According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people with ASD have:

• Difficulty with communication and interaction with other people
• Restricted interests and repetitive behaviours
• Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and ability to function

Social communication / interaction behaviours may include:

• Making little or inconsistent eye contact
• Tending not to look at or listen to people
• Rarely sharing enjoyment of objects or activities by pointing or showing things to others
• Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
• Having difficulties with the back and forth of conversation
• Often talking at length about a favourite subject without noticing that others are not interested or without giving others a chance to respond
• Having facial expressions, movements, and gestures that do not match what is being said
• Having an unusual tone of voice that may sound sing-song or flat and robot-like
• Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions

Restrictive / repetitive behaviours may include:

• Repeating certain behaviours or having unusual behaviours. For example, repeating words or phrases, a behaviour called echolalia
• Having a lasting intense interest in certain topics, such as numbers, details, or facts
• Having overly focused interests, such as with moving objects or parts of objects
• Getting upset by slight changes in a routine
• Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature

People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:

• Being able to learn things in detail and remember information for long periods of time
• Being strong visual and auditory learners
• Excelling in math, science, music, or art

Diagnosing Autism Spectrum Disorder (ASD)

(Please note Skylight Psychiatry currently only provides diagnostic assessments for adults)

Doctors diagnose ASD by looking at a person’s behaviour and development. It is important for those with concerns to seek out assessment as soon as possible so that a diagnosis can be made, and treatment can begin.

Diagnosis in Young Children

Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Check-ups

Every child should receive health check-ups during early years. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviours, have older parents, have certain genetic conditions, or who were born at a very low birth weight. An MCHAT can be completed online for parents who are concerned.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviours and combine those answers with information from ASD screening tools, and with his or her observations of the child.

Children who show developmental problems during this screening process will be referred for a second stage of evaluation.

Stage 2: Additional Evaluation

This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.

This team may include:

• A developmental paediatrician—a doctor who has special training in child development
• A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behaviour
• A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
• A speech-language pathologist—a health professional who has special training in communication difficulties

The evaluation may assess:

• Cognitive level or thinking skills
• Language abilities
• Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

• Blood tests
• Hearing test

The outcome of the evaluation will result in a formal diagnosis and recommendations for treatment.

Diagnosis in older children and adolescents

ASD symptoms in older children and adolescents who attend school are often first recognised by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialise in ASD for additional testing.

Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humour, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.

Diagnosis in adults

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental-health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD). This is why we conduct a mental health review by an experienced psychiatrist to confirm the diagnosis and ensure that other mental health disorders are not causing similar symptoms. Additionally, treatment for underlying mental health disorders can be provided.

Adults who notice the signs and symptoms of ASD should talk with a doctor and ask for a referral for an ASD assessment. While testing for ASD in adults is an ever changing process, referrals typically come from the General Practitioner or a secondary mental health team.

Part of the process may include a screening assessment. The expert will ask about concerns, such as:

• Social interaction and communication challenges
• Sensory issues
• Repetitive behaviours
• Restricted interests

Information about the adult’s developmental history will help in making an accurate diagnosis, so an ASD evaluation may include talking with parents or other family members.

Getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help. Studies are now underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of transition-age youth and adults with ASD.

Some people experience difficulties later in their life such as struggling with work, marriage difficulties or mental health problems.

Changes to the diagnosis of ASD

In 2013, a revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released. This revision changed the way autism was classified and diagnosed. Using the previous version of the DSM, people could be diagnosed with one of several separate conditions:

• Autistic disorder
• Asperger’s’ syndrome
• Pervasive developmental disorder not otherwise specified (PDD-NOS)

In the current revised version of the DSM (the DSM-5), these separate conditions have been combined into one diagnosis called “autism spectrum disorder.” Using the DSM-5, for example, people who were previously diagnosed as having Asperger’s syndrome would now be diagnosed as having autism spectrum disorder. Although the “official” diagnosis of ASD has changed, there is nothing wrong with continuing to use terms such as Asperger’s syndrome to describe oneself or to identify with a peer group.