How is Autism Diagnosed?
Parents are usually the first to notice unusual behaviors in their
child. In many cases, their baby seemed "different" from birth-being
unresponsive to people and toys, or focusing intently on one item
for long periods of time. The first signs of autism may also appear
in children who had been developing normally. When an affectionate,
babbling toddler suddenly becomes silent, withdrawn, violent,
or self-abusive, something is wrong.
Even so, years may go by before the family seeks a diagnosis. Well-meaning
friends and relatives sometimes help parents ignore the problems with
reassurances that "Every child is different," or "Janie can talk-she
just doesn't want to!" Unfortunately, this only delays getting appropriate
assessment and treatment for the child.
Indicators of Normal Development
| Age |
Skills or Abilities Awareness and Thinking |
Communication |
Movement |
Social |
Self-help |
| birth- 3 months |
Responds to new sounds Follows movement of hands with eyes Looks
at object and people |
Coos and makes sounds Smiles at mother's voice |
Waves hands and feet Grasps objects Watches movement of own hands
|
Enjoys being tickled and held Makes brief eye contact during feeding
|
Opens mouth to bottle or breast and sucks |
| 3-6 months |
Recognizes mother Reaches for things |
Turns head to sounds and voices Begins babbling Imitates sounds
Varies cry |
Lifts head and chest Bangs objects in play |
Notices strangers and new places Expresses pleasure or displeasure
Likes physical play |
Eats baby food from spoon Reaches for and holds bottle |
| 6-9 months |
Imitates simple gestures Responds to name |
Makes nonsense syllables like gaga Uses voice to get attention
|
Crawls Stands by holding on to things Claps hands Moves objects
from one hand to the other |
Plays peek-a-boo Enjoys other children Understands social signals
like smiles or harsh tones |
Chews Drink from a cup with help |
| 9-12 months |
Plays simple games Moves to reach desired objects Looks at pictures
in books |
Waves bye-bye Stops when told "no" Imitates new words |
Walks holding on to furniture Deliberately lets go of an object
Makes markes with a pencil or crayon |
Laughs aloud during play Shows preference for one toy over another
Responds to adult's change in mood |
Feeds self with fingers Drinks from cup |
| 12-18 months |
Imitates unfamiiar sounds and gestures Points to a desired object |
Shakes head to mean "no" Begins using words Follows simple commands
|
Creeps upstairs and downstairs Walks alone Stacks blocks |
Repeats a performance laughed at Shows emotions like fear or
anger Returns a kiss or hug |
Moves to help in dressing Indicates wet diaper |
| 18-24 months |
Identifies parts of own body Attends to nursery rhymes Points
to pictures in books |
Uses two words to describe actions Refers to self by name |
Jumps in place Pushes and pulls objects Turns pages of book one
by one Uses fingers and thumb |
Cries a bit when parents leave Becomes easily frustrated Pays
attention to other children |
Zips Removes clothes without help Unwraps things |
| 24-36 months |
Matches shapes and objects Enjoys picture books Recognizes self
in mirror Counts to ten |
Joins in songs and rhythm Uses three-word phrases Uses simple
pronouns Follows two instructions at a time |
Kicks and throws ball Runs and jumps Draws straight lines Strings
beads |
Pretends and plays make believe Avoids dangerous situations Initiates
play Attempts to take turns |
Feeds self with spoon Uses toilet with some help |
Diagnostic procedures
To date, there are no medical tests like x-rays or blood tests that
detect autism. And no two children with the disorder behave the
same way. In addition, several conditions can cause symptoms that
resemble those of autism. So parents and the child's pediatrician
need to rule out other disorders, including hearing loss, speech
problems, mental retardation, and neurological problems. But once
these possibilities have been eliminated, a visit to a professional
who specializes in autism is necessary. Such specialists include
people with the professional titles of child psychiatrist, child
psychologist, developmental pediatrician, or pediatric neurologist.
Autism specialists use a variety of methods to identify the disorder.
Using a standardized rating scale, the specialist closely observes and
evaluates the child's language and social behavior. A structured interview
is also used to elicit information from parents about the child's behavior
and early development. Reviewing family videotapes, photos, and baby
albums may help parents recall when each behavior first occurred and
when the child reached certain developmental milestones. The specialists
may also test for certain genetic and neurological problems.
Specialists may also consider other conditions that produce many of
the same behaviors and symptoms as autism, such as Rett's Disorder or
Asperger's Disorder. Rett's Disorder is a progressive brain disease
that only affects girls but, like autism, produces repetitive hand movements
and leads to loss of language and social skills. Children with Asperger's
Disorder are very like high-functioning children with autism. Although
they have repetitive behaviors, severe social problems, and clumsy movements,
their language and intelligence are usually intact. Unlike autism, the
symptoms of Asperger's Disorder typically appear later in childhood.
Diagnostic criteria
After assessing observations and test results, the specialist makes
a diagnosis of autism only if there is clear evidence of:
- poor or limited social relationships
- underdeveloped communication skills
- repetitive behaviors, interests, and activities.
People with autism generally have some impairment within each category,
although the severity of each symptom may vary. The diagnostic criteria
also require that these symptoms appear by age 3.
However, some specialists are reluctant to give a diagnosis of autism.
They fear that it will cause parents to lose hope. As a result, they
may apply a more general term that simply describes the child's behaviors
or sensory deficits. "Severe communication disorder with autism-like
behaviors," "multi-sensory system disorder," and "sensory integration
dysfunction" are some of the terms that are used. Children with milder
or fewer symptoms are often diagnosed as having Pervasive Developmental
Disorder (PDD).
Although terms like Asperger's Disorder and PDD do not significantly
change treatment options, they may keep the child from receiving the
full range of specialized educational services available to children
diagnosed with autism. They may also give parents false hope that their
child's problems are only temporary.
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