The complexity of Autism means that diagnosis is not easy or direct. Diagnosis is a process of gathering information from a range of situations and over some time. In the end any diagnosis will be based on a great deal of information which may seem contradictory. These descriptions indicate some of the characteristics which might be significant.
Autism
The Triad of Impairments
Social interaction
A child with autism will:
Often appear aloof and indifferent to other people, especially other children, although some will enjoy certain forms of active physical contact.
Passively accept social contact and even show some signs of pleasure in this, but will rarely make spontaneous approaches.
Occasionally approach other people but in an odd, inappropriate, repetitive way, paying little or no attention to the responses of those they approach.
Social communication
A child with autism will:
Not appropriate the social uses and the pleasure of communication. This is true even of those who have a lot of speech, which they use to talk 'at' others and not 'with' them.
Not understand that language is a tool for conveying information to others. They may be able to ask for their own needs but find it hard to talk about feelings or thoughts and will not understand the emotions, ideas and beliefs of other people.
Not really understand the meaning of gestures, facial expressions or tone of voice. Higher functioning children to use gestures but these tend to be odd and inappropriate.
Understand and use language very literally, with an idiosyncratic, sometimes pompous choice of words and phrases and limited content of speech. Though some children are fascinated with words, they will not use them to interact socially.
Imagination
A child with autism will:
Be unable to play imaginatively with objects or toys or with other children or adults.
Tend to focus on minor or trivial things around them, for example an earring rather than the person wearing it, or a wheel instead of the whole train.
Have a limited range of imaginative activities, possibly copied and pursued rigidly and repetitively.
Miss the point of pursuits that involve words e.g. social conversation, literature, especially fiction and subtle verbal humour.
Repetitive activities
Alongside the triad of impairments, the child will always show repetitive activity or behaviour. At a simple level, this might involve repeatedly flicking their fingers or an object like a piece of string.
Aspergers Syndrome
1. Lack of non-verbal expressions, associated either with 1. idiosyncratic facial expressions, gestures, voice prosody or posture; or 2. an inability to recognise socially important cues; or 3. both.
Severe impairment in reciprocal social interaction
(at least two of the following):
(a) Inability to interact with peers
(b) Lack of desire to interact with peers
(c) Lack of appreciation of social cues
(d) Socially and emotionally inappropriate behaviour
2. Unusual 'special' interests which are narrow and private. The special interest may be idiosyncratic or pursued obsessively, or both. Special interests often involve collecting objects or memorising facts.
All-absorbing narrow interest
(at least one of the following):
(a) Exclusion of other activities
(b) Repetitive adherence
(c) More rote than meaning
3. Imposition of routines and interests
(at least one of the following):
(a) on self, in aspects of life
(b) on others
Pragmatic abnormalities of speech
CHAT can help identify autistic children
The Checklist for Autism in Toddlers has questions for parents to answer in each of nine areas of development: social play, social interest, pretend play, joint attention, protodeclarative pointing, functional play, protoimperative pointing, motor development and "rough and tumble play". A further five questions are asked of the GP or Health Visitor.
In initial trials this instrument detected all four children later identified as autistic from a sample of just under a hundred 18 month olds. the wider use of this checklist as a screen for possible autism has raised many questions including the ethics of identifying children when there may not be methodologies (or resources) to treat them.
