How does the doctor decide if my child has autism?
How does the doctor decide if my child is autistic?
One of the wonderful things about your child is that they are unique. All children are unique and differ from each other in countless ways. Some people are tall, some are short, some are left-handed, some love to eat pickles, some are allergic to dairy, and some kids are more into roller coasters than others. With all of this normal diversity, how does a doctor decide if a person has autism? Aren’t all autistic people unique too? You are right.
You or someone you know may have a developmental evaluation scheduled to explore if a child qualifies for an autism diagnosis. Or maybe you have just completed the evaluation and are looking at the results. In any case, you will be comforted to know that there are specific guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders- 5th Edition (DSM-V) for all official mental and behavioral health diagnoses, including autism. The person evaluating your child will compare what they observe against these official guidelines in order to make or rule out a diagnosis of autism.
The evaluator observes the child. They give them a series of published tests and see how they perform. They interview you about how the child behaves and home and incorporate that information too. Once all of this information is compiled (standardized test scores, informal observations, parent interview), the child is compared to the guidelines to see if their specific profile qualifies for a particular diagnosis, such as autism.
Either at your child’s evaluation or after your provider has written their evaluation report, you will receive their findings. Below you will find some of the terms commonly used in evaluation reports. Keep in mind that much of the terminology used is meant to please insurance providers and increase the chances that they will pay for therapy services to support your child’s development. Receiving any sort of news that your child needs support is not easy, and hopefully hearing some of these words ahead of time may help you mentally prepare and understand that the evaluator is not judging you or your child, they are simply writing a report and following guidelines to get your child the best help possible.
What are the official criteria for an autism diagnosis?
Autism’s formal medical term is Autism Spectrum Disorder and is characterized as a “developmental disability.” As of 2013’s most recent diagnostic guidelines as labeled by the DSM-V, it is characterized by difficulties in all of the following social communication areas:
reciprocal interaction with others
nonverbal communication skills
developing/maintaining relationships
In addition to challenges with social-communication skills, to qualify for a diagnosis of autism a child must also demonstrate at least two of the following:
atypical repetitive behaviors
need for things to always be the same
restricted interests that might be abnormally intense
unusual responses to sensory input
The DSM further specifies that these challenge areas must be present early in life and cannot be better explained by another diagnosis.
Finalizing a diagnosis of autism can also take into account difficulties in other areas such as play skills, fine motor, gross motor, sensory skills, behavior and learning/academics.
“Severity Levels”
A person’s ability profile can range across a spectrum from having mild difficulties to significant difficulties for each skill area, which is why it’s called a spectrum. It is important to keep in mind that different people require more support in some skill areas than others because each person is unique. In fact, many people in the autistic community dislike using any labels to identify “severity” or “level of functioning” because of the fact that each person demonstrates strengths and weaknesses in different areas. Nevertheless the DSM and those in the medical community frequently use labels related to “severity” and “functioning” and so we are including them here for educational purposes.
In the DSM, there are currently 3 distinct “Severity Levels,” which can help guide treatment planning. The levels are defined by the amount of support that a person generally requires, as determined by the evaluator. The levels are:
Level 1: Requiring Support
Level 2: Requiring Substantial Support
Level 3: Requiring Very Substantial Support
It is important to note that very young children are very rarely assigned “level 1” as all young children require extra support. Whatever level your child is assigned during their initial assessment does not necessarily predict their long-term needs. These levels are a tool that professionals use to help create an appropriate and personalized treatment plan.
If interested, here is a link to the current CDC diagnostic criteria for autism spectrum disorder. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
You might also be interested in reading:
Or download a copy of our Toddler Talk Autism Characteristics Checklist
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