The ICD-10 is the most commonly used manual for autism diagnosis in the UK and it describes autism like this:
“A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual’s functioning in all situations” ( IInternational Statistical Classification of Diseases and Related Health Problems 10th Revision, 2016)
It puts childhood autism, Asperger syndrome, atypical autism and other pervasive delays under the same grouping. This is because all of these syndromes have a developmental delay that affects their social interaction and social communication. The other aspects of the developmental delay affects which diagnosis is received.
The DSM-5 (Diagnostic and Statistical Manual, version 5) is not as commonly used in the UK, but the diagnostic criteria do appear a little easier to understand. As the ICD-10, it specifies the social interaction and social communication difficulties, as well as “restricted and repetitive patterns of behaviours, activities or interests” (DSM-5, 2013).
So that all sounds quite complicated and a little wordy, what does it actually mean for us?
- Social interaction : a lots of our children on the spectrum struggle with non-verbal communication. They don’t understand body language or facial expressions easily. This means it can be really hard for them to cope in social situations because they are constantly trying to unlock the puzzle of what is being said to them, as well as being overwhelmed by all the ‘extra’ non-verbal information.
- Social communication: this is language that is used in social situations (National Autistic Society, 2008) Our children may have delayed speech development, they may not understand when we speak to them, or they may use repetitive phrases and sentences that they have overhead (echolalia). They can also take idioms a bit literally: saying “It’s raining cats and dogs” has sent my son to the window on many an occasion.
- Restricted and repetitive patterns of behaviours, activities or interests: Are any of your children obsessed with Thomas the Tank Engine, The Gruffalo, the colour red or anything else that is just the best thing ever in their world? Our children often have obsessions and they struggle with change. This means they may have the same fascination for many years, or they may like to walk the same route to school every day, or where the same colour pants on Saturdays.
There is another aspect to this as well, and it’s something that in recent years has really come to the front of studies in Autism: sensory issues.
For a long time, the diagnostic criteria for autism was the ‘Triad of Impairments’: social interaction, social communication and inflexibility of thought (Autism in the Early Years, 2010). However, recently this was changed to the diad of impairments.
- Social communication and social interaction difficulties
- Restricted and repetitive patterns of behaviours, activities or interests, including sensory behaviour.
Many of our children have trouble with sensory processing. They may find certain noises unbearable, some visual stimuli can be too much (eg. when the lights are too bright), they may seem to overreact to certain tastes and textures, and may engage in ‘sensory seeking behavior’ such as spinning round in circles or flapping their hands. I know with my eldest, he is very particular about the texture of clothes that he wears and is especially sensitive to certain foods. He has had the same packed lunch for the last five years, and you know what? It’s not a battle worth fighting. He has food he enjoys and he growing healthily so although i encourage him to try a new thing on at least three separate occasions, there is no point in putting us both through the stress of food he can’t cope with.
Coming soon: A more in-depth look at sensory processing difficulties..
American Medical Association., (2016), International Statistical Classification of Diseases and Related Health Problems 10th Revision, Chicago, IL, USA.
American Psychiatric Association., (2013). Diagnostic and statistical manual of mental disorders DSM-IV-TR. 1st ed. Washington, D.C.
National Autistic Society, (2008), NAS EarlyBird Programme Parent Book, London, England.
Cumine et al, (2010). Autism in The Early Years. 2nd ed. Oxfordshire, England.