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Issues Related to Identification of Children with Autism Spectrum Disorders (Asds): Insights from Dsm-5

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Issues Related to Identification of Children with Autism Spectrum Disorders (Asds): Insights from Dsm-5 ISSUES RELATED TO IDENTIFICATION OF CHILDREN WITH AUTISM SPECTRUM DISORDERS (ASDS): INSIGHTS FROM DSM-5 Abstract: The article examines issues related to identification Mourad Ali Eissa Saad, PhD of children with autism spectrum disorders (ASDs). The focus Professor of Special Education is on the Diagnostic Criteria in DSM-5 diagnostic features, Dean College of Education associated features supporting diagnosis, and prevalence are Kie University discussed. Hama, Syria E-mail: [email protected] Keywords: autism spectrum disorders (ASDs), DSM-5 diagnostic criteria, associated features supporting diagnosis, prevalence. Journal of Psycho-Educational Sciences | Vol. 7, No. 3 London Academic Publishing, December 2018, pp. 62 – 66 https://www.journals.lapub.co.uk/index.php/IJPES Journal of Psycho-Educational Sciences | Vol. 7, No. 3 (December 2018) INTRODUCTION SUBTYPES SUBSUMED UNDER A SINGLE DIAGNOSIS The American Psychiatric Association's In the DSM-5 (American Psychiatric Association Diagnostic and Statistical Manual of Mental 2013) four PDD subcategories specified in DSM- Disorders (DSM) is a classification of mental IV of autistic disorder, Asperger's disorder disorders with associated criteria designed to (syndrome), childhood disintegrative disorder facilitate more reliable diagnoses of these (CDD), and pervasive developmental disorder not disorders. Autism spectrum disorder is a new otherwise specified (PDD-NOS) are now DSM-5 name that reflects a scientific consensus subsumed into the one broad category of autism that four previously separate disorders are actually spectrum disorder. The subtype terms will no a single condition with different levels of symptom longer be used diagnostically under the DSM-5. severity in two core domains. It has become a The PDD subtype Rett’s Disorder (syndrome) standard reference for clinical practice in the is excluded from the new ASD category. This is mental health field. DSM has been used by because the DSM focuses on disorders that can be clinicians and researchers from different defined behaviourally, without a molecular or orientations (biological, psychodynamic, biological test (Kurita 2011). Rett’s syndrome is a cognitive, behavioural, interpersonal, family single gene neurological disorder in which those /systems), all of whom strive for a common with the condition may go through a phase of social language to communicate the essential impairment, language regression and repetitive characteristics of mental disorders presented by motor mannerisms resembling autism (Rutter and their patients. Uher 2012). The criteria are concise and explicit and Terminology has also changed. The name intended to facilitate an objective assessment of pervasive developmental disorder (PDD) has now symptom presentations in a variety of clinical been changed to Autism Spectrum Disorder settings—inpatient, outpatient, partial hospital, (ASD). The term “mental retardation” has been consultation- liaison, clinical, private practice, and replaced with the term “intellectual disabilities”. primary care—as well in general community epidemiological studies of mental disorders. DSM- 5 is also a tool for collecting and communicating AUTISM SPECTRUM DISORDERS (ASDS), PDD- accurate public health statistics on mental disorder NOS AND ASPERGER SYNDROME morbidity and mortality rates (American Psychiatric Association 2013). DSM-5 folds Asperger syndrome and PDD-NOS This manual introduces neurodevelopmental into the category of autism spectrum disorder. The disorders, among which is autism spectrum aim is to produce a clearer and simpler diagnostic disorder which is characterized by persistent system with improved recognition and diagnosis deficits in social communication and social for those on the autism spectrum across all ages interaction across multiple contexts (deficits in and ability levels. The main objective of the social-emotional reciprocity, non-verbal revision to the DSM relating to ASD was to communication and developing relationships), as increase the specificity of diagnosis, that is, make well as restricted, repetitive patterns of behaviour, it easier to identify ASD as distinguished from interests, or activities (American Psychiatric other non-autistic disorders and to increase the Association 2013). stability of diagnosis over time (Skuse 2012). The manual changed subsuming several PDD Having a single diagnostic entity avoids the subtypes into a single diagnosis of autism spectrum problem of an individual receiving serial or disorder in the DSM-5 that reflected a wide-spread sometimes concurrent, diagnoses of PDD-NOS, consensus that autism is best considered as existing autism and Asperger syndrome, depending on the on a spectrum with variable manifestations across clinician they see or maturation. Numerous studies lifespan, gender, and intellectual level and/or have reported little qualitative difference between language. autism disorder and Asperger Disorder subtypes (Broadstock 2014). Happé (2011) suggests that the DSM-5 changes reflect that it is a time to 63 Issues Related to Identification of Children with Autism Spectrum Disorders (ASDs) reintegrate Asperger disorder with the rest of the interests, or activities, as manifested by at least spectrum and to demand the same level of respect two of the following: 1. Stereotyped or and lack of stigma for individuals across the full repetitive motor movements, use of objects, or range of manifestations of the spectrum. speech (e.g., repetitive hand flapping, lining Removal of Asperger syndrome and PDD- up toys or flipping objects, delayed or NOS as distinct disorder classifications from the immediate parroting of others’ speech, DSM reflects multiple concerns regarding the idiosyncratic phrases). reliability and application of these diagnoses when 2. Insistence on sameness, inflexible adherence applying their DSM-IV diagnostic criteria. These to routines, or ritualized patterns of verbal or include that: in clinical field trials, ASD experts nonverbal behaviour (e.g., extreme distress at frequently make different diagnoses based on the small changes, difficulties with transitions, same presenting symptoms in the same individual; rigid thinking patterns, greeting rituals, need the boundary between Asperger syndrome and to take same route or eat same food every day). autism is not clear on a population basis; and in up 3. Highly restricted, fixated interests that are to half of patient diagnoses of autism, Asperger's abnormal in intensity or focus (e.g., a child Disorder and PDD NOS are not stable within the who is extremely attached to a spoon, an adult same individual over time (Broadstock 2014). who spends hours rewriting specific phrases). 4. Extremely exaggerated or dulled reactions to sensations or unusual interest in sensory DIAGNOSTIC CRITERIA IN DSM-5 aspects of the environment (e.g., apparent To be diagnosed with ASD, a person needs to fulfil indifference to pain/temperature, adverse the following criteria (American Psychiatric response to specific sounds or textures, Association 2013): excessive smelling or touching of objects, visual fascination with lights or movement). 1. Persistent deficits in social communication 5. (These criteria can be currently occurring or and interaction across multiple contexts, as have occurred in the patient’s past. Examples demonstrated by all of the following: are illustrative, not exhaustive.) 1. Deficits in social-emotional reciprocity, 3. Symptoms must be present in the early ranging, for example, from abnormal social developmental period. Though, symptoms approach and inability to have normal back- may not become fully apparent until social and-forth conversation; to reduced sharing of demands exceed limited capacities. Symptoms interests, emotions, or affect; to failure to may also be masked by learned strategies in initiate or respond to social interactions. later life. 2. Deficits in nonverbal communicative 4. Symptoms cause clinically significant behaviours used for social interaction, impairment in social, occupational, or other ranging, for example, from poorly integrated important areas of current functioning. verbal and nonverbal communication; to 5. These disturbances are not better explained by abnormalities in eye contact and body intellectual disability (intellectual language or deficits in understanding and use developmental disorder) or global of gestures; to a total lack of facial expressions developmental delay. Intellectual disability and nonverbal communication. and autism spectrum disorder frequently co- 3. Deficits in developing, maintaining, and occur. Social communication should be below understanding relationships, ranging, for what is expected for general developmental example, from difficulties adjusting behaviour level, in order to make comorbid diagnoses of to suit various social contexts; to difficulties in autism spectrum disorder and intellectual sharing imaginative play or in making friends; disability. to absence of interest in peers. 4. (These criteria can be currently occurring or In DSM-5, sensory abnormalities are newly have occurred in the patient’s past. Examples included as a core, diagnostic symptom of the are illustrative, not exhaustive.) restricted, repetitive patterns of behaviour (RRB) 2. Restricted, repetitive patterns of behaviour, domain. This change is based on empirical 64 Journal of Psycho-Educational Sciences | Vol. 7, No. 3 (December 2018) research finding that this symptom has sensitivity Genetic and physiological. Heritability estimates
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