How Is Autism Spectrum Disorder (ASD) Diagnosed? | Trenna Sutcliffe and Peter Attia

TL;DR

Autism spectrum disorder is diagnosed by an experienced clinician who evaluates social communication and restricted interests or repetitive behaviors. The social communication criteria require differences in all three areas: social reciprocity, non-verbal communication, and understanding relationships. Significant cases may be diagnosed quickly, while milder presentations can require multiple visits and information from parents, teachers, or therapists. Read on to understand the criteria, specialists, and assessment process.

Transcript

let's talk a little bit more about autism now of course it was referred to as ASD right autism spectrum autism spectum disorder tell me today how is the diagnosis of autism made because I think when many people think of autism you know if they're old enough they might think of Rainman right you're going to think of somebody who in a very short inte... Read More

Key Insights

• Autism spectrum disorder is diagnosed based on clinical traits, not a single lab test, by analyzing behavior in two areas: social communication skills and restricted interests with repetitive behaviors. There is no gold-standard assessment, though certain components must be included.
• The social communication criterion requires differences in three specific areas: social reciprocity (the back-and-forth of interaction), non-verbal communication (using and interpreting eye contact and gestures), and understanding relationships. A patient must show differences in all three to qualify.
• The term 'autism spectrum disorder' emerged in 2013 with the DSM-5, which merged previously separate labels including Asperger's syndrome and PDD-NOS (pervasive developmental disorder not otherwise specified) into one umbrella category.
• The diagnosis is typically made by a physician, usually a developmental behavioral pediatrician or psychiatrist, occasionally a pediatric neurologist, or by a psychologist who conducts the assessment and gets to know the child.
• Severity determines the assessment process: significant cases with major impairments can often be diagnosed quickly, while milder symptoms require multiple visits on different days and multiple assessment types directly with the child.
• The diagnosis functions as a tool that helps adults understand a child, provides structure for leveraging strengths and building skills, and helps secure resources through school or insurance, but the label alone reveals little about an individual child.
• A common saying captures autism's variability: 'you've met one child with autism, you've met one child with autism,' meaning effective treatment plans require understanding each child's unique profile of strengths and challenges.
• Under DSM-5 criteria, language impairment may or may not be present, so a diagnosis must specify whether it comes with or without intellectual disability and with or without language impairment, reflecting how broad the spectrum has become.

Questions & Answers

Q: How is autism spectrum disorder diagnosed?

An expert with substantial autism experience analyzes the child’s clinical traits and behavior in two areas: social communication and restricted interests or repetitive behaviors. The assessment includes a history and direct work with the child, while milder cases may also require multiple visits and information from parents, teachers, or therapists.

Q: What social communication differences are required for an ASD diagnosis?

The criteria require differences in all three social communication areas: social reciprocity, non-verbal communication, and understanding relationships. These cover the back-and-forth of interactions, the use and interpretation of eye contact and gestures, and skills such as building friendships, playing with peers, and understanding group contexts.

Q: Who can diagnose autism spectrum disorder?

The assessment is generally performed by a physician or psychologist. The physician is most often a developmental behavioral pediatrician or psychiatrist, though a pediatric neurologist or someone with similar training may occasionally conduct it.

Q: Is there a single gold-standard test for autism?

No single gold-standard assessment is identified in the discussion. An assessment must include certain components, but it can involve multiple methods and should allow the clinician to understand the individual child.

Q: Can autism be diagnosed in one visit?

A trained clinician may diagnose a child with significant impairments fairly quickly after taking a good history and working directly with the child. Milder presentations may require multiple visits on different days, different assessments, and input from parents and other people in the child’s life.

Q: What changed with the DSM-5 in 2013?

The term autism spectrum disorder emerged with the DSM-5 in 2013. It created an umbrella diagnosis broad enough to include children with extensive speech and language skills who nevertheless struggle with social communication and have restricted interests or repetitive behaviors.

Q: Why does an autism assessment need to identify a child’s individual profile?

The autism label alone reveals little about what a particular child is like because the spectrum is very broad. Understanding the child’s unique strengths and challenges is necessary for developing a useful treatment plan and deciding how best to support skill building.

Q: How can an autism diagnosis help a child?

The diagnosis can help adults understand the child and provide structure for leveraging strengths and building skills. It can also help the child obtain resources at school or through insurance, although the diagnosis remains only one part of understanding the child.

Summary & Key Takeaways

• Autism spectrum disorder is a very broad spectrum. Older descriptions centered on nonverbal, isolated children with mannerisms like hand-flapping, but today many diagnosed children have strong speech and language skills yet struggle with social communication and show restricted interests and repetitive behaviors.

• Diagnosis relies on clinical traits assessed by an experienced expert across two areas. Social communication requires differences in three domains: social reciprocity, non-verbal communication, and understanding relationships. Assessments are done by developmental behavioral pediatricians, psychiatrists, or psychologists, with no single gold-standard test.

• The DSM-5 in 2013 combined autistic disorder, Asperger's syndrome, and PDD-NOS into ASD. Clear-cut cases are picked up around ages two to three, while children with stronger cognitive and language skills are diagnosed later, with about half diagnosed after age six.