of normal development:
(1) Deceleration of head growth between ages 5 and 48 months.
(2) Loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing).
(3) Loss of social engagement early in the course (although often social interaction develops later).
(4) Appearance of poorly coordinated gait or trunk movements.
(5) Severely impaired expressive and receptive language development with severe psychomotor retardation
Childhood Disintegrative Disorder (299.10 DSM-IV)
A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.
B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
(1) Expressive or receptive language.
(2) Social skills or adaptive behavior.
(3) Bowel or bladder control.
(4) Play.
(5) Motor skills.
C. Abnormalities of functioning in at least two of the following areas:
(1) Qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity).
(2) Qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play).
(3) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms
D. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.
PDD-NOS (299.80 DSM-IV)
The essential features of PDD-NOS are severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills; and stereotyped behaviors, interests, and activities. The criteria for Autistic Disorder are not met because of late age onset; atypical and/or sub- threshold symptomotology are present.
This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypical Personality Disorder, or Avoidant Personality Disorder. For example, this category includes "atypical autism"- presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or sub-threshold symptomatology, or all of these.
Autism spectrum disorders (ASD, link back to ASD) can co-exist with mental health conditions such as:
- ADD
- ADHD
- Anxiety Disorder
- Depression
- Obsessive-Compulsive Disorder
- Sleep disorders
- Oppositional Defiant Disorder
- Reactive Attachment Disorder
- Social Phobia
- Tourette’s Disorder (vocal and motor tics)
- Enuresis and Encopresis (bed wetting and fecal soiling)
It requires a skillful professional who has experience in ASD to distinguish characteristics that are autism versus those associated with the co-existing mental health disorders.