Autism Spectrum Disorders: 10 symptoms and diagnosis.

The keys to an accurate diagnosis of this psychological disorder.

Autism Spectrum Disorder (ASD) has traditionally been one of the main sources of controversy due to the difficulty of knowing how to classify it in the classification of psychopathologies in a clear and permanent way.

Moreover, with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013, the taxonomy of this psychopathology has been modified with respect to the previous version DSM-IV TR. Specifically, it has gone from being included together with other diagnostic labels within the Pervasive Developmental Disorders to all of them being established under the denomination of ASD indistinctly. Even so, different levels of involvement (I-IV) have been proposed to be specified in the diagnosis made.

Autism Spectrum Disorders: how to diagnose them?

Early detection of autism is complexThe early detection of autism is complex, since in most cases it is the parents who give the first warning signs. Authors such as Wing (1980), Volkmar (1985), Gillberg (1990) and Frith (1993), affirm that the symptoms of autism appear before the age of three, but add that it is difficult to detect them during the first year of life.

There is still some difficulty and lack of knowledge regarding the information available in the primary care service that allows for early detection. As indicated in one of the studies carried out in the USA (English and Essex, 2001), it was found that the first to suspect the presence of manifestations that could indicate autistic functioning was the family (60%), followed at a great distance by pediatricians (10%) and educational services (7%). In addition, there are multiple manifestations in the form and intensity in which this disorder appears in the early ages.. Even with all these difficulties, early detection can occur around 18 months of age or even earlier.

Tests and tools for the detection of ASD

At present, there is no test or medical test that by itself indicates whether a person has ASD. The diagnosis of ASD must include complementary observation of the person's behavior, knowing his or her developmental history and applying a battery of medical and psychological tests to detect the manifestation of the signs and symptoms of autism.

Some of the tests used for the early detection of autism are the CHAT by Baron-Cohen (1992), the M-CHAT by Robins, Fein, Barton and Green (2001), the IDEA by Rivière and Martos (1997) and the IDTA-18 by F.J. Mendizábal (1993). The age of application of these tests would be between 18 and 36 months.

In addition to the tests mentioned above, it is essential to collect information on the child's behaviors in the company of different people and in different contexts, integrating the various sources of data in a comprehensive manner and clarifying possible discrepancies. The earliest possible detection of any alteration in child development makes possible the establishment of an early intervention program capable of promoting the child's personal and social development capabilities to the maximum and the adequate orientation of the child's family members. For this purpose, it is advisable to rely on the following sources it is convenient to rely on the following possible sources of information:

• Test-scales in clinical sessions.
• Interviews and information from both teachers and parents.
• Observation in natural situations (home, school) and/or structured observations of the interaction with parents and evaluated.

Symptoms and criteria for detecting autism.

In order to carry out an appropriate assessment from the age of three years onwards, the following areas of assessment should be considered. the following areas of assessment should be taken into considerationThe following areas of assessment, together with the tests that are used for the evaluation of child development (both in the clinical population and in the rest of the population), should be taken into account in order to carry out an appropriate evaluation from the age of three.

Extreme values in the measurement scales, both under and over depending on the test, can be very useful to complement the diagnosis of autism or ASD.

1. Social assessment

Consists of gathering information on social interest, quantity and quality of social initiatives, eye contact, joint attention, body imitation, body imitation, body language, and social skills.joint attention, body, vocal and motor imitation, attachment, expression and recognition of emotions. For this purpose, structured interviews with parents are used, such as the ADI-R by M. Rutter, A. Le Couteur and C. Lord (1994). Lord (1994);

Structured observation in the clinical context of both planned (CARS by DiLalla and Rogers, 1994) and unplanned interactions with the father and mother; videos provided by the family and various clinical instruments (Normative Test such as the Vineland Test by Sparrow, Balla and Cicchetti (1984), Criterial Test such as the Uzgiris-Hunt, revised by Dunts (1980) or Developmental Inventories such as the Battelle, Spanish adaptation by De la Cruz and Gonzalez (1996).

Some symptoms that can be detected

• Lack of expression of emotions.
• Isolation with peers.

2. Communicative evaluation

Information is collected on intentionality, communicative tools, functions, contents, contexts and comprehension.. Structured interviews (ADI-R 1994), structured observations (ACACIA by Tamarit 1994, PL-ADOS by DiLavore, Lord & Rutter 1995), family videos and various clinical instruments (such as the Reynell Language Development Scale by Edwards, Fletcher, Garman, Hughes, Letts and Sinka 1997; and the ITPA by Samuel A. Kirk, James J. McCarthy, Winifred D. Kirk, revised edition 2004, Madrid: TEA), among others, are used.

Some symptoms that can be detected

• Literal interpretation of sentences.
• Delay in the appearance of verbal communication.

3. Play

Information is collected on exploration, functional play, symbolic play, role-playing and cooperative play.. Structured interviews (ADI-R 1994), semi-structured observations (free play), family videos and various clinical instruments (Lowe & Costello Symbolic Play Test 1988) are used.

Some symptoms that can be detected

• Difficulties in understanding the nature of roleplaying.
• Rejection of social play.

4. Cognitive evaluation

Information is collected to make an assessment of the sensory-motor level, developmental level, evaluation of stimulus and sensory preferences, learning style and potential, executive and metacognitive skills. and sensory preferences, learning style and potential, executive and metacognitive skills, and academic skills.

The following scales can be used: the Leiter International Performance Scale, adapted by Arthur in 1980, the Weschler Intelligence Scales (WPPSI-III 2009 and WISC-V 2015), the Bayley Scales of Child Development by Bayley 1993, the Uzgiris-Hunt Child Development Scale, revised by Dunts in 1980 and the PEP-R (Psychoeducational Profile) by Mesibov, Schopler and Caison 1989.

Some symptoms that can be detected

• Appearance of an unusually developed cognitive ability.
• General cognitive difficulties.

5. Motor evaluation

Measurement of fine and gross motor skills by observation, information and application of the Brunet Lezine Scale by O. Brunet and L. Lezine 1951 and/or the PEP-R by Mesibov, Schopler and Caison 1989.

Some symptoms that can be detected

• Alterations in gait and posture.
• Alterations in motor anticipation.

6. Family-environmental assessment

Knowledge by means of the family interview of the impact of the diagnosis, their resources to overcome it and to establish adequateand their resources to overcome it and to establish appropriate ways of collaboration in the intervention, the family-child interaction and the structure of the domestic environment.

7. Medical evaluation

Use of neurological and neuroimaging tests (Electroencephalogram EEG, Computerized Axial Tomography CT, Single Photon Emission Tomography SPECT, Magnetic Resonance MRI, Blood and urine tests, evoked potentials). There must be an absence of localized lesions that could explain the symptoms.

8. Evaluation of personal autonomy

Fundamentally by means of interviews and application of questionnaires to the parents about feeding, sphincter control, dressing and grooming.. One of the most widely used scales is the Lawton and Brody Scale, translated into Spanish in 1993.

9. Evaluation of behavioral problems

Assessment of the presence or absence of behavioral problems (disruptive behaviors, aggression, aggression, etc.). (disruptive behaviors, aggression, self-injury, stereotypies, pica, regurgitation, phobias...), their intensity and frequency by means of questionnaires or structured interviews such as the ADI-R 1994, or the ICAP (Inventory of Service Planning and Individual Programming) Spanish adaptation by the University of Deusto, Bilbao in 1993.

10. Assessment of preferences

Knowledge of objects, toys, stimuli, sensory modalities, activities, food, etc., etc., etc.etc. The preferred ones in order to use them as reinforcers or motivators for other activities or relevant communication objectives.

By way of conclusion

As we have seen, the diagnosis of autism should be made on the basis of a complete clinical evaluation, and should be based strictly on internationally agreed criteria, for three main purposes:

• To ensure access to the appropriate support and intervention services and intervention services appropriate to the particularity of the case.

• To ensure that scientific research can be comparable, both in its clinical aspects and especially in the assessment of the efficacy of different services. To ensure that scientific research can be comparable, both in its clinical aspects and especially in the assessment of the efficacy of the different services and treatments proposed..

• To ensure education appropriate to the particular needs of the child's case.The lack of rigorous diagnostic procedures could lead to the exclusion of children with autism from special services foreseen for them, as well as to the inclusion of people with other psychological conditions.