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| ==Diagnostic Criteria== | | ==Diagnostic Criteria== |
| When the rising [[prevalence]] of autism spectrum disorders sparked research in the late 1990s, medical opinion initially attributed the increase to improved diagnostic screening or changes in the definition of autism. In [[1994]], the fourth major revision of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV) was published with updated criteria for the diagnosis of autism and autism spectrum disorders.<ref>{{cite journal |author= Tidmarsh L, Volkmar FR |title= Diagnosis and epidemiology of autism spectrum disorders |journal= Can J Psychiatry |volume=48 |issue=8 |pages=517–25 |date=2003 |pmid=14574827 |url=http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2003/september/tidmarsh.asp}}</ref>
| | ===DSM-V Diagnostic Criteria for Autism Spectrum Disorder<ref>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== |
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| Autism is defined in the [[DSM-IV-TR]] as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior.
| | *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. |
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| Professional medical associations, including the [[American Academy of Pediatrics]], say that this revision was an important factor in increasing the apparent prevalence of autism and a 2005 study by [[Mayo Clinic]] researchers found increases in autistic spectrum disorder diagnoses followed the revisions in DSM criteria and changes in funding for special education programs.<ref>{{cite journal |journal= Arch Pediatr Adolesc Med |date=2005 |volume=159 |issue=1 |pages=37–44 |title= The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study |author= Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ |doi=10.1001/archpedi.159.1.37 |pmid=15630056 |url=http://archpedi.ama-assn.org/cgi/content/full/159/1/37}}</ref>
| | :*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 ofgestures: to a total lack of facial expressions and nonverbal communication. |
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| An increased awareness of autistic spectrum disorders by parents and pediatricians may have also led to increased reporting of Autism due to 'case substitution', which occurs when children with other disorders are identified as autistic.<ref>{{cite journal |journal=Pediatrics |date=2006 |volume=117 |issue=4 |pages=1028–37 |title= The contribution of diagnostic substitution to the growing administrative prevalence of autism in US special education |author= Shattuck PT |doi=10.1542/peds.2005-1516 |pmid=16585296 |url=http://pediatrics.aappublications.org/cgi/content/full/117/4/1028 |laysummary=http://www.news.wisc.edu/12368 |laydate=2006-04-03}}</ref> This misdiagnosis may occur for several reasons including an increase in government funding for care of children diagnosed as autistic, but not for children with a similar degree of disability and need. If this is occurring, it means that children who in the past would probably have been diagnosed as having a learning disability or a psychiatric disorder, or not diagnosed at all, are recorded as cases of autistic spectrum disorder.<ref>{{cite journal |journal= Harv Mag |date=2008 |volume=110 |issue=3 |pages= 27–31, 89–91 |title= A spectrum of disorders |author= Pettus A |url=http://harvardmagazine.com/2008/01/a-spectrum-of-disorders.html}}</ref>
| | :*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:Severity is based on social communication impairments and restricted, repetitivepatterns of behavior (seeTable 2). |
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| Children who are not primarily autistic, e.g. those with [[Fragile-X Syndrome]] (with characteristics that fit the criteria for autism) and even [[Down's Syndrome]] may have the diagnostic group with the best funding assigned. Dr. Fred Volkmar, a Yale University autism researcher, has said that "[[diagnostic substitution]]" was prompted by better services for autism.<ref name="cnn2003">{{cite news
| | '''''AND''''' |
| |title=Uncovering autism's mysteries: Is there more autism? Or just a new definition?
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| |url=http://edition.cnn.com/2003/HEALTH/conditions/03/02/autism.ap/
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| |publisher=Associated Press
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| |date=2003-03-02
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| |accessdate=2007-12-30
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| |quote='Autism is kind of a fashionable diagnosis,' Volkmar said. 'Everybody's interested in getting better services.'
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| }}</ref>
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| Care should be exercised when attempting to determine whether a person with autism is "high functioning" or "low functioning" based on an IQ score since it is sometimes difficult to measure IQ in autistic persons accurately using standard measurement instruments. The amount of language processing necessary on the tests and the large quantity of verbal instructions involved in the testing process even on the "non-verbal" portion of standard intelligence measures can produce a misleadingly low score. There can be a significant difference between an autistic person's measured IQ scores when comparing standard testing methods and a truly non-verbal method such as the Leiter-R.
| | *B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by atleast 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., simplemotor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic |
| | phrases). |
| | :*2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficultieswith transitions, rigid thinking patterns, greeting rituals, need to take same route or |
| | eat same food every day). |
| | :*3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,strong attachment to or preoccupation with unusual objects, excessively circumscribed |
| | or perseverative interests). |
| | :*4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects ofthe environment (e.g., apparent indifference to pain/temperature, adverse responseto specific sounds or textures, excessive smelling or touching of objects,visual fascination with lights or movement). |
| | :*Specify current severity:Severity is based on social communication impairments and restricted, repetitivepatterns of behavior (see Table 2). |
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| A diagnosis of high-functioning autism exists in neither the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV-TR]] nor the [[ICD|ICD-10]], which have diagnoses of autistic disorder and childhood autism respectively. Analogous to ''high-functioning'' when applied to [[schizophrenia]] and other psychiatric disorders, the term high-functioning autism started out as a shorthand to describe diagnosed autistic individuals who could nevertheless speak and carry on with many day-to-day activities like eating and dressing independently. ''Low-functioning autism'' was the conceptual opposite. Researchers then began using ''high-functioning autism'' as a quasi-diagnostic label itself, along with ''low-functioning autism'' and sometimes also [[Asperger's Syndrome]], to distinguish relative levels of adaptation and development.
| | '''''AND''''' |
| | *C. Symptoms must be present in the early developmental period (but may not becomefully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). |
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| | '''''AND''''' |
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| | *D. Symptoms cause clinically significant impairment in social, occupational, or other importantareas of current functioning. |
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| | '''''AND''''' |
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| | *E. These disturbances are not better explained by intellectual disability (intellectual developmentaldisorder) or global developmental delay. Intellectual disability and autism |
| | spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrumdisorder and intellectual disability, social communication should be below that expectedfor general developmental level. |
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| | }} |
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| | <SMALL>''Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not othenwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder. Specify if; With or without accompanying inteliectual impairment With or without accompanying language impairment Associated with a icnown medicai or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition.) Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].) With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.) .''</SMALL> |
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| There is some evidence that the label has wrongly become a catch-all diagnosis for badly-behaved children. In 2000 in the [[UK]], the lead clinician and autism specialist at Northgate and Prudhoe [[NHS]] Trust in [[Morpeth, Northumberland|Morpeth]], Dr Tom Berney, published a paper commenting on this. He wrote in the prestigious ''British Journal of Psychiatry'':- "There is a risk of the diagnosis of autism being extended to include anyone whose odd and troublesome personality does not readily fit some other category. Such over-inclusion is likely to devalue the diagnosis to a meaningless label."
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Diagnostic Criteria
DSM-V Diagnostic Criteria for Autism Spectrum Disorder[1]
| “
|
- 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 ofgestures: 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:Severity is based on social communication impairments and restricted, repetitivepatterns of behavior (seeTable 2).
AND
- B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by atleast 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., simplemotor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic
phrases).
- 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficultieswith transitions, rigid thinking patterns, greeting rituals, need to take same route or
eat same food every day).
- 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,strong attachment to or preoccupation with unusual objects, excessively circumscribed
or perseverative interests).
- 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects ofthe environment (e.g., apparent indifference to pain/temperature, adverse responseto specific sounds or textures, excessive smelling or touching of objects,visual fascination with lights or movement).
- Specify current severity:Severity is based on social communication impairments and restricted, repetitivepatterns of behavior (see Table 2).
AND
- C. Symptoms must be present in the early developmental period (but may not becomefully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
AND
- D. Symptoms cause clinically significant impairment in social, occupational, or other importantareas of current functioning.
AND
- E. These disturbances are not better explained by intellectual disability (intellectual developmentaldisorder) or global developmental delay. Intellectual disability and autism
spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrumdisorder and intellectual disability, social communication should be below that expectedfor general developmental level.
|
”
|
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not othenwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder. Specify if; With or without accompanying inteliectual impairment With or without accompanying language impairment Associated with a icnown medicai or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition.) Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].) With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.) .
References
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
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