A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Autumn's expressive language is around 18 months maybe a little higher. She doesn't "talk" in conversation. She only speaks when she needs something (for example: "I want juice please"). She can recite all of her letters, numbers, shapes and colors. She is labeling what seems to be everything, but again we do not have any real back and forth conversation, but we've been working on this daily. For instance, doesn't ask how I am or says things like "baby is happy" or "daddy is sad, I help daddy feel better." Which, at her age, she should say by now. She should be more "in tune" to other peoples feelings and the world surrounding her. The best way to put this is I feel as if she doesn't understand what others think or feel. She lacks the empathy where she can't relate or read others emotions. If I cry, she doesn't understand. She also doesn't smile back at me when I smile at her unless I tickle her. Basically, sometimes I feel like I'm seen as a tool to get her what she needs.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Autumn still struggles with eye contact and it takes several times for her to respond when I call her name. Her receptive and expressive speech (again) is lower than it should be. She still has difficulty understanding directions but has improved somewhat. She will also scream and make strange sounds like crow sounds or will say the same words/sentence in order again and again. We believe the screaming/crowing is a vocal stim. This is something were currently trying to work on decreasing. Also, one can have excellent expressive language, meaning they can speak/talk well, but they have a difficult time engaging in conversations or become lost in their own words. So lack of speech doesn't always mean autism. There are some extremely talkative kids who have Autism because of the above (debunking myths here).
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
This is where Autumn is trying but there's some trouble mainly bc of the lack of words used to communicate. She will say hello to the little kids and grab their hand to play, but when they try to talk back to her to engage in a conversation, Autumn can't say anything else and "looses" them. It's one of the most heartbreaking things to watch. She does great otherwise, but mainly prefers to play alone after trying to engage with the kids. Her make believe play is great for her age. However, she doesn't like it whenever myself or a therapist tries to play and take turns. She will scream and fight her way out of it, but eventually she'll come along. Sharing and turn taking has been an ongoing work in progress and this has improved immensely over the last few months, but still a struggle at times.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
As stated in the first section, she does become fixated on certain words and sounds. We don't believe she has echolalia, but tends to repeat the last thing said at times. Still not enough for her therapists and myself to be alarmed. She will line things up (lining up isn't always an indicator of autism-this is the organizational piece that I love about her) she flaps her hands whenever she gets excited and has verbal stims (she currently crows).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
My Autumn Belle is big on routine and I mean, HUGE on routine and "sameness" as sameness is her comfort. However, she does adjust pretty well when she's not home and at her Memas house or when were on vacation. Maybe it's because I'm with her or she's with her Mema whom she also loves and trusts and she still gets the typical things that are part of her routine? I'm going to assume so. Another factor mentioned above is her difficulty to adjusting to new things. This is typical anytime one of her therapists introduces something new. Same with me here at home. She will scream and cry and throw herself on the floor whenever we try a new activity. This doesn't last too long because we don't allow this behavior for too long. After a few minutes, she comes along and will participate, but her "non-compliance" is one of our biggest concerns and the only reason why we implemented ABA therapy this past winter to kick this behavior in the bud. Anything new, "no thanks" in her world. This goes for foods (chicken and applesauce almost every day) and new people as well, which is why she scored extremely low in the Battelle. She didn't want to do the "work" bc she didn't "know" the therapist administering the test. However, on the upside, she has been saying hello to new people whenever were out. This is a huge and I mean HUGE milestone in our lives. Usually she says hi and is back to being fixated on something else or will repeatably say "hi" over and over while the person tries to engage in conversation with her. A work in progress.
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
To be honest, I am not sure if she has any real attachment to anything other than her momma lol. She currently is preoccupied with wanting to watch Frozen every night before bed. It's become her bedtime routine but not sure if that counts.
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Yes, yes and yes. Autumn also has sensory processing disorder, but that's just another symptom of her autism and I can write an entire post on this topic alone. She needs constant pressure/deep massages. She seems to be hyposensitive when it pertains to pain or water temperatures (bath water too hot or too cold or food too hot and she doesn't say anything-of course I cool it down and take her out of the tub immediately knowing if the temp isn't right). She has light sensitivity. Hates loud sounds or people talking at the same time. For example, in mickeymouse club house, she screams when they say "oh toodles". I guess she's filtering out the sound. She is constantly moving and going. Nonstop. Rarely naps. Has poor coordination meaning she walks over everything and trips easily. Some of these symptoms mimic ADHD but she's too young to be diagnosed with it. For now, we have her on a sensory diet where we jump with her, rock her and do other activities to help "calm her". Again, a lot to say here, but the above are the main concerns.
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior(see Table 2).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
I started to see symptoms when she was about 18 months. She also lost words and this was probably the biggest indicator something wasn't "right". The "Prelude" post breaks down this in more details.
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
Yes, I would say this has in more ways than one: social (her communication deficits), occupational (the sensory processing disorder), adaptive/self-help, etc. The communication and sensory issues are the biggest concerns. Everything else is relatively mild.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
No global developmental delay bc of multiple areas of delays.
***So I hope that my personal breakdown of what Autism looks like for us helps you understand a little more about the spectrum regarding Autumn. I didn't list every little thing here because this has already turned into a novel. Autumn has made tremendous strides with EI therapies and us working with her in decreasing the "non-compliant" behaviors. Her symptoms may get better or worse with age, but the above is regarding today. Lots of love and hope. As in her favorite movie and song (changing the lyrics): "The stims never bothered me anyway".
The "non-compliance" above.
The pressure below (looks like a normal hug, but this is usually every few minutes and she pushes her lips against my cheek and squeezes my neck so hard that I feel like she is strangling me. She also likes to wrap her arms around me from my back and climb on me like a monkey and will make funny sounds when she does this. Looks so precious and believe me, it can be, but every few minutes it can become exhausting and painful for me bc she's pulling my hair and my skin.)