(to read my personal journey with Language Disorders, please click HERE)
One should start with Kanner’s original definition, with a hallmark of antisocial behavior underlying the condition beyond what would be explained by mental retardation or a language disorder. Children with Autism have very low rates of social interaction (both verbally and nonverbally) and often actively resist social contact. Many of them will pinch or bite or throw very, very intense tantrums when nonverbal social contact is initiated. Most late talkers are quite social in many situations which do not require talking, and so they do not meet the basic definition of autism.
From there one should use the DSM-IV definition which includes self stimulation and other compulsive repetitive (and bizarre) routines. I must say here that all children engage in routines and that these are important for learning and in no way clinically significant. Look at Mr Rogers, he opened the show the same way for decades, is he autistic or “on the spectrum?” Any parent who is asked about routines will have many examples for all their children. The key in autism is compulsivity and difficulty in redirecting the child.
A subset of children with autism engage in self injury and many use echolalia (not unprompted imitation, which is actually a good thing and no a clinical sign), which is defined as the meaningless repetition of adult utterances. Children using echolalia almost seem to be indicating that they know they are supposed to say something, so they pick something out that they heard recently and say it to terminate the interaction.
Anyway, a diagnosis of autism requires SEVERE (and the DSM-IV does say severe) disruption in the following areas: language (all late talkers meet this criteria) and behavior (severe rigidity in adhering to routines) and use of self stimulation (and I don’t mean spinning when listening to the soundtrack from the latest Disney cartoon and I definitely don’t mean lining up toys unless the child will refuse to move the location, lines up all kinds of things in addition to toys, and refuses to play with toys in other ways). And, as mentioned above, antisocial in a way that transcends what would be expected from the language deficits. To receive a diagnosis of autism, a child must display SEVERE clinically significant behavior in ALL THREE areas. Children with autism also do not engage in pretend or symbolic play (this is also a key feature of autism that is easily observed in nonautistic late talkers).
Also, and this is a very key point, autism will not disappear when the child learns to talk. So many late talkers are initially labeled autistic, only to have all signs of autism go away when they learn to talk. This is not autism, and folks who claim to cure autism should not be including these children in their reports.
PDD-NOS is accurately applied when a child only meets two of the three areas. For example, a social child who uses echolalia and hand flapping. I do not use “on the autism spectrum” because it is too imprecise. Because late talking is one characteristic of autism (all children with autism talk late) some label all late talkers as “on the autism spectrum.” As you have probably gathered by now, I strongly disagree with this characterization.
Just because all children with autism talk late, does this mean that all late talkers have autism? This is absurd, rather like saying that because all humans are mammals, all mammals are on “the human spectrum.”
A final word. When a clinician has seen and worked with children who meet the full definition of autism, it is unmistakable. The problem is that this condition is quite rare (thank goodness), so that I wonder whether all these questionable labels are being generated by folks with no experience with Kanner’s type of child or those meeting the full DSM-IV description.
Stephen M. Camarata, PhD
John F. Kennedy Center for Research on Human Development
Vanderbilt University School of Medicine
Nashville, Tennessee 37232
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