DIAGNOSTIC SUPPORTS
When a child is diagnosed with autism spectrum disorder, his or her history and behaviors are examined according to a standard set forth by the DSM-IV, a diagnostic manual for professionals in the behavioral health fields. In particular, there are three major behavioral areas, or symptom domains, that must be considered in determining if the child meets the criteria for an ASD diagnosis. Understanding these three symptom domains is important for two major reasons. The first is that to understand why someone has diagnosed your child with autism (or if you want to determine this for yourself), you will need to understand these “core symptoms.”
The second reason is to understand the basis for intervention. The behaviors pinpointed to diagnose the condition are the same ones that are targeted for intervention. The goal of intervention is to create and strengthen foundational social, communication, and cognitive competence, not just teach a list of random behaviors. Understanding the three domains helps you to understand how direct treatment, supports, your efforts, and environmental adaptations can all help your child move forward in skills and independence.
The three symptom domains apply to the whole age range, from infancy and preschool, to school age, adolescence, and adulthood. However, the component behaviors take different forms across this large age range. In addition, children “on the spectrum” range very widely in how severe their disability is. So, although the same core symptoms exist, the specific behaviors that represent them can be present or absent to some degree depending on the particular child.
The first symptom domain is Social Interaction. From a very early age--really from birth--the young child has ways to get the attention of adults, to respond to social input from adults and others, and to keep this interaction going for a while. As children develop, with increasing social communication skills, they can get social interaction going and keep it going for longer periods of time. The function of this set of skills is to create relationships with others that meet caregiving needs as well as social and emotional needs in the form of ongoing relationships that nurture, teach, and change and grow in a feedback system between the partners in the relationship.
The second is Communication. Communication also starts from an early age. Below about six months, the infant’s communicative output needs to be interpreted by the parent (for example, how different cries sound), and thus the parent bears the majority of the responsibility for understanding the specific message. With development and increasing skills, the child is able to bear more of the responsibility and uses vocalization, eye contact, and gesture to effectively communicate. With ASD, not only is the vocal and verbal output usually delayed, but gesture and social components are specifically affected. As the children develop, those with milder symptoms learn to speak yet retain difficulty in truly effective communication because of gaps in knowing how to use social means to get their message across.
The third is Stereotyped and Repetitive Behavior. This area has come to encompass a large and varied set of behaviors. On the one hand, it involves the stereotype of autistic behavior, that is, unusual movements such as spinning and rocking, walking on toes and hand flapping, as well as unusual sensory behaviors such as starting at lights and fans, smelling things, watching rolling credits on videos, feeling textures, and so on. On the other hand, the repetitive feature is also seen in children who develop obsessions with topics and want only to learn and talk about superheroes, trains, weather, sports statistics, and so on. For very young children, their unusual behavior and interests need to be understood by evaluating their play development. Play and object use progress in a well-documented developmental pattern, again from birth. By the time the typically-developing child is 24 months old, he has a rather developed and complex play repertoire. Thus, it is not difficult to evaluate if a child is developing typical vs. ASD play behavior by 18-24 months.
Host: Patricia Towle, PhDAgency: Westchester Institute for Human DevelopmentWebsite: www.wihd.orgEmail: ptowle@wihd.orgPhone: 914-493-8212
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