Although each child will display his particular type of ASD in a unique way, there are specific symptoms that form a basis on which a diagnosis can be made. The different degrees of these symptoms will determine the specific diagnosis. Although, for example, almost all spectrum disorder kids will have communication deficits, a classical autism case will display speech issues differently from a child who has Asperger's Syndrome.
ASD is characterized by difficulties in three main areas: social interaction, communication, and patterns of behavior, interests, and activity. Within these three categories are four criteria used to determine if the diagnosis of ASD is appropriate.
A diagnosis of ASD requires that at least one of the signs within each category be met, along with a minimum of six signs from all of the categories.
Children with autism usually display these signs readily. By contrast, pervasive developmental disorder, which is characterized by the same symptoms in milder form, is less easily diagnosed. Parents may need to have consultations with several experts to determine the exact diagnosis in the less extreme cases.
The diagnosis of all diseases and disorders in the United States are standardized through manuals on which medical professionals have collaborated in order to achieve uniformity. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, published by the American Psychiatric Association, is the manual used to classify autism spectrum disorders. Wherever a patient sees a physician, the same standards are applied to classify a particular disorder.
How a child interacts socially is the first of the three categories examined to ascertain whether an autism spectrum disorder is present. The child's physician will be involved, and a child psychologist or psychiatrist may also examine the child or do specific tests. Other experts will be consulted if needed. The professionals will look for:
Reduction or absence of eye contact, facial expressions, or body language
Inability to form friendships within a peer group
Unwillingness or inability to share enjoyment or accomplishments with others
Inability to relate and share emotions on a social level
The impairment of social skills in a child with autism may be obvious to a parent, even when a child is very young. As a child matures, the interaction skills within the peer group isolate the child further, as he is unable to relate to other children and adults.
The behaviors of autism may seem strange, but upon consideration, you will see they reflect the child's effort to establish predictability and order in his world. A world with limited language, or no language at all, is out of control. Repetitive behavior can help the child gain some control.
Communication is the second area experts analyze to determine if autism or a related condition is present. This exam involves a physician, speech therapist, and possibly other experts such as a child psychologist or psychiatrist. The communication difficulties in an ASD child are typical to most of the conditions on the spectrum. These include:
Reduction, absence, or loss of spoken language
No attempt to replace language with another method of communication
Inability to converse with another person even if speech is present
Repetitive use of words, or echolalia (echoing words without meaning)
Absence of imaginative play typical to a specific age group
Communication is imperative for human beings to function successfully. This impairment may be the most painful for parents to understand and cope with on a day-to-day basis. A child may have had language at a young age, perhaps saying “mommy” or “daddy” or identifying various objects within the house, and then lose those words completely.
Some children with autism engage in a behavior called stimming. This stands for self-stimulating behavior, which some experts believe is used as a calming measure. Stimming can include: rocking, spinning an object repeatedly, twisting or twirling an object, repeating words or phrases, and other repetitive activities.
A child may be suspected of being deaf because of the total lack of response to spoken language. It is common for the diagnostic trail to begin with a parent or grandparent asking for an auditory test because of the child's apparent lack of hearing. However, when the tests show that the child's hearing is normal, further testing will most likely lead to the ASD diagnosis.
Patterns of Behavior, Interests, or Activity
The behaviors in a child with ASD are very distinctive and will be an indicator of where a child places on the spectrum. This exam involves a physician, who may be a pediatric neurologist, a child psychologist, various therapists, and possibly experts in the mental health field. They will look for characteristics such as:
Intense preoccupation with a particular activity
Compulsive engagement in routines that serve no practical function
Repetitive movements such as flapping, spinning, and/or body movements
Intense preoccupation with parts of a whole—for example, the spinning tires on a bicycle rather than the entire bicycle
The intensely repetitive use of a VCR to watch the ending credits of a film is a common behavior in children with ASD. They will often spend an hour or more rewinding the tape to view the words as they move by on the screen. Music accompanying these credits is even more appealing.
The behaviors of ASD are perhaps the best known of the signs and symptoms. Films have illustrated behaviors exhibited by people on the autism spectrum, so the public is familiar with this set of symptoms. Most children with autism appear perfectly normal to the bystander until certain behaviors such as flapping or spinning indicate that autism or a related condition is present. These behaviors are an early indicator as well, and they may be what prompt parents to seek a medical opinion.