This course will focus on the key features of autism that distinguish it from other disorders. The reason I suggested this topic is because of the increase in the number of diagnosed cases of autism. Sometimes I'm called into a case where a child has been diagnosed with autism, but it turns out that the child doesn't have autism after all. Therefore, it is important, as I'm sure we would all agree, to get this diagnosis correct.
Speech language pathologists are learning more and more about autism and more commonly being involved in, or is sometimes the primary diagnostician of autism spectrum disorders. As you can see, I think we are uniquely qualified to do that diagnostic very appropriately and accurately, so I hope that you will learn how to participate in diagnosing autism and how to get the diagnosis right.
Is it Autism?
So, is it autism? It is a question that seems to continue to elude us. Autism is a serious medical condition that bestows lifelong issues for individuals with the condition, their family, and their community. Accurate diagnosis is important for the individual, their family, and everybody who cares about them. The diagnostic criteria for autism has changed, but the disorder remains the same as when Leo Kanner identified it in 1943. It's a disorder that evidences itself in the presentation of social, communication, and behavioral symptoms.
There is still no reliable medical test to identify autism and there's no standardized measure that alone can diagnose the condition either. The best method of identifying autism continues to be by observation of skilled professionals who work extensively within the autistic population in collaboration with their families, educators, and medical professionals. Together, we can put the pieces of the puzzle together and render an accurate autism diagnosis. A good place to begin is to understand the diagnostic signs of autism that collectively yield the diagnosis of autism and are either specific to autism or might indicate just one facet of the disorder.
Who are the diagnosticians who participate in this process? Autism can be diagnosed by a wide range of professionals including doctors, teachers, educators, and therapists like speech language pathologists. It doesn't have to be any one of these individuals, so it's important to recognize we can play a very important, if not a main role in performing the diagnosis as speech language pathologists.
Who Is Qualified to Assess the Core Features of ASD
Who is qualified to assess the core features of ASD? The core features involve communication, social skills, and behavior. I would argue that the speech language pathologist is the diagnostician of choice for diagnosing autism. As recommended by ASHA, we need to have extensive experience before we take on this role, but if you, as a speech language pathologist, have extensive experience in this population, you may be one of the more qualified diagnosticians on the team. It's important to remember that.
Roles of the SLP: ASD and SCD
In 2006, ASHA came out with a series of papers to delineate more information for speech-language pathologists about autism spectrum disorders. One of those papers delineates the roles and responsibilities of speech-language pathologists in diagnosing and treating autism spectrum disorders.
- Assessment and Intervention
Even if we do play one of the major roles in the diagnostic procedure, we need to do this in collaboration with other people, including the family members, educators, medical professionals, anyone who's been involved with the child. We can play a role in screening for autism spectrum disorders. There are a number of good screening tools available for assessing the condition and assessing the communicative and social abilities of the child and intervening in those ways as well as making the actual diagnosis. Speech-language pathologists also participate in research relative to autism spectrum disorders and in advocating for these individuals and their families. We can play a role in many ways and I encourage you to consult this 2006 paper from ASHA regarding the many different ways that we can participate.
ASD: New Diagnostic Parameters
Changing Criteria for Diagnosing Autism (APA)
How have the diagnostic criteria changed for autism spectrum disorders? For many years, the diagnostic and statistical manual of the American Psychiatric Association specified a set of diagnostic criteria that are globally used to diagnose the condition. In 2013 they had a major revision of these criteria. As of 2017, there are many individuals with autism spectrum disorder or Asperger's disorder or PDD-NOS who still have those diagnoses and based on the 2013 standards or diagnostic criteria, they keep those diagnoses until they are re-evaluated. There are many different diagnostic terms today and it's important to be aware of the criteria under which individuals were diagnosed and re-diagnosed if they are reassessed in the future.
In 2000, the DSM-4 specified that there were five pervasive developmental disorders. One of those was autistic disorder, or autism, as we more commonly refer to it. It was one of five disorders which were entitled pervasive developmental disorders because they were pervasive into almost every aspect of the individual's life. Autistic disorder was diagnosed by a series of social, behavioral, and communication symptoms that I will discuss shortly.
Asperger's disorder, on the other hand, was differentiated from autism in that the individuals with this condition were very fluent with their language. They most-likely presented some early language delays, but once they learned language they spoke in sentences conversationally in a very fluent way. This very much differentiated it from autistic disorder in which individuals had life-long difficulty putting communication together, even if they achieve conversational language. A lot of times it was still very difficult for them to put their thoughts into words and to think in words.
There were three other pervasive developmental disorders in this category. One was pervasive developmental disorder, not otherwise specified, or PDD-NOS. This turned out to be the most popular category of pervasive developmental disorder. It was intended to be for individuals who exhibited some characteristics of autism, yet not enough characteristics to give the full diagnosis of autistic disorder. The original authors of the DSM-4 intended this to be a placeholder condition when diagnosticians, maybe very early in development, were not sure whether the child was going to present the full autistic disorder or maybe just had a few characteristics that they may develop out of over time. It was really meant to be a placeholder in which a new diagnosis, or a new evaluation, was conducted in a year or so to determine whether or not autistic disorder or Asperger's disorder or some other condition was present. However, in practice, PDD-NOS was a diagnosis that frequently stuck and followed the child for quite a long time. The other two other conditions in this category were Rett's Disorder and childhood disintegrative disorder. These were both neurodegenerative conditions that are genetic or neurological in origin and are much rarer than the other three conditions, as it turns out.
The DSM-4 specified that a diagnosis of autism or Asperger's syndrome or PDD-NOS needed to be rendered by the time the child was three years of age and the presenting symptoms should be there for the diagnosis to be rendered by that time. In 2013, the American Psychiatric Association, after a long period of study and consultation with many autism experts, set forward a new group of diagnostic standards. They did away with the category of pervasive developmental disorders and renamed a category of autism spectrum disorders all for itself. In a sense this gave the diagnosis of autism a greater standing in the psychiatric community. They completely revamped how autism was diagnosed and while you will still see the communication, social, and behavioral components in the diagnosis, they became a little more specific in terms of exactly what behaviors we wanted to look for. This is a good change and one that has helped us to know what we're looking for better than we did before.
Specifically, for a diagnosis of autism spectrum disorders there will be social, communication, and interaction deficits, restricted behaviors, activities and interests similar to before. Now, instead of diagnosing autistic disorder, Asperger's disorder, PDD-NOS, autism is diagnosed based on a level of severity. Level 1 individuals with autism are those that require the least support. They have more communication. They're much more verbal. They are going to communicate in sentences or conversationally. Level 2 individuals need some support from others. Level 3 are individuals with autism who have minimal verbal ability, certainly limited understanding of language, limited social skills, and behavioral aspects that would be expected and they are going to require very substantial support to be independent. No longer does the diagnosis have to be rendered by age three, but rather just very early in development.
Diagnoses Then and Now: A Comparison
The diagnoses then and now could be laid out according to Figure 1.
Figure 1. Diagnoses Then and Now: A comparison.
On the left side of figure 1, there are autism levels 1, 2 and 3. This used to be represented by diagnosis such as autism, pervasive developmental disorder, high functioning autism, or Asperger's syndrome, but the new diagnosis would either be at level 1, 2 or 3. We would expect people who formerly had a diagnosis of Asperger's syndrome or high functioning autism to be level 1 and people with autism or a diagnosis of PDD-NOS would most likely be at 2 or 3.
They also added a new diagnostic category – social communication disorder. This one is especially interesting for speech language pathologists. These are individuals who evidence all of the pragmatic language deficits that we often see such as difficulties with nonverbal communication and difficulty interacting with others. But, they don’t have all of the other symptoms of autism. Diagnoses that were commonly used in this category before were nonverbal learning disorder and some people with Asperger syndrome may have fallen into this category as well.
ASD: Social Communication and Interaction Deficits
Let’s take a closer look at the criteria to help you sort out the criteria that were used formerly and those that are being used in new diagnostic evaluations since 2013. There are new diagnostic standards for diagnosing autism spectrum disorder.
Social-emotional reciprocity. The APA specified that this is a disorder with primary social, communication, and interaction deficits. Notice that the language has changed and that they're understanding that the social communication piece of this is very important and that individuals with autism present persistent deficits in these areas, particularly in the area of social-emotional reciprocity. For example, failing to engage with other people, failing to be interested in the communication of other people, difficulty initiating, difficulty taking turns. Perhaps there is difficulty with joint attention, just sharing attention with another person you want to communicate with, difficulty showing off and sharing the joy of something with another human being. These are characteristics that we don't see in children with autism early on. Some of these skills can be developed and we work very hard to develop them. But when we see a child for a diagnostic, we're looking for these kind of core deficits in social-emotional reciprocity.
Nonverbal communication. We're also looking for deficits in nonverbal communication. I was glad to see the APA including this category because it's very important. Nonverbal communication are those nonverbal communicative messages that carry so much meaning, like our eye messages. What are we saying with our eyes? Are we saying that we're interested in someone's communication or not? Are we saying with our eyes that we understand what someone's saying or we don't? Are we saying with our eyes that we're being a little bit sarcastic and that our verbal message doesn't match our nonverbal message? There are all kinds of eye messages that we send to one another.
Similarly, we use our voice to communicate a lot of nonverbal information. Are we asking a question or are we making a statement? Are we hoping that someone's going to listen to us? Are we changing our vocal register when we talk to young children or when we talk to other people or not? There are many types of voice messages that we send to one another when we're sending a verbal message.
Then there's our body language that helps to get across our meaning. How close or far away we stand to people also says something about the communicative message that we're sending. People with autism don't read these signals very well. They're having a hard enough time decoding the verbal piece of the message and they're just not very good at being able to simultaneously read all of these nonverbal signals and encode meaning from them.
Negotiating social relationships. People with autism have difficulty approaching other people, knowing how to start a verbal or nonverbal interaction with them, and this goes on into having difficulty making friends and maintaining relationships later.
ASD: Restricted Behaviors, Activities, Interests
Another category in the new diagnostics standards is similar but kind of collapses across some of the former categories as restricted behaviors, activities, and interests.
Repetitive stereotypic movements, speech or use of objects. People with autism do have some repetitive stereotypic movements. Sometimes we refer to these as stereotypies, or motor movements that don't seem to have any purpose but are repeated over and over again. This also happens with speech in terms of echolalia, saying things over and over again for no apparent reason, and using objects repetitively, not necessarily for the function they were intended.
Insistence on sameness and routines. It was replete through Leo Kanner's early papers, that children with this new condition that he had identified wanted things to be the same. They wanted a routine. They didn't just want it. They seemed to need it. Anytime the routine was broken they would react negatively to it and often scream and tantrum. So this insistence on sameness and need for routine continues today as one of the seminal characteristics of this disorder.
Restricted interests; fixations. Individuals with autism are typically not interested in too many things and may be fixated on certain topics or on certain things. Often during a diagnostic evaluation, I often ask the family if given a short period of time to do whatever the individual wanted, what would they do. Usually, if the person has autism, the family can tell me one or two things that the individual likes to do over and over again, or with higher functioning individuals there is something they like to talk about over and over again.
Hyper- or hypo- sensory experiences. People with autism have a lot of altered sensory experiences. Quite simply, they don't experience the world the way you and I do. They're often hypersensitive to certain smells or sounds, which means that they don't hear things the way we do. They don't hear your voice the way I would hear your voice. They don't see things the way that we would see things. One time, a little girl with autism told me that my hair looked like a halo. When she described it to me more in depth, she said that she could see each individual hair on my head as if it was an individual thing rather than hair as you and I would see it. People with autism are not experiencing the world from a sensory perspective in the same way as you or I, so it may not be surprising that they're not responding to it the same way either.
Kozi hii itazingatia sifa kuu za ugonjwa wa akili zinazomtofautisha na magonjwa mengine. Sababu ya kuanzisha hii ni kwa sababu ya kuongezeka kwa idadi ya wagonjwa wa ugonjwa wa akili. Wakati mwingine mimi huitwa katika kesi ambapo mtoto amepatikana na ugonjwa wa akili, lakini inageuka kuwa mtoto hana ugonjwa wa akili baada ya yote. Kwa hiyo, ni muhimu, kama nina uhakika sisi sote tutakubaliana, kupata utambuzi huu sahihi. Wataalamu wa lugha ya hotuba wanajifunza zaidi na zaidi juu ya ugonjwa wa akili na mara nyingi wanahusika katika, au wakati mwingine ni mgonjwa wa msingi wa matatizo ya autism. Kama unavyoona, ninaamini tuna sifa za kipekee za kufanya uchunguzi huo kwa usahihi na usahihi, kwa hivyo natumaini utajifunza jinsi ya kushiriki katika utambuzi wa ugonjwa wa akili na jinsi ya kupata utambuzi sahihi. Je, ni ugonjwa wa akili? Kwa hiyo, je, ni ugonjwa wa akili? Ni swali ambalo linaonekana kuendelea kutotufanya tuelewe. Autism ni hali mbaya ya afya ambayo hutoa matatizo ya maisha kwa watu walio na hali hiyo, familia zao, na jamii yao. Uchunguzi sahihi ni muhimu kwa mtu binafsi, familia yake, na kila mtu anayemjali. Ugonjwa wa autism umebadilika, lakini bado ni ugonjwa ambao Leo Kanner aliugundua mwaka 1943. Ni ugonjwa unaojitokeza katika dalili za kijamii, za mawasiliano, na za tabia. Bado hakuna mtihani wa matibabu wa kuaminika wa kutambua ugonjwa wa akili na hakuna kipimo cha kawaida ambacho peke yake kinaweza kugundua hali hiyo. Njia bora ya kutambua ugonjwa wa akili ni kupitia uchunguzi wa wataalamu wenye ujuzi ambao hufanya kazi kwa wingi ndani ya idadi ya watu wenye ugonjwa wa akili kwa kushirikiana na familia zao, walimu, na wataalamu wa matibabu. Pamoja, tunaweza kuunganisha vipande vya fumbo hilo na kutoa utambuzi sahihi wa ugonjwa wa akili. Sehemu nzuri ya kuanza ni kuelewa dalili za utambuzi wa autism ambazo kwa pamoja hutoa utambuzi wa autism na ni maalum kwa autism au inaweza kuonyesha tu kipengele kimoja cha ugonjwa. Ni waganga gani wanaoshiriki katika mchakato huu? Ugonjwa wa autism unaweza kugunduliwa na wataalamu mbalimbali ikiwa ni pamoja na madaktari, walimu, walimu, na wataalamu wa tiba kama vile wataalamu wa lugha ya usemi. Kwa hivyo, ni muhimu kutambua kwamba tunaweza kucheza jukumu muhimu sana, ikiwa sio jukumu kuu, katika kufanya utambuzi kama wataalamu wa lugha ya hotuba. Ni nani anayehitimu kutathmini sifa za msingi za ASD? Sifa za msingi zinahusisha mawasiliano, ustadi wa kijamii, na tabia. Kwa hivyo, kwa sababu ya hali ya lugha ya lugha, mtaalamu wa lugha ya lugha ni mtu wa kwanza kugundua ugonjwa wa autism. Kama ilivyoelezwa na ASHA, tunahitaji kuwa na uzoefu mkubwa kabla ya kuchukua jukumu hili, lakini kama wewe, kama mtaalamu wa lugha ya hotuba, una uzoefu mkubwa katika idadi hii, unaweza kuwa mmoja wa wataalamu wa utambuzi wenye sifa zaidi katika timu. Ni muhimu kukumbuka hilo. Katika mwaka wa 2006, ASHA ilitoa safu ya karatasi ili kuelezea habari zaidi kwa wataalamu wa lugha ya hotuba kuhusu matatizo ya autism. Mojawapo ya karatasi hizo inaonyesha majukumu na majukumu ya wataalamu wa magonjwa ya usemi na lugha katika kugundua na kutibu matatizo ya autism. Hata kama tuna jukumu kubwa katika utaratibu wa utambuzi, tunahitaji kufanya hivyo kwa kushirikiana na watu wengine, ikiwa ni pamoja na wanafamilia, walimu, wataalamu wa matibabu, mtu yeyote ambaye amehusika na mtoto. Kwa hivyo, ni muhimu sana kufanya uchunguzi wa uchunguzi wa ugonjwa wa autism spectrum. Kuna njia kadhaa za uchunguzi zinazotumiwa kuamua hali ya mtoto na uwezo wake wa kuwasiliana na kuwasiliana na kuingilia kati kwa njia hizo na pia kuamua ugonjwa. Wataalamu wa lugha ya hotuba pia wanashiriki katika utafiti unaohusiana na matatizo ya autism na katika kutetea watu hawa na familia zao. "Kama sehemu ya mpango huu, tunakuomba uangalie makala hii ya ASHA ya 2006 kuhusu ""Njia nyingi za kushiriki.""" "AUTISM: ""New Diagnostic Parameters Changing Criteria for Diagnosing Autism"" (APA) - ""Mipango mpya ya utambuzi wa ugonjwa wa akili"" (AASD) ni kipengele cha kwanza katika orodha ya magonjwa ya akili." Kwa miaka mingi, mwongozo wa utambuzi na takwimu wa Chama cha Psychiatric cha Amerika ulifafanua seti ya vigezo vya utambuzi ambavyo hutumiwa ulimwenguni kote kugundua hali hiyo. Mwaka 2013 walifanya marekebisho makubwa ya kanuni hizo. Kwa mfano, watu wengi wenye ugonjwa wa Asperger au autism spectrum disorder (ASD) bado wana utambuzi huo, na kulingana na viwango vya 2013 au vigezo vya utambuzi, wanahifadhi utambuzi huo hadi watakapopimwa tena. Kuna aina nyingi za utambuzi wa ugonjwa wa kisukari, na ni muhimu kujua ni kwa nini watu walipigwa na kuambukizwa na kuambukizwa tena. DSM-4 ilionyesha kuwa kuna matatizo matano ya maendeleo. Mojawapo ya matatizo hayo ilikuwa ugonjwa wa akili, au ugonjwa wa akili, kama tunavyouita kwa kawaida. "Hiyo ni moja ya matatizo matano ya akili ambayo yanaitwa ""pervasive developmental disorder"" kwa sababu yanahusisha karibu kila sehemu ya maisha ya mtu." Ugonjwa wa autism uligunduliwa kwa mfululizo wa dalili za kijamii, za tabia, na za mawasiliano ambazo nitazungumzia hivi karibuni. Kwa upande mwingine, ugonjwa wa Asperger ulitofautiana na ugonjwa wa akili kwa sababu watu walio na ugonjwa huo waliweza kuzungumza lugha yao kwa ufasaha. "Wanaweza kuwa na ""kuchelewa kwa lugha"" mapema, lakini mara tu wanapofundisha lugha, wanazungumza katika sentensi kwa njia ya mazungumzo kwa njia ya ufasaha." Hii ni tofauti kubwa na ugonjwa wa autism, ambapo watu wana shida ya maisha ya kuweka mawasiliano pamoja, hata kama wanafikia lugha ya mazungumzo. Mara nyingi ilikuwa vigumu sana kwa watu hao kueleza mawazo yao kwa maneno. Kulikuwa na matatizo mengine matatu ya ukuzi katika jamii hii. Ugonjwa wa Uendelezaji wa Kuenea, Haujatajwa vinginevyo (PDD-NOS) Hii ilionekana kuwa jamii maarufu zaidi ya ugonjwa wa ukuzi unaoenea. Ilikuwa ni kwa ajili ya watu ambao walionyesha baadhi ya sifa za autism, lakini si sifa za kutosha kutoa utambuzi kamili wa ugonjwa wa autism. "Wanahabari wa awali wa DSM-4 walitaka hii kuwa hali ya ""masharti"" wakati wagonjwa, labda mapema sana katika maendeleo, hawakuwa na uhakika kama mtoto alikuwa akitoa ugonjwa kamili wa autism au labda alikuwa na sifa chache ambazo zinaweza kuendeleza nje ya muda." "Kama ilivyoelezwa hapo juu, ""mfano wa kwanza wa utambuzi mpya wa ugonjwa wa akili ni uchunguzi wa uchunguzi wa ugonjwa wa akili wa Asperger au ugonjwa wa autism.""" Hata hivyo, katika mazoezi, PDD-NOS ilikuwa utambuzi ambao mara nyingi ulishikilia na kumfuata mtoto kwa muda mrefu. Hali nyingine mbili katika jamii hii zilikuwa Ugonjwa wa Rett na Ugonjwa wa Uharibifu wa Utoto. Kwa sababu ya hali ya neurodegenerative, ambayo ni ya asili ya urithi au neurological, ni muhimu sana kwa watu wenye ugonjwa wa akili. DSM-4 ilionyesha kwamba utambuzi wa ugonjwa wa akili au Asperger ulihitaji kutolewa wakati mtoto alikuwa na umri wa miaka mitatu na dalili za kuwasilisha zinapaswa kuwapo kwa utambuzi wa utambuzi. Mwaka 2013, Shirika la Tiba ya Akili la Marekani (APA) baada ya muda mrefu wa utafiti na kushauriana na wataalamu wengi wa ugonjwa wa akili, lilianzisha kundi jipya la viwango vya utambuzi. "Kama ilivyoelezwa hapo juu, ""ugonjwa wa maendeleo ya kuenea"" ni aina ya ugonjwa wa autism wa kawaida, na ""ugonjwa wa autism wa kawaida"" ni aina ya ugonjwa wa autism wa kawaida." Kwa njia fulani hilo lilifanya utambuzi wa ugonjwa wa akili uwe na umaana mkubwa zaidi katika jamii ya wagonjwa wa akili. "Walifanya marekebisho kamili ya jinsi autism ilivyogunduliwa na wakati bado utaona mawasiliano, kijamii, na vipengele vya tabia katika utambuzi, walikuja kuwa maalum zaidi katika suala la ""ni tabia gani hasa tulitaka kuangalia.""" Hii ni mabadiliko mazuri na moja ambayo imetusaidia kujua nini sisi ni kuangalia kwa bora kuliko tulifanya kabla. Kwa mfano, kwa ugonjwa wa autism, kuna matatizo ya kijamii, mawasiliano, na mwingiliano, tabia zilizopunguzwa, shughuli na maslahi sawa na hapo awali. Kwa sasa, badala ya kugundua ugonjwa wa Asperger, ugonjwa wa PTSD, ugonjwa wa autism unagunduliwa kulingana na kiwango cha ukali. Watu wenye ugonjwa wa akili wa kiwango cha kwanza ndio wanaohitaji msaada mdogo zaidi. Wana mawasiliano mengi zaidi. Wao ni zaidi ya maneno. Wanaweza kuwasiliana kwa kutumia sentensi au mazungumzo. Watu wa kiwango cha pili wanahitaji msaada kutoka kwa wengine. Watu wenye autism ya kiwango cha tatu wana uwezo mdogo wa kusema, uwezo mdogo wa kuelewa lugha, ujuzi mdogo wa kijamii, na tabia ambazo zinatarajiwa, na wanahitaji msaada mkubwa ili wawe huru. Si lazima utambuzi ufanywe kufikia umri wa miaka mitatu, bali ni mapema sana katika ukuzi. Ugonjwa wa zamani na sasa: Ulinganisho Ugonjwa wa zamani na sasa unaweza kuelezwa kulingana na Mchoro wa 1. Picha ya 1. Uchunguzi Wakati huo na Sasa: Ulinganisho. Upande wa kushoto wa picha ya kwanza unaonyesha viwango vya autism vya 1, 2 na 3. "Hii ni pamoja na autism, ""pervasive developmental disorder,"" ""high functioning autism,"" au ""Asperger's syndrome,"" lakini kwa sasa, ugonjwa huo umepatikana katika viwango vya 1 na 2." Watu ambao walikuwa na ugonjwa wa Asperger au autism ya hali ya juu walikuwa katika kiwango cha kwanza, na watu wenye ugonjwa wa autism au PDD-NOS walikuwa katika kiwango cha pili au tatu. Pia waliongeza jamii mpya ya utambuzi <unk> ugonjwa wa mawasiliano ya kijamii. Hii moja ni hasa ya kuvutia kwa pathologists lugha ya hotuba. Watu hawa wanaonyesha matatizo yote ya lugha ya vitendo ambayo mara nyingi tunaona kama vile ugumu wa mawasiliano yasiyo ya maneno na ugumu wa kuingiliana na wengine. Lakini, hawana dalili nyingine zote za ugonjwa wa akili. Ugonjwa wa Asperger ni ugonjwa wa kujifunza usio wa maneno, na watu wengine wanaosumbuliwa na ugonjwa huo wanaweza pia kuanguka katika jamii hii. ASD: Uwasiliano wa Jamii na Ukosefu wa Maingiliano Hebu tuangalie kwa karibu vigezo ili kukusaidia kutenganisha vigezo vilivyotumiwa hapo awali na zile zinazotumiwa katika tathmini mpya za utambuzi tangu 2013. Kuna viwango vipya vya utambuzi vya kugundua ugonjwa wa autism. Uwezo wa kuwasiliana kwa njia ya kijamii na kihisia-moyo. APA ilibainisha kwamba hii ni ugonjwa na msingi wa kijamii, mawasiliano, na upungufu wa mwingiliano. "Kumbuka kwamba lugha imebadilika na kwamba wanaelewa kwamba sehemu ya mawasiliano ya kijamii ni muhimu sana na kwamba watu wenye autism wana mapungufu ya kudumu katika maeneo haya, hasa katika eneo la ushirikiano wa kijamii na kihisia. """ Kwa mfano, kushindwa kushirikiana na watu wengine, kushindwa kuvutiwa na mawasiliano ya watu wengine, ugumu wa kuanzisha, ugumu wa kuchukua zamu. Labda kuna ugumu wa kuzingatia pamoja, kushiriki tu uangalifu na mtu mwingine unayetaka kuwasiliana naye, ugumu wa kuonyesha na kushiriki furaha ya kitu na mwanadamu mwingine. Hii ni tabia ambayo hatuoni katika watoto wenye ugonjwa wa akili mapema. Baadhi ya ujuzi huu unaweza kuendelezwa na tunafanya kazi kwa bidii sana kuuweka. Lakini tunapomwona mtoto kwa utambuzi, tunatafuta aina hizi za upungufu wa msingi katika ushirikiano wa kijamii-hisia. Mawasiliano yasiyo ya maneno. Pia tunatafuta upungufu katika mawasiliano yasiyo ya maneno. """Nilikuwa na furaha kuona APA ikijumuisha jamii hii kwa sababu ni muhimu sana." Mawasiliano yasiyo ya maneno ni ujumbe wa mawasiliano usio wa maneno ambao una maana nyingi, kama ujumbe wa macho yetu. Tunasema nini kwa macho yetu? Je, unasema kwamba tunapendezwa na mawasiliano ya mtu au la? Je, sisi kwa macho yetu tunasema kwamba tunaelewa kile ambacho mtu mwingine anasema au hatuna? Je, sisi ni kusema na macho yetu kwamba sisi ni kuwa kidogo sarcastic na kwamba ujumbe wetu wa mdomo hailingani ujumbe wetu nonverbal? Kuna aina zote za ujumbe wa macho ambayo sisi kutuma kwa kila mmoja. Vivyo hivyo, tunatumia sauti yetu kuwasiliana na watu habari nyingi zisizo za maneno. Je, tunauliza swali au tunafanya taarifa? Je, tunatumaini kwamba mtu fulani atatusikiliza? Je, tunabadilisha sauti zetu tunapozungumza na watoto wadogo au tunapozungumza na watu wengine? Kuna aina nyingi za ujumbe wa sauti ambazo tunatuma kwa kila mmoja wetu wakati tunatuma ujumbe wa mdomo. Pia kuna lugha ya mwili ambayo husaidia kuelezea maana ya maneno. Ukaribu wetu au umbali wetu kutoka kwa watu unaonyesha ujumbe tunaopeleka. Watu wenye ugonjwa wa akili hawawezi kusoma ishara hizi vizuri sana. "Wanajaribu sana kufunua ujumbe wa maneno, na hawawezi kusoma ishara zote zisizo za maneno kwa wakati mmoja na kuunda maana kutoka kwao.""" Kufanya mazungumzo juu ya mahusiano ya kijamii. Watu wenye ugonjwa wa akili wana shida ya kukaribia watu wengine, kujua jinsi ya kuanza mwingiliano wa maneno au usio wa maneno nao, na hii inaendelea kuwa na shida ya kufanya marafiki na kudumisha mahusiano baadaye. "A.S.D. (Restricted Behaviors, Activities, Interests) ni aina ya ugonjwa wa akili unaoweza kuonekana kwa njia tofauti na ule unaoweza kuonekana kwa njia tofauti, na kwa sababu ya tabia, shughuli na maslahi yaliyopunguzwa.""" Mageuzi ya mara kwa mara ya kawaida, usemi au matumizi ya vitu. Watu wenye ugonjwa wa akili wana baadhi ya harakati za kawaida zinazorudiwa-rudiwa. "Wakati mwingine tunaita hizi ""mabadiliko ya kawaida"" au ""harakati za magari"" ambazo zinaonekana kuwa hazina kusudi lolote lakini zinarudiwa tena na tena." "Hii pia hutokea na hotuba katika suala la echolalia, kusema mambo tena na tena bila sababu ya wazi, na kutumia vitu mara kwa mara, si lazima kwa ajili ya kazi walikuwa wamekusudiwa. """ Kusisitiza juu ya usawa na utaratibu. Leo Kanner aliandika katika kitabu chake cha kwanza cha utafiti kuhusu hali ya watoto, na alionyesha kwamba watoto waliopata ugonjwa huo walitaka mambo yawe sawa. Walitaka utaratibu. Hawakutaka tu. Walionekana kuwa wanahitaji msaada huo. Wakati wowote utaratibu ulipovunjwa wao wangeitikia vibaya na mara nyingi walipiga kelele na kukasirika. Kwa hiyo, kusisitiza juu ya kuwa sawa na kuhitaji utaratibu huendelea leo kama moja ya sifa kuu za ugonjwa huu. Mapendezi yaliyopunguzwa; mapendezi ya kudumu. Watu wenye ugonjwa wa akili kwa kawaida hawapendezwi na mambo mengi sana na wanaweza kuwa na mtazamo wa mambo fulani au mambo fulani. Katika uchunguzi wa matibabu, mara nyingi mimi huwauliza familia ikiwa wapewa muda mfupi wa kufanya chochote ambacho mtu huyo anataka, wangefanya nini. Kwa kawaida, ikiwa mtu ana ugonjwa wa akili, familia inaweza kuniambia kitu kimoja au viwili ambavyo mtu huyo anapenda kufanya tena na tena, au na watu wa hali ya juu kuna kitu wanachopenda kuzungumza juu yake tena na tena. Hyper- au hypo- hisia uzoefu. Watu wenye ugonjwa wa akili wana uzoefu mwingi wa hisia uliobadilika. Kwa ufupi, hawajionea ulimwengu kama wewe na mimi. Wao ni hypersensitive kwa harufu au sauti, na hivyo hawawezi kusikia mambo kama sisi. Hawasikii sauti yako kama mimi ningesikia sauti yako. Hawaoni mambo kwa njia ambayo sisi tungeyaona. "Mara moja, msichana mmoja aliyekuwa na ugonjwa wa akili aliniambia kwamba nywele zangu zilikuwa kama ""mwisho wa dunia.""" "Aliponielezea kwa kina zaidi, alisema kwamba angeweza kuona kila nywele moja kichwani mwangu kama kwamba ilikuwa kitu cha mtu binafsi badala ya nywele kama wewe na mimi tungeiona.""" Watu wenye ugonjwa wa akili hawajionea ulimwengu kutoka kwa mtazamo wa hisia kwa njia ile ile kama wewe au mimi, kwa hivyo inaweza kuwa haishangazi kwamba hawajibu kwa njia ile ile pia.