Autism: Triad vs. Dyad

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).