Diagnostic Assessment
Observational evaluations
Parents, family members, or other caregivers are often the first to notice when a child does not meet typical developmental milestones, such as engaging in speech, making eye contact, playing with other children, or participating in social interactions.
Autism may not always be readily identified in children and adults, especially if the symptoms are subtle or if the individual has additional disabilities or health issues. Additional factors, such as the presence of conditions like apraxia, can make autism more difficult to detect. As a result, Autism Spectrum Disorders (ASDs) might remain unrecognized for years and might only be diagnosed during significant educational challenges or life crises that lead to interactions with professionals skilled in identifying the disorder.
Healthcare professionals use the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR, to assess autism spectrum disorder in children and the related social communication disorder (SCD). Diagnosis is based on a specific set of behaviours, communication challenges, and/or developmental delays.
Diversity in Autism
Autism is characterized by a wide range of severities and symptoms. A timely and accurate diagnosis, along with early detection, significantly improves the chances of achieving optimal outcomes. This enables the early implementation of appropriate educational supports.
DIAGNOSTIC CRITERIA – DSM-5
In North America, medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (revised May 2013) to evaluate autism spectrum disorder (ASD). For a full copy of this manual, please visit the American Psychiatric Association website.
For your convenience, here is the section from the DSM-5 on Autism Spectrum Disorders:
AUTISM SPECTRUM DISORDER 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
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Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
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Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
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Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
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Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
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Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
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Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
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Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
NOTE: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
TABLE 2 SEVERITY LEVELS FOR AUTISM SPECTRUM DISORDER
Level 3: “Requiring very substantial support”
Social Communication:
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
Restricted, Repetitive Behaviours:
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2: “Requiring substantial support”
Social Communication:
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.
Restricted, Repetitive Behaviours:
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1: “Requiring support”
Social Communication:
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
Restricted, Repetitive Behaviours:
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.