What is autism and how is it diagnosed.
DSM-5 Diagnostic Criteria
A diagnosis of autism is made on the basis of observed behaviour.
Clinicians must use careful observation of behaviours to determine whether a child’s difficulties are related to autism, or are better described by another condition.
The criteria as defined in the DSM-V
Diagnostic Criteria A
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history :
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Diagnostic Criteria B
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests 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).
Diagnostic Criteria C
Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
Diagnostic Criteria D
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
Diagnostic Criteria E
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. Autism Spectrum Disorder 299.00 (F84.0) (DSM-V, American Psychiatric Association, 2013; Retrieved from Autism Speaks).
Alexithymia
Alexithymia is characterized by difficulties in identifying, describing, and processing one’s own feelings, often marked by a lack of understanding of the feelings of others, and difficulty distinguishing between feelings and the bodily sensations of emotional arousal (Kooiman, Spinhoven, & Trijsburg, 2002).
An important aspect of social relatedness is the ability to empathize with the feelings of others. Empathy involves two major components:
- a cognitive component e.g., theory of mind, perspective taking, or mindreading
- an affective component, emotional processing, which allows us to share the feelings of others.
Miriam webster definition of Alexithymia.
