The DSM (Diagnostic and Statistical Manual) is used by mental health professionals as a means of diagnosing patients and by schools, service providers and insurance companies to determine what disorders and treatments to cover. The previous revision of the DSM was published in 1994.
What is Autism?
Autism is defined as a developmental disorder that affects the child’s ability to make contact, develop language, and engage in interpersonal communication. The syndrome is included in the diagnostic spectrum called PDD pervasive developmental disorder (DSM-IV 1994).
Autism Definition DSM-IV
Published in 1994
Characteristics of the Autistic Disorder
The criteria that characterize autism are defined in the Diagnostic Handbook of the Psychiatric Association DSM IV. It is important to state that at least 6 of the following parameters should be apparent in order to suspect autism.
Clear Inability to Interact Socially
- Absence of non-verbal communication, such as eye contact, facial expression, body language
- Basic inability to relate to others
- Inability to share or participate in a pleasurable activity
- Inability to express affection
Clear Inability to Communicate
- Lack of language development
- Lack of initiative for verbal expression
- Repetitive sounds
Stereotypical Ritualistic Behavior
- Limited interest in objects
- Intensive, obsessive use of specific objects
- Stereotypical, repetitive movements
- Lack of spontaneous and imaginary play
Autism Definition DSM-V
To be published in May, 2013
The major change in the diagnosis of autism is the use of the umbrella term of “autism spectrum disorder,” of the DSM-V (Diagnostic and Statistical Manual – Fifth Edition), which combines the currently separate diagnoses of autism, Asperger’s syndrome, pervasive developmental disorder – not otherwise specified (PDD-NOS) and childhood disintegrative disorder. Therefore, the individual diagnoses of the aforementioned disorders will no longer exist.
The goal, according to the APA, is to more accurately and consistently diagnose children as having “autism spectrum disorder,” a term which is widely used by experts in the field today.
Many parents and advocates are concerned that these changes to diagnostic criteria may result in their children losing their diagnosis, and therefore their services, such as behavioral therapy. While it is difficult to predict in real-world settings how these changes will affect diagnosis, the panel of trustees in charge of researching and approving these changes asserts that the new criteria point to more inclusionary and transparent criteria, rather than exclusionary, for several reasons:
- The new criteria will integrate gestures and verbal communication
- The domain of social behavior has been altered from “failure to develop peer relationships and abnormal social play” in the DSM-IV (Diagnostic and Statistical Manual – Fourth Edition) to “difficulties adjusting behavior to suit different social contexts” in the DSM-V
- 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, allowing for older children to be diagnosed
- Severity of symptoms will be looked at, instead of checking off symptoms from the list of criteria such as stereotypy or language delay, which will help eliminate misinterpretation and misdiagnosis of another disorder, such as ADHD
- Many school districts and insurance companies do not currently cover services for children with an Asperger’s diagnosis, therefore a diagnosis of “autism spectrum disorder” would aid in gaining services
The experts emphasized that those currently diagnosed will not lose their diagnosis when the changes go into effect, unless there is a discernible, clinical reason to reevaluate a patient.
Identified by Clinical Observations
- Does not respond to his (own) name
- Inappropriate laughter or crying
- Lack of ability to interpret facial expressions
- Often verbal or babbling (preverbal) sounds are lacking
- Use of the adult’s hand to obtain what is desired
- Attachment to a certain object
- Various phobias such as water, noises, toilet training
- Food fixations
Two diagnostic tools commonly used in diagnosis of autism:
- ADOS - Autism rating observation scale
- ADI-R - Autism diagnostic interview – revised
It is critically important that the diagnostic process takes place at a number of meetings, over several days, so that the child is observed in different situations, at different hours of the day, in order to eliminate the influences of shyness, anxiety, fatigue, hunger, tension, boredom, etc.
It should be noted that I.Q. tests may not be valid in the diagnosis of the young symptomatic child.
Infants diagnosis – Early Signs of Pre-Autism Scale for Infants (ESPASI)
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