What Is Autism Spectrum Disorder?

Persistent deficits in social communication and social interaction across multiple contexts;

Symptoms must be present in the early developmental period (typically recognized in the first two years of life); and,

Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment or disability that children with ASD can have. Some children are mildly impaired by their symptoms, while others are severely disabled. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer includes Asperger’s syndrome; the characteristics of Asperger’s syndrome are included within the broader category of ASD.

Information on ASD can also be found on the Eunice Kennedy Shriver National Institute of Child Health and Human Development website and the Centers for Disease Control and Prevention website.

Autism Spectrum Disorder

Let’s consider one possible case:
There was a young boy who was a genius and was the subject of a Ph.D. dissertation when he was 6 years old. He was given test after test for days, documenting him as a genius. Now, in school, he had a very distinct problem with social interaction with other children and adults. Great, slap him with Autism Spectrum Disorder. But, wait, if a symptom is caused by a physical problem rather than mental, you can’t count that symptom as being ASD. Oh, well, that makes a difference in this case. This boy’s right eye was located on the right side of the eye, looking that direction all the time – it didn’t track with the other eye. Neither teachers or students would look at him or interact with him because they were so put off by that eye. There just went our ASD label based on no/not much, social interaction, out the window.

Let’s don’t give up trying to put that label on this kid. He concentrated totally on his task and was making things that worked all the time. He was constantly busy creating and that was more fun than doing stupid kid games with other kids, so he didn’t do that. He did what he loved. Math was natural to him, physics was natural, gee, he sounds like Albert Einstein, oh, well, Einstein was sick with that, too. This kid is now a man and has never stopped creating. He has no use for a TV because his fun and relaxation is creating. He is a family man, too. Thank goodness no school or mental authority got hold of him and slapped him with a mental disorder.

There are true autistic children who require help. Let’s consider when a person “should” or “could” have a mental disorder label for any reason. If a person is running his/her life successfully, no mental diagnosis for anything should be given and it won’t be if that person never gets a mental examination anyway. If you are never tested, you get no label. If you never have your child tested, he/she gets no label. If you “refuse” to have your child tested, that child gets no label.

Here are the symptoms and the number of them that would have to be satisfied before an Autism Spectrum Disorder could be applied to a person. An interview with parents, the child, observation of the child, and testing would have to be done before this label could be applied. I have psychologically evaluated maybe 2,000 people over my career, and tested two children with severe autism. I evaluated many hundreds of children for placement or not, in Special Education, and those two children required an autism label.

New Diagnostic Criteria for Autism Spectrum Disorder

To be diagnosed with ASD, an individual must have displayed symptoms starting in early childhood, and those symptoms must impair the individual’s ability to function in day-to-day life.

Social and Communication Deficits:

In order to receive a diagnosis of Autism Spectrum Disorder, a person must have all three of the following deficits:

1. Problems reciprocating social or emotional interaction - This can include difficulty establishing or maintaining back-and-forth conversations and interactions, inability to initiate an interaction, and problems with shared attention or sharing of emotions and interests with others.

2. Severe problems maintaining relationships - This can involve a complete lack of interest in other people, difficulties playing pretend and engaging in age-appropriate social activities, and problems adjusting to different social expectations.

3. Non-verbal communication problems - This can include abnormal eye contact, posture, facial expressions, tone of voice, and gestures, as well as an inability to understand these non-verbal signals from other people.

Repetitive and Restrictive Behaviors:
In addition, the individual must display at least two of these behaviors:

1. Extreme attachment to routines and patterns and resistance to changes in routines

2. Repetitive speech or movements

3. Intense and restrictive interests

4. Difficulty integrating sensory information or strong seeking or avoiding behavior of sensory stimuli

There is now one disorder, not five as the last DSM was. Language Delay has been removed and not part of this diagnosis anymore.

I’ll write a short post about the two autistic children I tested so you can understand some of the behaviors of these children.

Someone on this thread talked about the research done, how it was done, to make these decisions about children who might be autistic. I found that research and will put the link on here if I kept that and I think I did.

Research completed before changing DSM IV autism diagnoses to DSM V autism diagnosis:
You may read this research at:
http://www.ncbi.nlm.nih.gov/pubmed/23032385

Two children with severe autism:

A child of about 4 years of age was brought to me for psychological evaluation. The parent knew there was something wrong with the child’s behavior but did not know what it could be.

The child was left with me and child was sitting at a table made for his size. The child would not look at me. The only way I could get his attention was to slam my hand down on the table, then he would look. He could not maintain eye contact. When he spoke, which was seldom even though I asked simple questions or tried to talk about something familiar with him, he referred to himself as “he”. “He” did “x”. Not one sentence started with, “I”. He was not in this world, would not come into this world, he stayed in his world. If he had said, “I”, it would mean he was in this world with me, so he used “he” to stay inside himself. He could not be formally tested because he was not going to admit he was here. Of course, that very behavior was leading me to autism.

The mom said he beats his head on the wall. He does not use “I” with her, either and she has to make a loud noise before he turns to her direction. Was he like this from the time he could interact with the mother and didn’t? Had he always beat his head against the wall? Any physical reason this was happening – any convulsions? Any physical trauma at birth. Was he a full term baby? I probed to see if anything had hurt this child like an accident, or had he gotten scared at night in a dark room, anything out of the ordinary?

He was normal until after the age of two, and one day – he was at grandmother’s house with just grandmother and toddled or crawled into the bathroom and pushed the door and it locked. I don’t recall the type lock it was but it locked and the light was not on. The grandmother went nuts and was crying and screaming outside the door and he was crying and screaming inside the bathroom at the door.

This went on until firemen came and took off that door and I recall it was over an hour before the door was gone. This child had not been the same since. He became autistic because he wasn’t coming back to this world after that event. I referred her to a neurologist to make sure he was neurologically intact. After that, if neurologically normal, a child psychologist was the best choice to try to get him back in this world.

A brilliant couple came to see me, he was with NASA, and they brought their 5 year old son with them – plus the son’s large regular phonebook. I say it was the child’s phonebook because it was – no one was getting that phonebook from him. He sat there concentrating on every name in that book. If told a name, he knew where it was in that book. He had memorized the phone book. The book was his security and his pleasure and his everything.

He had some interaction with the parents as he did acknowledge them, I didn’t exist to him, but he wasn’t giving up his phonebook. His birth was normal but by the time of three he was obsessing with certain toys and now it was the phonebook. The parents had tried every way to convince him to give it up, and he wasn’t about to do it. Now, at 5, he could read every name in there. This was a very smart kid. I knew I was seeing autism, discussed it with them and I recommended a certain place in Houston for further evaluation as they had the ability in that complex to medically check neurological health and hearing, etc., and if no physical reason why this was happening, start a program there to bring this kid back to this world.

The dividing line between normal and not normal, is, can this person adequately control his/her life at whatever age this person is? Neither of these children could control his life appropriately for that age. They were severe cases and intervention had to be done to get these kids back.

I think too many children are getting this label, and more are going to get this label when it is inappropriate.

It’s like Bipolar when that term was added – everyone wanted to have that. Before we called it Bipolar, we called it Manic Depressive. That just didn’t sound cool, so there weren’t that many Manic Depressives compared to today’s huge Bipolar population.

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