Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)1 - Diagnostic Criteria for 299.00 Autistic Disorder (Autism) - Social Interaction 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.
Social Interaction Symptoms
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
Translator's Note: "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 social interaction will be "gross and sustained." Difficulty interacting with other people will be very different from the normal shyness or immaturity other people may show. The person will have difficulty interacting normally with all people, not just strangers, etc. The person will have difficulty interacting with others in all settings, not just outside the home, etc. The person may act somewhat better at home or school or in other settings or with other people, but the essential features of autism will still be present. Remember, to be diagnosed with autism, the person must show at least two of the following symptoms of impaired social interaction:
(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
Translator's Note: "Marked impairment" means not just occasionally failing to use these nonverbal behaviors but "gross and sustained" difficulties with them. Some researchers believe that persons with autism may be different from birth. Two characteristic body posture difficulties reported in the literature include: infants who arch their backs away from their caregiver to avoid physical contact and infants who fail to anticipate being picked up (by becoming limp or stiff). Poor eye-contact is probably the most common symptom reported by parents of children with autism. It may be the first and most obvious symptom noted, however, not all children with autism have poor eye-contact. The Checklist for Autism in Toddlers (CHAT) checks for the following nonverbal behaviors in children at age 18 months: ability and desire to play peek-a-boo, purposeful pointing with the index finger, eye-contact, and looking where others look. If an 18 month old child does not perform these things, the CHAT would suspect autism or a developmental delay. The American Academy of Neurology, the Child Neurology Society, and the American Academy of Pediatrics lower the threshold to age 12 months, saying, if the child shows "no babbling, or pointing, or other gesture by 12 months . . . or ANY loss of ANY language or social skills at ANY age" the child should have an immediate evaluation for the presence of autism. Does your child, look you in the eye, point to things he wants, point to things she is interested in, look at what you are looking at, look where you point, show typical emotions on his face, reach to be picked up, get her body posture ready for expected activities (pattycake, peek-a-boo, riding a toy horse, etc.)? If not and your child's developmental age peers can do these things, your child may meet this criteria for qualitative impairment in this aspect of social interaction.
(b) failure to develop peer relationships appropriate to developmental level
Translator's Note: "Failure" means failure to relate to peers in all settings, not just strangers, although the child may get along better with family members. The child may prefer to be alone, may play near other children but not interact with them; may be interested in what other children do but not participate. Some children may show no interest in other people at all. Older persons with autism may be interested in having friends but may not understand how to make or keep friends. Severely affected children may seem to be unaware of the presence of others. Does your child play with other children, have friends, want to be with other children or siblings, understand the "rules" of friendship and family, 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 social interaction.
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
Translator's Note: "Spontaneous" is a key word here. Does your child do these things without having to be prompted by you? One of the true joys of parenting is seeing the excitement that your child shows when he or she does something for the first time or is just having fun with something. It shows in the child's face and typically, the child will make attempts to get you involved in their joy and excitement. Does your child bring you things to show you, point to things he wants, show excitement about you or toys or other things, get excited at successes, point to animals or other things of interest during a car ride, 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 social interaction.
(d) lack of social or emotional reciprocity
Translator's Note: This is the "give and take" of social interaction. Somehow we all learn this "dance" of getting along with others. When they smile, we smile. When they cry, we tend to be sad. When one child is generous and gives a cookie to a peer, the peer is more likely to share something he or she has. This "treat others the way you want to be treated" rule works pretty well for most of us. Children or adults with autism may not understand that other people have feelings, can be hurt, have their own thoughts and desires, etc. Does your child smile at you when you smile, get happy when you praise him, get sad when you are sad, attempt to comfort siblings in distress, hit others when hit first, 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 social interaction.
Go To Communication 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.
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