Description:

Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social communication and interaction, and repetitive behaviors or narrow, obsessive interests. Four to five times more boys than girls are diagnosed with autism, although the reason is unclear. Environmental factors such as parents having children later in life, fever and infection during pregnancy, and premature birth have been linked to an increased risk of autism in children. People with ASD might have trouble with eye contact or reading social cues, intense focus on specific topics, and repetitive behaviors(like counting, lining up objects, and hand-flapping). Autism is a brain difference, not acting weird. Many autistic people also have strength in memory, pattern recognition, and creativity. Speech therapy, social skills learning, and supportive environments can help.

Diagnosis:

The criteria in the DSM-5 for diagnosing ASD include 3 listed deficits in social communication and social interactions. Clinicians must be sure that these characteristics are not due to developmental delay alone. To be diagnosed with ASD, an individual must meet all three of the following criteria:

1. Difficulties insocial emotional reciprocity, including trouble with social approach, back and forth conversation, sharing interests with others, and expressing/understanding emotions.
2. Difficulties in nonverbal communicationused for social interaction including abnormal eye-contact and body language and difficulty with understanding the use of nonverbal communication like facial expressions or gestures for communication.
3. Deficits in developing and maintaining relationships with other people(other than with caregivers), including lack of interest in others, difficulties responding to different social contexts, and difficulties in sharing imaginative play with others.

The criteria in the DSM-5 also include demonstrating at least 2 of the following 4 restricted and repetitive behavior, interests, or activities:

1. Stereotyped speech, repetitive motor movements, echolalia (repeating words or phrases, sometimes from television shows or from other people), and repetitive use of objects or abnormal phrases.
2. Rigid adherence to routines, ritualized patterns of verbal or nonverbal behaviors, and extreme resistance to change (such as insistence on taking the same route to school, eating the same food because of color or texture, repeating the same questions); the individual may become greatly distressed at small changes in these routines.
3. Highly restricted interests with abnormal intensity or focus, such as a strong attachment to unusual objects or obsessions with certain interests, such as train schedules.
4. Increased or decreased reactivity to sensory input or unusual interest in sensory aspects of the environment, such as not reacting to pain, strong dislike to specific sounds, excessive touching or smelling objects, or fascination with spinning objects.

In addition to the changes in criteria for the ASD diagnosis, the new DSM-5 has also added a severity rating. The new DSM offers ways to identify ASD levels of severity for each individual. The 3 levels of severity include:

1. Level 1. “REQUIRING SUPPORT”: Individuals with this level of severity have difficulty initiating social interactions, may exhibit unusual or unsuccessful responses to social advances made by others, and may seem to have decreased interest in social interactions. Additionally, repetitive behaviors may interfere with daily functioning. These individuals may have some difficulty redirecting from their fixed interests.
2. Level 2. “REQUIRING SUBSTANTIAL SUPPORT”: Individuals with this level of severity exhibit marked delays in verbal and non-verbal communication. Individuals have limited interest or ability to initiate social interactions and have difficulty forming social relationships with others, even with support in place. These individuals’ restricted interests and repetitive behaviors are obvious to the casual observer and can interfere with functioning in a variety of contexts. High levels of distress or frustration may occur when interests and/or behaviors are interrupted.
3. Level 3. “REQUIRING VERY SUBSTANTIAL SUPPORT”: This level of severity causes individuals with ASD severe impairment in daily functioning. These individuals have very limited initiation of social interaction and minimal response to social overtures by others and may be extremely limited in verbal communication abilities. Preoccupations, fixed rituals, and/or repetitive behaviors greatly interfere with daily functioning and make it difficult to cope with change. It is very difficult to redirect this person from fixated interests.