1. Warrnambool 30th March
Diagnosis of ASD

2. DSM5 Diagnostic Criteria for Autism

3. 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

4. Social and Emotional Reciprocity
Shy, withdrawn, introverted
Intrusive, intense and motivated to socialise

5. The Highly Skilled Profile
The criteria need to acknowledge the profile of abilities and coping and camouflaging strategies of people who have attained social communication skills via intellectual analysis, eg many girls and women
Observation, analysis and imitation
Superficial social abilities
Contrived reproduction, an act

6. 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.

7. Theory of Mind
Ability to read and interpret the cues and context that indicate someone’s feelings, thoughts, intentions and beliefs (Alien)
Ability to self-reflect, to perceive and think about one’s own thoughts and to monitor, communicate and manage one’s own emotions (inner turmoil)

8. 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.

9. Social Understanding
Number, quality and duration of friendships through childhood and adolescence
Need for a social guide in childhood
Ability to read and adjust to social situations
Degree of social-emotional reciprocity in interactions

10. Social Understanding Motivation for friendship Team skills
Adult relationship experiences
Social anxiety
Wearing a ‘mask’ or using a ‘script’
Soclialising is effortful and exhausting

11. Social Understanding Ability to cope with social ‘chit chat’
Bullying experience
Ability to reflect on others’ thoughts, feelings and intentions
Physical proximity
Sense of humour

12. Nonverbal communication
Ability to read examiner’s facial expression, gesture and tone of voice
Use of eye contact
Range of facial expressions
Their use of nodding, reciprocal smiles and complimentary sounds

13. Emotion Understanding
Limited vocabulary for emotions
Difficulty understanding expression of affection
Experience and expression of anxiety and anger throughout life
Rapidity of mood and intensity of emotion
Timing and expression of empathy

14. Introspection
Ability to describe own inner thoughts and feelings in the present
Ability to describe self in terms of personality characteristics rather than actions and abilities
Subjective sense of being different

15. 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).

16. 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).

17. 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

18. Special Interests Enjoyment Thought blocker (anxiety)
Energizer when exhausted or depressed
Sense of identity and employment
Creation and enjoyment of an alternative world

19. Special Interests Encyclopedic knowledge.
Origin may be associated with a pleasurable occasion or to resolve a fear.
Limited duration but always replaced.
More than one interest at a time as the person matures.
Reduces anxiety and stress.

20. Nature of the Interests
Self-directed and self-taught.
Solitary and intuitive activity.
Development of a cataloguing system.
Creative arts, drawing, sculpture, music and poetry.
Attention to detail.

21. Clinician’s Perspective.
Change in the person’s persona when talking about the interest.
Macabre interests can be a sign of depression or bullying.
When severely stressed there can be a progression from an activity for pleasure to a compulsive act (OCD).

22. Sensory Sensitivity Auditory (sudden or ‘sharp’ noises, pitch) Tactile
Visual
Aroma
Proprioceptive system (position and movement of the body)
Pain
Mind and body connection

23. 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

24. Clinically Significant Impairment
Social, occupational, or other important areas of current functioning
Where to draw the line? Subjective
Eligible for government support (USA, Health insurance)

25. Clinically Significant Impairment
Asperger personality type (Broader Autism Phenotype)
Progression beyond clinically significant impairment
Clinical experience and 3 longitudinal studies, 10-15% become sub- clinical