Lady Neptune's blog: "autism"

Autism Diagnosis Checklist Signs of Autism There are two major diagnostic classification systems in current use, the International Classification of Diseases, version 10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV ). They have similar symptom criteria for diagnosis based on three general impairments, with the following behaviours, which are out of line with their mental age: 1. Social Delayed or abnormal social development. 2. Language and communication Delayed or abnormal language and communication both verbal and non-verbal. 3. Thought and behavior Rigidity of thought and behavior and lack of imagination. Displays ritualistic behavior, reliance on routines, impairment of imaginative play. DSM-IV is diagnostic criteria used in the United States and many other parts of the world. ICD-10 is the most commonly used ASD classification system in the UK and Europe, although many research studies also use DSM-IV or other criteria. The diagnostic criteria for ASD continue to develop as more research is done and understanding improves, and they are likely to change with future revisions. Timing of Diagnosis In children under 2 years of age typical ASD symptoms may not be noticeable. However, absence of such behaviours should not totally rule out the possibility of diagnosis. However, regardless of the age of the child, if there is a suspicion of autistic tendencies then early referral can make a difference. Another form of diagnosis assessment is the Checklist for Autism in Toddlers (CHAT ) which was designed to identify 18 month old children at risk of ASD. Here are some general guidelines derived from CHAT that can be used by parents as an informal way to assess a child General Developmental Warnings of Possible ASD in Pre-School children Delay or absence of spoken word Looks through people; not aware of others Not responsive to other’s facial expressions/ feelings Lack of pretend play; little or no imagination Does not show typical interest in peers or play near peers purposefully Lack of turn-taking in games Unable to share pleasure Non-verbal communication delays or impairment Does not point at an object to direct another person to look at it Lack of gaze monitoring Lack of initiation of activity or social play Unusual or repetitive hand and finger mannerisms Unusual reactions or lack of reaction to sensory stimuli Signs of Possible ASD in school-age Children Communication impairments Abnormalities in language development including muteness Odd or inappropriate prosody (the acoustic properties of speech) i.e. pitch/ tone Persistent echolalia Reference to self as “you”, “she” or “he” beyond three years Unusual vocabulary for child’s age/social group Limited use of language for communication and/or tendency to talk freely only about specific topics Social impairment Inability to join in play with other children or inappropriate attempts at joint play (may manifest as aggressive or disruptive behavior) Lack of awareness of classroom “norms” (criticising teachers, unwillingness to co-operate in classroom activities, inability to appreciate or follow current trends and fads and fit in with the crowd) Easily overwhelmed by social and other stimulation Failure to relate normally to adults (too intense/ no relationship) Showing extreme reaction to invasion of personal space and resistance to being hurried Impairments of interests, activities and/or behaviours Lack of flexible cooperative imaginative play/creativity Difficulty in organising self in relation to unstructured space (e.g. hugging the perimeter of playground, halls) Inability to cope with change or unstructured situations, even ones that other children enjoy (school trips, teachers being away etc) Other factors Any other evidence of odd behaviours including unusual responses to sensory stimuli Signs of Possible ASD in adolescents General Picture Long standing difficulties in social behaviours, communication and coping with change, which are more obvious at times of transition (e.g. change of school, leaving school) Significant discrepancy between academic ability and “social” intelligence, most difficulties in unstructured social situations, e.g. in school breaks Socially “naive”, lack common sense, not as independent as peers Language, non-verbal skills and social communication Problems with communication even if they have a wide vocabulary and normal use of grammar. May be unduly quiet, may talk at others rather than hold a “to and fro” conversation, or may provide excessive information on topics of their own interest. Unable to adapt their style of communication to social situations e.g. may sound like “a little professor” (overly formal), or be inappropriately familiar May have speech peculiarities including “flat”, unmodulated speech, repetitiveness May take things literally and fail to understand sarcasm or metaphor Unusual use and timing of non-verbal interaction (eg eye contact, gesture and facial expression) Social Problems Difficulty making and maintaining peer friendships though may find it easier with adults or younger children Can appear unaware or uninterested in peer group “norms”, may be alienated by behaviours which transgress “unwritten rules” May lack awareness of personal space, or be intolerant of intrusions on own space Rigidity in thinking and behavior Preference for highly specific, narrow interest or hobbies, or may enjoy collecting, numbering or listing Strong preference for familiar routines, may have repetitive behaviours or intrusive rituals Problems using imagination e.g. writing, future planning May have unusual reactions to sensory stimuli e.g. sounds, tastes, smell, touch, hot or cold.