Autism Diagnosis based on the DSM-V
Autism Diagnosis is formally based on 5 criteria on the Diagnostic and Statistical Manual of Mental Disorders for Autism Spectrum Disorder (DSM-V). This version was introduced in 2013. The diagnosis will be labelled Autism Spectrum Disorder (ASD). The 5 criteria that must be met for an autism diagnosis includes:
- Social Communication & Interaction Deficits
- Restricted, repetitive patterns of behaviour, interests, or activities,
- Difficulties MUST be present in the early developmental years even if they were identified later or child now has coping strategies to “hide” the deficits
- Symptoms are present from the early developmental period even if not identified until later in childhood
- Deficits cannot be better explained by intellectual disability or global developmental delay.
Social Communication and Interactional Signs of Autism Spectrum Disorder (ASD)– Criteria 1 for an Autism Diagnosis on the DSM-V.
These concerns need to be:
- persistent or ongoing issues and
- impacting on more than one area of a child’s life (e.g., family life and ability to cope in a learning environment (child care, Kindy, school).
How these Social Communication and Interactional deficits in Autism present may change depending on the child’s age. However, the DSM-V notes that the Social communication and interactional deficits may include:
Deficits in social-emotional connections with others that contributes to an Autism Diagnosis on the DSM-V.
a. Unusual ways of interacting socially and /or poor back-and-forth skills during attempted conversations;
b. Limited sharing of interests, emotions, or feelings (e.g., happy to play with a favourite toy on their own, rarely or do not seek out adults, siblings or peers, may not seek out cuddles if they hurt themselves)
c. Poor at starting interactions (e.g., won’t ask for help, may not look at a person to indicate they need something)
d. Poor responding to social interactions (e.g.. doesn’t answer / respond to questions, or say Hi/ Bye to people, doesn’t turn or come when name called).
Deficits in Nonverbal Communication Skills contributes to a Diagnosis of Autism
a) poorly connected verbal (talking) and nonverbal (gestures/pointing) communication;
b) Poor eye contact and body language
c) Delays or disorders of understanding and use of gestures (e.g., they do not look to what you are pointing at or may not respond to gestures such as “come here”; they don’t use no pointing themselves to show things or to respond to questions (e.g., where’s your nose).
d) Total lack of facial expressions and nonverbal communication (rarely smile in response to play, or will smile and laugh seemingly randomly).
Deficits in Developing, Maintaining, and Understanding Relationships contributes to a Diagnosis of Autism.
a) difficulties adjusting behaviour to suit various social contexts (loud voice or screaming in any environment, dislikes movement restricted even in busy areas)
b) difficulties in sharing imaginative play (doesn’t pretend to feed teddy with a spoon, pretend to drive a toy car as if it is going from one point to another)
c) problems in making friends;
d) no interest in peers.
Restricted, repetitive patterns of behaviour, interests, or activities - Criteria 2 for an Autism Diagnosis on the DSM-V.
A child must have had or continues to present with at least two of the following”
Stereotyped or repetitive body movements or use of objects
This can include:
- Simple motor stereotypes such as lining up toys or flipping objects.
- Stereotyped or repetitive speech/vocalisations e.g., echolalia where a child just repeats back what they heard but it carries no meaning e.g.., parent says “Hallo Tommy” and Tommy repeats back “Hallo Tommy”.
- The child has vocalisations, words or phrases they personally repeat a lot (i.e., idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal & nonverbal behaviour.
This can include:
- gets very upset at little changes,
- finds moving between tasks or places hard (transitions),
- rigid thinking patterns (has to do the something the same way as they can’t see there might be another way of doing the same thing).
- rituals around meeting and farewelling people
- need to take the same route or eat same food all the time).
Highly restricted, fixated interests that are abnormal in intensity or focus
This can include:
- strong attachment to or preoccupation with unusual objects (e.g., a hair brush),
- excessively circumscribed or perseverative interest (e.g, wants to do the same thing with the same object over and over. An example might be turning light switches on and off continually and they will always look for the light switches in what every environment they are in).
Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment
This means they may over react to even small exposures (hyper-) or not even notice (hypo-) when exposed to something. This might include:
- apparent indifference to pain or temperature,
- screams or becomes upset in response to specific sounds or feelings of things (e.g., rougher feeling clothes).
- excessive smelling or touching of objects,
- visual fascination with lights or movement.
Symptoms are not the result of accident, injury and have been present from birth - Criteria 3 for an Autism Diagnosis on the DSM-V.
Symptoms must be present in the early developmental period. Sometimes they may not have been obvious in the early baby or infant stages. The autism symptoms may not become fully obvious until social demands put pressure on the areas of deficits. For example, the skills to build peer relationships are not as important until a child begins to more independently interact with other children. Echolalic speech will not be apparent until the child starts talking. Sometimes deficits are hidden by learned strategies in later life but are still present.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. - Criteria 3 for an Autism Diagnosis on the DSM-V
All of the above symptoms need to be notable enough to be stopping the child and family from interacting functionally with their community. Socially, families may find that the need for the child to stick to routines causes them to be limited in what they can do or even house bound. The child’s insistence on only eating a limited range of foods may be impacting on their nutrition or restricting growth. The child’s ability to attend child care, Kindy or school may be reduced or prohibitive.
Remember some children may have another diagnosis in addition to Autism. Some known medical or genetic conditions are frequently associated with an Autism diagnosis. Sometimes these conditions can make the recognition of Autism signs more difficult. Children can have more than one diagnosis. For example, a child may have Autism and attention deficit hyperactivity disorder (ADHD). They may have Autism and a hearing impairment.
Clinical issues and symptoms are not better explained by intellectual disability or global developmental delay - Criteria 4 for an Autism Diagnosis on the DSM-V
Intellectual disability and autism spectrum disorder frequently co-occur and some of the symptoms can seem similar. To obtain a diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. This is because a key criterion of autism is reduced social communication skills. No matter what level of intellectual ability a child presents with, their social communication will need to be “worse” than their general ability for an autism diagnosis to be given.
Autism Spectrum Disorder for one child will functionally look different to another. This is because some children will have more features of one criteria than another criteria. Sometimes the impact of family life and development is mild as all the symptoms are present but not stopping the child significantly from to participating in day to day activities. For other children autism is debilitating. This is why the DSM-V has introduced severity levels.
Hence a child will receive a diagnosis of autism with a severity rating of 1, 2, or 3.
How the symptoms for each criteria looks may also change depending on the child’s age (link back to may browse page that has the age criteria buttons.0.
Reference: Many, W. Testing the Construct Validity of Proposed Criteria for DSM-5 Autism Spectrum Disorder
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