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DSM 5

The key systems that drive California to flourish and how those systems came to be
by

claire palmer

on 20 June 2013

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Transcript of DSM 5

Autism Spectrum Disorders:
Diagnosis & The DSM
THE END
There is no medical test for autism.
they know even less about what is happening physiologically in most individuals with autism
one day there may be a medical test for ASD to diagnose children very early and ensure appropriate services
scientists do not yet understand how the brain works when it is working in the typical way
You
Are Here
Wait and see
Optimal
Outcome!
Typical
Development
Good Intervention
ASD
Diagnosis
?
...until then...
...ASDs must be diagnosed by direct observation, parent interviews and cognitive testing.

"a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [which] is associated with present distress...or disability...or with a significant increased risk of suffering."
Skilled Clinicians
Accurate Parent Reporters
Unskilled Clinicians
Inaccurate Parent Reporters
Often out of touch with child
Unfamiliar with child development
DSM definition of a Mental Disorder:
Psychotic
&
Schizophrenia
Bipolar
Substance Related
and Addictive
Disorders
Neurocognitive
Disorders
(e.g. Delirium,
Parkinsons,
Alzheimers, etc.)
Personality
Disorder
Depressive
Somatic
Symptom


Sexual
Dysfunction
Feeding
& Eating
Obsessive
Compulsive
Anxiety
Sleep-Wake
Disorders
Gender
Dysphoria
Dissociative
Paraphillic
Disruptive, Impulse
Control and Conduct
Elimination
Trama &
Stress-Related
(e.g. voyeuristic,
Pedophillic)
Universe
of
DSM
Disorders
Intellectual
Disability
Motor Disorder
Attention Deficit
Disorder
& Hyperactivity
Specific
Learning
Disorder
(e.g. Tourette's, TIC)
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
Autistic Disorder (Classic Autism)
Asperger's Disorder (Asperger Syndrome)
Rett's Disorder (Rett Syndrome)
Childhood Disintegrative Disorder (CDD)
Autism Spectrum
DSM IV
Communication
Neurodevelopmental
Disorders
DSM-5
"Autism Spectrum"
Disorder
no Subtypes
new Specifiers
new Severity Ratings

Bad Actor Clinicians
DSM IV
DSM 5
Amy Palmer - Families for Early Autism Treatment

your child's brain shows signs of being "wired" differently
scientists around the world do not yet understand how
it is interfering with your child's ability to perceive information about other people and learn from them in the way typical children learn
it will be a lifelong difference, but your child will improve with special teaching
the diagnosis is being made now so that you can begin getting help and have the best outcome for your child
An ASD Diagnosis Means:

-The American Psychiatric Association
“Highlights of Changes from DSM-IV-TR to DSM-5”
“Autism spectrum disorder is a new DSM-5 name that reflects a scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.”
Social Communication
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 difficulities in sharing imaginative play or in making friends; to absence of interest in peers.
Communication
DSM-IV
"Triad" of Impairments
Restricted and Repetitive
Behaviors
Communication
Social
1.Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patters of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the 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 of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)
Communication
Restricted and Repetitive
Behaviors
Social
DSM-5
"Dyad" of Impairments
E. They are not better explained by intellectual disability (formerly mental retardation) … to make co-morbid diagnoses of ASD and ID, social communication must be below that expected for general developmental level
C. They must cause clinically
significant impairments in current functioning
D. The symptoms have to be present in early childhood (vs. by age 3).


A
B
Social (Pragmatic) Communication Disorder
The DSM-5 states,

“individuals with a well-established DSM-IV diagnoses of either autistic disorder, Asperger’s disorder or PDD-NOS should be given the diagnosis of autism spectrum disorder."
DSM still reliable even though it shrinks the spectrum
if a borderline case, see an experienced, independent clinician
beware the diagnosis “social (pragmatic) communication disorder”
could be good for some with Asperger's
no need to be re-evaluated if now diagnosed. You can’t “lose” a well-established diagnosis (but you could lose services)
may be diagnosed as ASD "with accompanying intellectual impairment"
learn about restricted interests and repetitive behaviors
learn about sensory symptoms
Takeaways:
Full transcript