Diagnosing Autism

Autism can be very difficult to diagnose because each person with autism is different. Also the diagnostic criteria has changed many times over the years. Even now, with the DSM-IV definition, there are aspects that are vague and confusing. For example, what constitutes a failure to develop peer relationships appropriate to developmental level? What is an appropriate developmental level? It is unclear what the definition means in certain cases.

DSM IV Diagnostic Criteria for Autism:
(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)
(A) qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or “mechanical” aids )
(B) qualitative impairments in communication as manifested by at least one of the following:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play
(III) The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder

There are also difficulties with early diagnosis. Here are a list of 5 difficulties I have compiled:
1. In the DSM-IV criteria for diagnosing autism, section B states that there is a delay of or a complete lack of language. In order to diagnose autism, the child must have time to develop speech and this therefore leads to a later diagnosis of autism. Autism involves a delay in development, but children are always changing so for some, slower speech is just the way they are growing and learning.
2. Also in the DSM-IV there are criteria for social interaction such as failure to develop peer relationships. In order to diagnose a child with autism, it is necessary for the child to interact with other children. This interaction typically does not happen until the child is a little older and around other children. This is why diagnosing autism from birth or infancy can be very difficult.
3. There are a wide range of differential diagnoses that can commonly be confused with autism if not carefully looked at and assessed such as: mental retardation, language disorder, or other specific developmental disorders.
4. The assessment process is long and involves many tests and steps in order to secure a proper diagnosis. Some of the steps include: detailed medical and developmental history, blood tests, and routine hearing and vision tests – all which take time.
5. Every autistic child is very different from each other so diagnosis is difficult. Certain autistics struggle with characteristics that another autistic has mastered. Individual diagnosis is essential, and this takes time.

Another issue has been raised by autistics about the problems with diagnosing autism. Much of the time autism is diagnosed by what an autistic individuals cannot do and not what they can do. We diagnose on the basis that the autistic individual cannot socialize properly or that they do not make normal eye contact. We do not take into account the fact that many autistic individuals have heightened senses and abilities that neurotypicals do not have. Autism should always be diagnosed by a set of characteristics observed from direct contact with the individual.

As I have stated before, autism is not a disorder, but clearly there are people who think this way. Here is but one source where this misconception comes from: www.cureautismnow.org

“Autism is a biological disorder, it can only be diagnosed by observing behavior. Currently, there is no medical test to diagnosis autism.”

So clearly there are many different opinions on autism and whether is constitutes as a disorder or not.  Beyond that, there are also many differing opinions as to how to diagnose autism or whether autism should even be diagnosed in the first place.  It should be up to the autistic individual in question as to whether or not he/she desires a diagnosis and then whether or not he/she would like to refer to the label of autism in the future.