What is Autism?

Autism, or Autistic Disorder, falls under the category of a Pervasive Developmental Delay. It is a developmental disorder characterized by impaired social interaction and communication as well as restricted and repetitive patterns of behavior and interests (American Psychiatric Association, 2000).

How is autism diagnosed?

Most practitioners rely on diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR; American Psychiatric Association, 2000). The DSM-IV gives the following guidelines for a diagnosis of Autistic Disorder (p. 75).

(1) Impairments in social interaction by at least TWO of the following:

a. Impairments in nonverbal behaviors such as eye contact, facial expressions, and gestures used to regulate social interaction

b. Failure to develop peer relationships

c. Lack of shared enjoyment or interests with other people

d. Lack of social or emotional reciprocity (reciprocity refers to a mutual exchange between two people)


(2) Impairments in communication by at least ONE of the following:

a. Delay in, or total lack of, spoken language

b. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

c. Stereotyped and repetitive use of language or idiosyncratic (peculiar) language

d. Lack of spontaneous make-believe play or social imitative play appropriate to developmental level


(3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities by at least ONE of the following:

a. Preoccupation with one ore more interests that is abnormal either in intensity or focus

b. Inflexible adherence to specific routines or rituals

c. Repetitive motor mannerisms (e.g. hand or finger flapping or complex whole-body movements)

d. Persistent preoccupation with parts of objects

For a child diagnosed with autism, delays in social interaction, language, or imaginative play occur prior to the age of 3.

What should be included in an evaluation for autism?

An evaluation for autism is based on behaviors rather than medical tests. In order to accurately diagnose autism, an evaluation should be conducted by a team of professionals with expertise in the areas of language development, social and behavioral development, and cognitive development. A diagnosis should not be made based on the results of one assessment tool.

Instruments used during an evaluation for autism may include the following:

  • Autism Diagnostic Observation Schedule (ADOS)- The ADOS is a semi-structured, standardized assessment of communication, social interaction, and play for individuals referred for evaluation because of possible autism spectrum disorders. The activities set forth in the ADOS allow the examiner to observe the presence of behaviors that are known to be important to the diagnosis of autism spectrum disorders at different developmental levels and chronological ages. The ADOS can be used with pre-verbal children through verbally fluent adults. An individual is administered the most appropriate one of four modules based on the expressive language skills and chronological age of the individual.
  • Autism Diagnostic Interview-Revised (ADIR)- The ADIR is a standardized parent interview providing the examiner detailed information regarding the child’s developmental history and current behaviors. The interview takes approximately 1-2 hours in which the examiner asks the parent a series of questions in eight content areas:
  1.  The child’s background: medical, educational, family
  2.  Overview of behavior
  3.  Early development
  4.  Language acquisition and loss of language or other skills
  5.  Current language and communication skills
  6.  Social development and play
  7.  Interests and behaviors
  8.  Other relevant behaviors such as aggression, self-injurious behaviors, etc.
  • Childhood Autism Rating Scale (CARS)- The CARS is a 15-item questionnaire that is generally completed by the parent. It takes approximately 5-10 minutes to complete. The CARS is designed to provide information regarding early development; social, emotional, and communication skills; repetitive behaviors; play and routines; and unusual sensory interests.
  • Gilliam Autism Rating Scale (GARS)- The GARS is a 42-item questionnaire that is generally completed by the child’s parent. The GARS takes approximately 5-10 minutes to complete. Questions are grouped into three subcategories for scoring: Stereotyped Behaviors, Communication, and Social Interaction. The GARS is used to identify behaviors consistent with autism in individuals ages 3 through 22.

What is the cause of autism?

The cause of autism is not yet known. Some experts in the field believe that autism may be the result of a number of factors that impact brain development before, or shortly after, birth. There is believed to be a genetic component to the disorder. Other causes that have been suspected, but not proven include diet, mercury poisoning, vaccines, or an inability of the body to use vitamins and minerals properly. While vaccinations in the past received a great deal of attention related to autism, studies have failed to show any connection between vaccines and autism. The Institute of Medicine and the Centers for Disease Control and Prevention (CDC) both agree that there is no scientific data to link vaccinations to autism.

Early Signs and Symptoms of Autism

Most parents of children with autism suspect that something is wrong by around 18 months of age. Autism can reliably be diagnosed in children by the age of 2. Children should be evaluated routinely by their pediatrician and especially if any of the following language developmental milestones are not met:

12 months: gesturing (pointing, waving goodbye) and babbling

16 months: use of single words

24 months: use of 2-word phrases

Any regression in early social or language skills should also be evaluated.

Research overwhelmingly supports early intervention for children with autism. The earlier autism is diagnosed, the better the outcome for interventions. Parents should always listen to their instincts. Contact your child’s pediatrician if you suspect any red flags associated with autism.

Here is some additional information on working with children with autism.

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