Core Symptoms of ASD
The current diagnostic criteria (DSM-5) characterizes ASD as affecting individuals across their lifespan in two core functional areas:
- challenges related to social communication and social interactions and
- restricted repetitive behaviors, interests, or activities.
It does not mean that individuals with ASD do not engage in communication, socially, or otherwise. Rather, their behavior in these core areas are different from those observed in children of the same developmental age.
Children under the age of two years: Early Indicators of ASD
- a child being limp or floppy when not seated upright or when being held
- rarely crying in environments that would typically induce crying (such as pain, hunger, or discomfort)
- being difficult to comfort (or being comforted only by motion)
- a limited understanding or use of specific gestures or other communication methods
- a lack of babbling, pointing, or gesturing by 12 months of age
- complete lack of speech by 16 months of age
- an inability to combine words by 2 years of age
- limited eye contact or social smiling (smiling in responses to parents/caregivers)
- limited interest in or awareness of others in the environment
- unusual (high or low) sensitivity to the sensory features of an object or environment (sight, sound, smell, taste, feel)
Children over the age of two:
- difficulty expressing wants or needs
- have limited conversation skills or even loss of expressive language
- high levels of stress related to minor changes within their environment, such as their favorite toy being put away in a different spot
- spend a significant amount of time seeking sensory input (such as spinning in circles or wedging themselves into tight spaces)
Other possible early indicators:
- engagement in repetitive motor movements such as flapping their hands or even hurting themselves
- oftentimes a lowered sensitivity to pain
- limited or no imaginative play or understanding of social rules or interactions of playtime.
Children over two years old are generally strong visual learners and react well to visual cues and routines.
Other possible early indicators of ASD in younger children may include:
- failure to respond to his or her name
- strong attachment to a particular toy or object
- playing with toys or objects in a different manner from typical peers
- limited smiling
- lack of attending to what others are attending to (i.e., joint attention).
Although the presence of these or any early indicators does not necessarily mean that a child has ASD, it may suggest that a child should be screened for ASD or other possible developmental delays by a medical professional.
Fundamentals of a Diagnosis
If you notice any signs and indicators of ASD, ask your physician. First, individuals may undergo a general developmental screening, hearing assessment, and, if needed, additional medical testing specific to parent and/or physician concerns. If concerns remain, a physician or pediatrician would recommend a comprehensive evaluation by a multidisciplinary team to administer specific ASD diagnostic screening tools and possibly a referral to other specialists.
The following professionals are qualified to provide a diagnosis:
- developmental pediatricians
- pediatric neurologists
- psychologists with expertise in childhood onset disorders and ASD
Other disciplines, such as therapists or social workers may screen and suggest further referral for ASD evaluation but are not qualified to make formal medical diagnoses.
During the comprehensive evaluation, one or more of the providers noted above would observe a child’s:
- social skills and communication
- cognitive ability (IQ)
- play skills
- everyday skills such as feeding and dressing
In addition, the provider may conduct interviews with the child’s parents and/or review information from other caregivers (such as teachers and therapists) or providers to learn how the child behaves and interacts across settings. They will also want to obtain information about the child’s developmental, social, family, and behavioral histories.
Additional testing may be undertaken to rule out other medical, mental health, and/or neurodevelopmental disorders. The medical professional may also utilize standardized diagnostic tools, such as the Autism Diagnostic Interview – Revised (ADI-R) or the Autism Diagnostic Observation Schedule – Generic (ADOS-G). A medical diagnosis of ASD is made according to diagnostic criteria as described in the current version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013).
Medical Diagnosis vs. Educational Classification
A medical diagnosis of ASD is an important step in identifying service needs. These services may be covered by certain insurance providers and are related to the overall health of the child across settings.
By contrast, within the school setting, a child may be eligible for special education services under ASD eligibility
- if the child meets diagnostic criteria for ASD as outlined within the current edition of the DSM-5 and
- if such symptoms or challenges result in a consistent and negative impact upon the child’s academic achievement and/or functioning performance.
(As specified within the Individuals with Disabilities Education Improvement Act (IDEA) and the Indiana Department of Education Article 7.)
A medical diagnosis of ASD may be used in consideration of eligibility decisions but is not necessary or sufficient to make the educational classification.
Determining Special Education Eligibility
A multidisciplinary team comprised of qualified professionals (e.g., school psychologists, speech-language pathologists, occupational therapists, and special education teachers, among others depending on the student’s unique needs) will conduct an educational evaluation of the student’s:
- academic achievement
- functional skills across settings
- communication skills
- motor and sensory responses
- developmental history
Following and based upon this evaluation, a case conference committee (CCC) comprised of various school professionals and the student’s parents will decide whether the student’s ASD symptoms result in a consistent and significant negative impact on their academic achievement or functional performance. If the CCC concludes that the student’s ASD does negatively interfere with learning, they would be determined to be eligible for special education services within the school setting.