Diagnosing Autism Spectrum Disorders is done using the "Bible" for diagnosing psychiatric and developmental disorders, the Diagnostic and Statistical Manual, now in it's 4th edition (frequently referred to as the DSM IV.) A physician or child psychologist will be sure that the child conforms to the guidelines of the DSM IV before diagnosis. It is important that a diagnosis is thorough, since autism is often co-morbid with other disabilities, including ADHD (Attention Deficit Hyperactivity Disorder,) anxiety disorders and Obsessive Compulsive Disorder (OCD.)
There are also other disorders that may have some of the same characteristics, such as delayed language and poor social skills. Specifically, Rhett's Disorder (primarily among females) and Childhood Disintegrative Disorder need to be eliminated. The most important part of diagnosis is how it may shape the instructional or therapeutic strategies chosen to help the identified child.
The DSM IV requires that the child exhibit a total of six (or more) items from three categories with at least two from the first category, and at least one each from the other two.
(A) qualitative impairment in social interaction, as manifested by at least two of the following:
- marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
- failure to develop peer relationships appropriate to developmental level
- 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)
- lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
(B) qualitative impairments in communication as manifested by at least one of the following:
- 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)
- in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- stereotyped and repetitive use of language or idiosyncratic language
- lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- apparently inflexible adherence to specific, nonfunctional routines or rituals
- stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
- persistent preoccupation with parts of objects
(II) 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.
(Diagnostic and Statistical Manual, Fourth Edition, 1996. American Psychiatric Association.)
Screening Instruments
Although the DSM IV is the gold standard, psychologists, child psychiatrists and physicians often use a number of standardized instruments to collect information for the diagnosis. Among them are:
- Autism Behavior Checklist (ABC) Teacher or Parent Input collected through a checklist.
- Checklist for Autism in Toddlers (CHAT) Limited checklist of symptoms by Baron Cohen, the English godfather of Autism research.
- Childhood Autism Rating Scale (CARS) A screening instrument that requires some training. It may over-identify children with delayed language.
- Gilliam Autism Rating Scales, edition 2 (GARS-2) A normed instrument in a structured interview format.
Other Assessments
Intelligence Testing: An individual intelligence test should be administered at some point by a certified professional. Read more here:
Speech and Language Screening:
Since language is impacted by autism, a thorough speech and language assessment is valuable to understanding treatment and educational challenges. The following are common tools
