The Spectrum of Disorders
FINAL EXAM REVIEW
DSM 5- Two Domains
“[Autism] criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism,” according to the APA.
ASD is now characterized by
1. Deficits in social communication and social interaction
2. Restricted and repetitive behaviours, interests and activities
Severity may vary in both domains
The symptoms of some people previously diagnosed with DSM-IV PDD may meet DSM-5 criteria for social communication disorder
A co-morbid diagnosis of ADHD is now allowed
The new criteria will integrate gestures and verbal communication
The domain of social behavior has been altered from: DSM-IV -"failure to develop peer relationships and abnormal social play" to DSM-5 -"difficulties adjusting behavior to suit different social contexts"
‘Unusual sensory responses’ will be included. This reflects growing research that these behaviours are prevalent in those with ASD
A patient's history will be taken into account, rather than depending on behaviors that are observed during assessment, therefore the age of onset will be more flexible
Severity of symptoms will be assessed, instead of checking off symptoms from the list of criteria. May help eliminate misinterpretation and misdiagnosis of another disorder, such as ADHD
Changes in Assessment
Must display 5 of 7 Criteria
Must display all 3 criteria in this domain
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communication behaviours for social interactions
3. Deficits in developing and maintaining relationships
Repetitive Behaviours/Restricted Interests
Must display 2 of 4 criteria
1. Stereotyped or repetitive speech, motor movements or use of objects
2. Excessive adherence to routines, ritualized patterns, excessive resistance to change
3. Highly restricted, fixated interests at abnormal intensity
4. Hyper or Hypo-reactivity to sensory input, unusual interest in sensory aspects of environm’t
Introduction to Diagnosing the ASD’s- Initial Steps
“There are currently to methods for diagnosing ASD’s using physical tests”
Parents, or others may notice some differences in child’s development
Concerns and observations mentioned to Physician or other health professional
A pediatrician observes the child, does screening
If a doctor suspects ASD he/she follows process of formal diagnosis.
Kanner’s features of autism are consistent with diagnosis today
Research has improved identification, refined diagnosis, treatment, education
Strengths, special talents seen in individuals with ASD
Diagnosis and intervention continue to evolve as more is learned about ASD.
Red Flags in Autism
The Challenges to Diagnosis
Features of ASD and features of developmental disability or condition may be co-existing
“Normal” intelligence and features of ASD: may not be apparent in the diagnostic interview
Knowledge of typical developmental changes in many areas and variation in these changes
Difficulty in recognizing symptoms
Behaviour can vary depending on the environment and people present.
No biomarkers to identify ASD, clinical judgment
Subtle features yet debilitating effects
Co-existing conditions and differential diagnosis.
Wide range of symptoms and different severity
Early detection of ASD is limited by the lack of early screening tools.
Need multidisciplinary team: psychologist, neurologist, and psychiatrist, SLP, OT.
Requires neurological assessment, cognitive, language testing.
The Importance of Early Diagnosis
Many of these types of behaviour have not yet fully emerged in typically developing children
Look at foundational skills
Screening at birth?
Have the biological-medical issues been thoroughly examined?