Autism/Asperger's Syndrome: DSM-IV Criteria

Diagnostic Criteria, Assessment, LOGIC

The official diagnostic criteria presented here (below the list of selected research references) are from DSM-IV -- The Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Washington, DC: American Psychiatric Association (1994).

It's not what people know that's deceiving; it's what they know that's not true.

    Misdiagnosis. Misclassification. Misintervention. Miseducation. When one hears of instant cures, spontaneous recovery, diet-based remedies, and the like, check the published literature in the major journals. Also query the experts -- those with the earned credentials, those with the years of experience, those competent and kind enough to publish their findings. During this search for the truth, bear in mind all along that when you listen to false authorities, you do so at your considerable peril ... and eventual outrage (see email letter, bottom of this page).

     This website, the Biblio-Refs research database, your nearby college or university library, and the local resource center will all assist all genuine efforts to "get the facts."

Word of caution: Autism remains a mystery. A mystery. Accordingly, we well-meaning care-providers are being pressured if not crushed by legends of ill-minded people, special interest groups, flighty organizations, and whole new industries -- all of which want to start yet another group, form yet another organization, convene yet another conference, ask for more and more and .... well, read the shocking email letter at the bottom of this page!

Tread cautiously! Much like 30 years ago when "LD" was all the rage, these days a hell of a lot of people stand to benefit from yet another label -- drug companies, untold new autism-specific educational lobbies, instant expert workshop presenters, instant assessment developers, and a gross assortment of hangers-on wanting in on the action! Remember: Just because industries and individuals stand to gain, you don't have to accept false blame. So read on -- carefully, cautiously, thoroughly, thoughtfully, and with a sense of objective balance.

    Assessment

False authorities ignore facts. They want you to believe the fantasies that hold their lives together. Not so long ago, one persistent fantasy was that 'facilitated communication' "worked." A lot of people got hurt, some individuals were sued, and too much heartache and personal hurt was dumped on well- meaning people until research debunked that notion. Only false authorities and dreamers continue to cling to 'FC therapy'.
     These days the pet fantasy is that autistics "recover." That too shall pass. In the meantime, read the research, search the literature, contact the experts. If you do, you will discover a fact conveniently ignored by the fantasy-huggers: No published research documents the assertion that those correctly diagnosed/assessed as autistic subsequently recover. Moreover, to date not one leading expert is on record as asserting that a correctly assessed autistic child "recovers." How easily ignorance discounts research.

     There are several assessment tools used by genuine experts to evaluate children regarding autism. Some of those instruments are: (1) Childhood Autism Rating School (Schopler et al, 1988). (2) Vineland Adaptive Behavior Scales. (3) The APA Diagnostic & Statistical Manual of Mental Disorders -- DSM-III, DSM-III-R, DSM-IV. (4) Autism Diagnosis Interview. (5) Autism Diagnostic Observation Scale. (6) PL-ADOS (Pre-linguistic Autism Diagnostic Observation Schedule).      Generally, no one tool is relied upon for a determination; other of the instruments (and still others) are used to confirm, verify, and re-verify that the assessment is as accurate as extant science presently allows (see Parks citation below).

"Most people will sacrifice more and fight harder to protect a valuable illusion then defend an unglamorous truth."

Do Autistics "Recover"...please?

    Just the facts: So let the data do the talking and send the false authorities off and walking! Take some time and read at least some of the "starter refs" below. The Tager-Flusberg and Sullivan (1994) study compared autistic, retarded, and normal children. The Sigman (1994) study looks at the "core" deficits that characterize autism. The Yirmiga et al. (1998) article comprehensively (and may I say brilliantly) pulls together a vast volume of research. They begin with the thesis that "a deficit in theory of mind has been described as a core deficit in autism" (Baren-Cohen, 1989; Hobson, 1993; Russell et al., 1991). The Yirmiga et al. (1998) study found that "individuals with autism have impaired mental abilities." They set forth in great depth the overwhelming research that led to such a conclusion (heresay to those still clinging to the "recovery" fantasy). To wit: those mental impairments are significant and broad. Powerful reading, as are the other references provided below.

    Again, just the facts. Again, those interested in genuine information regarding autism will enjoy this page, this website, and the research provided. All others -- hit the books and spare the rest of us those self-indulging fantasies!

    Genuine thinkers, please do consult the references. Then ask false authorities for their credentials. The fallacy arguments they rely upon to struggle against the factual information reflected in this short list of research studies will stagger the objective mind.

QUOTE

"Autism is a behaviorally defined, life-long static developmental disorder of the brain that is poised for neurobiological investigation. It affects at least 1 or 2 in 1000 persons and has a broad range of severity. It has multiple causes, with genetics playing a major role. According to the DSM-IV, defining features are impaired sociability, language and communication, and range of interests and activities. Mental deficiency is frequent but by no means universal. The cognitive profile is characteristic, occasionally with a superior but narrow talent. Perseveration, concreteness, affective blunting, and lack of insight into other persons' thinking may be conspicuous. The neurological basis of autism's many sensorimotor features, including stereotypies, is unknown. Attention and sleep are affected, and one third of individuals experience epilepsy by adulthood. Whether subclinical epilepsy plays a role in the developmental regression of the one third of the toddlers who lose their language skills and become autistic remains to be determined. Clinical neuroimaging and biochemical investigations are generally unremarkable. Fewer than 35 brains have been examined pathologically, none with modern techniques. The findings thus far suggest subtle prenatal neuronal maldevelopment in the cerebellum and certain limbic structures. Abnormalities in distributed networks involving serotonin and perhaps other neurotransmitters require further documentation."

Source: Rapin, I. & Katzman, R. (1998). Neurobiology of autism. Annals of Neurology, 43, 7-14.

Bailey, A., LeCouteur, A., Gottesman, I., Bolton, P., Simonoff, E., Yuzda, E., & Rutter, M. (1993). Autism as a strongly genetic disorder: Evidence from a British twin study. Psychological Medicine, 25, 63-77.

Cook, E.H. (1990). Autism: A review of neurochemical investigation. Synapse, 6, 292-308.

Dawson, G. (Ed.). (1989). Autism: Nature, diagnosis and treatment. New York: Guilford.

Dawson, G. (1996). Neuropsychology of autism: A report on the state of the science. Journal of Autism and Developmental Disorders, 26, 179-184.

Egel, A.L., Koegel, R.L., & Schreibman, L. (1980). A review of educational treatment procedures for autistic children. In L. Mann & D. Sabatino (Eds.), Third review of special education (pp. 130-158). New York: Grune & Stratton.

Freeman, B.J., & Ritvo, E.R. (1984). The syndrome of autism: Establishing the diagnosis and principles of management. Pediatric Annals, 13, 284-296.

Hedbring, C., & Newsom, C. (1985). Visual overselectivity: A comparison of two instructional remediation procedures with autistic children. Journal of Autism and Developmental Disorders, 15, 9-22.

Howlin, P. (1998). Practitioner review: Psychological and educational treatments for autism. Journal of Child Psychology and Psychiatry, 39, 307-322.

Koegel, R.L., Egel, A.L., & Dunlap, G. (1980). Learning characteristics of autistic children. In W. Sailor, B. Wilcox, & L. Brown (Eds.), Methods of instruction for severely handicapped students (pp. 259-301). Baltimore: Brookes.

Lovaas, O.I. (1980). Behavioral teaching with young autistic children. In B. Wilcox & A. Thompson (Eds.), Critical issues in educating autistic children and youth (pp. 220-233). Washington, DC: Department of Education, Office of Special Education.

Newsom, C.D., Carr, E.G., & Lovaas, O.I. (1979). The experimental analysis and modification of autistic behavior. In R.S. Davidson (Ed.), Modification of pathological behavior (pp. 109-187). New York: Gardner Press.

Ornitz, E.M., & Ritvo, E.R. (1976). The syndrome of autism: A critical review. American Journal of Psychiatry, 133, 609-621.

Parks, S. (1983). The assessment of autistic children: A selective review of available instruments. Journal of Autism and Developmental Disorders, 13, 255-268.

Prior, M. (1979). Cognitive abilities and disabilities in infantile autism: A review. Journal of Abnormal Child Psychology, 7, 357-380.

Rutter, M. (1978). Diagnosis and definition of childhood autism. Journal of Autism and Childhood Schizophrenia, 8, 139-161.

Rutter, M. (1985). The treatment of autistic children. Journal of Child Psychology and Psychiatry, 26, 193-214.

Rutter, M. (1991). Autism: Pathways from syndrome definition to pathogenesis. Comprehensive Mental Health Care, 1, 5-26.

Rutter, M. (1998). Routes from research to clinical practice in child psychiatry: Retrospect and prospect. Journal of Child Psychology and Psychiatry, 39, 805-816.

Rutter, M. (1999). Autism: two-way interplay between research and clinical work. Journal of Child Psychology and Psychiatry, 40, 169-188.

Rutter, M., Bailey, A., Bolton, P., & Le Couteur, A. (1994). Autism and known medical conditions: Myth and substance. Journal of Child Psychology and Psychiatry, 35, 311-322.

Rutter, M., Bailey, A., Simonoff, E., & Pickles, A. (1997). Genetic influences and autism. In D.J. Cohen & F.R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 370-387). New York: Wiley.

Rutter, M., & Plomin, R. (1997). Opportunities for psychiatry from genetic findings. British Journal of Psychiatry, 171, 209-219.

Sigman, M. (1994). What are the core deficits in autism? In S.H. Broman & J. Grafman (Eds.), Atypical cognitive deficits in developmental disorders: Implications for brain functioning (pp. 139-157). Hillsdale, NJ: Erlbaum.

Smalley, S.L., Asarnow, R.F., & Spence, M.A. (1988). Autism and genetics: A decade of research. Archives of General Psychiatry, 45, 953-961.

Tager-Flusberg, H., & Sullivan, K. (1994). Predicting and explaining behavior: A comparison of autistic, mentally retarded and normal children. Journal of Child Psychology and Psychiatry, 35, 1059-1075.

Waterhouse, L., Fein, D., & Modahl, C. (1996). Neurofunctional mechanisms in autism. Psychological Review, 103, 457-489.

Yirmiga, N., Erel, O., Shaked, M., & Solomonica-Levi, D. (1998). Meta-analyses comparing theory of mind abilities of individuals with autism, individuals with mental retardation, and normally developing individuals. Psychological Bulletin, 124, 283-307.

Reminder: Please consider downloading Biblio-Refs -- THE practical Research Assistant, if you're serious. These "starter references" are but a small fraction of the information resources available in Biblio-Refs.

Please read the following content carefully and closely...

Source: DSM-IV -- The Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Washington, DC: American Psychiatric Association (1994).

Page 66

"299.00 Autistic Disorder

(A) total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

  (1) qualitative impairment in social interaction, as manifested by at least two of the following:     (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction     (b) failure to develop peer relationships appropriate to developmental level     (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)     (d) lack of social or emotional reciprocity   (2) qualitative impairments in communication as manifested by at least one of the following:     (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime)     (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others     (c) stereotyped and repetitive use of language or idiosyncratic language     (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level   (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:     (a) encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus     (b) apparently inflexible adherence to specific, nonfunctional routines or rituals     (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)     (d) persistent preoccupation with parts of objects

(B) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

(C) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

 

After reading the above critera for correctly assessing autism, do you still honestly believe an autistic individual can "recover"?

Page 75

"299.80 Asperger's Disorder

(A) Qualitative impairment in social interaction, as manifested by at least two of the following:

    (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction     (2)failure to develop peer relationships appropriate to developmental level     (3)a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people(e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)     (4)lack of social or emotional reciprocity. (B)Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:     (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus     (2) apparently inflexible adherence to specific, non-functional routines or rituals     (3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)     (4) persistent preoccupation with parts of objects (C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. (D) There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) (E) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. (F)Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. Page 77

299.80 Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder.
    For example, this category includes atypical autism --- presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these."

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(Please go to References Section of this website, Biblio-Refs, for a wide selection of published articles on autism from top research journals.)