Why and How Did My Child Receive a Diagnosis of Autism?
A brief and simplified explanation of the new DSM-5 as it relates to people with autism having difficulty talking and understanding
The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5 or DSM-V, for short) is the latest edition of a tool used by medical professionals to classify and diagnose mental disorders. It is important to understand that disorders, not the person himself or herself, are diagnosed and labeled. Diagnoses, labels, or classifications are necessary for professionals to have an accurate description and communicate clearly with other professionals, parents, and the community at large in order to provide the best treatment for the individual. The following is my interpretation of the DSM-5’s sections that discuss communication. The DSM-5 identifies two areas of need for people with Autism Spectrum Disorder: A. Persistent deficits in social communication and social interaction across multiple contexts… B. Restricted, repetitive patterns of behavior, interests, or activities (as manifested by at least two specified qualifiers)
What do these mean?
A. Persistent deficits in social communication and social interaction across multiple contexts…:
Let’s break down this trait into everyday words:
“persistent deficits” - constant problems everyday
“social” - how a person purposefully looks for and enjoys friendly companionships or relationships with other people in a community or a society
“across multiple contexts” - many different types of environments or situations
These “persistent deficits” may include:
1. Deficits in social-emotional reciprocity
Your child may find it difficult to or often does not:
approach or get involved in social situations.
have a natural flow of talking and understanding during conversation.
share different kinds of interests, emotions, or reactions; initiate or respond to social interactions. For example, while at the playground, your child might not:
easily go up to and chat with other children;
show concern for another child who got hurt;
recognize that another child is struggling and needs help to swing on the swing;
understand or respond to the other children’s requests to play.
2. Deficits in nonverbal communicative behaviors
Your child may find it difficult to or often does notunderstand and/or use nonverbal communication (e.g., eye contact, body language, gestures, facial expressions)
Your child might misinterpret nonverbal cues such as mistaking sweat for tears or crossing arms out of anger versus being cold.
Your child might not be alert to some cues like a nervous shake of the leg or a frown.
Even when your child is alert of some cues, he or she may not be aware of their meanings such as a furrowed brow for a look of confusion or a raised eyebrow for curiosity.
3. Deficits in developing, maintaining, and understanding relationships
Your child may find it difficult to or often does not:
adjust his or her behavior in different social environments or situations.
sharing imaginative play.
showing an interest in other children his or her age or in making friends.
While in a library where a quieter voice is a courtesy to others, your child instead might use her or his regular voice or even shout.
While at the public pool, your child might prefer to twirl a beach ball around by himself instead of finding other children to play a game with that beach ball.
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases). “Echolalia” - Also called “scripting”, is the “echo”, repetition, or imitation of words or sounds made by another person or source such as song lyrics, battery-operated toys that make sounds, cartoon characters, recordings, and so on. “Idiosyncrasy” is a type of behavior that a particular person displays which is uniquely odd or strange. For instance, idiosyncratic communication would be occurring if your child were to continuously and for no reason, aimlessly recite lines from a movie or catch-phrases like, “Thank you. Come again!”
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday). For example: “Rigid thinking patterns” - Your child may not be able to accept and/or negotiate being first to take a turn at a game or can’t deal with losing the game. “Greeting rituals” - Your child may have routines that never change, so he or she is unable to say the same thing in different ways (e.g., “Hey!”; “What’s up?”; “What’s new?”; “What’s happening?”) or she or he will always give the same response (“I’m fine”) despite being sick or angry, or maybe he or she responds “I’m fine. How are you?” without looking at you and then walking away.
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed [restricted] or perseverative interests). Your child might “perseverate” or have repeated, selective interests or repetitive activities that he or she enjoys that continue on and on and can’t easily switch ideas. For example: Your child might always want to talk about the solar system or the year books or games or movies were published.
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Your child may be “hypo-reactive”= not aware of and not reacting to his or her surroundings, or “hyper-reactive”= too aware of and over-reacting to his or her environment.
Now that you are aware of and better understand upon what the diagnosis of ASD is based, you can be a reliable observer of your child which is of great importance to your child. When you discuss your observations with your child’s team such as medical professionals, teachers, therapists, family, friends, and community members, everyone will be enabled to work together effectively to provide the best care for your child.
To learn more, refer to http://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria