What Is Autism Spectrum Disorder?

Criteria for Autism Diagnosis

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Before May 2013, there were five separate autism spectrum diagnoses. Today, according to the American Psychiatric Association's diagnostic manual, the DSM-5, there is just one Autism Spectrum Disorder. Whether your autism is very severe or relatively mild, whether your diagnosis was Asperger syndrome or Autistic Disorder, you are now grouped under the same umbrella diagnosis. If you already have an autism spectrum disorder diagnosis—even one that no longer exists in the DSM—you are still considered to be autistic.

How the DSM (Diagnostic Manual) Works

The DSM-5, sometimes called the "Bible" of mental health diagnosis, is used to determine who gets services, what kind of services they get, and whether or not they are eligible for particular forms of education. If your child is evaluated by an experienced professional who feels she fits these criteria, she will receive both a diagnosis and a set of resources including therapies, special education services, and other options that may be available through your state or county.

Here are the basic diagnostic criteria for the DSM-5 Autism Spectrum Disorder:

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2 .Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat the same food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

What to Do if Your Child Seems to Fit the Criteria for Autism

The criteria for autism may seem pretty straightforward, and you may feel sure that your child is autistic. In fact, however, there are some specific tests that help practitioners determine whether symptoms rise to the level of autism. It's also possible that autism-like symptoms are actually caused by something other than autism; hearing loss, anxiety, speech issues, and even ADHD can be mistaken for autism.

If you're worried, though, it's a very good idea to seek a screening and evaluation. A screening is usually provided by your pediatrician. While it's not a diagnosis, it can help your doctor to determine whether a formal evaluation is appropriate.

An evaluation is a process that involves several professionals and includes an array of tests and interviews. Your pediatrician, school psychologist, or Autism Society chapter can help you find an evaluation team that is experienced and knowledgeable.

Sources:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

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