Handouts for WA: DSM5

DSM5 Diagnostic Criteria for Autism

Key Differences Between DSM-IV-TR and DSM 5 Three domains become two (lose the language domain) Shift from categorical to dimensional concept Level of severity Specifiers

Criterion A: Persistent deficits in social communication and social interaction across contexts, manifested by all three of the following: Deficits in social-emotional reciprocity; ranging for example, from abnormal social approach and failure of normal back and forth conversation to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions

Deficits in non-verbal communicative behaviours used for social interaction; ranging from poorly integrated verbal and nonverbal communication, to abnormalities in eye contact and body-language, or deficits in understanding and use of gestures, to a total lack of facial expressions and non-verbal communication. Deficits in developing, understanding and maintaining relationships, ranging for example, from difficulties adjusting behaviour to suit various contexts: to difficulties sharing imaginative play or in making friends; to absence of interest in peers. Specify current severity

Criterion B: Restricted, repetitive patterns of behaviour, interests, or activities as manifested by at least two of the following: Stereotyped or repetitive motor movements, use of objects or speech; (such as simple motor stereotypes, lining up toys or flipping objects, echolalia, or idiosyncratic phrases).

Criterion B: Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behaviour, or excessive resistance to change; (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route, or eat the same food every day).

Criterion B: Highly restricted, fixated interests that are abnormal in intensity or focus; (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (e.g., as apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity

DSM 5 Criterion C: Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies later in life). Criterion D: Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

DSM 5 Criterion E These disturbances are not better explained by intellectual disability or global developmental delay. Social communication should be below that expected for general developmental level.

DSM 5: Specify if: With or without accompanying intellectual impairment. With or without accompanying language impairment. Associated with a known medical or genetic condition or environmental factor. Associated with another neurodevelopmental, mental, or behavioural disorder With Catatonia

Specify current severity: Level 3 – Requiring very substantial support Level 2 - Requiring substantial support Level 1 – Requiring support

Comparison of DSM-IV and DSM-5 McPartland et al 2012 Jr. Am. Acad. Child and Adol. Psychiatry Yale study 933 participants in the DSM IV field trial Applied new DSM5 criteria Only 25% of those with Asperger’s Disorder would retain a diagnosis of ASD

Comparison of DSM-IV and DSM-5 Matson et al 2012 Res in ASD 227 adults with autism and intellectual disability Decline in diagnosis of 36% using DSM5 Study of 2721 toddlers 48% fewer toddlers diagnosed using DSM5

Comparison of DSM-IV and DSM-5 Matson et al 2012 JADD 42:8 Relaxing the algorithm 2 of the 3 criteria in social communication and interaction, only 34% fewer toddlers diagnosed As above and 1 of the 4 criteria in Restricted and repetitive behaviour (instead of 2) 18% fewer diagnosed

Comparison of DSM-IV and DSM-5 Gibbs et al 2012 JADD 42:8 Compared DSM IV and children 25% did not meet DSM5 criteria Taheri and Perry 2012 JADD 42:9 131 children 2-12 years 37% did not meet DSM5 criteria

Comparison of DSM-IV and DSM-5 Huerta et al (Catherine Lord) 2012 Amer Jr Psychiatry DSM 5 criteria identified 91% of children with a DSM IV diagnosis

DSM 5 Maener et al 2014 Impact of DSM 5 6,577 cases of 8 year old children in the USA 81.2% of DSM-IV-R children achieved a DSM 5 diagnosis

Speech and Language Characteristics. Pragmatics, Prosody and Pedantry.

Sensory Sensitivity: Hyper and Hypo Sensitivity Vision Hearing Tactile Olfactory Gustation Proprioception (body awareness affecting hunger, pain and toileting skills Vestibuar system

Sensory Sensitivity Sensory processing in adults with ASD 94% reported extreme levels of sensory processing Unusual sensory processing can occur across the life span Can be reported as early as 6-12 months Was originally part of the 1980 diagnostic criteria for ASD but not unique to ASD e.g. schizophrenia

Motor Clumsiness Delayed motor skills Clumsy Unusual locomotion - funny run Unusual gait Immature ball catching skills Poor coordination when using playground equipment Accident prone Poor manual dexterity Handwriting

3 Developmental Trajectories 1)No period of typical development- autism signs present from birth 2)Developmental plateau- child achieves typical developmental milestones and then the rate of progress declines 3)Regression- child loses skills (20- 35%)

Developmental Plateau Autism emerges slowly

Regression

The Child ’ s Reaction to Being Different Before the Diagnosis Four reactions: Depression and isolation Imagination and fantasy Arrogance and anger Imitation

Reaction to the Diagnosis Diagnosis of Asperger’s syndrome Few teenagers perceive the advantages of the diagnosis

Reaction to the Diagnosis Distance themselves from the diagnosis Reluctant to let others know Fear of being singled out, not ‘normal’ and stigmatized Unlike adults, did not have pride in the diagnosis