What is autism?
This deceptively simple question is a huge part of the problem. Today, “autistic disorder” is considered a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”), the standard reference for the classification. The diagnostic criteria, included below, include (1) impairments in social interaction, (2) impairments in verbal and non-verbal communication, and (3) stereotypical restricted or repetitive patterns of behavior and interests. There are no universally accepted biomarkers such as physical characteristics or blood or urine tests. The three domains of diagnostic criteria for autistic disorder cover a wide spectrum, from individuals with no language, almost no social interaction and severe behavioral problems, to extremely high-functioning individuals with intense interests and quirky personalities. The range of autism spectrum disorders formally includes autism, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Syndrome, and Pervasive Development Disorder Not Otherwise Specified (PDD-NOS).
Diagnostic Criteria for 299.00 Autistic Disorder
The following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV
(A) A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
- 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
- failure to develop peer relationships appropriate to developmental level
- 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)
- lack of social or emotional reciprocity
(2) qualitative impairments in communication as manifested by at least one of the following:
- 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)
- in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- stereotyped and repetitive use of language or idiosyncratic language
- lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- apparently inflexible adherence to specific, nonfunctional routines or rituals
- stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
- persistent preoccupation with parts of objects
(B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
- social interaction
- language as used in social communication,
- symbolic or imaginative play.
(C) The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.