Autism Symptoms and Characteristics in Accordance with the American Psychiatric Association (2013)

*Please note that the following information is extracted from the DSM-V (2013).

To be diagnosed on the Autism Spectrum, it is important to consider that not all symptoms must be present, but enough to meet the criteria outlined by the diagnostic manual. For a proper screening and diagnosis to take place, it is important to consult with a developmental pediatrician and/ or neuropsychologist when concerned. Diagnosis are valid and reliable when based on multiple sources of information including clinician’s observations, caregiver history, and (when possible) self-report (American Psychiatric Association, 2013).

Characteristics

  1. Deficits in social communication and social interaction
    1. Deficits in social-emotional reciprocity
      1. Many have language deficits that could range from complete lack of speech to language delays, poor comprehension of speech, echoed speech, or have an overly literal comprehension of language.
      2. Expresses difficulties in back and forth social conversations even if grammar and vocabulary are learned. Conversations tend to be one-sided and/ or difficulties producing commentaries on other people’s interests might be present. For example, monologues or using “quotes” from movies when speaking.
      3. Adopts an unusual or abnormal approach in social situations or conversations. They tend to express difficulties processing and responding to complex social cues such as joining or leaving a conversation.
      4. Expresses difficulties initiating or responding to social interactions.
      5. Has difficulties sharing with others his or her interests, emotions or affect.
    2. Deficits in nonverbal communication within social interactions
      1. Absent, reduced or atypical eye contact (relative to cultural norms).
      2. Lack of or limited non-verbal behavior in verbal conversations. For example, lack of usage or understanding of another person’s body language including body orientation and speech intonation.
      3. An early sign of autism is impairment in joint-attention (lack of pointing, showing, or bringing objects to share interest with others, or failure to follow someone’s pointing or eye gaze).
      4. Difficulties understanding and using gestures in conversation.
      5. A total lack of facial expressions and non-verbal communication.
    3. Deficits in developing, maintaining, and understanding relationships (according to age, gender and culture)
        1. Absent, reduced, or atypical social interest that are apparent through rejection from others, passivity or inappropriate approaches that are either aggressive or disruptive.
        2. Difficulties adjusting to meet social contexts.
        3. Difficulties with imaginative / pretend play.
        4. Insistence on playing by very fixed rules.
        5. Difficulties making or maintaining friendships.
        6. Absence in sharing other people’s interests.
        7. Difficulties understanding jokes, white lies, sarcasm and/ or irony.
        8. Preference in playing alone or desire to play with much younger children or older people.
        9. Difficulties understanding what a friendship consists of/ entails.

      * Please note that relationships with siblings, co-workers, and caregivers are important to consider.

  2. Restrictive or repetitive patterns of behavior, interests or activities.
    1. Stereotypic or repetitive motor movements, use of objects, or speech.
      1. Simple motor stereotypes (ex: hand flapping, finger flipping).
      2. Lining up toys or flipping objects (ex: spinning coins).
      3. Repetition in speech (ex: Echolalia, delayed or immediate parroting of heard words, and/ or using the word “you” when talking about self)
    2. Difficulties with inflexibilities and adherence to routine or ritualized patterns of verbal and/ or non-verbal behaviours.
      1. Extreme distress over small changes.
      2. Difficulties with transitions.
      3. Rigid thinking patterns.
      4. Greeting rituals.
      5. A need to take the same route or eat the same food everyday.
    3. Restricted and fixated interests.
      1. Strong attachment or preoccupation with unusual objects (ex: elevators, escalators).
      2. Excessive interests.
    4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.
      1. Apparent indifference to pain/ temperature.
      2. Adverse response to specific sounds or textures.
      3. Excessive smelling or touching of objects.
      4. Visual fascination with lights or movements.
      5. Oral sensitivity (ex: refusal for eating spices, crunchy, sticky, or gooey foods).
  3. Deficits need to be present in early developmental period, but may not be noticeable until social demands exceed capabilities or may be missed due to learned strategies.
  4. Deficits cause significant impairment in social, occupational, or important areas of functioning.
  5. Deficits or autism symptoms are not explained by intellectual disabilities or global developmental delay. Even though intellectual disabilities and autism co-occur in comorbid diagnostics, intellectual impairments are not part of diagnostic criteria.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Eilan, N., Hoerl, C., McCormack, T., &Roessler, J. (Eds). (2005). Joint-attention: communication and other minds. Great Clarendon Street, Oxford : Oxford University Press.

Rutter, M., Le Couteur, A., & Lord, C. (2005).Autism Diagnostic Interview-Revised. Los Angeles : Western Psychological Services.

Sroufe, L.A. (1997). Emotional development: the organization of emotional life in  the early years. Cambridge, United Kingdom :Cambridge University Press.