what are the disorders that make up the autism spectrum disorders group?

[gabriela]

Technically, The Autism Spectrum Disorders include

• Asperger syndrome
• Autism
• Childhood disentegrative Disorder
• Pervasive Developmental Disorder - Not Otherwise Specified
• Rett Syndrome

Asperger syndrome


From DSM IV (p77):





Diagnostic Criteria FOR 299.80 Asperger's Disorder



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

1. marked impairments 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, nonfunctional 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 impairments 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 social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia







GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER

1. Severe impairment in reciprocal social interaction

1. (at least two of the following)
   • (a) inability to interact with peers
   • (b) lack of desire to interact with peers
   • (c) lack of appreciation of social cues
   • (d) socially and emotionally inappropriate behavior
   
   
2. All-absorbing narrow interest
   
   
   (at least one of the following)
   • (a) exclusion of other activities
   • (b) repetitive adherence
   • (c) more rote than meaning
   
   
3. Imposition of routines and interests
   
   
   (at least one of the following)
   • (a) on self, in aspects of life
   • (b) on others
   
   
4. Speech and language problems
   
   
   (at least three of the following)
   • (a) delayed development
   • (b) superficially perfect expressive language
   • (c) formal, pedantic language
   • (d) odd prosody, peculiar voice characteristics
   • (e) impairment of comprehension including misinterpretations of literal/implied meanings
   
   
5. Non-verbal communication problems
   
   
   (at least one of the following)
   • (a) limited use of gestures
   • (b) clumsy/gauche body language
   • (c) limited facial expression
   • (d) inappropriate expression
   • (e) peculiar, stiff gaze
   
   
6. Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis.)









A More Down-to-Earth Description by Lois Freisleben-Cook.



NOTE: (This was originally a post to the bit.listserv.autism newsgroup/listserv)

I saw that someone posted the DSM IV criteria for Asperger's but I thought it might be good to provide a more down to earth description. Asperger's Syndrome is a term used when a child or adult has some features of autism but may not have the full blown clinical picture. There is some disagreement about where it fits in the PDD spectrum. A few people with Asperger's syndrome are very successful and until recently were not diagnosed with anything but were seen as brilliant, eccentric, absent minded, socially inept, and a little awkward physically.

Although the criteria state no significant delay in the development of language milestones, what you might see is a "different" way of using language. A child may have a wonderful vocabulary and even demonstrate hyperlexia but not truly understand the nuances of language and have difficulty with language pragmatics. Social pragmatics also tend be weak, leading the person to appear to be walking to the beat of a "different drum". Motor dyspraxia can be reflected in a tendency to be clumsy.

In social interaction, many people with Asperger's syndrome demonstrate gaze avoidance and may actually turn away at the same moment as greeting another. The children I have known do desire interaction with others but have trouble knowing how to make it work. They are, however, able to learn social skills much like you or I would learn to play the piano.

There is a general impression that Asperger's syndrome carries with it superior intelligence and a tendency to become very interested in and preoccupied with a particular subject. Often this preoccupation leads to a specific career at which the adult is very successful. At younger ages, one might see the child being a bit more rigid and apprehensive about changes or about adhering to routines. This can lead to a consideration of OCD but it is not the same phenomenon.

Many of the weaknesses can be remediated with specific types of therapy aimed at teaching social and pragmatic skills. Anxiety leading to significant rigidity can be also treated medically. Although it is harder, adults with Asperger's can have relationships, families, happy and productive lives.

Dr. Lois Freisleben-Cook








* "Asperger's Syndrome Characteristics"







by Roger Meyer

Below is a list of Asperger’s Syndrome characteristics. Most have been extracted from medical diagnostic criteria, descriptions offered by medical and counseling professionals, articles by educators and from employment biographies of approximately a dozen independent-living, medically or self-diagnosed AS adults over the age of 25. While every adult occasionally manifests these characteristics, what distinguishes adults with AS is their consistency of appearance, their intensity, and the sheer number of them appearing simultaneously. Some characteristics do not apply to everyone, so persons consulting this list should not feel compelled to find them all. Adults with AS who wish to compose employment biographies for their own enlightenment and/or as contributions to research should weigh the significance of the ones they share, and have their compositions accurately reflect that impact.

Social Characteristics

• Difficulty in accepting criticism or correction
• Difficulty in offering correction or criticism without appearing harsh, pedantic or insensitive
• Difficulty in perceiving and applying unwritten social rules or protocols
• "Immature" manners
• Failure to distinguish between private and public personal care habits: i.e., brushing, public attention to skin problems, nose picking, teeth picking, ear canal cleaning, clothing arrangement
• Naïve trust in others
• Shyness
• Low or no conversational participation in group meetings or conferences
• Constant anxiety about performance and acceptance, despite recognition and commendation
• Scrupulous honesty, often expressed in an apparently disarming or inappropriate manner or setting
• Bluntness in emotional expression
• "Flat affect"
• Discomfort manipulating or "playing games" with others
• Unmodulated reaction in being manipulated, patronized, or "handled" by others
• Low to medium level of paranoia
• Low to no apparent sense of humor; bizarre sense of humor (often stemming from a "private" internal thread of humor being inserted in public conversation without preparation or warming others up to the reason for the "punchline")
• Difficulty with reciprocal displays of pleasantries and greetings
• Problems expressing empathy or comfort to/with others: sadness, condolence, congratulations, etc.
• Pouting,, ruminating, fixating on bad experiences with people or events for an inordinate length of time
• Difficulty with adopting a social mask to obscure real feelings, moods, reactions
• Using social masks inappropriately (you are "xv" while everyone else is ????)
• Abrupt and strong expression of likes and dislikes
• Rigid adherence to rules and social conventions where flexibility is desirable
• Apparent absence of relaxation, recreational, or "time out" activities
• "Serious" all the time
• Known for single-mindedness
• Flash temper
• Tantrums
• Excessive talk
• Difficulty in forming friendships and intimate relationships; difficulty in distinguishing between acquaintance and friendship
• Social isolation and intense concern for privacy
• Limited clothing preference; discomfort with formal attire or uniforms
• Preference for bland or bare environments in living arrangements
• Difficulty judging others’ personal space
• Limited by intensely pursued interests
• Often perceived as "being in their own world"

Physical Manifestations

• Strong sensory sensitivities: touch and tactile sensations, sounds, lighting and colors, odors, taste
• Clumsiness
• Balance difficulties
• Difficulty in judging distances, height, depth
• Difficulty in recognizing others’ faces (prosopagnosia)
• Stims (self-stimulatory behavior serving to reduce anxiety, stress, or to express pleasure)
• Self-injurious or disfiguring behaviors
• Nail-biting
• Unusual gait, stance, posture
• Gross or fine motor coordination problems
• Low apparent sexual interest
• Depression
• Anxiety
• Sleep difficulties
• Verbosity
• Difficulty expressing anger (excessive or "bottled up")
• Flat or monotone vocal expression; limited range of inflection
• Difficulty with initiating or maintaining eye contact
• Elevated voice volume during periods of stress and frustration
• Strong food preferences and aversions
• Unusual and rigidly adhered to eating behaviors
• Bad or unusual personal hygiene

Morbid (shared, dual, multiple) Diagnostic Conditions

• Learning Disability
• Attention Deficit Disorder (ADD)
• Obsessive Compulsive Disorder (OCD)
• Central Auditory Processing Disorder (CAPD)
• Hyperlexia
• Depression
• Anxiety
• Non-verbal Learning Disorder (NVLD)
• Hypertension
• Semantic Pragmatic Language Disorder
• Tourette’s Syndrome
• Dysthymia

Cognitive Characteristics

• Susceptibility to distraction
• Difficulty in expressing emotions
• Resistance to or failure to respond to talk therapy
• Mental shutdown response to conflicting demands and multi-tasking
• Generalized confusion during periods of stress
• Low understanding of the reciprocal rules of conversation: interrupting, dominating, minimum participation, difficult in shifting topics, problem with initiating or terminating conversation, subject perseveration
• Insensitivity to the non-verbal cues of others (stance, posture, facial expressions)
• Perseveration best characterized by the term "bulldog tenacity"
• Literal interpretation of instructions (failure to read between the lines)
• Interpreting words and phrases literally (problem with colloquialisms, cliches, neologism, turns of phrase, common humorous expressions)
• Preference for visually oriented instruction and training
• Dependence on step-by-step learning procedures (disorientation occurs when a step is assumed, deleted, or otherwise overlooked in instruction)
• Difficulty in generalizing
• Preference for repetitive, often simple routines
• Difficulty in understanding rules for games of social entertainment
• Missing or misconstruing others’ agendas, priorities, preferences
• Impulsiveness
• Compelling need to finish one task completely before starting another
• Rigid adherence to rules and routines
• Difficulty in interpreting meaning to others’ activities; difficulty in drawing relationships between an activity or event and ideas
• Exquisite attention to detail, principally visual, or details which can be visualized ("Thinking in Pictures") or cognitive details (often those learned by rote)
• Concrete thinking
• Distractibility due to focus on external or internal sensations, thoughts, and/or sensory input (appearing to be in a world of one’s own or day-dreaming)
• Difficulty in assessing relative importance of details (an aspect o the trees/forest problem)
• Poor judgment of when a task is finished (often attributable to perfectionism or an apparent unwillingness to follow differential standards for quality)
• Difficulty in imagining others’ thoughts in a similar or identical event or circumstance that are different from one’s own ("Theory of Mind" issues)
• Difficulty with organizing and sequencing (planning and execution; successful performance of tasks in a logical, functional order)
• Difficulty in assessing cause and effect relationships (behaviors and consequences)
• An apparent lack of "common sense"
• Relaxation techniques and developing recreational "release" interest may require formal instruction
• Rage, tantrum, shutdown, self-isolating reactions appearing "out of nowhere"
• Substantial hidden self-anger, anger towards others, and resentment
• Difficulty in estimating time to complete tasks
• Difficulty in learning self-monitoring techniques
• Disinclination to produce expected results in an orthodox manner
• Psychometric testing shows great deviance between verbal and performance results
• Extreme reaction to changes in routine, surroundings, people
• Stilted, pedantic conversational style ("The Professor")

Work Characteristics

Many of the manifestations found in the categories above can immediately translate into work behaviors or preferences. Here are some additional ones:

• Difficulty with "teamwork"
• Deliberate withholding of peak performance due to belief that one’s best efforts may remain unrecognized, unrewarded, or appropriated by others
• Intense pride in expertise or performance, often perceived by others as "flouting behavior"
• Sarcasm, negativism, criticism
• Difficulty in accepting compliments, often responding with quizzical or self-deprecatory language
• Tendency to "lose it" during sensory overload, multitask demands, or when contradictory and confusing priorities have been set
• Difficult in starting project
• Discomfort with competition, out of scale reactions to losing
• Low motivation to perform tasks of no immediate personal interest
• Oversight or forgetting of tasks without formal reminders such as lists or schedules
• Great concern about order and appearance of personal work area
• Slow performance
• Perfectionism
• Difficult with unstructured time
• Reluctance to ask for help or seek comfort
• Excessive questions
• Low sensitivity to risks in the environment to self and/or others
• Difficulty with writing and reports
• Reliance on internal speech process to "talk" oneself through a task or procedure
• Stress, frustration and anger reaction to interruptions
• Difficulty in negotiating either in conflict situations or as a self-advocate
• Ver low level of assertiveness
• Reluctance to accept positions of authority or supervision
• Strong desire to coach or mentor newcomers
• Difficulty in handling relationships with authority figures
• Often viewed as vulnerable or less able to resist harassment and badgering by others
• Punctual and conscientious
• Avoids socializing, "hanging out," or small talk on and off the job

DSM-4 Criteria for Autistic Disorder and Pervasive Developmental Disorder, Not Otherwise Specified (PDD NOS)

To be diagnosed with autistic disorder at least one sign (each) from parts A, B, and C must be present plus at least six overall. Those meeting fewer criteria are diagnosable as PDD NOS.



A. Qualitative impairments in reciprocal social interaction:

1. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction.
2. Failure to develop peer relationships appropriate to developmental level
3. Lack of spontaneous seeking to share enjoyment, interests, or achievements with others.
4. Lack of socioemotional reciprocity.

B. Qualitative impairments in communication:

1. 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 gesture or mime).
2. Marked impairment in the ability to initiate or sustain a conversation with others despite adequate speech.
3. Stereotyped and repetitive use of language or idiosyncratic language.
4. Lack of varied spontaneous make- believe play or social imitative play appropriate to developmental level.

C. Restricted, repetitive, and stereotyped patterns of behavior, interest, or activity:

1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest, abnormal either in intensity or focus.
2. An apparently compulsive adherence to specific nonfunctional 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.

Abnormal or impaired development prior to age three manifested by delay or abnormal functioning in at least one of the following areas: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.






Autism is the common term for a range of disabilities medically classified as Pervasive Developmental Disorders (PDD). Autism/PDD is characterized by qualitative differences in the development of cognitive, language, social or motor skills, and these are usually apparent before age three. Research evidence suggests that autism may result from an underlying difficulty with expressive movement and its regulation, severely challenging the individual to keep body movements, including sensory responses, in control. These sensorimotor problems can make it difficult to respond consistently and productively to other individuals and to the environment.

Autism/PDD occurs in approximately fifteen out of every 10,000 births and is four times more common among males than females. It is found throughout the world in families of all racial, ethnic and social backgrounds. While autism was once erroneously believed to arise from stresses in a child's psychological environment, modern medical evidence suggests that irregularities in the development of the brain and central nervous system give rise to the syndrome of autism. Causes of this development are diverse and may include chemical exposure, viral and genetic factors.

Autism/PDD is not an illness or a "thing" a person "has." It is a collection of responses which must be viewed in context, and observation is always more productive than labeling. Across the wide spectrum of the autism/PDD syndrome, individual variations on several key features can be recognized. Reciprocal social interactions, both verbal and nonverbal, are unusual in quality and generally difficult to synchronize and to carry out. Impairments of the central nervous system typically result in over-reactions, under-reactions, or inconsistent responses to various sensory stimuli. Because sensory input is difficult to organize and control, the individual's activities and interests may appear restricted in their nature and repertoire, frequently involving significant repetition and a need for predictability rather than change. It is important to view the behavior of people with autism/PDD as meaningful adaptations and to take a positive, respectful approach to them, forgoing the common tendency to judge their competence and capacity on the basis of their sensorimotor challenges.











Diagnostic Criteria for 299.10 Childhood Disintegrative Disorder

A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

B. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:

1. 1. 1. expressive or receptive language
      2. social skills or adaptive behavior
      3. bowel or bladder control
      4. play
      5. motor skills

C. Abnormalities of functioning in at least two of the following areas:

1. 1. 1. qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
      2. qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make believe play)
      3. restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms

D. The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.

[Sc@tterBr@in_UK]

I liked the explanation in the O.A.S.I.S. guide because it clarifies the terms. Although they are often used interchangeably, ASD <> PDD <> Autism.

PDD is a group of disorders that contains the ASDs but not exclusively.

Rett's disorder for example, while autistic-like, isn't strictly speaking an ASD.

Autism is a sub-category of PDDs but not the only ASD.

[gingagirl]

Has anyone ever heard of Fragile X syndrome being included as an ASD? Where I work, I have heard several people say Fragile X is "on the spectrum", that people with Fragile X have autistic-like behaviors, but I don't really see it. But I've only known one person with Fragile X, so I don't know.

The guy I know is overly-sensitive to other people's feelings -- he has broken down in tears when someone pretends to cry, he fixates on negative events and will apologize repeatedly if he hurts someone or breaks something.

He does not speak much, but this seems to be due to a physical inability speak clearly. He uses a communication device to talk with people, and often won't stop talking. However, he does fixates on certain topics and repeats some words & phrases over and over again. Also, he's content to use the device by himself , repeating messages over & over, but not actually talking to anyone. I guess this would fit with ASD.

He has a lot of difficulty making eye contact.
He has trouble staying near people when talking to them --but does fine if he sits down during conversations -- this may be due to a physical-sensory problem ...I think the OT said he needs to move to monitor where his body is (propriception)

He has difficulties with sensory integration ...so that also fits with ASD.

Hmm, I guess there are enough related symptoms to say Fragile X could be included as an ASD. What do you think?

[Sc@tterBr@in_UK]

While some (few) individuals with Fragile X have autistic traits or even full-blown autism, the majority don't. So no it's not on the Spectrum, it's just that some with Fragile X are.

[Mom of Twins]

HI , What about NT...Neurotypical Disorder / Syndrome?

Has anyone got any input on it? It is supposedly milder(less noticable) than Aspergers. I beleive MY 4 yr old daughter is more then just a little "Independent". She has meltdowns over things all the time , like not being the first to walk throught the front door or if you pass something to her she will freak that she did not get to pick it up herself. This is not just here & there... this is every little thing that happens daily...she will meltdown if she is not in controle. Also her twin brother has now been dx ADHD 2 months ago & is responding to ritilin miraculously.He is getting a lot more possitive attention as apposed to the Negitive he used to get. I think this Frustrates my daughter who was quite happy to be the "Good" child. She also has a little trouble contecting quickly to kids. At the playground she prefers to talk to the moms rather then the kids...her brother on the other hand (ADHD) Is all about the kids. As soon as we arrive at any playground with any kids he Shouts ," Oh good all my friends are here!"

2 other things that make me think she maybe NT is the fact that,
tho she was slightly delayed in beginning to speak....When she did, look out She spoke as clearly as an english proffessor. Never baby talk. She also studies body language to the extreme & uses it to better understand what people are expecting of her.

I welcome any input from Anyone who is familiar with this disorder .

Thanks
MOT

[Lady Lark]

I can't say that I'm familiar with it, cause I've never heard of it before.

[Turbochica]

I found this link with info:
http://www.nichd.nih.gov/health/topics/asd.cfm

[sarek]

Originally Posted by Mom of Twins

HI , What about NT...Neurotypical Disorder / Syndrome?

Has anyone got any input on it? It is supposedly milder(less noticable) than Aspergers. I beleive MY 4 yr old daughter is more then just a little "Independent". She has meltdowns over things all the time , like not being the first to walk throught the front door or if you pass something to her she will freak that she did not get to pick it up herself. This is not just here & there... this is every little thing that happens daily...she will meltdown if she is not in controle. Also her twin brother has now been dx ADHD 2 months ago & is responding to ritilin miraculously.He is getting a lot more possitive attention as apposed to the Negitive he used to get. I think this Frustrates my daughter who was quite happy to be the "Good" child. She also has a little trouble contecting quickly to kids. At the playground she prefers to talk to the moms rather then the kids...her brother on the other hand (ADHD) Is all about the kids. As soon as we arrive at any playground with any kids he Shouts ," Oh good all my friends are here!"

2 other things that make me think she maybe NT is the fact that,
tho she was slightly delayed in beginning to speak....When she did, look out She spoke as clearly as an english proffessor. Never baby talk. She also studies body language to the extreme & uses it to better understand what people are expecting of her.

I welcome any input from Anyone who is familiar with this disorder .

Thanks
MOT

Actually NT is the term commonly used for people who are strictly mainstream. Meaning they have no ADD, no bipolar or ASD or anything else.

I recall some very funny people who run an As site coining the phrase NT disorder and even giving it a fake DSM IV code complete with fake symptoms and treatments. This is the link, but be forewarned, it is fake. Even though most NT's I know are really like that.

http://isnt.autistics.org/

None of this looks like the description you give of your daughters symptoms.
It looks more like it might be something somewhere on the spectrum.

[Turbochica]

there is SO much to read in that one very long post here. I am very much interested in learning more about autism since I am now working with autistic teen boys.

thanks for the info it will take me awhile to read through it

[mirandatoritess]

wikipedia

Characteristics

Autism is a highly variable neurodevelopmental disorder[17] that first appears during infancy or childhood, and generally follows a steady course without remission.[18] Overt symptoms gradually begin after the age of six months, become established by age two or three years,[19] and tend to continue through adulthood, although often in more muted form.[20] It is distinguished not by a single symptom, but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.[21] Autism's individual symptoms occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.[22]
Social development
Social deficits distinguish autism and the related autism spectrum disorders (ASD; see Classification) from other developmental disorders.[20] People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars".[23]
Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers differ more strikingly from social norms; for example, they have less eye contact and turn taking, and do not have the ability to use simple movements to express themselves, such as the deficiency to point at things.[24] Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.[25] Most autistic children display moderately less attachment security than non-autistic children, although this difference disappears in children with higher mental development or less severe ASD.[26] Older children and adults with ASD perform worse on tests of face and emotion recognition.[27]
Children with high-functioning autism suffer from more intense and frequent loneliness compared to non-autistic peers, despite the common belief that children with autism prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.[28]
There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD. The limited data suggest that, in children with mental retardation, autism is associated with aggression, destruction of property, and tantrums. A 2007 study interviewed parents of 67 children with ASD and reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in non-autistic children with language impairments.[29] A 2008 Swedish study found that, of individuals aged 15 or older discharged from hospital with a diagnosis of ASD, those who committed violent crimes were significantly more likely to have other psychopathological conditions such as psychosis.[30]
Communication
About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.[31] Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia)[32][33] or reverse pronouns.[34] Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD:[4] for example, they may look at a pointing hand instead of the pointed-at object,[24][33] and they consistently fail to point at objects in order to comment on or share an experience.[4] Autistic children may have difficulty with imaginative play and with developing symbols into language.[32][33]
In a pair of studies, high-functioning autistic children aged 8–15 performed equally well as, and adults better than, individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.[35]
Repetitive behavior
Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R)[36] categorizes as follows.


A young boy with autism who has arranged his toys in row
Stereotypy is repetitive movement, such as hand flapping, head rolling, or body rocking.
Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines.
Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
Ritualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.[36]
Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy, or game.
Self-injury includes movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging.[4] A 2007 study reported that self-injury at some point affected about 30% of children with ASD.[29]
No single repetitive or self-injurious behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.[37]
Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.[21] An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.[38] Many individuals with ASD show superior skills in perception and attention, relative to the general population.[39] Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some,[40] although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.[41] Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).[42] An estimated 60%–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking;[40] deficits in motor coordination are pervasive across ASD and are greater in autism proper.[43]
Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;[29] this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;[44] studies report conflicting results, and the relationship between GI problems and ASD is unclear.[45]
Parents of children with ASD have higher levels of stress.[46] Siblings of children with ASD report greater admiration of and less conflict with the affected sibling than siblings of unaffected children and were similar to siblings of children with Down syndrome in these aspects of the sibling relationship. However, they reported lower levels of closeness and intimacy than siblings of children with Down syndrome; siblings of individuals with ASD have greater risk of negative well-being and poorer sibling relationships as adults.[47]
Classification

Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior.[18] These symptoms do not imply sickness, fragility, or emotional disturbance.[20]
Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder.[48] Unlike with autism, people with Asperger syndrome have no substantial delay in language development.[2] The terminology of autism can be bewildering, with autism, Asperger syndrome and PDD-NOS often called the autism spectrum disorders (ASD)[12] or sometimes the autistic disorders,[49] whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the classic autistic disorder; in clinical practice, though, autism, ASD, and PDD are often used interchangeably.[1] ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.[50]
The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication.[51] Because the behavior spectrum is continuous, boundaries between diagnostic categories are necessarily somewhat arbitrary.[40] Sometimes the syndrome is divided into low-, medium- or high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds,[52] or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial. Autism can also be divided into syndromal and non-syndromal autism; the syndromal autism is associated with severe or profound mental retardation or a congenital syndrome with physical symptoms, such as tuberous sclerosis.[53] Although individuals with Asperger syndrome tend to perform better cognitively than those with autism, the extent of the overlap between Asperger syndrome, HFA, and non-syndromal autism is unclear.[54]
Some studies have reported diagnoses of autism in children due to a loss of language or social skills, as opposed to a failure to make progress, typically from 15 to 30 months of age. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype,[13][24][32][55] or that there is a continuum of behaviors between autism with and without regression.[56]
Research into causes has been hampered by the inability to identify biologically meaningful subgroups within the autistic population[57] and by the traditional boundaries between the disciplines of psychiatry, psychology, neurology and pediatrics.[58] Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans, to help further neurogenetic studies of autism;[59] one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects.[3] It has been proposed to classify autism using genetics as well as behavior.[60]

[Nelson1967]

Why are they not screening all who see a psych for this too