Autism Spectrum Disorders: 10 Symptoms and Diagnosis

Autism Spectrum Disorder (ASD) has always been a major subject of controversy due to the difficulty of knowing how to frame it in the classification of psychopathologies in a clear and permanent manner.

In addition, with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013, the taxonomy of this psychopathology has been changed from the previous version DSM-IV TR. Specifically, it went from including with other diagnostic labels in Generalized Developmental Disorders to indiscriminately establishing all of them as ASD. However, different levels of involvement (I-IV) have been proposed to be specified in the diagnosis made.

Autism spectrum disorders: how to diagnose?

Early detection of autism is complex, Since in most cases it is the parents who give the first warning signs. Authors such as Wing (1980), Volkmar (1985), Gillberg (1990) and Frith (1993) claim that symptoms of autism appear before the age of three but add that it is difficult to detect them during of the first year of life.

There are still difficulties and a certain ignorance regarding the information held in the primary care unit which allows for early detection. As one of the studies in the United States indicates (English and Essex, 2001), it was found that the first to suspect the presence of manifestations that could indicate autistic functioning was family (60%), followed by far by pediatricians (10%) and educational services (7%). outraged the manifestations of form and intensity in which this disorder appears in the early ages are multiple. Even with all of these difficulties, early detection can occur around the age of 18 months or even earlier.

Tests and tools for the detection of ASDs

Currently, there is no medical test or test that on its own will tell if a person has ASD. The diagnosis of autism spectrum disorders should include further observation of the person’s behavior, knowledge of their developmental history, and the application of a battery of medical and psychological tests to detect the manifestation of signs and symptoms of autism. .

Some of the tests used for the early detection of autism are Baron-Cohen CHAT (1992), Robins, Féin, Barton and Green M-CHAT (2001), River IDEA and Martos (1997) and IDTA- 18 by FJ Mendizábal (1993). The age of application of these tests would be between 18 and 36 months.

In addition to the tests indicated above, it is essential to collect information on the child’s behavior in the company of different people and in different contexts by comprehensively integrating the different data sources and clarifying any possible discrepancies. The earliest possible detection of any alteration in the child’s development makes it possible to set up an early intervention program capable of promoting as much as possible the child’s personal and social development capacities and the appropriate guidance of the children. of his relatives. for that it is advisable to rely on the following possible sources of information:

  • Test scales in clinical sessions.
  • Interviews and information from teachers and parents.
  • Observation in a natural situation (home, school) and / or structured observations of the interaction with parents and assessed.

Symptoms and criteria for detecting autism

Perform an appropriate assessment from the age of three the assessment areas described below should be considered, With the tests used to assess the development of the child (both in the clinical population and in the rest).

Extreme values ​​on the measurement scales, both default and excess depending on the test, can be very useful in supplementing the diagnosis of autism or ASD.

1. Social assessment

consists of collect information on social interest, quantity and quality of social initiatives, eye contact, Joint attention, bodily, vocal and motor imitation, affection, expression and recognition of emotions. For this, structured parental interviews such as ADI-R by M. Rutter, A. Le Couteur and C. Lord (1994) are used;

Structured observation in the clinical context of both planned interactions (CARS by DiLalla and Rogers, 1994) and unplanned interactions with father and mother; videos provided by the family and various clinical instruments such as normative tests like the Vinelandde Sparrow, Balla and Cicchetti (1984), criteria tests like the Uzgiris-Hunt, revised by Dunts (1980) or development inventories like the Battelle, a Spanish adaptation of De la Cruz and González (1996).

Some symptoms that can be detected

  • Lack of expression of emotions.
  • Isolation from peers.

2. Communicative assessment

Information is collected on intentionality, communication tools, functions, content, contexts and understanding. Structured interviews (ADI-R 1994), structured observations (Tamarit ACACIA 1994, DiLavore PL-A TS, Lord & Rutter 1995), family videos and various clinical instruments (such as the language development scale) are used. . By Reynell of Edwards, Fletcher, Garman, Hughes, Letts and Sinka 1997, and the ITPA by Samuel A. Kirk, James J. McCarthy, Winifred D. Kirk, revised edition 2004, Madrid: TEA), among others.

Some symptoms that can be detected

  • Literal interpretation of sentences.
  • Delay in the onset of verbal communication.

3. Game

Information is collected on exploration, functional play, symbolic play, role play and cooperative play. Structured interviews (ADI-R 1994), semi-structured observations (free game), family videos and various clinical instruments are used (Lowe & Costello 1988 Symbolic Game Test).

Some symptoms that can be detected

  • Difficulties understanding the nature of role play.
  • Rejection of social gambling.

4. Cognitive assessment

Information is collected to assess sensorimotor level, level of development, assessment of preferences stimulus and sensory, learning style and potential, executive and metacognitive skills and academic skills.

The following scales can be used: Leiter International Execution Scale, adapted by Arthur in 1980, Weschler Intelligence Scales (WPPSI-III 2009 and WISC-V 2015), Bayley Child Development Scales Bayley 1993, the Uzgiris-Hunt Child Development Scale, revised by Dunts in 1980 and the PEP-R (Psychoeducational Profile) of Mesibov, Schopler and Caison 1989.

Some symptoms that can be detected

  • Emergence of unusually developed cognitive ability.
  • General cognitive difficulties.

5. Motor assessment

Fine and gross motor measurement by observing, informing and applying the Brunet Lezine scale of O Brunet and L. Lezine 1951 and / or the PEP-R of Mesibov, Schopler and Caison 1989.

Some symptoms that can be detected

  • Changes in gait and posture.
  • Changes in motor anticipation.

6. Environmental and family assessment

Knowledge through family interview of the impact of the diagnosis, Their resources to overcome it and establish appropriate ways of collaboration in the intervention, the family-child interaction and the structure of the family environment.

7. Medical assessment

Use of neurological tests and neuroimaging (EEG electroencephalogram, CT-calculated axial tomography, SPECT single-photon emission tomography, MRI, blood and urine analysis, evoked potentials). There should be an absence of localized lesions that could explain the symptoms.

8. Assessment of personal autonomy

Basically, through interviews and the application of questionnaires to parents sure feeding, sphincter control, dressing and toilet. One of the most widely used scales is the Lawton and Brody scale, translated into Spanish in 1993.

9. Assessment of behavior problems

Assessment of the presence or absence of behavior problems (Disruptive behaviors, aggressiveness, self-harm, stereotypes, sin, regurgitation, phobias …) its intensity and frequency by means of questionnaires or structured interviews such as the ADI-R 1994, or the ICAP (Inventory of planning services and individual programming) Spanish adaptation by the University of Deusto, Bilbao on 1993.

10. Evaluation of preferences

Knowledge of objects, toys, stimuli, sensory modalities, activities, food, Etc. preferred so that they can be used as reinforcements or motivators for other relevant communication activities or objectives.

To conclude

As we have seen, the diagnosis of autism must be made on the basis of a complete clinical evaluation, and must be based strictly on internationally recognized criteria, for three main purposes:

  • Ensure access to appropriate support services and an intervention adapted to the particularity of the case.
  • So that scientific research can be compared, both clinically and in terms of evaluation of the effectiveness of the various services and treatments offered.
  • Provide education adapted to the specific needs of the case of the child in questionSince less rigorous diagnostic procedures could lead to the exclusion of autistic children from the special services provided to them, as well as favor the inclusion of people with other psychological cases.

Bibliographical references:

  • International Autism-Europe Association (2000): Description of autism.
  • Jané, MC and Domènech-Llaberi, I. (1998): Infantile autism. In González Barrón, R. (coord.). Child and adolescent psychopathology. Madrid: Pyramid, p. 295-318.
  • Martos-Pérez, J. Neurol Magazine; 42 (Suppl 2) S99-S101 (2006): Autism, neurodevelopment and early detection.
  • Mendizábal, FJ (1993): An attempt to address the issue of early detection of autism. Proceedings of the VII Congress of Autism. Editorial Amarú.
  • Pedreira, MJ (2003): Assessment, diagnosis, neurobiology and treatment of autism. Madrid: Laertes edition.
  • Rivière, A. Autism and generalized developmental disorders. In A. Marchesi, C. Coll and J. Palacios Eds. (1999): Psychological development and education III. Madrid: Aliança Psicologia, p. 329-360.

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