Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)1 - Diagnostic Criteria for 299.00 Autistic Disorder (Autism) - Behavior Symptoms
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
Translator's Note: Autistic Disorder (more commonly referred to as autism) is diagnosed by behavioral observation of the following symptoms. Typically, a medical doctor or psychologist will diagnose autism. If a person shows six or more of these symptoms (in the ratio above), then he or she is said to have the diagnosis of autism.
Behavior Symptoms
(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:
Translator's Note: The behaviors, interests, and activities are not just occasional. The behaviors, interests, and activities are time-consuming, repeated over and over, and performed to the exclusion of other, more-appropriate behaviors. All of us engage in odd behaviors occasionally, but a person with autism may engage in these behaviors, interests, and activities in extreme ways, almost constantly, and in ways that are difficult to stop or control. Remember, to be diagnosed with autism, the person must have at least one of the following symptoms of restricted, repetitive, and stereotyped patterns of behavior, interests, and activities:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
Translator's Note: This is not just a preference for some things over others, but a consuming "need" to have, think about, talk about, or experience some specific thing, topic, or sensation. Persons with autism may become obsessively interested in trains, cars, specific objects, specific toys, specific subjects, specific foods, etc. The person may spend most of his or her time collecting, playing with, manipulating, tasting, feeling, thinking about, or talking about these things. Attempting to change the person's interest may be met with disinterest, persistent attempts to continue their preoccupation, or even an angry rejection of the attempted change of subject. Does your child have to have certain objects with her, "collect" odd things, collect a certain type of toy, get "hooked" on certain TV shows/videos/books, play with certain toys or objects exclusively (for example, trains, cars, strings, straws, buttons, etc.) and strongly resists your attempts to change this interest? Does your child only want to talk about their special interest, always attempt to get the subject around to his interest, or resist talking about things that do not pertain to their interest? If these things are true of your child, your child may meet the criteria for this aspect of restricted, repetitive, and stereotyped behaviors, interests, and activities. Note: The area of interest may be related to a sensory need that the specific object meets for the person (for example, the person may choose toys that feel a certain way, are visually stimulating, make certain sounds, have a certain smell, or taste, etc.).
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
Translator's Note: Persons with autism may insist on sameness, resist change, and demand that things be done in the same way it has always been done. The child may line toys up in straight lines, play with their toys in a prescribed way, demand the same foods, want to wear the same clothes daily, etc. In addition, the child may become very upset if these routines are changed in any way. The person with autism may become upset if the route to school or work is changed in any way. The person with autism may perform odd rituals with toys or objects that must be performed the same way each time. A child may have to touch each toy in the toy box a certain way, flick the lights three times before turning them off or on, count each step as he goes up or down, etc. The routines and rituals may remind one of obsessive-compulsive behavior. Does your child have specific routines or rituals like these that must be performed almost daily or more often? Will your child get upset if the routine or ritual is changed, stopped, delayed, or interrupted? If these things are true of your child, your child may meet the criteria for this aspect of restricted, repetitive, and stereotyped behaviors, interests, and activities.
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)
Translator's Note: Some children with autism may develop head-banging or incessant rocking as infants, however, this is not always the case. The movements and mannerisms may involve fingers, hands, arms, feet, legs, head, mouth, body part combinations, or the whole body. A child with autism may flick her fingers in front of her eyes, may flap his hands, may rock back and forth or side to side, may jump up and down when excited, may cover her ears, may rub his head or other body parts, etc. These behaviors may be repeated hundreds of times in an hour or may happen several times a day. The child may be redirected from the activity or may not engage in the activity when occupied with some constructive activity but will typically return to the activity when not otherwise engaged. Does your child engage in any of these repetitive behaviors? If these things are true of your child, your child may meet the criteria for this aspect of restricted, repetitive, and stereotyped behaviors, interests, and activities. Note: The repetitive behavior may be related to a sensory need that the action meets for the person (for example, the person may flick fingers for the visual stimulation, may rub objects for the tactile stimulation, may chew things for the oral or taste sensation, may tap hands or fingers on things to get a certain sound sensation, or may place fingers in front of the nose for the smell, etc.).
(d) persistent preoccupation with parts of objects
Translator's Note: Children with autism may play with different toys but only be interested in a certain aspect or feature or part of the toy or object. For example, the child may play with toy cars but only to spin the wheels, or may choose only things that make a noise, things that open and close, or have some other common feature. The child may spin everything, may tear toys apart to obtain strings or other parts of the toy, may flick parts of the toy or object, etc. The child may engage in this unusual play for minutes to hours at a time and may resist any attempt to change her focus. Does your child get preoccupied with certain parts (or aspects) of objects or toys in any of these ways? If so, your child may meet the criteria for this aspect of restricted, repetitive, and stereotyped behaviors, interests, and activities.
Additional Criteria
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
Translator's Note: The person may not be diagnosed with autism until age five, fifteen, or thirty-five. However, a delay in social interaction, language as used in social communication, or symbolic or imaginative play must have been present before age three.
C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
Translator's Note: These are two related pervasive developmental disorders with similar symptoms but different age of onset, course, and have additional symptoms. The professional diagnosing the person would rule these out before diagnosing autism.
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1 Note: The DSM-IV-TR portions were reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association.
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