The definition of autism was the topic of this column last week: a necessary discussion to define what the future of these editions will explore. However, now that we’ve somewhat figured that out (at least as much as we need to for this column’s sake), we can dig deeper into unmasking the mysteries of autism.
The first step is also the first of someone with autism: a diagnosis. Although a professional diagnosis is not required and self-diagnosis can be adequate, this article will focus on professional and standard diagnoses. Different systems of diagnoses exist that all vary slightly but, for the most part, use the same series of observations and developmental milestone-tracking.
Autism is typically, at least currently, diagnosed during infant and toddler years. The primary catalyst for a diagnosis is observations during well-visits and parents/guardians when a child is young. My parents and doctors realized I exhibited unusual behaviors like trouble hearing, yet my hearing seemed good, or not speaking with people. However, I talked to myself quite a lot. We went to a psychologist, and I was screened for autism when I was around 18 months old. The screening process is primarily observational, along with some tests and questions about behaviors. These include questions about social skills amongst peers, receptiveness to the world, repetitive behaviors, and others. The testing can consist of basic math (mostly counting due to frequently young ages), cognitive testing like shape and color puzzles, and sequencing (like taking turns).
After all the testing and interviews are complete, the doctor recommends whether a diagnosis is possible. Since there is no definitive test for autism, most doctors will recommend an autism diagnosis, sometimes to different degrees. For my diagnosis, the doctor told my parents I had a textbook case of Aspergers. Still, since a change in diagnosis standards, their suggested diagnosis was high-functioning autism (see the definitions article of this column for more information on the difference and other namings of what I am referring to as “autism”).
A critical topic of autism diagnoses is the age at which an individual is looking for a diagnosis. As far as it is known, autism does not appear over time, which means that individuals cannot neurologically go from not having autism to having it; it can be problematic when older individuals beyond their toddler years seek a diagnosis. When screening older individuals, doctors typically rely on the memory of parents, guardians, and other caretakers from the individual’s childhood, asking the same questions asked for a toddler’s screening. Questions about an individual’s youth are also the procedure for progressive screenings, or when individuals previously diagnosed with autism are re-screened to assess if their condition has changed, specifically degraded, and require more services. This testing process happened to me several times throughout my grade school years.
One issue with screening for autism for an older individual is their ability to cope and work with their symptoms. Individuals with autism often rely on being able to “act” like individuals without autism. This process can make using an older individual’s current behavior unreliable for a diagnosis. This “acting” is a complex topic, often more personal than definitions and diagnosis standards. I will discuss this in the following article of this column: the masking process.
