What is Autism
Mental health professionals in North America as well as in many other countries use the DSM (Diagnostic and Statistical Manual of Mental Disorders) in order to agree on how to classify disorders. The fifth version of the DSM (DSM-5) appeared in 2013. According to the new diagnostic criteria published in this manual, we consider that a person has an Autism Spectrum Disorder (ASD) when they present persistent deficits in the following main areas:
– Social communication & Interactions
– Repetitive/ Restricted Behaviors
Here are some examples:
| Social communication & Interactions | Repetitive/ Restricted Behaviors | |
| Young children | Don’t join their peers to play together, gesture very little or not at all (nodding, blowing a kiss, waving bye are examples of gestures), have particular eye contact (absent; fleeting). May have language delays, started talking late… | May play with the same toys over and over again, line up objects, spin things repeatedly, peer at objects from a particular angle, have major difficulties dealing with changes and transitions. Can engage in hand flapping or other repetitive hand or body movements. |
| School-aged children | Significant difficulties playing (particularly pretend-play) and working with others (school projects), have few friends, use little gestures, have particular eye contact. Use overly-formal vocabulary, have a particular intonation when speaking… | May have a very strong interest for a specific theme (e.g. trains, a specific TV series) to the point that it is difficult for them to stop talking about it. May have repetitive hand or body movements. May have rituals (e.g. having to complete actions in a certain sequence). |
| Adolescents & Adults | May have few friends despite the interest in socializing, social difficulties at school/work, difficulties understanding sarcasm/expressions/double meanings. Difficulty understanding social cues. Use overly-formal vocabulary, have a particular intonation when speaking… | May have a very strong interest for a specific theme (e.g. medieval times, past Prime Ministers) that interferes with their daily life (e.g. school, work). May have rituals. |
Although in order to have a diagnosis of ASD the person needs to have symptoms in both main areas, each person with ASD is unique and presents their own behaviors that we consider as being deficits in one area or another. In addition, the deficits or difficulties have to interfere with the person’s daily life and have to have been present since early development (before the age of 3).
It can be difficult to diagnose a person with ASD correctly, which is why it is beneficial to be diagnosed by professionals who are specialized and highly familiar with ASD. Many persons, including children, with ASD are initially misdiagnosed as having ADHD, Tourette Syndrome, Obsessive-Compulsive Disorder, intellectual disability, attachment disorders…
In young children particularly, it is important to test intellectual abilities and ASD in order to determine whether one or both disorders are present. A proper evaluation is essential in understanding what the person’s difficulties are and which interventions can help them best.
About the tools used for diagnosis
The ADI-R and the ADOS-2 are currently considered to be the “gold standard” with regards to autism diagnostic. In order to use them, clinicians need to be highly familiar and experienced with autism and to undergo specialized trainings (by certified trainers).
The ADI-R is a standardized interview that provides extensive information that assists clinicians in determining the need to diagnose Autism Spectrum Disorders (ASDs). Three domains of functioning are examined throughout the interview: language and communication, reciprocal social interactions and restricted, repetitive and stereotyped behaviors and interests. The interview is performed with the parents. It can be used to assess children and adults.
The ADOS (second edition) is an assessment used to observe and obtain information in the areas of ‘communication, reciprocal social interactions, and restrictive and repetitive patterns of behaviors and interests associated with a diagnosis of ASD’. Five modules are available and the psychologist chooses which one is most appropriate for each individual, based on his or her age and language abilities. The module for toddlers can be used starting 12 months, while the module 4 is better suited for teens and adults who use a fluid and complex language. The ADOS integrates planned social situations that incite certain behaviors to appear. In addition, the ADOS allows for the evaluation of imagination and creativity because these are often difficult concepts for people with autism. The psychologist carefully observes the child in order to determine whether they present symptoms of autism following the ADOS protocol
Additional resources
