Signs of Autism
01/01/10 17:49 Filed in: Autism
Diagnostic and Statistical Manual of Mental Disorders: DSM IV
(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) First there needs to be problems related to qualitative impairment in social interaction, as manifested by at least two of the following:
Qualitative impairments in social interaction really is the heart of autism. Many of the other symptoms can be seen in other populations. You can have problems with language unrelated to autism and repetitive patterns of behavior occur in many conditions and people with delays unrelated to autism.
The first criteria under this category looks for 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.
Here we see a child who often does not look you in the eye when you address them. They may not show normal facial expressions during interactions with others or be able to read the non verbal behavior of others. For example they may not recognize when you are mad at them or they may not notice when you are sad or crying. You feel a disconnect around emotional engagements. They often do not use changes in facial expressions or body movements to communicate and regulate social interactions. For example when a child is bothering them a typical child may raise a hand to indicate stop and their face may demonstrate accompanying facial expressions of threat to convey that they mean business. Often a child on the autism spectrum would be more likely hit or just leave the situation.
The second criteria under this category looks for a failure to develop peer relationships appropriate to developmental level.
Often the easiest sign here is that children on the autism spectrum do not have friends who are their same age. Often it is easier to relate to older or younger children. Children the same age as your child have high expectations in regard to social interaction and if those expectations are not met they often disengage and do not continue to try to relate to a child with autism. Younger children do not recognize the problem and older children nurture and make allowances. Often you can tell because your child does not play with other children their age, leave when other children their age come to play with them, or aggress toward children that try to engage them in play.
The third criteria under this category looks for a problems with 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).
The general thing I look for here is does a child find objects and want to run to mom or dad to show them what they found. “Look what I found,” is basically what they are saying with their behavior even if they cannot say the words. What is important here is that when they bring something to you they do not need you to do anything with it. Many children with autism will bring objects to their parents but they will need the parent to do something for them like open a can or container. For me if there is a need that the parent is filling aside from shared enjoyment they are not really sharing interests. Most typically developing children will see a cow or something of interest and point to it essentially saying,“Mom, Dad look at that”. Children with autism will often not do this. Reaching vaguely for what they want does not count here. Reaching for something out of reach is not really pointing.
The final criteria under this category looks for problems with social or emotional reciprocity (not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids ).
Social reciprocity is the ability to recognize greetings, and departures and the ability to interact with others in a way that society expects. Does your child greet others with words or through their behavior when he or she meets them. A child meeting a new person may say, “Hi” or may nod or smile at them to acknowledge their presence. With a friend or family member they may run up and hug them or give them a high five without the other person initiating it. When asked if they want a drink they may say, “No” or shake their head to indicate that they do not want something. In general, does your child respond socially as expected to the people they encounter. Emotional reciprocity is the ability to recognize that mom is upset and go over to her and give her a hug or the ability to recognize that someone is annoyed and react to that emotion in some fashion that decreases their annoyance. Can they play cooperative social games such as kick ball or freeze tag.
(B) Next there needs to be 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).
This is fairly self explanatory. Is your child’s ability to communicate at the level of other children the same age. If they cannot speak can they use gesture to communicate what they want aside from pushing and pulling behaviors and reaching for what they want. Many children who only have a problem with verbal speech will compensate with complex gestures to indicate what they want. They can still shake their head for yes and no, put their hand out to tell someone to stop or wave to get someone to come over to them. They will be able to point to where they want to go and use gestures to convey their emotions.
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
Here the most often seen sign of a problem is repetitively talking about a single topic. They may have complex language but only talk about a topic that is of interest to them. When someone else asks them questions they often do not respond or quickly change the topic to something they are interested in. When talking to someone with problems in this area you get the feeling that you are not really having a conversation with someone.
Stereotyped and repetitive use of language or idiosyncratic language.
What you will see here is echolalia or the repeating of the last word or words you say to a child. For example, You may ask, would you like a cookie and the child would respond “cookie?”. A child with autism may repeat lines from movies or songs many times throughout the day. Another way you may see symptoms in this area is if a child makes noises or says phrases for no reason other than they like the sounds they are making. Idiosyncratic language is often described as the child speaks a language they made up. They sound like they are talking but you cannot understand what they are saying. Often one or two word will pop out as recognizable followed by a string of gibberish. In children with autism you often see them progress in their speech development by first using echolalia and movie talk, as their abilities to use language expand you find that the movie talk is appropriate at times and your child is using movie talk to communicate. Eventually the movie talk becomes less rote and becomes indistinguishable from normal speech.
Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Children with problems in this area don’t pick up a block and pretend it is an airplane or a car. You do not see them using one thing and pretending it is something else. They do not play house or pretend to be a super hero. They don’t imitate things mom and dad do like shaving or making supper. Children with autism may play with toys in odd ways like walking around with them and moving them from place to place or throwing them and watching them drop or move through the air.
(C) Finally there needs to be restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
Here we see children that are almost obsessed with certain things. Common interests are trains or certain cartoon or movie characters that they talk about all day long. Many typical children will do some of this but it will not be as extreme as a child with autism. You may see tantrums and aggression if they are not allowed to follow through with their interests or they lose one of the items they are obsessing about.
Apparently inflexible adherence to specific, nonfunctional routines or rituals.
Children who have problems in this area get very used to how things are done. When something is done in a different way they may become very upset and tantrum. You may find that if you do not follow their routine their whole day will be thrown off.
Stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements).
Generally what we see here is a child who’s body movements are overwhelmed when their emotions get high. When they get excited or mad certain movements begin. Common movements are related to their hands flapping uncontrollably when they are excited or mad. Typically the child will raise their hands and they will flap excitedly along side their head or shoulders. Other movements could involve the child holding the hands very still and tight with minor tremors or having a rigid body posture when excited. Obsessive walking on the tips of the toes or any unusual body movements would suggest a problem in this area.
Persistent preoccupation with parts of objects.
This is often hard to determine. What you may notice is that you are looking a picture together and the child with autism points out some minor thing about the picture that misses what is really going on in the picture. Or the child will point out minor parts of things that they are looking at and want to talk about it. Fascination with taking things apart probably is the result of this preoccupation.
Once all of these criteria are met there needs to be delays in either social interaction, language as used in social communication, or symbolic or imaginative play before the age of three years.
Finally the disturbance cannot be better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
(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) First there needs to be problems related to qualitative impairment in social interaction, as manifested by at least two of the following:
Qualitative impairments in social interaction really is the heart of autism. Many of the other symptoms can be seen in other populations. You can have problems with language unrelated to autism and repetitive patterns of behavior occur in many conditions and people with delays unrelated to autism.
The first criteria under this category looks for 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.
Here we see a child who often does not look you in the eye when you address them. They may not show normal facial expressions during interactions with others or be able to read the non verbal behavior of others. For example they may not recognize when you are mad at them or they may not notice when you are sad or crying. You feel a disconnect around emotional engagements. They often do not use changes in facial expressions or body movements to communicate and regulate social interactions. For example when a child is bothering them a typical child may raise a hand to indicate stop and their face may demonstrate accompanying facial expressions of threat to convey that they mean business. Often a child on the autism spectrum would be more likely hit or just leave the situation.
The second criteria under this category looks for a failure to develop peer relationships appropriate to developmental level.
Often the easiest sign here is that children on the autism spectrum do not have friends who are their same age. Often it is easier to relate to older or younger children. Children the same age as your child have high expectations in regard to social interaction and if those expectations are not met they often disengage and do not continue to try to relate to a child with autism. Younger children do not recognize the problem and older children nurture and make allowances. Often you can tell because your child does not play with other children their age, leave when other children their age come to play with them, or aggress toward children that try to engage them in play.
The third criteria under this category looks for a problems with 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).
The general thing I look for here is does a child find objects and want to run to mom or dad to show them what they found. “Look what I found,” is basically what they are saying with their behavior even if they cannot say the words. What is important here is that when they bring something to you they do not need you to do anything with it. Many children with autism will bring objects to their parents but they will need the parent to do something for them like open a can or container. For me if there is a need that the parent is filling aside from shared enjoyment they are not really sharing interests. Most typically developing children will see a cow or something of interest and point to it essentially saying,“Mom, Dad look at that”. Children with autism will often not do this. Reaching vaguely for what they want does not count here. Reaching for something out of reach is not really pointing.
The final criteria under this category looks for problems with social or emotional reciprocity (not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids ).
Social reciprocity is the ability to recognize greetings, and departures and the ability to interact with others in a way that society expects. Does your child greet others with words or through their behavior when he or she meets them. A child meeting a new person may say, “Hi” or may nod or smile at them to acknowledge their presence. With a friend or family member they may run up and hug them or give them a high five without the other person initiating it. When asked if they want a drink they may say, “No” or shake their head to indicate that they do not want something. In general, does your child respond socially as expected to the people they encounter. Emotional reciprocity is the ability to recognize that mom is upset and go over to her and give her a hug or the ability to recognize that someone is annoyed and react to that emotion in some fashion that decreases their annoyance. Can they play cooperative social games such as kick ball or freeze tag.
(B) Next there needs to be 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).
This is fairly self explanatory. Is your child’s ability to communicate at the level of other children the same age. If they cannot speak can they use gesture to communicate what they want aside from pushing and pulling behaviors and reaching for what they want. Many children who only have a problem with verbal speech will compensate with complex gestures to indicate what they want. They can still shake their head for yes and no, put their hand out to tell someone to stop or wave to get someone to come over to them. They will be able to point to where they want to go and use gestures to convey their emotions.
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
Here the most often seen sign of a problem is repetitively talking about a single topic. They may have complex language but only talk about a topic that is of interest to them. When someone else asks them questions they often do not respond or quickly change the topic to something they are interested in. When talking to someone with problems in this area you get the feeling that you are not really having a conversation with someone.
Stereotyped and repetitive use of language or idiosyncratic language.
What you will see here is echolalia or the repeating of the last word or words you say to a child. For example, You may ask, would you like a cookie and the child would respond “cookie?”. A child with autism may repeat lines from movies or songs many times throughout the day. Another way you may see symptoms in this area is if a child makes noises or says phrases for no reason other than they like the sounds they are making. Idiosyncratic language is often described as the child speaks a language they made up. They sound like they are talking but you cannot understand what they are saying. Often one or two word will pop out as recognizable followed by a string of gibberish. In children with autism you often see them progress in their speech development by first using echolalia and movie talk, as their abilities to use language expand you find that the movie talk is appropriate at times and your child is using movie talk to communicate. Eventually the movie talk becomes less rote and becomes indistinguishable from normal speech.
Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Children with problems in this area don’t pick up a block and pretend it is an airplane or a car. You do not see them using one thing and pretending it is something else. They do not play house or pretend to be a super hero. They don’t imitate things mom and dad do like shaving or making supper. Children with autism may play with toys in odd ways like walking around with them and moving them from place to place or throwing them and watching them drop or move through the air.
(C) Finally there needs to be restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
Here we see children that are almost obsessed with certain things. Common interests are trains or certain cartoon or movie characters that they talk about all day long. Many typical children will do some of this but it will not be as extreme as a child with autism. You may see tantrums and aggression if they are not allowed to follow through with their interests or they lose one of the items they are obsessing about.
Apparently inflexible adherence to specific, nonfunctional routines or rituals.
Children who have problems in this area get very used to how things are done. When something is done in a different way they may become very upset and tantrum. You may find that if you do not follow their routine their whole day will be thrown off.
Stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements).
Generally what we see here is a child who’s body movements are overwhelmed when their emotions get high. When they get excited or mad certain movements begin. Common movements are related to their hands flapping uncontrollably when they are excited or mad. Typically the child will raise their hands and they will flap excitedly along side their head or shoulders. Other movements could involve the child holding the hands very still and tight with minor tremors or having a rigid body posture when excited. Obsessive walking on the tips of the toes or any unusual body movements would suggest a problem in this area.
Persistent preoccupation with parts of objects.
This is often hard to determine. What you may notice is that you are looking a picture together and the child with autism points out some minor thing about the picture that misses what is really going on in the picture. Or the child will point out minor parts of things that they are looking at and want to talk about it. Fascination with taking things apart probably is the result of this preoccupation.
Once all of these criteria are met there needs to be delays in either social interaction, language as used in social communication, or symbolic or imaginative play before the age of three years.
Finally the disturbance cannot be better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.