What is Autism?

Autism is a pervasive developmental disorder that affects children globally across all areas of functioning in their lives. Autism impacts the normal development of the brain in the areas of social interaction and communication skills. Most commonly autism is characterized by the following: difficulties in communication and socialization, stereotyped behaviors and delay in speech and language skills.

In 2006, the Center for Disease Control's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network found that an average of 1 in every 110 children born in the United States have autism, making autism the most common of the pervasive developmental disorders. Additionally, one in every 70 boys is on the Autism Spectrum.

Researchers have reported associations between the following are causes for autism:

1. Toxic or infectious damage to the Central Nervous System
2. Genetic Factors
3. Children with Fetal Alcohol Syndrome
4. Children who were affected with Rubella during their mother’s pregnancy
5. Children whose mothers took a variety of medications that are known to damage the fetus

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Diagnosing Autism

Autism is diagnosed by observable behaviors using the diagnostic criteria presented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM – IV). Because there is no medical test for autism, it is not always easily diagnosed. Typically, the first recognized symptom is delayed speech.

In order to be diagnosed with autism, the child must demonstrate deficiencies in social interaction and communication as well as restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.

Autistic Disorder

DSM – IV Criteria, Pervasive Development Disorder
299.00 Autistic Disorder

1. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
1. Qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
2. failure to develop peer relationships appropriate to developmental level
3. a lack of 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)
4. lack of social or emotional reciprocity
2. Qualitative impairments in communication as manifested by at least one of the following:
1. 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)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
4. persistent preoccupation with parts of objects
2. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
3. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

(Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.)

The Confusion of Diagnostic Labels

The intent behind the DSM-IV is that the diagnostic criteria not be used as a checklist, but rather as guidelines for diagnosing pervasive developmental disorders. There are no clearly established guidelines for measuring the severity of a person's symptoms. Therefore, the line between autism and other labels such as PDD-NOS and Asperger’s Syndrome is blurry (Boyle, 1995).
In addition to autism, there are several other diagnoses that fall within the Autism Spectrum, including Pervasive Developmental Disorder-Not otherwise Specified and Asperger’s Syndrome.

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Asperger's Disorder

Asperger's Disorder, also referred to as Asperger's or Asperger's Syndrome, is a developmental disorder characterized by a lack of social skills, difficulty with social relationships, poor coordination and poor concentration and a restricted range of interests, but normal intelligence and adequate language skills in the areas of vocabulary and grammar. Asperger's Disorder appears to have a somewhat later onset than Autistic Disorder, or at least is recognized later. An individual with Asperger's Disorder does not possess a significant delay in language development however, he or she may have difficulty understanding the subtleties used in conversation, such as irony and humor. Also, while many individuals with autism have mental retardation, a person with Asperger's possesses an average to above average intelligence (Autism Society of America, 1995). Asperger's is sometimes incorrectly referred to as "high-functioning autism." The diagnostic criteria for Asperger's Disorder as set forth in the DSM-IV are presented below.

Diagnostic Criteria for Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of 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)
4. lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
   
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
   
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
   
4. persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single word used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder, or Schizophrenia. (APA, 1994, p. 77)

(Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.)

Pervasive Developmental Disorder Not Otherwise Specified

Children with PDD-NOS either (a) do not fully meet the criteria of symptoms clinicians use to diagnose any of the four specific types of PDD above, and/or (b) do not have the degree of impairment described in any of the above PDD specific types.

According to the DSM-IV, this category should be used "when there is a severe and pervasive impairment in the development of social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder" (American Psychiatric Association, 1994, pp. 77-78).

There is some disagreement among professionals concerning the PDD-NOS label. Some professionals consider "Autistic Disorder" appropriate only for those who show extreme symptoms in every one of several developmental areas related to autism. Other professionals are more comfortable with the term Autistic Disorder and use it to cover a broad range of symptoms connected with language and social dysfunction. Therefore, an individual may be diagnosed by one practitioner as having Autistic Disorder and by another practitioner as having PDD-NOS (or PDD, if the practitioner is abbreviating for PDD-NOS).

Generally, an individual is diagnosed as having PDD-NOS if he or she has some behaviors that are seen in autism but does not meet the full DSM-IV criteria for having Autistic Disorder. Despite the DSM-IV concept of Autistic Disorder and PDD-NOS being two distinct types of PDD, there is clinical evidence suggesting that Autistic Disorder and PDD-NOS are on a continuum (i.e., an individual with Autistic Disorder can improve and be re-diagnosed as having PDD-NOS, or a young child can begin with PDD-NOS, develop more autistic features, and be re-diagnosed as having Autistic Disorder)

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