Monday, May 16, 2011

New Directions for Diagnosis and Screening in Autism Spectrum Disorders

Catherine Lord, Ph.D (
Dr. Lord is on the committee for the DSM-V.  They are working on changing the diagnostic criteria in the DSM-V for autism.

Implications of Diagnosis:
1.        Prognosis – Most people do not grow out of autism.
2.       Etiology – There is a strong genetic component.
3.       Course- Behaviors get worse in the early toddler years and then get better (although there is some withdrawal in adolescence).
4.       Appropriate treatments
5.       Risks for other difficulties, i.e., seizure disorder

Where are We Now in Diagnosis?
-          Diagnoses are generally stable.  Need the combined efforts of both the clinicians and the parents.

Definite Factors in Autism – Social Impairment, speech/communication impairment, repetitive behaviors and restricted interests.   However, a child showing only one of the above factors could have something different like a language disorder or intellectual disability.

In addition to the above factors, autism can also contribute to GI dysfunction, sleep disturbance, epilepsy (EEG abnormalities), immune dysfunction, motor problems/apraxia.

The Landscape of Autism has Changed
-          More toddlers
-          More older children without the intellectual disabilities
-          More adolescents and adults with other psych comorbidities

Then What?
There is a big trade off in time versus accuracy. 
-The faster the diagnoses, the narrower the comparison group.
-for more specific diagnoses need to compare age-related examples.
- Neurobiology = Dimensions (don’t know what was meant here, but I wrote it down J )

DSM V Developments
They are actually changing the DSM V to say DSM 5 so they can have new editions with the five and decimal.
Changes they are considering for the autism
 Diagnosis Criteria:
1.        They want to make it just one spectrum of autism disorder.  No longer separation between autism, PDD-NOS , Aspergers, etc.  It will just be a behavioral diagnosis because of concerns with scientific validity and concern about access to services.
2.       The focus will be on the behavioral aspect of the diagnosis rather than the speech aspect because there are many diagnoses out there involving speech impairment, but the behavior criteria always fits with autism.  Speech impairments will still be considered a trigger to evaluate a patient for an ASD.
3.       Want to be clear that they are not trying to get rid of Aspergers or PDD-NOS as a label for someone to use if they are more comfortable with that.  However, it will not be used as a medical diagnosis or for services.

-ASD defined by 3 domains: Social, language and repetitive behaviors.  They are considering combining the social and language domains as one and having the repetitive behaviors as a separate domain.  Language level needs to be combined with social skills because conversation involves both language and social skills.  For those with no repetitive behaviors, they would now be diagnosed with social communication disorder.
-Have added specific criterion to repetitive behaviors to include unusual responses and sensory seeking behaviors.

With new DSM V they are hoping to use modifiers with autism diagnoses, ie., autism and ADHD can now be put together or autism and Rett syndrome or Autism and Fragile X.
ASD can be defined with or without intellectual disabilities.

Severity Checklist
-The board for the DSM V wants to have a way to diagnose autism levels of severity.  As part of that, they have to separate social deficits from repetitive behaviors.  The level of severity would be an assessment of overall impairment and would allow ASD with other disorders (modifiers), i.e., ADD, depression, sleep disorders.
- Define/divide severity by how much supports a person needs. 
- Limit diagnosis to people who have impairments.   (There would be a hard middle ground for those with autism.  Can have a disorder but not need help.)

-          Focus not only on what goes awry but what goes well with autism.  Build their trust, confidence.  Build their communication skills.  Help them learn to be more comfortable with who they are.

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