Autism Spectrum Disorders: 10 Symptoms And Diagnosis
Autism Spectrum Disorder (ASD) has traditionally been one of the main sources of controversy due to the difficulty of knowing how to fit it into the classification of psychopathologies in a clear and permanent way.
Furthermore, with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013, the taxonomy of this psychopathology has been modified with respect to the previous version DSM-IV TR. Specifically, it has gone from being included along with other diagnostic labels within Generalized Developmental Disorders to all of them being established under the name of ASD indistinctly. Even so, different levels of involvement (I-IV) have been proposed to be specified in the diagnosis made.
Early detection of autism is complexsince 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) affirm that the symptoms of autism appear before the age of three but add that it is difficult to detect them during the first year of life.
There is still some difficulty and lack of knowledge regarding the information available in the primary care service that allows early detection. As indicated in one of the studies carried out in the USA (English and Essex, 2001), it was found that the first to suspect the presence of manifestations that could indicate autistic functioning were the family (60%), followed at a great distance by the pediatricians (10%) and educational services (7%). Besides There are multiple manifestations in form and intensity in which said disorder appears in the early ages.. Even with all these difficulties, early detection can occur around 18 months of age or even earlier.
Currently, there is no test or medical test that in itself indicates whether a person has ASD. The diagnosis of Autism Spectrum Disorders must include complementary observation of the person’s behavior, knowing their developmental history and applying a battery of medical and psychological tests to detect the manifestation of the signs and symptoms of autism.
Some of the tests used for the early detection of Autism are the CHAT by Baron-Cohen (1992), the M-CHAT by Robins, Fein, Barton and Green (2001), the IDEA by Rivière and Martos (1997) and the 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 behaviors in the company of different people and in various contexts, integrating the various data sources in a comprehensive manner and clarifying possible discrepancies. The earliest possible detection of any alteration in child development makes it possible to establish an early intervention program capable of maximizing the child’s personal and social development capabilities and the appropriate guidance of her family. For this It is advisable to rely on the following possible sources of information:
Symptoms and criteria to detect autism
To carry out an appropriate evaluation from three years of age The evaluation areas described below must be taken into accountalong with the tests used to evaluate child development (both in the clinical population and in the rest).
Extreme values on the measurement scales, both by default and excess depending on the test, can be very useful to complement the diagnosis of autism or ASD.
1. Social evaluation
It consists of collect information on social interest, quantity and quality of social initiatives, eye contactjoint attention, bodily, vocal and motor imitation, attachment, expression and recognition of emotions. For this purpose, Structured Interviews with parents 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 (CARS by DiLalla and Rogers, 1994) and unplanned interactions with the father and mother; videos provided by the family and various clinical instruments (Normative Tests such as the Vineland by Sparrow, Balla and Cicchetti (1984), Criteria Tests such as the Uzgiris-Hunt, reviewed by Dunts (1980) or Developmental Inventories such as the Battelle, a Spanish adaptation by De la Cruz and González (1996).
Some symptoms that can be detected
2. Communicative evaluation
Information is collected on intentionality, communicative tools, functions, contents, contexts and understanding. Structured interviews (ADI-R 1994), structured observations (ACACIA by Tamarit 1994, PL-ADOS by DiLavore, Lord & Rutter 1995), family videos and various clinical instruments (such as the Reynell Language Development Scale by Edwards, Fletcher, Garman, Hughes, Letts and Sinka 1997; and the ITPA by Samuel A. Kirk, James J. McCarthy, Winifred D. Kirk, revised edition in 2004, Madrid: TEA), among others.
Some symptoms that can be detected
3. Game
Information is collected on exploration, functional play, symbolic play, role-playing and cooperative play.. Structured Interviews (ADI-R 1994), Semi-structured Observations (free play), family videos and various clinical instruments (Lowe&Costello Symbolic Play Test 1988) are used.
Some symptoms that can be detected
4. Cognitive evaluation
Information is collected to make an assessment of the sensorimotor level, the level of development, and evaluation of preferences. stimulating and sensory, learning style and potential, executive and metacognitive skills and academic skills.
The following scales can be used: Leiter’s International Performance Scale, adapted by Arthur in 1980, the Weschler Intelligence Scales (WPPSI-III 2009 and WISC-V 2015), the Bayley Scales of Child Development from Bayley 1993, the of Uzgiris-Hunt Child Development, revised by Dunts in 1980 and the PEP-R (Psychoeducational Profile) of Mesibov, Schopler and Caison 1989.
Some symptoms that can be detected
5. Motor evaluation
Measurement of fine and gross motor skills through observation, information and application of the Brunet Lezine Scale by O. Brunet and L. Lezine 1951 and/or the PEP-R by Mesibov, Schopler and Caison 1989.
Knowledge through the family interview of the impact of the diagnosistheir resources to overcome it and establish appropriate ways of collaboration in the intervention, family-child interaction and the structure of the domestic environment.
7. Medical evaluation
Use of neurological and neuroimaging tests (EEG electroencephalogram, CT Axial Computed Tomography, SPECT Single Photon Emission Tomography, MRI Magnetic Resonance, blood and urine analysis, evoked potentials). There should be an absence of localized lesions that could explain the symptoms.
8. Evaluation of personal autonomy
Fundamentally through interviews and application of questionnaires to parents about feeding, toilet training, dressing and grooming. One of the most used scales is the Lawton and Brody Scale, translated into Spanish in 1993.
9. Evaluation of behavioral problems
Assessment of the presence or absence of behavioral problems (disruptive behaviors, aggression, self-harm, stereotypies, pica, regurgitation, phobias…) their intensity and frequency through questionnaires or structured interviews such as the ADI-R 1994, or the ICAP (Inventory of service planning and individual programming) Spanish adaptation by the University of Deusto, Bilbao in 1993.
10. Preference assessment
Knowledge of objects, toys, stimuli, sensory modalities, activities, foodsetc. preferred in order to use them as reinforcements or motivators of other activities or relevant communication objectives.
By way of conclusion
As we have seen, the diagnosis of autism must be made on the basis of a complete clinical evaluation, and must be strictly based on internationally agreed criteria, for three main objectives:
Ensure access to appropriate support services and intervention appropriate to the particularity of the case.
So that scientific research can be comparable, both in its clinical aspects and especially in the assessment of the effectiveness of the different services and treatments proposed.
Guarantee an education appropriate to the particular needs of the case of the child in questiongiven that lax diagnostic procedures could cause the exclusion of boys and girls with autism from special services provided for them, as well as encourage the inclusion of people who present other psychological cases.
