For the one in every 100 or so children in this country with autism, a diagnosis is a critical link to treatment and services. It means that school districts will provide extra resources, and insurance carriers will pay for medical and psychiatric treatment.

The word itself has been in use for more than 100 years, but as the psychiatric community prepares to update the definition of “autism,” many parents have panicked, fearing that if the definition changes, their kids will lose the diagnosis and the services that go with it.

The latest evidence suggests that most families need not worry.

“I’m looking at all the kids I’ve tested and I just don’t see that [happening],” says Karen L. Schiltz, Ph.D., a psychologist in private practice in Calabasas since 1988 and author of Beyond the Label: A Guide to Unlocking a Child’s Educational Potential (Oxford University Press, 2011). “I actually felt really relieved when I saw the new definition come out.”

The definition in question is part of the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Published by the American Psychiatric Association, it sets the standard for how health-care providers classify mental disorders. The book first listed autism as a unique diagnosis in 1980, but its definition hasn’t been revised since 1994. Meanwhile, the number of children diagnosed has skyrocketed, jumping 78 percent in the past decade.

No More Autism Sub-Categories

One reason the update is causing such a stir is that the proposed definition in DSM-5 collapses a whole range of autism spectrum sub-categories into one single diagnosis. This means that diagnoses like Autistic Disorder, Asperger’s syndrome and the umbrella term of “Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)” would go away, leaving only autism spectrum disorder (ASD) as a clinical label. Many parents have expressed concerns that their child’s diagnosis will disappear along with the subcategories.

Going forward, “the job of a clinical psychologist is to answer a question of, ‘Is it ASD or not,’ rather than, ‘Is it Autistic Disorder or Asperger’s disorder or PDD-NOS,’” says Marisela Huerta, Ph.D., a psychologist at Weill Cornell Medical College in New York. But, she says, parents don’t need to worry. A recent study led by Huerta suggests that most kids with a current diagnosis on the spectrum would keep that diagnosis under the new guidelines.

There’s no harm in eliminating the sub-categories, Huerta says, because research over the last decade fails to identify differences in the clinical presentation (or the range of symptoms) associated with Autistic Disorder, Asperger’s disorder and PDD-NOS. “More importantly, we’ve learned that the different DSM-IV categorical diagnoses are not used in a consistent manner by clinicians,” she says. One recent study even showed that the clinic where a child was evaluated was a more important factor than the child’s actual symptoms in the specific autism diagnosis they received, with some clinics seeming to favor one sub-category over another.

Including New Symptoms

And while it offers only one diagnostic label, the proposed overhaul is actually more inclusive in some ways than the current definition. The new definition would:

• Include sensory interests and aversions among the symptoms used to define ASD – These symptoms – being especially picky about food or irritated by the texture of clothing, for instance – aren’t included in the current diagnosing criteria.

• No longer require that a child exhibit evidence of developmental delays before age 3 – Instead, the definition would require that a child show examples of unusual behavior “in early childhood,” making it easier for clinicians to diagnose children whose delays weren’t noted early on.

• Account for the fact that social impairments may change over time – ASD may look different at age 3 than, say, at age 10 or 30.

The new definition is also more specific and makes it easier to tell the difference between autism and other disorders. Speech delays, which occur in kids with autism but also in those with a range of other problems, have been removed from the criteria. Meanwhile symptoms that are unique to autism – including repetitive movements like arm-flapping, rigid adherence to routines or rituals, and unusually intense or odd interests – must now be present for a diagnosis.

“A large body of research over the last decade has demonstrated that nearly all children with some form of autism demonstrate these types of behaviors at some point in their lives,” says Huerta. “The presence of these behaviors, alongside a pattern of social and communication difficulties, is unique to autism spectrum disorders.”

Huerta’s study, the largest to compare existing diagnostic criteria with the proposed changes, included data on 4,453 children with an autism spectrum diagnosis. She and colleagues reviewed detailed parent reports on the children, and applied the newly proposed criteria. It turned out that 91 percent of the children would be diagnosed with ASD under the new guidelines based on parent reports alone, and Huerta believes that clinician input would clinch a diagnosis for many of the remaining 9 percent. Her study appeared in a recent issue of the American Journal of Psychiatry.

Schiltz, who specializes in neuropsychological assessment, believes the new criteria could even eliminate roadblocks to diagnosing some kids – especially those whose delays were “camouflaged” during the early years. “A kid who played in the sandbox for hours and hours in early childhood seems normal,” she offers as an example, noting that if parents don’t notice that something isn’t right by the time their child is 3, it can be tough for them to get help.

The common question from parents has been, “Why wasn’t this diagnosed earlier?” Schiltz says.

Advice for Parents

The specific autism guidelines in DSM-5 are still under review, and won’t become official until 2013. But Schiltz says the new criteria and definition are only the beginning. You still need a thorough evaluation of the child in order to make a correct diagnosis.

“It takes years and years of experience to understand the complexity of autism,” she says. “When we assess children, it’s a process.”

She advises parents who suspect their child might have a problem to take good notes. “I encourage parents to write things down when you see something that’s not quite right,” she says. Take that list to your pediatrician, ask for a referral to a psychologist, and get another opinion if you feel you weren’t heard. Once you have your referral, Schiltz says, a quality evaluation will:

• look at all possible causes for the behaviors your child is displaying;

• look at your child in all of her different environments (i.e. at home, at school, with caregivers and peers);

• provide an accurate roadmap of all of your child’s strengths and weaknesses; and

• include input from parents, teachers and other caregivers.

The proposed new guidelines, Schiltz says, won’t alter the process a good psychologist goes through in making a diagnosis. But because the criteria are more specific, in some ways the process will be easier. “The way we evaluate will not change,” she says. “[But under the new guidelines] we have more items to look at, and less to argue.”

Studies about the incidence and effects of physical violence in children’s television programming are everywhere. But what about mental or emotional aggression? It turns out that “social bullying” – teasing, taunting, name calling, gossip, and social scheming – goes on in most of the TV programs that children watch, but has been largely ignored in research.

Children’s TV scenes involving social bullying are often played for laughs. And when the social bullies are attractive characters, plot lines rarely see them punished for their bad behavior. Nicole Martins, assistant professor in the communications department at Indiana University and co-author of a recent study of social aggression in children’s television, says that’s dangerous: Kids identify with attractive characters on their favorite shows and could follow in their bullying footsteps.

In their study, Martins and co-author Barbara J. Wilson found social aggression in 92 percent of shows that Nielsen Media Research listed as the 50 most popular with kids. They counted about 14 incidents per hour, on average, for a range of programs, from “The Amanda Show” to “Drake & Josh,” “Scooby Doo” and “The Simpsons.” Some, such as “Survivor” and “American Idol,” aren’t targeted directly at children but are still popular with kids.

“One of the worst offenders of socially aggressive behaviors was ‘American Idol,’” Martins says. “Simon [Cowell] was particularly nasty to the contestants who auditioned for the show, and Paula [Abdul] frequently called Simon names.”

Extensive research has demonstrated that children who watch physical violence on television become more violent themselves, and Martins says it’s possible kids could learn socially aggressive behavior the same way – especially if the social bullies always seem to get a laugh or come out ahead.

“In fact, my coauthor and I did a second study where we examined whether exposure to socially aggressive programs was related to children’s social aggression in a sample of 500 elementary school children,” Martin says. It turned out that the programs affected girls much more than boys.

She warns parents that they can’t assume a TV program is fine for their child to watch just because it contains no physical violence. “Parents should be aware that their children are watching programs that may not be violent in a physical sense, but are nonetheless antisocial in nature,” Martin says.

Her study was published a September issue of the Journal of Communication.

You’ve just sent your kids back to school, but if you want to curb the inevitable back-to-school colds you’ve got to work together as a family. The CDC says kids miss around 38 million school days a year due to the flu bug alone. Add in the common cold, and it’s a wonder that children make it into the classroom at all.

“The younger the child is, the more of those infections we’re going to see,” says Margaret Khoury, M.D., a pediatric infectious disease specialist at Kaiser Permanente Baldwin Park Medical Center. Children in kindergarten and first grade can have as many as one illness per month, and they can run together, with kids getting over one infection just as another pops up. “Parents come in and complain that their kids have been constantly sick,” Khoury says.

What is the source of all these germs? “Mostly our hands and our noses,” Khoury explains. But she has some simple strategies you can employ to keep the whole family healthier:

Teach kids to wash their hands. Yes, you’ve heard it before, but Khoury says this is the single best thing you can do to keep your kids healthy. And you can’t just remind kids to do it. (Though you should do that, too. Constantly. Especially when they come home from school.) You also have to show them how, and then watch to make sure they are doing it right. Hand sanitizers are OK in a pinch, but be careful if your little one’s hands are irritated by cold winter weather. Hand sanitizers could sting. “Washing hands is always the first choice,” Khoury says.

Live well. This means the kids – and the whole family – getting plenty of sleep and eating plenty of fruits, vegetables and other nutritious foods. It’s the best way to build up everyone’s immune system as cold and flu season kicks in.

Stay away from people who are sick. It’s impossible, but do your best. Cancel that play date if someone has a cold. Don’t go visit Aunt Sue if she has the flu.

Get everyone a flu shot. “We would love to vaccinate everyone before Thanksgiving,” says Khoury. “I tell patients, if you’re eating your Thanksgiving turkey and you haven’t had your flu vaccine, think of me.”

No matter what you do, some illness is unavoidable. “Unfortunately, those infections will happen,” Khoury says. When they do, cut back on activities and make sure the child who is ill gets plenty of rest. “This is the time to get homework done and go to bed early,” says Khoury, adding that the if someone in the family is sick, it’s a good idea for everyone to try for a little extra sleep.

It’s up to parents to set the example here. The kids should see you doing what you’ve asked them to do: washing your hands, eating your veggies, getting your flu shot, and getting to bed on time. That way everyone will be healthy for school, and work, in the morning.