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| |    How Is Autism Diagnosed? by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Parents often recognize that something is wrong when their children are still infants. Many times, however, it takes years before a doctor makes the actual diagnosis of autism. In the U.S., the average age of diagnosis is between two and three years; in other English-speaking countries, it is later still. One reason that it takes so long is that children's behaviors are complex and changing; it is not always easy to see a pattern before it has fully emerged. There is no clear-cut line between very mild autism and healthy children who are just somewhat odd socially. Autism is not unique in being bordered by a diagnostic gray area. Also, doctors who are not specialists in developmental disorders are often reluctant to label a child as autistic because the diagnosis is so upsetting to parents. Many parents are referred from one doctor to another, until finally one of them proclaims the diagnosis. There is no blood test, brain scan, or other high-tech test for autism. The diagnosis relies on the judgment of an experienced doctor, using a combination of interviews, questionnaires, and observations. Physical examinations and selected tests are important to look for other conditions that can be confused with autism, or that can occur along with autism. Diagnostic criteria You may read in a doctor's report that a child "meets criteria for autism." This may sound mysterious, but it isn't. In order to create a universal standard for the diagnosis of autism (and hundreds of other conditions), groups of experts have created lists of criteria. The most widely used are the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and the International Classification of Diseases, 10th edition (ICD-10). The criteria in these books are very similar, so that for practical purposes it doesn't matter which one a doctor uses. The criteria for autism include problems with communication and social interactions, as well as repetitive and narrow behaviors and interests (as described in What is Autism?). The DSM-IV breaks down each of these problem areas into four criteria. For example, one criterion is "failure to develop peer relationships appropriate to developmental level." Another is "apparently inflexible adherence to specific nonfunctional routines or rituals." The diagnosis of autism requires that a certain number of criteria are met, that problems are evident before age three, and that there is no evidence for certain other conditions that can mimic autism. Reading the DSM-IV criteria can make diagnostic process seem mechanical or objective. In reality, it is neither. It takes an equal measure of art and science to interpret the criteria, and match them against observations of a complex and changing child. You can view a copy of the criteria by downloading a recent article, but it's probably best to borrow the entire Diagnostic and Statistical Manual of Mental Disorders from a library and settle down for a long read.
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