Diagnosing autism spectrum disorder

- [Voiceover] So Autism Spectrum Disorder is this really broad disorder where the affected person has trouble communicating and interacting with other people. And they also have this sort of restrictive and repetitive behavior where they can be really restrictive with their interests, maybe only showing interest in one or two activities and repetitive with their behaviors or maybe the routines that they need in place. And while we're not entirely sure yet what causes Autism Spectrum Disorder, we do have a few clues that we've kind of picked up over the years that are helping us try to figure out what the cause is. So we know that if kids have a family member, someone who they share some of their DNA with, also known as a blood relative, if one of their family members has Autism Spectrum Disorder, well they have a higher chance of also having Autism Spectrum Disorder. And we also know that boys are more likely than girls to develop Autism Spectrum Disorder. So both of these suggest to us that maybe genetics is playing part of a role in the development of Autism Spectrum Disorder. And we also know that the older the parents are when they have their kid, the higher the chances that the kid will have Autism Spectrum Disorder. And that kind of points to a genetic cause as well. So those are some of the clues we have, but we're still trying to figure out the whole puzzle when it comes to the cause of Autism Spectrum Disorder. So if we suspect that a kid might have Autism Spectrum Disorder, how might we go about confirming or diagnosing Autism Spectrum Disorder? Well, for Autism Spectrum Disorder there really isn't a test like a blood test or a scan or anything like that that we can use to make the diagnosis. So what we have to do instead is really look for the signs of Autism Spectrum Disorder. The trouble with communicating and interacting and the restrictive and repetitive behaviors. So you can imagine that diagnosing Autism Spectrum Disorder can be a little tricky, and that sometimes it can take quite a while for a diagnosis to be made. So to help us with diagnosing Autism Spectrum Disorder, there's actually a really useful manual sort of like a guidebook that we use called the Diagnostic and Statistical Manual of Mental Disorders, or what we often shorten to the DSM. So let's actually pull up what we would find if we cracked open the DSM and checked out the criteria for diagnosing Autism Spectrum Disorder. Now something that I should mention here is that the most current version of the DSM which is the fifth edition, so the DSM 5. Well when it came out a few years ago, there were actually some big changes made to Autism Spectrum Disorder. So in the DSM 4, the older version of the DSM, there were several different Autism Spectrum Disorders including Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder and now in the DSM 5 all of these different Autism Spectrum Disorders have kind of been merged into one spectrum disorder. Autism Spectrum Disorder, and this was done because kids with these different disorders, they really do fall along a spectrum, and the hope was to make diagnosing a child a bit more accurate. So now in the DSM 5 there's just one Autism Spectrum Disorder and kids will fall in different places along this spectrum. Okay, so the current requirements for diagnosing Autism Spectrum Disorder are split up into two main categories and these categories, they're actually the main signs of Autism Spectrum Disorder. So the first category that we would find in the DSM is persistent deficits in social communication and interaction. And this just basically means that the child's social development is not quite tracking along the way it should be. So a child would have to display issues with their social interactions in order for us to consider diagnosing them with Autism Spectrum Disorder. And there are actually a few specific ways that a child would need to show this, this deficit in social communication and interaction. So the first one here is deficits in social and emotional reciprocity. Now reciprocity is when two people do something for each other, so in a social situation this is kind of the back and forth flow of a conversation where we respond to each other in similar ways. So maybe someone smiles at you and says good morning. Well, you would likely do the same. You would return their smile and say good morning back to them as well. And when you do that, you're returning, you're reciprocating their emotions and their social gestures. So having trouble with understanding and using this sort of social and emotional reciprocity is one of the communication deficits that we would need to see in someone in order to diagnose Autism Spectrum Disorder. And it's not simply because they don't want to say hi. I'm sure everyone's got someone they're not stoked to say hi to, but it's because the reciprocation it doesn't really occur to them as a social requirement, if you will. Now another sign that we would need to see in order to diagnose Autism Spectrum Disorder is some sort of deficit in developing and maintaining relationships. And here we're talking about relationships with peers, with people around the same age. Because it's actually not uncommon for kids with Autism Spectrum Disorder to befriend people who are younger or older than them, but then still struggle with building relationships with people their own age. And the last sign that we would need to see under this social communication and interaction category here is some sort of deficit in nonverbal communication. So this means that the person would have trouble understanding and using things like hand gestures and eye contact and facial expressions when they're communicating. So that's the fist category that would need to be checked off before you would consider diagnosing someone with Autism Spectrum Disorder. And that makes sense, right? Because trouble with social communication and interaction is one of the main signs that we see in someone with Autism Spectrum Disorder. So there's one more main category that also needs to be checked off before we can officially make a diagnosis of Autism Spectrum Disorder. And as you might have guessed, this category is one of the other main signs of Autism Spectrum Disorder, and that's restrictive and repetitive behavior and interests. So you might remember that for a kid with Autism Spectrum Disorder, there are a few different ways that they might show this, this restrictive and repetitive behavior and interests. So they might have really fixated interests. Maybe they're only really interested in one or two activities and they show no interest in any others. They might be really strict about following routines or rituals, or maybe they really struggle with change. They might have repetitive sounds or movements or behaviors that they perform. Or maybe they react to stimulation like bright lights or loud sounds a bit more or a bit less than what we would expect. So these are the two main categories that we would need to check off in order to diagnose Autism Spectrum Disorder. And there are two little things that I should also mention that the DSM requires from a kid in order to make that diagnosis. So one is that all of these behaviors, they start coming on when the kid is in early childhood. And the other is that these behaviors, they interfere with the kid's daily life. All right, so now we know what we need to see in order to diagnose a kid with Autism Spectrum Disorder. So how do we go about looking for these signs? Well what we really rely on is asking the parents questions and talking to and playing with the kid to see if we can pick up on any of these signs here. Now these questions, they'll vary quite a bit depending on how old the kid is. So maybe if the child is a toddler, let's say they're between the age of six months old to two years old. Well, to look for this deficit in social communication and interaction, we might ask the parents if their child makes eye contact or smiles and laughs with the parent. Or maybe we'll ask if the child tries to show or share toys with the parent. If the kid was a bit older, we might ask the parent how the kid is doing with making friends at school. And if we wanted to look for this restrictive, repetitive behavior, we might ask how the kid handles change or unexpected situations like a different bed time routine or going on a trip. Maybe we'll ask the parents to see if their child has any particular habits that they like to repeat like lining up toys in a special way, or if they've noticed that any environmental stimuli like a car honking or a light flashing really tends to bother their kid. Now, while these are the diagnostic criteria, part of diagnosing Autism Spectrum Disorder also involves ruling out disorders that can look like Autism Spectrum Disorder. So for example, intellectual disability, which is when someone has trouble functioning in many areas of their life, like communication, taking care of themselves at school with their academics, well, intellectual disability can actually kind of look the same as Autism Spectrum Disorder, especially when the kid is young. It's hard to decide if a kid's trouble with communication and interaction is due to Autism Spectrum Disorder, or due to an intellectual disability. So, part of diagnosing Autism Spectrum Disorder involves trying to really make sure that the trouble that the kid is having fits this picture here of Autism Spectrum Disorder rather than the picture of another disorder like intellectual disability. And to make things a little trickier, it's actually not uncommon for kids with Autism Spectrum Disorder to also have an intellectual disability. So this means that they would meet the criteria for both Autism Spectrum Disorder and intellectual disability. This doesn't mean that all children with Autism Spectrum Disorder have intellectual disability, not at all. Often, there's no intellectual impairment at all, but this just highlights that sometimes, especially when the kid is really young and still growing and developing, it can be a little tricky to figure out exactly what's behind their struggles with communication and interaction. So it may take a few years to make a final diagnosis, but diagnosing Autism Spectrum Disorder really comes down to observing the child's social behaviors and habits for some time.