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This page contains information and summaries of published research that are intended for people with professional training in mental health.  We urge caution since it may be difficult to know how to interpret the information without advanced training in psychology or psychiatry.

We recommend that readers interested in information intended for the general public check other areas of this web site (such as Info for Adults or Info for Children).  They contain similar information, but in a more readable form.  Also, elsewhere we have provided links to other websites that we feel may be helpful.

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 to 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.

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The information posted on this site reflects our understanding of peer-reviewed research and generally accepted principles in psychology.  It is not intended to be used for self-treatment or as a substitute for individualized assessment and treatment by a licensed professional, and should not be construed as professional advice.

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