Expert: Dr. Sharon A. Mitchell - 7/14/2011

Question
My child's psychiatrist said that my daughter cannot have high functioning autism because she shows us things she has drawn, or walls she has made with bricks. Is it possible for a hild to show you things and still have high functioning autism?

Answer
Good morning Lesley,

It's my guess that there might be other factors leading your psychiatrist to think that your daughter does not meet the diagnostic criteria for autism. I think he is feeling that when your daughter shows you what she has done, she is showing a social interest. Although this is something we want to develop in kids with autism, many don't show this interest in sharing and interacting, at least initially and without some work on the part of the adults.

Perhaps this is something you have worked on already with your little girl. Sometimes, before the parent or therapist starts working with a child, that child will easily meet all the criteria for autism. After responding to therapy (whether formal or what you do at home on your own), some kids no longer so clearly show these deficits. That's a good thing.

Actually, there is no such diagnostic label as "high functioning autism". The exact current labels are:

- Autistic Disorder
- Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
-Asperger's Disorder
- Rett's Syndrome
- Childhood Disintegrative Disorder

The latter two are a little different in that they are quite rare and these children become progressively worse. Kids with PDD appear to be on the autism spectrum but don't quite meet all the criteria for Autistic Disorder. Kids with Asperger's have no delays in acquiring language and must have intellectual ability within the average to above range.The Centers for Disease Control lists the exact diagnostic criteria at http://www.cdc.gov/ncbddd/autism/hcp-dsm.html

The First Signs website has some nice videos that compare a child with autism alongside a typically developing child of the same age. You must first register before gaining access to the videos, but it's free and there is no obligation. Take a look at http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Although this is in no way a diagnostic test, this next link is a screener that could give an indication whether or not your child may fall somewhere on the autism spectrum: http://www.childbrain.com/pddassess.html

If after reviewing the videos and looking at the diagnostic criteria, you still strongly feel that your child fits the criteria for one of these labels, try talking to your psychiatrist again. If you and he still disagree, and a label is important, seek a second opinion.

Here is some general information on autism spectrum disorders: http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml

But, does the exact label matter? Perhaps, if you are seeking services that require a particular diagnosis.

What really matters is that your child is growing and progressing. The fact that she wants to share with you is wonderful and something to build on. If you go to this link, you can see some books that follow an approach you can do at home with your little girl. What I like about this approach is that it is doable for families, involves playing with your child (something you would be doing anyway) and follows a developmental approach: http://tinyurl.com/5u38u7m

It sounds like you went into the doctor's office thinking your child had autism and left thinking she does not. This is still the same little girl you had the day before. If she is becoming more social and wanting to share with you, you are obviously doing many things right and are on the right path.

All the best,

Dr. Sharon A. Mitchell