Autism and Asperger’s Diagnosis and Testing for Children and Teens

Dr. Michelle Matusoff, Clinical Psychologist, Newport Beach, Orange County, California

Autism is a disorder that has gained increasing recognition over the past several years.  Much has been reported about the diagnosis of Autistic Disorder (Autism), which falls into the category of the disorders known as the Pervasive Developmental Disorders. The Pervasive Developmental Disorders are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as involving severe and pervasive impairment in reciprocal social interaction skills, communication skills, or the presence of stereotyped behaviors, interests, and activities. 

Autism is characterized by symptoms such as poor eye contact, failure to develop peer relationships, lack of social or emotional reciprocity.  Children with Autism may also exhibit delays in spoken language, inability to initiate or sustain conversation with others, and repetitive use of language that may not make sense to others.  Certain behaviors are often characteristic of Autism, such as excessive preoccupation with one or more areas of interest, inflexibility with regard to routines and rituals, and repetitive motor movements such as flapping of the hands, or walking on one’s toes.  Children with Autism may also be very sensitive to certain visual stimuli, sounds, tastes, smells, or textures.

Prevalence

According to the National Institute of Mental Health (NIMH), between 2-6 of 1,000 children are diagnosed with a Pervasive Developmental Disorder.  Although there are five Pervasive Developmental Disorders listed in the DSM IV, the most commonly diagnosed include Autistic Disorder (Autism) and Asperger’s Disorder. 

Asperger's Disorder

Asperger’s Disorder is a more mild form of Autism, and does not involve the language delays that are typical of Autistic children.  In addition, children with Asperger’s Disorder do not exhibit delays in cognitive development or adaptive, self-help skills.  Children with Asperger’s Disorder may function well in all areas other than social interaction.  However, their inability to read social cues makes it almost impossible to sustain meaningful social relationships.  For example, individuals with Asperger’s are often unable to understand body language, sarcasm, and other “subtle innuendos” of the English language.  There is usually an inability to put oneself in another’s position (empathy), which is also an important part of social functioning.  Children with Asperger’s Disorder often set themselves apart with speech patterns that are unlike their peers.  Speech that is adult-like, robotic, or otherwise “odd” is not uncommon.   

Although described as more “mild” that Autistic Disorder, individuals with Asperger’s Disorder have a very difficult time socially, and often endure relentless teasing and criticism from peers.  As in the case of Autistic Disorder, early diagnosis and treatment of Asperger’s Disorder is crucial.

Diagnosing Autism

Although Autism is usually not diagnosed until age 3, there are studies that suggest we may be able to begin diagnosing this disorder earlier.  Developing infants are extremely social by nature from very early on, often drawing others into their world by looking into the faces of parents, smiling, etc.  When there is an impairment in this instinctive behavior, the observant parent and/or pediatrician may take notice. 

Early diagnosis of Autism is extremely beneficial.  There is a good deal of research that supports the utility of early intervention.  It appears as though the earlier that diagnosis and treatment occur, the more positive the outcome.  However, despite what we know about early intervention and Autism, NIMH reports that only 50% of children with Autism are diagnosed before kindergarten.

If Autism is suspected, a thorough physical exam with a pediatrician is recommended, in order to rule out a medical cause.  Next, a comprehensive assessment should be completed, including (but not limited to) the administration of measures developed specifically for diagnosing autism, observation, and detailed feedback from parents and teachers.

Treatment

The course of treatment for Autism varies greatly depending on the nature and severity of the disorder.  However, a very important component of treating any form of Autism is parent education. 

In some very mild cases, individual therapy that is instructive in nature, and social skills training may be sufficient.  Children with more severe forms of Autism may require additional resources such as an IEP (special education), speech and language services, psychiatric intervention, and/or placement in a specialized treatment program.

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