On what basis is a diagnosis of autism made? For a diagnosis of autism to be made the child will show symptoms in the following four areas before 36 months of age. Relating The child with autism often has extreme difficulties in relating to other people. The child will often avoid such basic communication as eye contact and is frequently described as being in a world of their own. Attempts to break into their world can provoke frustration and may lead to tantrums. The child with autism often resists being held and is generally indifferent to the social approaches of others. It is not unusual for the child with autism to treat other people as inanimate objects or as tools for their use (eg using someone's hand to open a door). Restricted activities or interests There is a lack of normal play development. Most children with autism have no imaginative play and the few who do, tend to repeat the same theme and rarely extend their games. When left to themselves, children with autism spend much of their time in repetitive and apparently pointless activities which absorb them to the exclusion of all else. Typical activities include rubbing surfaces, toe walking, flicking string, odd hand movements, smelling things or spinning. Children with autism strongly resist attempts to redirect them from these activities.In higher functioning people this behaviour is reflected in their restricted interests (eg bus routes,timetables, dinosaurs) and routines. People with autism feel tremendous anxiety at the unpredicability of daily life and these rituals and routines remove some of the uncertainty about what will happen next. Perception People with autism seem to have difficulty in making sense of their environment. This may account, in part, for the obsessive nature of their behaviour. They are reducing the world to those parts which they can understand and with which they feel safe. These reactions can vary from day to day. Often a child who will not respond to his name or a loud noise, will become distressed by a seemingly normal or sudden sound. Children with autism also have unusual responses to touch, pain and the temperature. They may either under or over react to these sensations. Communication The lack of response by an autistic child sometimes raises the suspicion that the child is deaf. People with autism do not communicate easily; some do not speak at all. Others simply echo back what is said to them (echolalia), while others use language in an odd and limited manner. Another speech characteristic is pronoun reversal where the child will say "You want a drink" instead of "I want a drink". Rhythm, tone and pace of speech can be affected with the resulting speech sounding odd. The person with autism may use language mainly to name objects and has little understanding of conversation. There are also difficulties in understanding other people's communication and in the ability to comprehend other people's thoughts and feelings. This lack of awareness is sometimes called theory of mind or mindblindness.

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