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Definition, Clinical Description, and Diagnosis

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In DSM-IV (American Psychiatric Association 1994) and its text revision, DSM-IV-TR (American Psychiatric Association 2000), autism is defined by the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills. There must also be symptoms of restrictive and repetitive behaviors and/or stereotyped patterns of interest that are abnormal in their intensity or focus. The emphasis is on severe and pervasive. In the 1970s, when the DSM characteristics of autism were being defined, many of the persons with autism who came for assessment had moderate to severe retardation, major language impairments, and many repetitive and odd behaviors. Today, there is a wider spectrum of symptom severity in those referred as possibly autistic. Approximately 50% of persons with autism may have normal verbal expressions and IQ scores, despite having moderate to severe social skills deficits. And if there is a continuous distribution of social and communication skills in the general population, where do we draw the line to make a diagnosis? At present, one must use clinical experience to make the decision. Because services follow diagnosis, the issue can be contentious, with the service providers often opting for more stringent criteria and the parents for less stringent ones.

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TABLE 13–1. DSM-IV-TR diagnostic criteria for autistic disorder

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