1. History of autism

The condition was first described by Kanner in 1943. He listed a number of features which, in theory, would identify children with this disorder. His use of the term “autistic” caused some confusion right from the start because it had previously been used in connection with the withdrawal into fantasy shown by schizophrenics. At that time it appeared to afflict children of well-educated parents in the upper socio-emotional classes, but this is more likely to reflect referral bias than clinical fact. (Aarons M, Gittens T, 1992, 8).

Firstly, the list of 9 key points, which are relevant to diagnose autism disorder have been represented by Kanner in this particular way: (1) An inability to develop relationships, (2) Delay in the acquisition of language, (3) Non-communicative use of spoken language after it develops, (4) Delayed echolalia, (5) Pronominal reversal, (6) Repetitive and stereotyped play, (7) Maintenance of sameness, (8) Good rote memory, (9) Normal physical appearance. (Aarons M, Gittens T, 1992, 9).

Kanner later reduced these points to two essential features: (1) Maintenance of sameness in children’s repetitive routines, (2) Extreme aloneness, with onset within the first two years. This reduction caused even more confusion, as many children, while clearly showing a pattern of difficulties, did not fit these criteria which picked out only cases of classic autism. (Aarons M, Gittens T, 1992, 9).

In the many thousands of case histories taken of children diagnosed as autistic, there appear to be two groups: those who show no normal behavior, except in having an unusually good or average ability in perhaps one area (but not speech), and those who appear to have up to two years of normal development, and then develop autistic behavior. (Roberts B, 1977, 23).

There is, however, still much debate about whether a child with autistic features at 2 ever showed normal communication responses, and in other abilities the norms are so wide that it is often difficult, if not impossible, to say that a child is abnormal in a particular aspect of development in his first year of life, and sometimes even in the second year. (Furneaux B, Roberts B, 1977, 23).

2.2 Diagnosis of autism

A formal diagnosis of autism is usually done by a psychiatrist or properly licensed psychologist who is familiar with autism and other developmental disabilities. The diagnosis should be based on direct observations of the person for whom a diagnosis is being requested, as well as interviews with parents, family members, and other important people in person’s life. A detailed life history should be part of any diagnostic procedure. Most professionals will follow a systematic method of diagnosis such as that provided in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. (Gerdtz J, Bregman J, 1990, 19).

Many diagnosticians use the list of the nine points provided by the National Society for Autistic Children (NSAC) when attempting to diagnose cases of autism; there is far more detail of description than in the Kanner list, and this factor is found helpful. An English psychiatrist, Dr Michael Rutter, notes amongst other criticisms that the committee does not specify how many of the criteria are necessary to make a diagnosis. Rutter also considers the time at which a feature becomes prominent is an important diagnostic factor. (Furneaux B, Roberts B, 1977, 24).

Items of behavior that may occur in the autistic conditions of childhood provided by the National Society for Autistic Children:

1. Gross and sustained impairment of emotional relationships with people.

2. Self-examination.

3. Pre-occupation with particular objects, or certain characteristics of them, without regard to their accepted functions, persisting long after the baby stage.

4. Sustained resistance to change in the environment, and a striving to maintain order or sameness.

5. Behaviour leading to suspicious of abnormalities of the special senses in the absence of any obvious physical cause.

6. Abnormalities of moods.

7. Speech disturbances.

8. Disturbances of movements and general activity.

9. A background of serious retardation in which islets of normal, near normal, or exceptional intellectual function or skill may appear.

In addition to the positive abnormalities listed above, the diagnosis of autism depends just as much upon nothing what the children do not do. (Furneaux B, Roberts B, 1977, 25).

If further information is needed for a diagnosis of autism there are standardized instruments that may be helpful. These instruments include the Childhood Autism Rating Scale (CARS) and the Autism Screening Instrument for Educational Planning (ASIEP). The CARS are useful not only in developing goals and objectives for educational and training programs for people with autism, but can also be used in the process of distinguishing autism from other handicapping conditions (Teal and Wiebe, 1986). (Gerdtz J, Bregman J, 1990, 20).

There are cases where even skilled and experienced professionals will disagree concerning a definite diagnosis of autism (Sugiyama and Abe, 1989). In these cases it is best to follow up with another professional, or team of professionals, in order to arrive at a conclusive diagnosis. (Gerdtz J, Bregman J, 1990, 20).

That is, to be diagnosed with autism, children must have difficulties socially interacting with others; they must have impairments in communication; and they must also show restricted interests. This sounds pretty straightforward but it’s complicated by the fact that although most agree that the disability is neurological, no biological or chromosomal test that can tell you if a child has autism. The diagnosis is simply based on observation of the three symptoms, and the expression of these symptom areas can vary considerably. (Koegel L, LaZebnik C, 2004, 2).