DOCSLIB.ORG

The Process People with Schizophrenia Or Schizoaffective Disorder Use to Return to Or

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Process People with Schizophrenia Or Schizoaffective Disorder Use to Return to Or The Process People with Schizophrenia or Schizoaffective Disorder Use to Return to or Initially Secure Employment after Diagnosis A dissertation presented to the faculty of the College of Education of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Willard A. Sheets June 2009 © Willard A. Sheets. All Rights Reserved. 2 This dissertation titled The Process People with Schizophrenia or Schizoaffective Disorder Use to Return to or Initially Secure Employment after Diagnosis by WILLARD A. SHEETS has been approved for the Department of Counseling and Higher Education and the College of Education by Tracy C. Leinbaugh Associate Professor of Counseling and Higher Education Renée A. Middleton Dean, College of Education 3 ABSTRACT SHEETS, WILLARD A., Ph.D., June 2009, Counselor Education The Process People with Schizophrenia or Schizoaffective Disorder Use to Return to or Initially Secure Employment after Diagnosis (184 pp.) Director of Dissertation: Tracy C. Leinbaugh Research indicates that people with schizophrenia or schizoaffective disorder have a high rate of unemployment. This qualitative phenomenological study was designed to explore the perceptions of eight individuals with either disorder who have secured employment after diagnosis. The rationale for this study arises from the researcher’s desire to find the process which was used by individuals with either disorder to become employed. It was the researcher’s assumption that uncovering such a process could lead to implementation of employment as a therapeutic goal of treatment with such individuals. The purposefully selected sample consisted of eight individuals from a Midwestern state who have been diagnosed with either disorder. The primary method of data collection was three in-depth interviews. The data were organized according to the research and field-developed questions asked of participants. Analysis and interpretation of findings were completed using the van Kaam method of qualitative data processing. The research revealed that participants in the study interpreted recovery as living in as much of a perceived degree of normalcy as possible. Recovery was found to be a developmental concept among participants. The six following categories were developed from the data: self-help; employment; assistance with employment; benefits of 4 employment; functioning at a perceived normal level while living as full a life as possible with the illness; and recovery to employment. Five themes were found: self-care; supports; issues of employment; rewards of employment; and recovery process. Fourteen sub-themes emerged from the analysis of data. They were as follows: medication compliance; stress reduction; approaching employment gradually and carefully; stigma; disclosure of condition; formal accommodations; change of employers due to problems of disability; lack of failure; family and friends; governmental support; private supports; intrinsic rewards of employment; extrinsic rewards of employment; developmental process; and normalcy. Recommendations are offered for mental health and rehabilitation professionals who work with this population and for further research possibilities. Given that multiple factors are present in an individual’s recovery to the point of employment with either disorder, the recommendations suggested should be considered on an individual basis. Approved: _____________________________________________________________ Tracy C. Leinbaugh Associate Professor of Counseling and Higher Education 5 ACKNOWLEDGEMENTS I thank Dr. Tracy Leinbaugh for her professional mentoring and editing suggestions. Her assistance has been elemental in the development and evolution of this study. I also thank Dr. Greg Janson for his continuing optimism and belief in the value of this project, as well as his editing suggestions and professional critiques of the chapters. Dr. Jerry Olsheski has been instrumental in his suggestions for the major themes of development in this study. His mentoring of my professional development is invaluable. Dr. Patricia Beamish has been most appreciated for her unwavering expectations of my scholarly development and her revision suggestions. To all committee members, I give my sincere thanks. I thank my mother and father whose belief in and encouragement of me has brought me to this point in my life. 6 TABLE OF CONTENTS Page Abstract ............................................................................................................................... 3 Acknowledgements ............................................................................................................. 5 Chapter 1: Introduction ..................................................................................................... 11 Background ........................................................................................................... 11 Researcher Bias ..................................................................................................... 15 Statement of the Problem ...................................................................................... 18 Significance........................................................................................................... 19 Delimitations ......................................................................................................... 19 Limitations ............................................................................................................ 20 Definition of Terms............................................................................................... 20 Summary ............................................................................................................... 22 Chapter 2: Literature Review ............................................................................................ 23 History of the Diagnosis of Schizophrenia ........................................................... 23 Pioneers in the Study of Schizophrenia .................................................... 23 More Current Theory ............................................................................................ 25 Summary ............................................................................................................... 25 Etiology of Schizophrenia ..................................................................................... 26 Genetic Influences .................................................................................... 26 Neuroanatomy Studies .............................................................................. 28 Treatment .............................................................................................................. 29 7 Medications and Psychotherapy ............................................................... 30 Recovery ............................................................................................................... 35 Hope .......................................................................................................... 40 Psychosocial Rehabilitation .................................................................................. 41 Employment Literature ............................................................................. 41 Americans with Disabilities Act ............................................................... 43 Individual Aspects of Employment .......................................................... 45 Self-Efficacy ............................................................................................. 47 Barriers to Employment ........................................................................................ 48 Vocational Rehabilitation ..................................................................................... 50 Workplace Climate/Consumer Value Fit .................................................. 50 Fountain House ......................................................................................... 53 Choose–Get–Keep .................................................................................... 54 Skills Training ........................................................................................... 55 Individual Placement and Support ............................................................ 57 Research in Different Countries ............................................................................ 58 Integration of Work Skills and Social Skills ............................................. 58 Other Factors Associated With Employment ........................................... 61 Summary ............................................................................................................... 63 Chapter 3: Methodology ................................................................................................... 65 Phenomenology..................................................................................................... 65 Epoche................................................................................................................... 65 8 Triangulation ......................................................................................................... 66 The Researcher ...................................................................................................... 68 Participants ............................................................................................................ 70 Qualitative Clarity ................................................................................................
Load more

Recommended publications
  • 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).
    [Show full text]
  • FROM MELANCHOLIA to DEPRESSION a HISTORY of DIAGNOSIS and TREATMENT Thomas A
    1 FROM MELANCHOLIA TO DEPRESSION A HISTORY OF DIAGNOSIS AND TREATMENT Thomas A. Ban International Network for the History of Neuropsychopharmacology 2014 2 From Melancholia to Depression A History of Diagnosis and Treatment1 TABLE OF CONTENTS Introduction 2 Diagnosis and classifications of melancholia and depression 7 From Galen to Robert Burton 7 From Boissier de Sauvages to Karl Kahlbaum 8 From Emil Kraepelin to Karl Leonhard 12 From Adolf Meyer to the DSM-IV 17 Treatment of melancholia and depression 20 From opium to chlorpromazine 21 Monoamine Oxidase Inhibitors 22 Monoamine Re-uptake Inhibitors 24 Antidepressants in clinical use 26 Clinical psychopharmacology of antidepressants 30 Composite Diagnostic Evaluation of Depressive Disorders 32 The CODE System 32 CODE –DD 33 Genetics, neuropsychopharmacology and CODE-DD 36 Conclusions 37 References 37 INTRODUCTION Descriptions of what we now call melancholia or depression can be found in many ancient documents including The Old Testament, The Book of Job, and Homer's Iliad, but there is virtually 1 The text of this E-Book was prepared in 2002 for a presentation in Mexico City. The manuscript was not updated. 3 no reliable information on the frequency of “melancholia” until the mid-20th century (Kaplan and Saddock 1988). Between 1938 and 1955 several reports indicated that the prevalence of depression in the general population was below 1%. Comparing these figures, as shown in table 1, with figures in the 1960s and ‘70s reveals that even the lowest figures in the psychopharmacological era (from the 1960s) are 7 to 10 times greater than the highest figures before the introduction of antidepressant drugs (Silverman 1968).
    [Show full text]
  • 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.
    [Show full text]
  • Bipolar Disorder - Accessscience from Mcgraw-Hill Education
    Bipolar disorder - AccessScience from McGraw-Hill Education http://accessscience.com/content/900194 (http://accessscience.com/) Article by: Grunze, Heinz School of Neurology, Neurobiology, and Psychiatry, Newcastle University, Newcastle, United Kingdom. Publication year: 2016 DOI: http://dx.doi.org/10.1036/1097-8542.900194 (http://dx.doi.org/10.1036/1097-8542.900194) Content Course of bipolar disorder What is the neurobiology behind bipolar Bibliography How frequent is bipolar disorder? disorder? Additional Readings Treatment of bipolar disorder A major mental disorder in which there are life-long episodes of both mania and depression; also known as manic-depressive illness. The first recognizable descriptions of mania and depression date back to the writings of Aretaeus of Cappadocia (a Greek physician who lived around 150–200 CE). The modern history of bipolar disorder begins in the mid-nineteenth century with the concept of folie circulaire (“circular insanity”), proposed by the French psychiatrist Jean-Pierre Falret. Later, around the beginning of the twentieth century, it was defined by the work of the German psychiatrist Emil Kraepelin. See also: Affective disorders (/content/affective-disorders/013750) Bipolar disorder is characterized by sudden and often unexplained mood swings, ranging from delirious mania to severe depression. These mood changes are regularly accompanied by other mental and behavioral symptoms, such as fluctuations of volition, activity level, and cognitive functioning. Symptomatic criteria for bipolar disorder have been conceptualized in diagnostic manuals [the two most important being the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by the American Psychiatric Association and the International Classification of Diseases (ICD-10) by the World Health Organization], with only minor differences between these manuals.
    [Show full text]
  • Bipolar Disorders 100 Years After Manic-Depressive Insanity
    Bipolar Disorders 100 years after manic-depressive insanity Edited by Andreas Marneros Martin-Luther-University Halle-Wittenberg, Halle, Germany and Jules Angst University Zürich, Zürich, Switzerland KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: 0-306-47521-9 Print ISBN: 0-7923-6588-7 ©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2000 Kluwer Academic Publishers Dordrecht All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com Contents List of contributors ix Acknowledgements xiii Preface xv 1 Bipolar disorders: roots and evolution Andreas Marneros and Jules Angst 1 2 The soft bipolar spectrum: footnotes to Kraepelin on the interface of hypomania, temperament and depression Hagop S. Akiskal and Olavo Pinto 37 3 The mixed bipolar disorders Susan L. McElroy, Marlene P. Freeman and Hagop S. Akiskal 63 4 Rapid-cycling bipolar disorder Joseph R. Calabrese, Daniel J. Rapport, Robert L. Findling, Melvin D. Shelton and Susan E. Kimmel 89 5 Bipolar schizoaffective disorders Andreas Marneros, Arno Deister and Anke Rohde 111 6 Bipolar disorders during pregnancy, post partum and in menopause Anke Rohde and Andreas Marneros 127 7 Adolescent-onset bipolar illness Stan Kutcher 139 8 Bipolar disorder in old age Kenneth I. Shulman and Nathan Herrmann 153 9 Temperament and personality types in bipolar patients: a historical review Jules Angst 175 viii Contents 10 Interactional styles in bipolar disorder Christoph Mundt, Klaus T.
    [Show full text]
  • Mental Health and Chronic Diseases CDC Fact Sheet
    Mental Health and Chronic Diseases Issue Brief No. 2 October 2012 Background Chronic diseases are non-communicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. They are the leading cause of death and disability in the United States. They cause 7 out of 10 deaths each year and are among the most preventable and treatable of all health problems (see figure below). Chronic diseases include illness such as heart disease, diabetes, cancer, and arthritis.1 Mental health disorders are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. They are medical conditions that often result in a reduced ability to cope with the routine daily activities such as going to work or raising a family. Just like chronic diseases, mental health disorders are treatable. Most people diagnosed with a serious mental health disorder can receive relief from their symptoms by following a treatment plan specifically designed for them by a trained psychologist or psychiatrist. Mental health disorders are not exclusive to those who exhibit a lack of personal strength, personality traits like being shy, or have a certain socioeconomic status. Mental health disorders include illnesses such as major depression, bipolar disorder, obsessive compulsive disorder, and post-traumatic stress disorder. One common finding is that people who suffer from a chronic disease are more likely to also suffer from depression.2 Scientists have yet to determine if having a chronic disease increases the prevalence of depression or depression increases the risk of obtaining a chronic disease.
    [Show full text]
  • A4-Depression Disease Fact Sheet
    Depression Fact Sheet What is Depression? Major depressive disorder (simply known as clinical depression or just depression) is a mental disorder that causes a persistent feeling of sadness and loss of interest¹. Depression is characterized by extended peCommonriods of low mo osymptd. It can lomsead to ainclude: variety of emotional and physical problems and can negatively affect a person's personal life as well as sleeping, eating habits, and general health decrease a person’s ability to function at work and at home. Key facts Depression is a common illness worldwide, with more than 264 million people affected². Major depression is one of the most common mental disorders with a 1-year prevalence of 7.1% with 2/3 having severe functional impairment but with only 1/3 seeking help³. Major depression reduces life expectancy by about 10 years. History The term depression derives from the Latin verb deprimere ("to press down"). The Greek physician Hippocrates årat described a syndrome of melancholia (“black bile”) characterized by all "fears and despondencies, if they last a long time"⁴. Depression became a synonym of melancholia by the end of the 19th century, probably thanks to the German psychiatrist Emil Kraepelin who was the årst to use it as a global term. The denomination “Major depressive disorder” was introduced the mid-1970s and was incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III in 1980. Symptoms Not everyone who is depressed experiences every symptom of depression. In many cases, depression symptoms are severe enough to cause problems in daily activities, such as work, school, social activities or relationships.
    [Show full text]
  • Mental Health Disorders by David Murphey, Ph.D., Megan Barry, B.A., and Brigitte Vaughn, M.S
    ADOLESCENT HEALTH HIGHLIGHT Publication # 2013-1 January 2013 Fast Facts Mental Health Disorders By David Murphey, Ph.D., Megan Barry, B.A., and Brigitte Vaughn, M.S. Mental disorders are diagnosable conditions characterized by changes in Mental disorders in adolescence are 1. thinking, mood, or behavior (or some combination of these) that can cause a common: An estimated one in five person to feel stressed out and impair his or her ability to function. These adolescents has a diagnosable disorders are common in adolescence. This Adolescent Health Highlight disorder.1 presents the warning signs of mental disorders; describes the types of mental disorders and their prevalence and trends; discusses the 2. Adolescence is the time when many consequences and risk of mental disorders; presents treatment options and mental disorders first arise. More barriers to accessing mental health care; and provides mental health than half of all mental disorders and resources. problems with substance abuse The definition and complexities of mental disorders (such as binge drinking and illegal drug use) begin by age 14.2 Medical science increasingly recognizes the vital link between a person’s physical health and his or her mental/emotional health. Mind and body are connected as one, each affected by the other, and both are influenced by a 3. The most prevalent mental disorder person’s genetic inheritance, environment, and experience. Just as the experienced among adolescents is 4 absence of disease does not adequately define physical health, mental depression, with more than one in health consists of more than the absence of mental disorders. Mental health four high school students found to is best seen as falling along a continuum, which fluctuates over time, and have at least mild symptoms of this across individuals, as well as within a single individual.3 condition.5 As defined in this Highlight, mental disorders are diagnosable conditions characterized by changes in thinking, mood, or behavior (or some 4.
    [Show full text]
  • Melancholia and Mania: the Historical Contributions of Aretaeus of Cappadocia and Emil Kraepelin
    University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2020-04-27 Melancholia and Mania: The Historical Contributions of Aretaeus of Cappadocia and Emil Kraepelin Marlier, Krystal Marlier, K. (2020). Melancholia and Mania: The Historical Contributions of Aretaeus of Cappadocia and Emil Kraepelin ( Unpublished master's thesis). University of Calgary, Calgary, AB. http://hdl.handle.net/1880/111923 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Melancholia and Mania: The Historical Contributions of Aretaeus of Cappadocia and Emil Kraepelin by Krystal Marlier A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS GRADUATE PROGRAM IN GREEK AND ROMAN STUDIES CALGARY, ALBERTA APRIL, 2020 © Krystal Marlier 2020 Abstract Two millennia ago, Aretaeus of Cappadocia, a physician from the first to second century CE, first presented a modern portrayal of the relationship between μανίη (mania) and μελαγχολίη (melancholia). His understanding is reflective of the nineteenth-century German clinician, Emil Kraepelin. I propose that Kraepelin and Aretaeus possess more similarities than differences. They were homologous in research techniques and nosology, with one significant difference in aetiology. Presently, Aretaeus’ classification remains recognized in psychiatry, though with a slight deviation in understanding and under different psychiatric labels.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]
  • Affective Disorders
    Psychiatr. Pol. 2020; 54(4): 641–659 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: https://doi.org/10.12740/PP/123167 A half-century of participant observation in psychiatry. Part II: Affective disorders Janusz Rybakowski Poznan University of Medical Sciences, Department of Adult Psychiatry and Department of Psychiatric Nursing Summary The last half-century, thanks to the efforts of outstanding researchers, brought about great progress in the pathogenesis and clinics of affective illnesses. The catecholamine and serotonin hypothesis delineated in the 1960s have retained significant merit. Since the 1990s, the theories have pointed on excessive immune activation and impairment of neuroplasticity under stress. Since the 1970s, a systematic subclassification of unipolar and bipolar affective disorder has proceeded. Epidemiological studies of the last half-century indicated a significantly higher prevalence of depression compared with previous decades. The 21st century brought evidence for a greater frequency of various forms of bipolar affective disorder. During the last 50 years, the etiopathogenesis, diagnosis and treatment of affective disorders were my favorite and fascinating clinical and research topics. This initiated in 1970 when I began my work in the Department of Psychiatry, Medical Academy in Poznan, on account of the introduction of lithium salts for the treatment of these disorders. In 1976–1977, I received a fellowship of the National Institutes of Health at the University of Pennsylvania in Philadelphia and partici- pated in research that elucidated the mechanism of lithium transport across cell membranes. I carried out the studies on the pathogenesis of affective disorders for more than 40 years afterward.
    [Show full text]
  • Autism Spectrum Disorder 299.00 (F84.0)
    Autism Spectrum Disorder 299.00 (F84.0) Diagnostic Criteria according to the Diagnostic Statistical Manual V A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text): 1. 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. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, 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 nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Specify current severity – Social Communication: Level 1 – Requiring Support 2- Substantial Support 3-Very Substantial Support Please refer to attached table for definition of levels. B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
    [Show full text]