Autistic Disorder

Table 84.2 A guide to the diagnosis of autistic disorder (after Tonge)⁸

1 Onset during infancy and early childhood.

2 An impairment of social interactions shown by at least two of the following:

• lack of awareness of the feelings of others

• absent or abnormal comfort seeking in response to distress

• lack of imitation

• absent or abnormal social play

• impaired ability to socialise, which may include gaze avoidance

3 Impairment in communication as shown by at least one of the following:

• lack of babbling, gesture, mime or spoken language

• absent or abnormal non-verbal communication

• abnormalities in the form or content of speech

• poor ability to initiate or sustain conversation

• abnormal speech production

4 Restricted or repetitive range of activities, interests and imaginative development, shown in at least one of the following:

• stereotyped body movements

• persistent and unusual preoccupations and rituals with objects or activities

• severe distress over changes in routine or environment

• an absence of imaginative and symbolic play

5 Behavioural problems:

• tantrums

• hyperactivity

• destructiveness

• risk-taking activity

 

 

The earliest signs of autistic spectrum disorder in infancy include:⁷

• excessive crying
• no response to cuddling if crying
• failure to mould the body in anticipation of being picked up
• stiffening the body or resisting when being held
• no babbling by 1 year
• resistance to a change in routine
• appearing to be deaf
• failing to respond or overacting to sensory stimuli
• persistent failure to imitate, such as waving goodbye
• a need for minimal sleep
• no single words by 16 months

The diagnosis remains difficult before the age of 2 years.

Latter features:

• fascination with certain toys/objects
• poor interaction with other children
• not pointing to objects, e.g. grabs parent's hands to show things