Many family members report that they “just knew something was wrong.” In many cases they asked their physician who described the problem as a “phase” the child was going through. It is important that parents follow their instincts. If a parent suspects a child is different and is having difficulty coping with his environment, there should be a further study to evaluate what behavioral characteristics exist that may lead a professional to a proper diagnosis. Families should seek the advice of a trained expert — and if autism is suspected, it is critical that the professional be familiar with recognizing and supporting a person with autism.
In the case of autism, there are no medical tests to establish a diagnosis and often the unusual behaviors that a person with autism displays may not be present until the age of 18 months to 3 years.
Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions. They may have difficulty initiating and/or maintaining a conversation. Their communication is often described as talking at others instead of to them. (For example, a monologue on a favorite subject that continues despite attempts by others to interject comments).
People with autism also process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may also exhibit some of the following traits:
- Insistence on sameness; resistance to change
- Difficulty in expressing needs, using gestures or pointing instead of words
- Repeating words or phrases in place of normal, responsive language
- Laughing (and/or crying) for no apparent reason; showing distress for reasons not apparent to others
- Preference to being alone; aloof manner
- Difficulty in mixing with others
- Not wanting to cuddle or be cuddled
- Little or no eye contact
- Unresponsive to normal teaching methods
- Sustained odd play
- Spinning objects
- Obsessive attachment to objects
- Apparent over-sensitivity or under-sensitivity to pain
- No real fears of danger
- Noticeable physical over-activity or extreme under-activity
- Uneven gross/fine motor skills
- Non-responsive to verbal cues; acts as if deaf, although hearing tests in normal range
The following is the criteria cited in the DSM IV-TR and used by trained professionals to identify whether an individual can be diagnosed with autism:
Diagnostic Criteria for 299.00 Autistic Disorder
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 gesture 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 and restricted 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 manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)
d. persistent preoccupation with parts of objects
B. 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.
C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.