Diagnosis

Autism has to be seen from a progressive standpoint, not just as one moment in time. Since it is a condition that affects all development, symptoms may look very different at different ages. Some aspects may not arise until later, others disappear over time. (Frith, 1989).

Frith (1989) adds that professionals may differ in their diagnosis when faced with 'borderline' cases. As a result, it's possible that a child may be diagnosed with autism at one center and something else at another (Frith, 1989).

Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD)

Diagnostic and Statistical Manual (DSM) DSM-III Infantile autism introduced in 1980 (APA). DSM III-R in 1987 presented an array of changes to the diagnostic criteria because the original description may have been too restrictive. DSM-IV 1994 attempted to improve upon the diagnostic criteria while maintaining developmental considerations.

Asperger's syndrome was introduced as a separate diagnostic category in the latest revisions of The International Classification of Diseases (ICD) ICD-10 (WHO, 1992) and DSM-IV (APA, 1994)

Standardised Diagnostic Instruments

  • Diagnostic Interview for Social and Communication Disorders (DISCO)
  • Autistic Diagnostic Interview-Revised (ADI-R)
  • Gilliam Autism Rating Scale (GARS)
  • Childhood Autism Rating Scale (CARS)
  • Autism Diagnostic Observation Schedule (ADOS)
  • Checklist for autism in Toddlers (CHAT)

Information gathered for assessment and diagnosis

Early assessment and diagnosis is critical for the child and their families. According to the NAS, "The need for early identification is made more urgent by the accumulating evidence that intensive early intervention in optimal educational settings results in improved outcomes in most young children with autism, including speech in 75% or more and significant increases in rates of developmental progress and intellectual performance” (Dawson and Osterling 1997; Rogers 1996, 1998). Early diagnosis helps to decrease family stress and and ensure that problem behaviors do not become entrenched.

Information about the child:

  • Observations of child at home, school, day care center, in addition to discussions with all caretakers, teachers and family members.
  • Repetitive and/or ritualistic behavior patterns
  • Audiological evaluation
  • Unusual sensory sensitivities?
  • Home video tapes-may show behaviors that may identify autistic behaviors (now commonly used in research for early identification)
  • Screening for heavy metal poisoning/metabolic testing
  • Adaptive behavior, sensorimotor and neuropsychological assessments
  • Desire for sameness, islets of ability, pursuit of narrow topics of interests?
  • Developmental history from infancy including head circumference, history of multiple ear infections and multiple courses of oral antibiotics.

Information about the mother:

Health history (Perinatal factors), general obstetric status, mothers age at the time of pregnancy, medication taken during pregnancy?

Length of pregnancy? Was there threatened miscarriage? Complications during delivery?