Could you get ASD diagnosis on basis of some traits and not others?

[Corialanusburt]

I'm constantly going backwards and forwards in my mind about whether we need to investigate possibility of autism in DD age 11.

I'm confused about whether some of all traits need to be seen to get diagnosis or whether it could be diagnosed on basis of seeing a lot of 1 or 2 traits only. Will describe her a little below:

She struggles with social interaction. She is very very shy. She has no friends in school. She doesn't particularly like very noisy, busy parties or shops. She won't eat veg and has sensory issue re: me eating; she hates the sound of me eating. She can be rigid e.g. Refusing to have my help with homework because it's not the way the teacher told her to do it. She enjoyed occasionally lining up her Moshi monsters when she was little. She had lots of separation anxiety at nursery and reception, very clingy tho fine as soon as I left.

On the other hand, there are autistic traits she doesn't have. She has no special interests. She doesn't talk at length about particular things. There's no unusual cadence or eccentricity in her voice or what she says. She is adaptable to changes in routine. She's never had a meltdown, tho she can get briefly angry. Her interaction with best friend is very normal. She understands figures of speech and is great at making inference from text. She reads between the lines easily. Although she finds it hard to interact, she's very conscious of the interaction between others.

That's just a snapshot but what do you think? Thanks

To get a dx of ASD your DD would have to score across the triad of impairments - so she would have to show some traits in all of them. So it is possible to have lots of Autistic traits but not get a dx if the traits are clustered in one or two areas.

Since you have concerns about her though, it would perhaps be worth discussing them, e.g. with your GP. How is she at school - do they have any concerns?

The diagnoses isn't actually based on traits, there's a thing called "The triad of impairments", you need debilitating impairments is all areas to be diagnosed.

This is actually where the idea of a spectrum comes from, which a lot of people who dont' really understand autism don't really realise.
For example, you might have a fairly big issue with social interaction, so display a lot of traits in the area, but very few with social communication so only have one trait.

Does she have social anxiety? I had it as a teenager. I was very anxious - very, very quiet - almost mute. Very few friends - no proper ones anyway. I didn't have sensory issues with food but do still get a bit ragey when I hear people eating! I was very focused on schoolwork and overly anxious about getting top marks - which I mostly did because I spent so much time studying. I don't have autism. I've almost 100% grown out of my social anxiety by now - mid 30s. I had no help for it - just my parents putting major pressure on me to socialise and be normal. That made be even more anxious. I wish they had not put that pressure on and I wish I had had some cognative behavioural therapy at the time and some medication for my anxiety. Now I'm quite sociable and chatty and have friends.

My son has autism. He also doesn't have some of the traits you listed and I was confused before he was diagnosed as he seemed to have some characteristics but not others .

He has very good use of language - he loves words and idioms. He is very flexible with language, not at all literal. He seems to have a flair for picking up idioms and figures of speech in a way that other children his age do not. He can read between the lines and understand people's motives and true feelings. However, he often misses these things if he is distracted or day dreaming - so he has a great ability to understand other people but doesn't always put it into practise.

My sons interactions with close friends that he likes look very 'normal' too. He is well able to interact provided the environment is right and he finds the other person engaging. If he finds someone not engaging then he doesn't even attempt to engage and acts like they are invisible.

He is largely ok with changes in routine. I would have no issues at all at home telling him about a change of plans. This might be more of an issue in school where he might feel a bit more stressed but it's not a major issue there.

My son does have a topic that he likes to discuss a lot - but it's a topic all the boys in his class like too and I've noticed that many of them talk about it a lot of the time. His level of interest seems on a par with the other boys.

My son does have meltdowns from time to time - but they are not the worst and are becoming much less frequent.

Whether she has autism or social anxiety or something else it sounds like she would benefit from some help.

Thank you'll for your very useful replies. DD has just been taken on by CAMHS. We're waiting to see what they can do/whether they can support school to help her.

Actually the triad of impairments is slightly out of date. The most recent diagnostic criteria (DSM-V) has reduced this to two impairments (a dyad of impairments); social communication impairments and restrictive interests/repetitive behaviours. If I remember correctly it also recognises sensory difficulties. The triad is still used in ICD -10 diagnostic criteria but this is a bit older.

That's useful Blaeberry. After reading your reply, I found this tick list:

www.ohsu.edu/xd/outreach/occyshn/programs-projects/upload/ASD-ID-Teams-DSM-V-Checklist.pdf

DD gets ticks for every thing in Social Comm/interaction and very little in restricted repetitive behaviours. Having said that, she got a fidget spinner yesterday and she quite likes spinning it. Also re: soc comm/interact. She could get ticks because of behaviour observed by the assessor or by school but if she were secretly filmed at home or with her best friend, you'd see an entirely different girl.

Our paediatrician recommended the 3di assessment for ds1 as there were some clear traits but other not so clear. From this he was diagnosed with atypical autism. He struggles with social situations and communication and whilst he has some special interests and likes routine these do not have such a big impact on his day to day life. She asked whether we wanted the diagnosis recorded as whilst the scores for social skills and communication where high enough for a diagnosis they were not very high and whilst the other scores were too low for a diagnosis they were only just below the cut off point. We felt that it was important that school recognised these difficulties rather than saw him as naughty or difficult so went ahead with the diagnosis.