Diagnostic guidelines for autism

The American Association of Childhood and Adolescent Psychiatry (AACAP) has established guidelines for diagnosing autism.¹ The criteria are designed so a health professional can assess a child's behavior relating to core symptoms of autism. Different types of diagnostic behavioral tests may be used to complement these criteria. The specific AACAP diagnostic guidelines are as follows.¹

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1) and one from (2) and (3):

(1) Qualitative impairment in social interaction, as manifested by at least two of the following:

(a) Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures, to regulate social interaction

(b) Failure to develop peer relationships appropriate to developmental level

(c) 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)

(d) Lack of social or emotional reciprocity

(2) Qualitative impairments in communication, as manifested by at least one of the following:

(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)

(b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) Stereotyped and repetitive use of language or idiosyncratic language

(d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) Apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(d) Persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: social interaction; language as used in social communication; symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative behavior.