Current diagnostic criteria for Autism Spectrum disorder focus on two domains of function: deficits in social communication and the presence of restricted interests and repetitive behaviors.
Social communication encompasses a number of skills. A diagnosis of Autism Spectrum Disorder, as per DSM-5, requires that deficits be present in all three of the following areas:
Children with good expressive speech often will not use it to functionally communicate in a social manner such as to express ideas, ask questions, engage in back-and-forth conversation, volunteer information, or comment on the environment.
1) Social-Emotional Reciprocity:
Abnormalities in social reciprocity involves the quantity and quality of social interest and engagement.
It includes social initiation, response and engagement in basic social exchange, reciprocal back-and-forth communication, sharing of emotions, and appropriate response to the environmental.
The earliest symptoms can manifest as a lack of a reciprocal social smile, poor eye contact, lack of response to the child’s name being called, decreased engagement in age appropriate activities and games.
Children also struggle with social engagement, showing little awareness or interest in others and difficulty sharing interests and enjoyment.
Some may demonstrate social interest but lack the social skills to initiate social engagement. They may struggle to join others in play activities, take turns, follow rules, and play cooperatively. They may be socially immature and have difficulty respecting appropriate social boundaries. They may also struggle communicating their emotions or understanding the emotions of others.
2) Nonverbal Communication:
Deficits in nonverbal communication encompass problems in expressing and understanding various behaviors such as eye contact, tone of voice, body language, facial expressions and gestures. They have limited or no ability to integrate verbal and nonverbal communication.
Children with autism spectrum disorder do not typically compensate for difficulty in verbal communication with nonverbal strategies (as seen in those with developmental language disorder), demonstrating a more significant and specifically social communication deficit.
3) Social Relationships:
Children with autism spectrum disorder have deficits in a wide range of behaviors required for building and maintaining successful social relationships, especially with same-age peers.
Young children with autism spectrum disorder may show little interest in other children or may be avoidant of any interaction, instead engaging in solitary or parallel play. Many children have difficulty varying or adapting their behavior to different social situations and have difficulty understanding different points of view or taking another’s perspective.
Verbal children often only converse about topics of personal interest and are not aware when someone is not interested or even overwhelmed.
Language can be overly literal, and children may not understand idioms or sarcasm, making it difficult to discern joking from teasing or real bullying.
Many children with autism spectrum disorder do not have understanding or insight into friendships or other social relationships.
REFERENCE: CONTINUUM: Lifelong Learning in Neurology: February 2018
Dr. Germano Falcao
Dr. Germano Falcao is a Mayo Clinic Trained Pediatric Neurologist who has a passion to care for children with neurological disorders and give support to their families. He is a compassionate and experienced physician, a published author, and a professor who specializes in areas involving Seizures and Epilepsy; Headaches and Migraine syndromes; Neurodevelopment Disorders; ADHD and Autism Evaluation.