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Autism Practice Parameters
American Academy of Child and Adolescent Psychiatry AACAP is pleased to offer Practice Parameters as soon as they are approved by the AACAP Council, but prior to their publication in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). This article may be revised during the JAACAP copyediting, author query, and proof reading processes. Any final changes in the document will be made at the time of print publication and will be reflected in the final electronic version of the Practice Parameter. AACAP and JAACAP, and its respective employees, are not responsible or liable for the use of any such inaccurate or misleading data, opinion, or information contained in this iteration of this Practice Parameter. PRACTICE PARAMETER FOR THE ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ABSTRACT Autism spectrum disorder (ASD) is characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills which arise in the first years of life. Although frequently associated with intellectual disability, this condition is distinctive in terms of its course, impact, and treatment. ASD has a wide range of syndrome expression and its management presents particular challenges for clinicians. Individuals with an ASD can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with this condition necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. Early, sustained intervention and the use of multiple treatment modalities are indicated. Key Words: autism, practice parameters, guidelines, developmental disorders, pervasive developmental disorders. ATTRIBUTION This parameter was developed by Fred Volkmar, M.D., Matthew Siegel, M.D., Marc Woodbury-Smith, M.D., Bryan King, M.D., James McCracken, M.D., Matthew State, M.D., Ph.D. -
Autism Spectrum Disorder: an Overview and Update
Autism Spectrum Disorder: An Overview and Update Brandon Rennie, PhD Autism and Other Developmental Disabilities Division Center for Development and Disability University of New Mexico Department of Pediatrics DATE, 2016 Acknowledgements: Courtney Burnette, PHD, Sylvia Acosta, PhD, Maryann Trott, MA, BCBA Introduction to Autism Spectrum Disorder (ASD) • What is ASD? • A complex neurodevelopmental condition • Neurologically based- underlying genetic and neurobiological origins • Developmental- evident early in life and impacts social development • Lifelong- no known cure • Core characteristics • Impairments in social interaction and social communication • Presence of restricted behavior, interests and activities • Wide variations in presentation DSM-5 Diagnostic Criteria • Deficits in social communication and social interaction (3) • Social approach/interaction • Nonverbal communication • Relationships • Presence of restricted, repetitive patterns of behavior, interests, or activities (2) • Stereotyped or repetitive motor movements, objects, speech • Routines • Restricted interests • Sensory* From Rain Man To Sheldon Cooper- Autism in the Media 1910 Bleuler • First use of the word autistic • From “autos”, Greek word meaning “self” 1943 Leo Kanner 1944 Hans Asperger 1975 1:5000 1985 1:2500 1995 1:500 “When my brother trained at Children's Hospital at Harvard in the 1970s, they admitted a child with autism, and the head of the hospital brought all of the residents through to see. He said, 'You've got to see this case; you'll never see it -
Bipolar Disorder in ADULTS the Disorder, Its Treatment and Prevention
Bipolar lidelse hos voksne, engelsk Information about BIPOLAR DISORDER IN ADULTS The disorder, its treatment and prevention Psykiatri og Social psykinfomidt.dk CONTENTS 03 What is bipolar disorder? 04 What causes bipolar disorder? 06 What are the symptoms of bipolar disorder? 09 How is bipolar disorder diagnosed? 10 Different progressions and modes of expression 11 How can bipolar disorder be treated and prevented? 14 What can you do to help yourself if you have bipolar disorder? 16 What can your loved ones do? Bipolar affective disorder (the term we will use in this publication is “bipolar disorder”) is a serious mental disorder. When a person has bipolar disorder, knowledge of the illness is important. The more you know, the better you can handle and prevent the illness and its consequences. This brochure describes the illness as well as options for its treatment and prevention. It is mainly intended for people being treated for bipolar disorder by the psychiatric service in Region Midtjylland. We hope this brochure will help you and your loved ones to learn more about the diagnosis of bipolar disorder. Kind regards The psychiatric service in Region Midtjylland Tingvej 15, 8800 Viborg Tel.: 7841 0000 Bipolar disorder in adults WHAT IS BIPOLAR DISORDER? Bipolar disorder is a mental illness lot in terms of reducing the progression characterised by episodes of mania, of symptoms and decreasing the hypomania (a mild form of mania), psychological and social costs to the depression and/or mixed state (a state individual and the family. where manic and depressive symptoms coexist or occur in rapid succession). -
Autism Terminology Guidelines
The language we use to talk about autism is important. A paper published in our journal (Kenny, Hattersley, Molins, Buckley, Povey & Pellicano, 2016) reported the results of a survey of UK stakeholders connected to autism, to enquire about preferences regarding the use of language. Based on the survey results, we have created guidelines on terms which are most acceptable to stakeholders in writing about autism. Whilst these guidelines are flexible, we would like researchers to be sensitive to the preferences expressed to us by the UK autism community. Preferred language The survey highlighted that there is no one preferred way to talk about autism, and researchers must be sensitive to the differing perspectives on this issue. Amongst autistic adults, the term ‘autistic person/people’ was the most commonly preferred term. The most preferred term amongst all stakeholders, on average, was ‘people on the autism spectrum’. Non-preferred language: 1. Suffers from OR is a victim of autism. Consider using the following terms instead: o is autistic o is on the autism spectrum o has autism / an autism spectrum disorder (ASD) / an autism spectrum condition (ASC) (Note: The term ASD is used by many people but some prefer the term 'autism spectrum condition' or 'on the autism spectrum' because it avoids the negative connotations of 'disability' or 'disorder'.) 2. Kanner’s autism 3. Referring to autism as a disease / illness. Consider using the following instead: o autism is a disability o autism is a condition 4. Retarded / mentally handicapped / backward. These terms are considered derogatory and offensive by members of the autism community and we would advise that they not be used. -
What Is Autism? Autism Is a Complex Brain Disorder That Affects a Child’S Ability to Communicate, Respond to Surroundings, Or Form Relationships with Others
What is autism? Autism is a complex brain disorder that affects a child’s ability to communicate, respond to surroundings, or form relationships with others. Autism is a developmental disorder of the brain that occurs in people of all racial, ethnic and social backgrounds. Children with autism are not unruly kids who choose not to behave. Generally diagnosed at age 2 or 3, few disorders are as devastating to a child and his or her family. Many children with autism will never be able to tell their parents they love them. While some people with autism are mildly affected, most people with the condition will require lifelong supervision and care and have significant language impairments. In the most severe cases, affected children exhibit repetitive, aggressive and self-injurious behavior. This behavior may persist over time and prove very difficult to change, posing a tremendous challenge to those who must live with, treat, teach and care for these individuals. The mildest forms of autism resemble a personality disorder associated with a perceived learning disability. First described over 50 years ago, the incidence of autism is rising steadily. While criteria for diagnosing autism have changed over time and the number of cases reported have increased, studies indicate that: . An estimated one in 1,000 children have autism . Two to five children per 1,000 show some form the disorder . As many as 1.5 million Americans today are believed to have some form of autism. Based on statistics from the U.S. Department of Education and other governmental agencies, autism is growing at a rate of 10-17 percent per year. -
Efficacy of the Treatment of Developmental Language
brain sciences Review Efficacy of the Treatment of Developmental Language Disorder: A Systematic Review Sara Rinaldi 1,2,* , Maria Cristina Caselli 3, Valentina Cofelice 4, Simonetta D’Amico 5,6,†, Anna Giulia De Cagno 2, Giuseppina Della Corte 7, Maria Valeria Di Martino 8, Brigida Di Costanzo 9,10, Maria Chiara Levorato 6,11,†, Roberta Penge 12, Tiziana Rossetto 2, Alessandra Sansavini 6,13,† , Simona Vecchi 14 and Pierluigi Zoccolotti 15,16 1 Developmental Neurorehabilitation Service, UOC Infancy, Adolescence, Family Counseling, AULSS 6 Euganea—Padua Bacchiglione District, Via Dei Colli 4/6, 35143 Padua, Italy 2 Federazione Logopedisti Italiani, Via Daniello Bartoli, 00152 Rome, Italy; [email protected] (A.G.D.C.); [email protected] (T.R.) 3 Institute of Cognitive Sciences and Technologies, CNR, 00185 Rome, Italy; [email protected] 4 “Iuvenia” Rehabilitation Centre, C.da Piana, 86026 Morcone, Italy; [email protected] 5 Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, P.le S. Tommasi, 1, 67100 Coppito, Italy; [email protected] 6 CLASTA—Communication & Language Acquisition Studies in Typical & Atypical Population, Piazza Epiro 12D, 00183 Rome, Italy; [email protected] (M.C.L.); [email protected] (A.S.) 7 Centro Panda, Via Antonio Gramsci, 38, 80022 Arzano, Italy; [email protected] 8 Health Professions Integrated Service, Azienda Ospedaliera dei Colli di Napoli, 80131 Napoli, Italy; [email protected] 9 Division -
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in -
Dsm-5 Diagnostic Criteria for Eating Disorders Anorexia Nervosa
DSM-5 DIAGNOSTIC CRITERIA FOR EATING DISORDERS ANOREXIA NERVOSA DIAGNOSTIC CRITERIA To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met: 1. Restriction of energy intaKe relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia. BULIMIA NERVOSA DIAGNOSTIC CRITERIA According to the DSM-5, the official diagnostic criteria for bulimia nervosa are: • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: o Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. o A sense of lacK of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating). -
Psychiatric Assessment of Severe Presentations in Autism Spectrum Disorders and Intellectual Disability
Psychiatric Assessment of Severe Presentations in Autism Spectrum Disorders and Intellectual Disability a,b, b Bryan H. King, MD *, Nina de Lacy, MD , c,d,e Matthew Siegel, MD KEYWORDS Autism Intellectual disability Self-injury Aggression Hyperactivity Psychiatric evaluation KEY POINTS Psychiatric illnesses are common in autism spectrum disorder (ASD)/intellectual disability (ID). Externalizing behaviors are common presenting symptoms but are etiologically nonspecific. Genetic conditions associated with ASD/ID may inform medical surveillance as well as potential therapeutics. Co-occurring medical conditions are common in ASD/ID and may contribute to symptom presentation. Environmental factors, for example, change in caregiver or experience of trauma, may be particularly significant in the setting of ASD/ID. INTRODUCTION Decades ago, Sovner and Hurley1 somewhat rhetorically debated whether individ- uals with ID experience affective illness. Although the answer then as now is an un- equivocal yes, uncertainty does remain as to how the presentation of psychiatric Disclosure Statement: B.H. King has received research funding and has served as a consultant for Seaside Therapeutics and Roche. Drs N. de Lacy and M. Siegel report no financial disclosures. a Department of Psychiatry and Behavioral Medicine, Seattle Children’s Autism Center, Seattle Children’s Hospital, Seattle, WA, USA; b Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; c Developmental Disorders Program, Spring Harbor Hospital, ME, USA; d Tufts University School of Medicine, Boston, MA, USA; e Maine Medical Center Research Institute, ME, USA * Corresponding author. E-mail address: [email protected] Child Adolesc Psychiatric Clin N Am 23 (2014) 1–14 http://dx.doi.org/10.1016/j.chc.2013.07.001 childpsych.theclinics.com 1056-4993/14/$ – see front matter Ó 2014 Elsevier Inc. -
Is Pervasive Developmental Disorder Not Otherwise Specified Less
J Autism Dev Disord DOI 10.1007/s10803-010-1155-z ORIGINAL PAPER Is Pervasive Developmental Disorder Not Otherwise Specified Less Stable Than Autistic Disorder? A Meta-Analysis Eme´lie Rondeau • Leslie S. Klein • Andre´ Masse • Nicolas Bodeau • David Cohen • Jean-Marc Guile´ Ó Springer Science+Business Media, LLC 2010 Abstract We reviewed the stability of the diagnosis of Keywords Validity Á Diagnosis Á Autistic disorder Á pervasive developmental disorder not otherwise specified Pervasive developmental disorder Á Autism Á Meta-analysis (PDD-NOS). A Medline search found eight studies reiter- ating a diagnostic assessment for PDD-NOS. The pooled group included 322 autistic disorder (AD) and 122 PDD- Introduction NOS cases. We used percentage of individuals with same diagnose at Times 1 and 2 as response criterion. The Over the past 15 years, there has been increasing interest in pooled Relative Risk was 1.95 (p \ 0.001) showing that the early identification of autism spectrum disorders AD diagnostic stability was higher than PDD-NOS. When (ASD). In that respect, several studies have examined the diagnosed before 36 months PDD-NOS bore a 3-year sta- stability of early diagnosis (Lord 1995; Cox et al. 1999; bility rate of 35%. Examining the developmental trajecto- Moore and Goodson 2003; Charman et al. 2005). In ries showed that PDD-NOS corresponded to a group of keeping with those studies, we conducted a meta-analysis heterogeneous pathological conditions including prodromic focussing on the stability of the diagnosis of pervasive forms of later AD, remitted or less severe forms of AD, and developmental disorder not otherwise specified (PDD- developmental delays in interaction and communication. -
Intellectual Developmental Disorder
Instruments for the early detection of dementia in persons with intellectual developmental disorder Elisabeth L. Zeilinger, Katharina A.M. Stiehl, Germain Weber University of Vienna, Faculty of Psychology, Austria 22nd Alzheimer Europe Conference 04.- 06.10. 2012 Changing perceptions, practice and policy Vienna, Austria OUTLINE 1. Background – Intellectual developmental disorder (IDD) – Dementia and IDD – Assessment-instruments for dementia in persons with IDD 2. Method – Systematic review 3. First results and further steps 4. Conclusion Intellectual developmental disorder (IDD) 3 criteria for diagnosis (AAIDD, 2010): 1. Limitations in intellectual functioning (IQ < 70) 2. Limitations in adaptive behavior 3. The disability originates before the age of 18 Life expectancy (Carter & Jancar, 1983; Strauss & Eyman, 1996) • 1930: ca. 20 years • 1980: ca. 58 years • 1996: ca. 72 years • 2000: mild IDD: nearly like general population severe IDD: reduced (Bittles et al., 2002; Patja et al., 2000) Challenge for the health care system Dementia becomes a more problematic health risk Dementia in persons with IDD - Prevalence No consistent estimates available! . 11,4% > 50 years (Moss, 1997) . 22% > 65 years (Lund, 1985) . Persons with trisomy 21: . 50+ years: 42% (Haveman,1997) . 60+ years: 26% (Coppus et al., 2006) 42% (Tyrrell et al., 2001) 56% (Haveman,1997) . 70+ years: 100% (Visser et al, 1997) Dementia in persons with IDD - Symptomatology Symptomatology differs from general population . Behavioral changes are frequent and early (often before cognitive changes) . Low pre-morbid cognitive level hinders identification of cognitive changes . „diagnostic overshadowing“ . Reduced life expectancy (especially in specific syndromes) Onset of dementia earlier than in the general population Dementia in persons with IDD - Assessment Assessment (screening and diagnosis) has to be adapted . -
Neurodevelopmental Disorders B
DSM-5 Training for DJJ Clinicians and Staff Preparing for DSM-5 Rajiv Tandon, M.D. Professor Of Psychiatry University of Florida May 12, 2014 Florida Hotel and Conference Center - Orlando 1 1 Disclosure Information NO RELEVANT FINANCIAL CONFLICTS OF INTEREST MEMBER OF THE DSM-5 WORKGROUP ON PSYCHOTIC DISORDERS CLINICIAN AND CLINICAL RESEARCHER 2 2 3 Program Outline • Introduction – Evolution of DSM and Why DSM-5 • Major Changes in DSM-5 – Structure – Content – Implications for Clinical Practice 4 4 What Characteristics Must A Medical Disorder Have? VALIDITY Must define a “Real” entity with distinctive etiology, pathophysiology, clinical expression, treatment, & outcome UTILITY Must be useful in addressing needs of various stakeholders, particularly patients and clinicians Must predict treatment response, guide treatment selection, and predict course and outcome Must be simple and easy to apply RELIABILITY Different groups of people who need to diagnose this condition must be able to do so in a consistent manner 5 5 Validating a Mental Disorder • Approaches to validating diagnostic criteria for discrete categorical mental disorders have included the following types of evidence: – antecedent validators (unique genetic markers, family traits, temperament, and environmental exposure); [ETIOLOGY] – concurrent validators (defined neural substrates, biomarkers, emotional and cognitive processing, symptom similarity); [PATHOPHYSIOLOGY/CLIN.] – and predictive validators (similar clinical course & treatment response [TREATMENT/PROGNOSIS] 6 6