A Brief Overview of the Criteria For Diagnosing Adults with
Autism
Currently, there is no one single medical test that will
definitively diagnose audlts with autism. Instead, the diagnosis
is made on the basis of observable characteristics of the
individual. Here is an overview of some of the different
diagnostic standards: I. Autism Diagnostic Interview-Revised
(ADI-R) The Autism Diagnostic Interview-Revised (ADI-R) is a
clinical diagnostic instrument for assessing autism in children
and adults. The ADI-R is a semi-structured instrument for
diagnosing autism in children and adults with mental ages of 18
months and above. The instrument has been shown to be reliable
and to successfully differentiate young children with autism
from those with mental retardation and language impairments. The
ADI-R focuses on behavior in three main areas and contains 111
items which specifically focuses on behaviors in three content
areas - they are: Quality of social interaction, (e.g.,
emotional sharing, offering and seeking comfort, social smiling
and responding to others); Communication and language (e.g.,
stereotyped utterances, pronoun reversal, social usage of
language); and... Behavior (e.g., unusual preoccupations, hand
and finger mannerisms, unusual sensory interests). (ADI-R)
Scoring The interview generates scores in each of the three
content areas. Elevated scores indicate problematic behavior.
For each item, the clinician gives a score ranging from 0 to 3.
A score of 0 is given when "behavior of the type specified is
probably present but defining criteria are not fully met"; a
score of 2 indicates "definite abnormal behavior"; and a score
of 3 is reserved for "extreme severity" of the specified
behavior. ICD 10 (World Health Organisation 1992) Diagnostic
Criteria Diagnosis requires that single words should have
developed by two years of age or earlier and that communicative
phrases be used by three years of age or earlier. Self-help
skills, adaptive behaviour and curiosity about the environment
during the first three years should be at a level consistent
with normal intellectual development. However, motor milestones
may be somewhat delayed and motor clumsiness is usual (although
not a necessary diagnostic feature). Isolated special skills,
often related to abnormal preoccupations, are common, but are
not required for diagnosis. Diagnosis requires demonstrable
abnormalities in at least 3 out of the following 5 areas: 1.
Failure adequately to use eye-to-eye gaze, facial expression,
body posture and gesture to regulate social interaction; 2.
Failure to develop (in a manner appropriate to mental age, and
despite ample opportunities) peer relationships that involve a
mutual sharing of interests, activities and emotions; 3. Rarely
seeking and using other people for comfort and affection at
times of stress or distress and/or offering comfort and
affection to others when they are showing distress or
unhappiness; 4. Lack of shared enjoyment in terms of vicarious
pleasure in other people's happiness and/or a spontaneous
seeking to share their own enjoyment through joint involvement
with others; 5. A lack of socio-emotional reciprocity as shown
by an impaired or deviant response to other people's emotions;
and/or lack of modulation of behavior according to social
context, and/or a weak integration of social, emotional and
communicative behaviours. Diagnosis also requires demonstrable
abnormalities in at least 2 out of the following 6 areas: 1. An
encompassing preoccupation with stereotyped and restricted
patterns of interest; 2. Specific attachments to unusual
objects; 3. Apparently compulsive adherence to specific,
non-functional, routines or rituals; 4. Stereotyped and
repetitive motor mannerisms that involve either hand/finger
flapping or twisting, or complex whole body movement; 5.
Preoccupations with part-objects or non-functional elements of
play materials (such as their odor, the feel of their surface/
or the noise/vibration that they generate); 6. Distress over
changes in small, non-functional, details of the environment.
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Diagnostic Criteria A. Qualitative impairment in social
interaction, as manifested by at least two of the following: 1.
Marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures, and
gestures to regulate social interaction; 2. Failure to develop
peer relationships appropriate to developmental level; 3. A lack
of spontaneous seeking to share enjoyment, interests or
achievements with other people (eg: by a lack of showing,
bringing, or pointing out objects of interest to other people);
4. Lack of social or emotional reciprocity. B. Restricted
repetitive and stereotyped patterns of behavior, interests, and
activities, as manifested by at least one of the following: 1.
Encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either in
intensity or focus; 2. Apparently inflexible adherence to
specific, non-functional routines or rituals; 3. Stereotyped and
repetitive motor mannerisms (eg: hand or finger flapping or
twisting, or complex whole-body movements); 4. Persistent
preoccupation with parts of objects C. The disturbance causes
clinically significant impairment in social, occupational, or
other important areas of functioning. D. There is no clinically
significant general delay in language (eg: single words used by
age 2 years, communicative phrases used by age 3 years). E.
There is no clinically significant delay in cognitive
development or in the development of age-appropriate self-help
skills, adaptive behavior (other than social interaction), and
curiosity about the environment in childhood. F. Criteria are
not met for another specific Pervasive Developmental Disorder,
or Schizophrenia. International Classification of Diseases
(ICD-10) issued by the World Health Organization
DIAGNOSTIC CRITERIA FOR AUTISM DISORDER (ICD-10) (WHO 1992)
At least 8 of the 16 specified items must be fulfilled. a.
Qualitative impairments in reciprocal social interaction, as
manifested by at least three of the following five: 1. failure
adequately to use eye-to-eye gaze, facial expression, body
posture and gesture to regulate social interaction. 2. failure
to develop peer relationships. 3. rarely seeking and using other
people for comfort and affection at times of stress or distress
and/or offering comfort and affection to others when they are
showing distress or unhappiness. 4. lack of shared enjoyment in
terms of vicarious pleasure in other peoples' happiness and/or
spontaneous seeking to share their own enjoyment through joint
involvement with others. 5. lack of socio-emotional reciprocity.
b. Qualitative impairments in communication: 1. lack of social
usage of whatever language skills are present. 2. impairment in
make-believe and social imitative play. 3. poor synchrony and
lack of reciprocity in conversational interchange. 4. poor
flexibility in language expression and a relative lack of
creativity and fantasy in thought processes. 5. lack of
emotional response to other peoples' verbal and non-verbal
overtures. 6. impaired use of variations in cadence or emphasis
to reflect communicative modulation. 7. lack of accompanying
gesture to provide emphasis or aid meaning in spoken
communication. c. Restricted, repetitive and stereotyped
patterns of behavior, interests and activities, as manifested by
ate least two of the following six: 1. encompassing
preoccupation with stereotyped and restricted patterns of
interest. 2. specific attachments to unusual objects. 3.
apparently compulsive adherence to specific, non-functional
routines or rituals. 4. stereotyped and repetitive motor
mannerisms. 5. preoccupations with part-objects or
non-functional elements of play material. 6. distress over
changes in small, non-functional details of the environment. d.
Developmental abnormalities must have been present in the first
three years for the diagnosis to be made