Diagnosis: Autism

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Although the symptoms of autism have been refined, these three general areas still continue to provide the basis of the symptoms of the spectrum. That is, to be diagnosed with autism, children must have difficulties socially interacting with others; they must have impairments in communication; and they must also show restricted interests. This sounds pretty straightforward, but it's complicated by the fact that although most agree that the disability is neurological, no biological marker has been found. That means that there is no blood or chromosomal test that can tell you if a child has autism. The diagnosis is simply based on observation of the three symptoms, and the expression of these symptom areas can vary considerably. For example, a child who socializes fine with adults but has no interest in children his own age would qualify, as would a child who has absolutely no interest in either adults or other children. A child who echoes everything another person says, a child who can make short sentences but cannot maintain a conversation, and a child who says nothing whatsoever would all qualify under the impaired-communication symptom. And finally, the child who spends all day riding her rocking horse, the child who spends hours each day lining up his mom and dad's shoes in a certain specific order, and the child who only plays with one toy repeatedly would all be a "yes" on the restricted-interests category.

To make things even more confusing, most children express some of these symptoms, so it's not even a simple "Do they have this symptom?" but the more complicated question of "To what extent do they have this symptom?" that determines where they fall on the continuum. In other words, does each symptom area fall within or outside the typical range?

If your child has difficulties in all three areas (social, communication, and restricted interests) that are outside of what would be expected from a typical child, she would meet the diagnostic criteria for autism. Now, let me complicate things even more for you: there are other disabilities that fall into the Autism Spectrum category.

For example, Asperger's syndrome occurs when the child doesn't really have any delays in language per se, but does have difficulties in social interaction. These children will also tend to have special interests and problems making conversation. For example, we work with one little boy who only wants to talk about lavatories in airplanes. Another only wants to talk about Rolex watches. Kids with Asperger's syndrome can become experts on certain topics, but these topics may be of little or no interest to others, while they themselves often show little interest in what occupies their peers.

Then, there is PDD-NOS (Pervasive Developmental Disorder, Not Otherwise Specified), also called Atypical Autism. Children are labeled with this when they have only two of the three categories. That is, they tend to have difficulties with social interaction and either communication difficulties or restricted interests, but not both. So, as you can see, over time, in an attempt to make the diagnosis more homogeneous, more subcategories of Autism Spectrum Disorder have been defined.

Hard News to Get
I saw one family not long ago with a nineteen-month-old son – cute as could be. But Caleb didn't say one single word, he wasn't interested in anyone, and he spent the full two hours we were with him spinning in circles. He didn't play with any toys in the room and didn't respond to his name. He had such clearly pronounced symptoms of autism that there wasn't even any question in my mind what his diagnosis should be.