Autism Spectrum Disorders

What are autism spectrum disorders? (ASD)

Autism Spectrum Disorder is a pervasive, neurological disorder consisting of delays in the area of social behavior and the presence of repetitive, stereotyped behavior. Until the revision of the diagnosis in 2013, delays in language development were considered part of the diagnosis as well.

Early indicators of autism include:

You can use the Modified Checklist for Autism in Toddlers (M-CHAT) located at Autism Speaks’ website to see if you want to have further conversations with your pediatrician. Please be advised that this is not a comprehensive or diagnostic list of early indicators.

  • Lack of gestures, pointing, and/or reaching by 12 months to communicate wants and needs
  • Child has not said first word(s) by 16 months
  • Does not make/sustain eye contact
  • When you point/comment, child does not follow point with eye gaze or share attention
  • Does not respond to name by turning head
  • Does not reach out to be picked up
  • Does not wave bye-bye in the first year
  • Resists being held/cuddled
  • Intense reactions to environmental stimuli such as noises, lights
  • Presence of repetitive behavior that does not seem to serve a function

This is not a comprehensive list; don’t ignore your concerns! Early, intensive intervention is a key to long-term outcomes. Autism Speaks presents a video glossary of common milestones in infancy and toddlerhood; you can sign up here.

Common Secondary Characteristics of Autism

Individuals with Autism may also display secondary characteristics such as:

  • Stimulus overselectivity: Attention to the irrelevant features of an item, scenario, or stimulus
  • Difficulty generalizing acquired knowledge to novel situations
  • Preoccupation with preferred topics of interest
  • Lack of imaginative play/symbolic play
  • May demonstrate “echolalia,” or repeating words/phrases
  • May demonstrate “scripting” or repeating material from TV shows, movies, and games out of context

DIAGNOSTIC CRITERIA (DSM-V)

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.

Specify current severity:

Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).

4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.