DSM IV-TR DIAGNOSTIC CRITERIA FOR AUTISTIC DISORDER

DSM IV-TR DIAGNOSTIC CRITERIA FOR AUTISTIC DISORDER

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 others (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
         
   1. 
      Restricted, repetitive, and stereotyped patterns of behavior, interest, 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
   

1. 
   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, or (3) symbolic or imaginative play.
   

1. 
   The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
   

Early diagnosis and treatment are important to reducing the symptoms of autism and improving the quality of life for people with autism and their families. There is no medical test for autism. It is diagnosed based on watching how the child talks and acts in comparison to other children of the same age. Trained professionals typically diagnose autism by talking with the child and asking questions of parents and other caregivers.

Under federal law, any child suspected of having a developmental disorder can get a free evaluation. The American Academy of Pediatrics recommends that children be screened for developmental disorders at well-child preventive visits before age three.

http://www.psychiatry.org/mental-health/key-topics/autism

The second stage of diagnosis must be comprehensive in order to accurately rule in or rule out an ASD or other developmental problem. This evaluation may be done by a multidisciplinary team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals who diagnose children with autism.

Because ASDs are complex disorders and may involve other neurological or genetic problems, a comprehensive evaluation should entail neurologic and genetic assessment, along with in-depth cognitive and language testing. In addition, measures developed specifically for diagnosing autism are often used. These include the Autism Diagnosis Interview-Revised (ADI-R)17 and the Autism Diagnostic Observation Schedule (ADOS-G).

Still another instrument often used by professionals is the Childhood Autism Rating Scale (CARS). It aids in evaluating the child’s body movements, adaptation to change, listening response, verbal communication, and relationship to people. It is suitable for use with children over 2 years of age. The examiner observes the child and also obtains relevant information from the parents. The child’s behavior is rated on a scale based on deviation from the typical behavior of children of the same age.

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  Modified Checklist for Autism in Toddlers (M-CHAT™)
  
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  1. Does your child enjoy being swung, bounced on your knee, etc.?
  
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  2. Does your child take an interest in other children?
  
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  3. Does your child like climbing on things such as stairs?
  
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  4. Does your child enjoy playing peek-a-boo/hide-and-seek?
  
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  5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or other pretend things?
  
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  6. Does your child ever use an index finger to point, to ask for something?
  
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  7. Does your child ever use an index finger to point, to indicate interest in something?
  
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  8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them?
  
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  9. Does your child ever bring objects over to you (parent) to show you something?
  
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  10. Does your child look you in the eye for more than a second or two?
  
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  11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)
  
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  12. Does your child smile in response to your face or your smile?
  
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  13. Does your child imitate you? (e.g. If you make a face, will your child do so?)
  
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  14. Does your child respond to his/her name when you call?
  
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  15. If you point at a toy across the room, does your child look at it?
  
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  16. Does your child walk?
  
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  17. Does your child look at things you are looking at?
  
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  18. Does your child make unusual finger movements near his/her face?
  
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  19. Does your child try to attract your attention to his/her own activity?
  
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  20. Have you ever wondered if your child is deaf?
  
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  21. Does your child understand what people say?
  
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  22. Does your child sometimes stare at nothing or wander with no purpose?
  
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  23.Does your child look at your face to check your reaction when faced with the unfamiliar?
  

ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps.  Very early indicators that require evaluation by an expert include:

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  no babbling or pointing by age 1
  
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  no single words by 16 months or two-word phrases by age 2
  
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  no response to name
  
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  loss of language or social skills
  
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  poor eye contact
  
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  excessive lining up of toys or objects
  
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  no smiling or social responsiveness.
  

• 
  impaired ability to make friends with peers
  
• 
  impaired ability to initiate or sustain a conversation with others
  
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  absence or impairment of imaginative and social play
  
• 
  stereotyped, repetitive, or unusual use of language
  
• 
  restricted patterns of interest that are abnormal in intensity or focus
  
• 
  preoccupation with certain objects or subjects
  
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  inflexible adherence to specific routines or rituals.
  

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs.  The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing.  Because hearing problems can cause behaviors that could be mistaken for an ASD, children with delayed speech development should also have their hearing tested.

Children with some symptoms of an ASD but not enough to be diagnosed with classical autism are often diagnosed with PDD-NOS.  Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors.

Symptoms:
By 8 to 10 months of age, many infants who go on to develop autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents' displays of anger or affection in typical ways.
It is common – but not universal – for those with autism to have difficulty regulating emotions. This can take the form of seemingly “immature” behavior such as crying or having outbursts in inappropriate situations. It can also lead to disruptive and physically aggressive behavior. The tendency to “lose control” may be particularly pronounced in unfamiliar, overwhelming or frustrating situations. Frustration can also result in self-injurious behaviors such as head banging, hair pulling or self-biting.
When language begins to develop, the person with autism may use speech in unusual ways. Some have difficulty combining words into meaningful sentences. They may speak only single words or repeat the same phrase over and over. Some go through a stage where they repeat what they hear verbatim (echolalia).

Some children and adults with autism tend to carry on monologues on a favorite subject, giving others little chance to comment. In other words, the ordinary “give and take” of conversation proves difficult. Some children with ASD with superior language skills tend to speak like little professors, failing to pick up on the “kid-speak” that’s common among their peers.

Sleep problems are common among children and adolescents with autism and may likewise affect many adults. Because of the constant sensory input that is occurring and the constant flow of information entering the mind.

Many persons with autism have unusual responses to sensory input. They have difficulty processing and integrating sensory information, or stimuli, such as sights, sounds smells, tastes and/or movement. They may experience seemingly ordinary stimuli as painful, unpleasant or confusing.

Some of those with autism are hypersensitive to sounds or touch, a condition also known as sensory defensiveness. Others are under-responsive, or hyposensitive. An example of hypersensitivity would be the inability to tolerate wearing clothing, being touched or being in a room with normal lighting. Hyposensitivity can include failure to respond when one’s name is called. Many sensory processing problems can be addressed with occupational therapy and/or sensory integration therapy.
Pica 

Pica is a tendency to eat things that are not food. Eating non-food items is a normal part of development between the ages of 18 and 24 months. However, some children and adults with autism and other developmental disabilities continue to eat items such as dirt, clay, chalk or paint chips. For this reason, it is important to test for elevated blood levels of lead in those who persistently mouth fingers or objects that might be contaminated with this common environmental toxin.

(1.) Communication: The student displays problems extending into many aspects of the communication process. Language, if present, may lack usual communicative function, content, or structure. Characteristics may involve both deviance and delay in both receptive and expressive language.

(2.) Social participation: The student displays difficulties in relating to people, objects, and events. Often students are unable to establish and maintain reciprocal relationships with people. The capacity to use objects in an age appropriate or functional manner may be ` absent, arrested, or delayed. The student may seek consistency in social events to the point of exhibiting rigidity in routines.

(3.) The repertoire of activities, interests, and imaginative development:

(4.) Developmental rate and sequences: The student may exhibit delays, arrests, regressions in physical, social, or learning skills. Areas of precocious or advanced skill development may also be present. While other skills may develop at normal or extremely depressed rates. The order of skill acquisition frequently does not follow normal developmental patterns.

(5.) Sensory processing: The student may exhibit unusual, repetitive or non-meaningful responses to auditory, visual, olfactory, gustatory, tactile, and/or kinesthetic stimuli. The student's behavior may vary from high levels of activity and responsiveness to low levels.

(6.) Cognition: The student may exhibit abnormalities in the thinking process and in generalizing. Difficulties in abstract thinking, awareness and judgment may be present as well as perseverative thinking and impaired ability to process symbolic information.