Diagnosing Autism
In order to determine whether a child meets criteria for a diagnosis of autism, a psychologist, working individually or as part of a team, collects information about the child’s early development and current skills. The emphasis is on collecting information about the child’s communication skills, social interactions and play.
·
Information is
collected from multiple sources, with the primary source of
information being the child’s parents.
·
If the child is
participating in early intervention services, the providers
(e.g., speech-language therapist, occupational therapist,
preschool teacher) working with the child are also asked to
describe the child’s skills.
·
Standardized
testing instruments are used to obtain information about the
child’s cognitive development (e.g., Mullen Scales of
Early Learning, Stanford-Binet Intelligence Scale: Fourth
Edition, Leiter International Performance Scale-Revised) and
adaptive functioning (e.g., Vineland Adaptive Behavior
Scales).
·
A structured
interview (Autism Diagnostic Interview, by Catherine Lord at
the University of Chicago), structured play interaction
scale (Autism Diagnostic Observation Schedule-Generic, by
Catherine Lord at the University of Chicago), or a behavior
checklist (e.g., CARS, TEACCH program at Chapel Hill in
North Carolina) may be used to obtain specific information
about deficits in the areas of socialization, communication,
and play and interests.
·
Observations of
the child across contexts may provide information about the
child’s interests and his/her ability to interact with
others.
After collecting information from multiple sources, the psychologist determines whether the child meets all of the criteria for a diagnosis of autistic disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) provides guidelines that psychologists use to determine whether people have psychiatric disorders. The DSM-IV lists criteria which an individual must exhibit in order to qualify for a particular disorder (e.g., mental retardation, autistic disorder, learning disabilities). The criteria for autistic disorder fall into three general areas: socialization, communication, and interests and activities.
Factors to Examine in the Area of Social Interaction
Joint Attention:
Children with autism often fail to exhibit joint attention.
Joint attention involves awareness that another
person is directing one’s attention to an
object/event/place/activity. For example, if an adult is blowing
bubbles, and the child is looking at the bubbles, the child
with autism may have difficulty understanding that an adult
is producing the bubbles. The child’s gaze may be focused
on the bubbles instead of moving from the bubbles to the
adult, in order to anticipate the adult’s actions.
Alternatively, the child may not understand that an
adult is directing his/her attention to an object or place.
When a child exhibits joint attention, the child, the
other person, and the object form a triangle, and the
child’s attention shifts from the other person to the
object and back again.
Limited joint attention may be related to difficulty
with quickly shifting attention from one object/person to
another and to difficulty with attending to and processing
multiple social cues (e.g., eye gaze, point, facial
expression) as these cues change.
Sharing
Experiences: Infants direct their parents’ attention
to objects that they are manipulating by showing or giving
these objects to their parents.
As toddlers and preschoolers, children use various
skills (e.g., calling their parents’ names, pointing to an
object across the room, describing their actions) to share
their experiences with their parents.
Children with autism are less likely than are
children who are typically developing to try to share their
play activities with their parents.
Nonverbal Communication for Social Purposes: Children who have autism are less likely than are typically developing children to use eye gaze, gestures, facial expressions, and body language to communicate their affect and responses to people with whom they are interacting. Eye gaze, or eye contact, is the nonverbal behavior that is used most frequently (correctly or incorrectly) as a marker of children’s interest in interacting with others. This may be because eye contact is easy to observe, and other nonverbal behaviors are more difficult to measure. In studies that examine children’s use of eye contact, children with autism make eye contact as frequently as do typically developing children. However, children with autism are less likely than are typically developing children to use eye contact to initiate or maintain interactions with others.
Factors to Examine in the Area of Communication
Delays in
spoken language: When parents of children with autism
are interviewed, the majority of these parents say that
their child’s language skills were slow to develop. A few parents say that their child
developed language skills in a typical manner until
one-and-one-half or two years of age and then lost the
skills that he or she had learned.
Functions of Language: Typically developing children use language in a wide variety of contexts (e.g., to label, request, share experiences, ask for information, express affection, telling a story). Children with autism often use language in a limited number of contexts and for functional (e.g., making requests, asking for assistance) rather than social (e.g., sharing an experience, joining another’s play) means.
Idiosyncratic Language: Children with autism may exhibit
immediate or delayed echolalia; they
repeat words or phrases that they have heard.
At times, echoing language seems to serve a useful
function by helping children with autism process and
comprehend language. Children
with autism frequently have difficulty understanding
abstract concepts (e.g., friendship) and abstract forms of
language (e.g., pronouns).
Some children with autism learn language by
associating an object or event with a label.
This label may be idiosyncratic rather than one that
has general meaning. For
example, a child may associate taking a break
with using with an Elmo doll and may say “Elmo”
to request a break.
Pragmatic communication: Pragmatic communication refers to social communication skills, the skills that people use to interact with others. Deficits in pragmatic communication are exhibited by children who are nonverbal as well as by children who use spoken language. Children who rely on gestures and other motor actions to communicate may fail to approach others to share experiences or invite others to interact with them. Children who are verbal may fail to initiate interactions with others, maintain conversation topics, monitor their voice volume or rate of speech, and select conversation topics that are of interest to others.
Factors to Examine in the Area of Interests and activities
Idiosyncratic
Play: Unusual play with toys sometimes involves
attending to a specific and minor aspect of a toy.
For example, a child may become absorbed in watching
the arrow of a See ‘N Say toy move in a circle. Play
activities are often repetitive or ritualized.
For example a child who plays with balloons by
sorting them by color and placing them in a straight line
may resist adults’ attempts to help him use the balloons
in a different manner.
Although all children explore sensory aspects of
toys, children with autism sometimes prefer using toys for
sensory stimulation to using toys in a more functional
manner (e.g., building with blocks, rolling a toy car).
Imaginative Play: Children with autism have difficulty understanding the meaning of their social experiences and so are less able than are typically developing children to enact these experiences in play. For example, a child with autism may recognize a doll when he sees it, but he is not likely to spontaneously use the doll as a symbol for himself or someone else.
Unusual Motor
Actions: Some children with autism exhibit repetitive
motor movements (e.g., rocking, hand flapping, spinning)
more frequently than do typically developing children.
In order to qualify for a diagnosis of autistic disorder, a child must exhibit impairments in the areas described above (social interaction, communication, and play and interests) before three years of age. Once the diagnosis of autism has been made, the child’s parents, case manager, and members of the assessment team discuss treatment options and determine which treatment approach will best fit the child’s needs.