Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)1 - Diagnostic Criteria for 299.00 Autistic Disorder (Autism) - Communication 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.
Communication Symptoms
(2) qualitative impairments in communication, as manifested by at least one of the following:
Translator's Note: Again, "qualitative impairment" means markedly abnormal or, if you will, very different from other people at the same age and developmental level. We are not talking about just a little different. While there are wide variations in the severity of symptoms in persons with autism, the symptoms themselves are very different from what you would see in most normally-developing children and adults. The impairment in communication seen in autism will be "marked and sustained and affects both verbal and nonverbal (communication) skills." The problems with communication will be very noticeable in most children and adults with autism. However, some children with autism spectrum disorders (e.g., Asperger's Syndrome) may have a normal vocabulary but will have a noticeable problem with their ability to use language socially. Remember, to be diagnosed with autism, the person must have at least one of the following symptoms of impaired communication:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
Translator's Note: The American Academy of Neurology, the Child Neurology Society, and the American Academy of Pediatrics recommend that a child should have an immediate evaluation for autism if the child shows "No babbling, or pointing or other gesture by 12 months. No single words by 16 months. No 2-word spontaneous (not echolalic) phrases by 24 months. ANY loss of ANY language or social skills at ANY age." Some children with autism may develop language and then lose these skills. The child may also have difficulty understanding spoken language (receptive) as well as producing language (expressive). Many children with autism have been suspected of being deaf because they do not seem to respond to spoken words or sounds. Others may respond to some sounds by covering their ears and ignore other sounds or voices. Does your child babble or use gestures to communicate by 12 months, use single words by 16 months, use two-word spontaneous (not echolalic) phrases by 24 months, use words to communicate needs and wants, use sign language or gestures to communicate, seem to understand what you say, etc.? If not and your child's developmental age peers normally do these things, your child may meet this criteria for qualitative impairment in this aspect of communication. Note: Children and adults with autism may not speak or use gestures to communicate, but be assured they will communicate their likes and dislikes through other methods (perhaps through their behavior).
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
Translator's Note: Conversation is an art. It is the give and take process of how one person prompts another to respond in predictable ways, which, in turn, prompts the other person to respond and on and on. Persons with autism may not know how to start a conversation, how to keep it going or what to say next, and how to properly end a conversation that maintains the relationship so that the person actually wants to talk to you again. Persons with autism who can talk well may be considered to be rude, or odd, or socially inept. Does your child start conversations in appropriate ways, keep the conversation going on the current topic, avoid from saying hurtful or embarrassing comments, end a conversation appropriately, etc.? If not and your child's developmental age peers normally do these things, your child may meet this criteria for qualitative impairment in this aspect of communication.
(c) stereotyped and repetitive use of language or idiosyncratic language
Translator's Note: A child or adult with autism may repeat words or phrases over and over and out of context. The words or phrases may change over time but they will be predictably present. Some children with autism echo what others have just said (immediate echolalia). Some may echo things heard minutes to hours before (delayed echolalia). Some children may use odd phrases to communicate wants and needs (for example, a child may say "Want moo-moo" to indicate he wants a drink of milk). The child may speak in ways that only their parent understands. Does your child repeat TV commercials, movie or story scripts, songs, or words or phrases you or others have said in ways that are repetitive and out of context? Does your child engage in these verbal behaviors for minutes to hours at a time with no known goal? Does your child speak in an odd "language" that only you can interpret? If these things are true of your child, your child may meet this criteria for qualitative impairment in this aspect of communication.
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
Translator's Note: One of the early signs of autism may be an inability to pretend. Pretending is a way to communicate that both persons involved in the play activity understand what is going on. It's sort of like being "in" on the joke. You both know you are playing. Persons with autism may have difficulty understanding another person's perspective or point of view so it may be very hard for them to pretend, or joke, or tolerate teasing, etc. The child may play with toys in a scripted way but have difficulty learning or trying different ways to play. Children with autism may be unable to imitate others. Adults with autism may have difficulty learning new job skills or imitating the actions of others. Does your child pretend in play (for example, pretend to be drinking coffee, pretend to be cooking, pretend to be combing their hair with an imaginary hairbrush, etc.)? Does your child play along in simple games and try to imitate your actions and/or words (for example, copy the moves in pattycake, Itsy Bitsy Spider, etc.)? If your child has difficulty doing these things, your child may meet this criteria for qualitative impairment in this aspect of communication.
Back To Social Symptoms - DSM-IV
Go To Behavior Symptoms - DSM-IV
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.
DISCLAIMER: This site is intended to provide basic information resources on Autistic Disorder. It is not intended to, nor does it, constitute medical or other advice. The author of the web site is not a medical doctor. Readers are warned not to take any action with regard to medical treatment or otherwise based on the information on this web site or links without first consulting a physician. This web site does not necessarily endorse any of the information obtained from any of the links on this page or links that other pages may lead you to. Neither does this web site promote or recommend any treatment, therapy, institution or health care plan. The information contained in this site is intended to be for your general education and information only and not for use in pursuing any treatment or course of action. Ultimately, the course of action in treating a given patient must be individualized after a thorough discussion with the patient's physician(s) and family.