The Triad of Autism
The
triad of impairments is in the base of the diagnosis of Autism,
according to the DSM IV (APA, 1994). It consists in impairments in
three specific areas: social interactions; social language and
communication skills; and restricted, repetitive and stereotyped
patterns of behaviour.
In the area of social
interactions the impairments could be expressed via the contact with
others and relationships. Some examples that an autistic child could
demonstrate in this area are: deficits in the use of several
non-verbal behaviours; inability to develop relationships according
to their developmental level; inability to seek to share,
spontaneously, enjoyment, interests and/or achievements with others;
and lack of social and/or emotional reciprocity, empathy (APA, 1994)
The social language and
communication skills impairments are related with the difficulty that
autistic individuals have to initiate or maintain a conversation, or
to use language as a information tool. For example, an autistic
individual may demonstrate: lack of verbal and non-verbal skills –
inability to understand questions, directions or expressions;
inability to initiate or sustain a conversation; use of stereotyped,
repetitive and/or idiosyncratic and metaphorical language –
sometimes only perceptible for those who are familiar with
individual; lack of imagination skills that could be detected through
make-believe play and/or social imitative play; use of an abnormal
pitch, intonation, rate, rhythm, and/or stress of speech (when the
speech is developed); immature use of grammatical structures (APA,
1994).
The restricted, repetitive and
stereotyped patterns of behaviour impairments are related to the
short flexibility of though, to the difficulty of accepting changes
and to the obsession regarding some topics, behaviours or activities.
According to DSM IV (APA, 1994), this area of impairments could be
observed through: abnormal intensity or focus in stereotyped and
restricted patterns of behaviour; use of stereotyped and repetitive
motor mannerisms; adherence to non-functional and specific routines;
restricted range of interests; insistence on sameness; inability to
cope with changes (APA, 1994).
Dyad of Autism
Nowadays the triad of impairments
concept is falling into disuse and it is being substituted by the
concept of dyad of impairments, and it used to diagnose the ASD
condition that became broader. The differences are few, although I
consider them important to be clarified.
The
dyad of impairments manifests in two wide areas: social communication
and social interaction in multiple contexts; and restricted
and repetitive patterns of behaviour, interests or activities (APA,
2013; Selfe, 2013).
The area of social communication
and social interaction encompass impairments in: the understanding
and use of language; the verbal and/or non-verbal communication; and
the interaction with others and development of relationships. For
example, an autistic individual may show: lack of social and/or
emotional reciprocity, empathy; difficulties to initiate or maintain
a conversation and/or answer to social overtures; reduced ability to
seek to share, spontaneously, interests, emotions and/or affection with others; inability to use and/or understand several non-verbal
behaviours; lack of ability to develop, sustain and/or understand
relationships; difficulties to adjust behaviour according to various
social contexts; imaginative play skills impairments; lack of
interest in peers (APA, 2013; Selfe, 2013).
On the other side, the area of
restricted and repetitive behaviours, interests or activities
encompass: the flexibility of behaviour, the acceptance of changes, organisational and planning skills, restricted and repetitive
behaviours, interests or activities, behaviours; sensory issues
conveyed in behaviours and/or needs. For example: use of stereotyped
and repetitive motor mannerisms (flapping hands), use of objects
(aligning objects) and/ or speech (echolalia, idiosyncratic phrases);
insistence on sameness; adherence to non-functional and specific
routines; inability to cope with changes; hyper or hypo reactivity
to sensorial stimulus and/or abnormal interest to environmental
sensorial features (APA, 2013, Selfe, 2013).