Aspergers Disorder And The Broader Autism Spectrum
Aspergers disorder and the broader autism spectrum have their own interesting and complex, and to some extent, interrelated, histories. In some respects, Aspergers original report stood in contrast to Kanners earlier paper. The cases that Asperger described, all boys with marked social difficulties , somewhat presaged the awareness over the past decades of the broader autism phenotype . This awareness has also reflected the similarly growing awareness of the complexity of the genetics of autism . Until Wings review of Aspergers original paper , however, there was relatively little awareness of the condition . Wing herself saw the condition as clearly being part of the autism spectrum and her paper became the inspiration for what can only be described as a plethora of differing diagnostic views on the concept , with no fewer than 5 distinctive approaches to Aspergers disorder emerging .
Criteria C And D For Social Anxiety Disorder
Criteria C and D for Social Anxiety Disorder
C. Social situations almost always provoke fear or anxiety.
Criteria C captures the pervasiveness of the experience. We arent talking about situational anxiety that comes and goes were talking about anxiety that is persistent and present in many contexts.
D. The social situations are avoided or endured with intense fear or anxiety.
Avoidance and anxiety go hand and hand. When we experience anxiety, we often avoid the thing that triggers the anxiety . Criteria C and D capture this element of social anxiety. The person nearly always pushes through the avoidance but experiences intense fear and anxiety , or they avoid these situations whenever possible .
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Associated Features Supporting Diagnosis
Many individuals with autism spectrum disorder also have intellectual impairment and/ or language impairment . Even those with average or high intelligence have an uneven profile of abilities. The gap between intellectual and adaptive functional skills is often large. Motor deficits are often present, including odd gait, clumsiness, and other abnormal motor signs . Self-injury may occur, and disruptive/challenging behaviors are more common in children and adolescents with autism spectrum disorder than other disorders, including intellectual disability. Adolescents and adults with autism spectrum disorder are prone to anxiety and depression. Some individuals develop catatonic-like motor behavior , but these are typically not of the magnitude of a catatonic episode. However, it is possible for individuals with autism spectrum disorder to experience a marked deterioration in motor symptoms and display a full catatonic episode with symptoms such as mutism, posturing, grimacing and waxy flexibility. The risk period for comorbid catatonia appears to be greatest in the adolescent years.
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Risks And Benefits Of Adult Diagnosis
Many adults who meet diagnostic criteria for ASD do not carry formal medical diagnoses of ASD, either because they have never come to medical attention or because they have been misdiagnosed with a differential condition . When deciding whether to refer an adult patient for a diagnostic evaluation for ASD, one should consider potential risks and benefits of a diagnosis, and should discuss these possibilities with the patient and, if applicable, their supporters.
Potential benefits of a formal diagnosis are as follows.
- Would confer legal rights to accommodations in school, at work, in healthcare, or in other settings.
- May assist the individual in developing a better understanding of self.
- May provide peace of mind through the professional confirmation of life experiences.
- May provide means to experience better coping or quality of life by more directly helping in recognizing strengths and accommodating challenges.
- May provide others means to understand and support the individual.
- May qualify the individual for benefits and services for people who have an ASD diagnosis.
- May qualify the individual for programs for people with disabilities, such as scholarships or incentives that are meant to increase workplace diversity.
Potential risks associated with seeking an ASD diagnosis are as follows.
Autism Diagnosis Criteria: Dsm
In 2013, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders . The DSM-5 is the standard reference tool used by healthcare providers to diagnose mental and behavioral conditions, including autism.
By special permission of the American Psychiatric Association, you can read the full-text of the new diagnostic criteria for autism spectrum disorder and the related diagnosis of social communication disorder.
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Diagnostic Criteria For 29900 Autism Spectrum Disorder
To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction plus at least two of four types of restricted, repetitive behaviors .
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
Developmental Screening In Pediatric And Primary Care Practice
Integrating routine developmental screening into the practice setting can seem daunting. Following are suggestions for integrating screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care.
An example of how developmental screening activities might flow in your clinic:
Involving Families in Screening
Research indicates that parents are reliable sources of information about their childrens development. Evidence-based screening tools that incorporate parent reports can facilitate structured communication between parents and providers to discover parent concerns, increase parent and provider observations of the childs development, and increase parent awareness. Such tools can also be time- and cost-efficient in clinical practice settings.2,3,4 A 1998 analysis found that, depending on the instrument, the time for administering a screening tool ranged from about 2 to 15 minutes, and the cost of materials and administration ranged from $1.19 to $4.60 per visit.5
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Asd Criteria And Manifestations In Adults
The DSM-5 specifies diagnostic critera for ASD.24 The following table summarizes the DSM-5 criteria, with examples of how these criteria may manifest in adults.22
Though the DSM-5 conceptualizes ASD primarily as a social-communication disorder, there is a growing literature supporting the hypothesis that ASD is primarily characterized by differences in information processing.23 See, for example, the intense world theory of ASD.
Adults on the autism spectrum may display autistic traits differently from children. Most people, regardless of whether or not they are on the autism spectrum, mature and behave differently as they get older. As such, adults on the spectrum may not fit society’s images of autistic children. In addition, adults often find coping strategies that help them function in the world, but that may make autistic traits harder to recognize.
There is great heterogeneity in the clinical presentation of ASD. Although anyone on the spectrum would be expected to have challenges with social communication, these challenges can show up in many different ways. For example, a person may not be able to speak, may misunderstand facial expressions and body language, or may take language too literally. A person may have difficulty starting a conversation, may need more time alone than most people, or may feel uncomfortable socializing with others without a planned activity.
Subdimensions Within Core Asd Symptoms
As diagnostic criteria for ASD have expanded to account for the heterogeneity in the quantity and quality of core and related symptoms , researchers have attempted to identify subdimensions within the core symptom domains of socialcommunication and RRBs to improve phenotyping. Using items from the ADOS-2, Autism Diagnostic Interview-Revised , and SRS-2, Zheng et al. established a four substantive-factor model within the socialcommunication domain that may capture the individual variability in symptoms. The first factor, basic social communication skills, included items measuring nonverbal communication, joint attention, emotional expression, and emotion recognition. Support for the basic social communication skills subdimension also comes from Bishop et al. , who identified this factor when comparing children with ASD to children with diagnoses other than ASD. The second factor from the Zheng et al. four-factor model was interaction quality, which was comprised of items related to the quality of conversations, initiations, and responses. The third factor, peer interaction and modification of behavior, included items measuring the quality of peer interactions and the extent to which individuals modify behaviors to interact appropriately with peers. The final factor, social initiation and affiliation, consisted of items about play, affiliation, and initiation of social interaction with peers .
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Functional Consequences Of Autism Spectrum Disorder
In young children with autism spectrum disorder, lack of social and communication abilities may hamper learning, especially learning through social interaction or in settings with peers. In the home, insistence on routines and aversion to change, as well as sensory sensitivities, may interfere with eating and sleeping and make routine care extremely difficult. Adaptive skills are typically below measured IQ. Extreme difficulties in planning, organization, and coping with change negatively impact academic achievement, even for students with above-average intelligence. During adulthood, these individuals may have difficulties establishing independence because of continued rigidity and difficulty with novelty. Many individuals with autism spectrum disorder, even without intellectual disability, have poor adult psychosocial functioning as indexed by measures such as independent living and gainful employment. Functional consequences in old age are unknown, but social isolation and communication problems are likely to have consequences for health in older adulthood. DIAGNOSTIC CRITERIA 10
Screening And Diagnosis Of Autism Spectrum Disorder For Healthcare Providers
Developmental screening can be done by a number of professionals in health care, community, and school settings. However, primary health care providers are in a unique position to promote childrens developmental health.
Primary care providers have regular contact with children before they reach school age and are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem.
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Autism Case Training Landing Page
CDCs online Autism Case Training for CME and CE has expired and is no longer available.
Learners are encouraged to use the following:
Identifying and Caring for Children with Autism Spectrum Disorder: A Course for Pediatric Clinicians
Available through April 2023Developed by the American Academy of Pediatrics Council on Children with Disabilities Autism Subcommittee, this FREE self-paced online PediaLink course educates pediatric clinicians about evidence-based practices in caring for children with autism spectrum disorder . The course consists of 7 units, each grounded in recommendations from the AAP clinical report, Identification, Evaluation and Management of Children with Autism Spectrum Disorder. Learners may complete all units or select specific units they would like to complete based on their needs, capacity, and professional interests. Units within the course are eligible for AMA PRA Category 1 Credit and Maintenance of Certification Part 2 points.
The CDC will continue to offer
Some of the content in the two offerings below is dated and will require instructors to provide the most current and evolving information on prevalence data, risk factors, genetic testing, interventions and medical management, and transition to adulthood.
Proportion Of Addm Network Asd Case Children Based On Dsm
Among the 6577 children who met the ADDM Network ASD case definition based on the DSM-IV-TR in surveillance years 2006 and 2008, 5339 met the DSM-5 criteria for ASD . Of the 3 criteria in the DSM-5 ASD social communication domain, deficits in nonverbal communication was the least frequent, with 86.8% of the 6577 children meeting this criterion. Restricted interests was the least frequent overall at 62.8% . Nearly all children who met ADDM Network ASD case definition either met, or were within 1 criterion of meeting, DSM-5 ASD criteria .
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Specify Current Severity: Severity Is Based On Social Communication Impairments And Restricted Repetitive Patterns Of Behavior
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history :
C. Symptoms must be present in the early developmental period .
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
NOTE: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Aspergers 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 otherwise meet criteria for autism spectrum disorder, should be evaluated for social communication disorder.
Design Setting And Participants
Cross-sectional, population-based ASD surveillance based on clinician review of coded behaviors documented in childrens medical and educational evaluations from 14 geographically defined areas in the United States participating in the Autism and Developmental Disabilities Monitoring Network in 2006 and 2008. This study included 8-year-old children living in ADDM Network study areas in 2006 or 2008, including 644 883 children under surveillance, of whom 6577 met surveillance ASD case status based on the DSM-IV-TR.
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Restricted Repetitive Patterns Of Behavior
This kind of behavior should be present and for a diagnosis at least two of these should be apparent:
Even if these symptoms are present, further requirements are still needed for an autism diagnosis. For example, the symptoms should be present from early onit is however possible that full manifestation only occurs later due to circumstances. These symptoms should cause significant problems in important areas of the childs life and should not be better explained by intellectual disability or global development delay.
International Classification Of Diseases Tenth Edition
The ICD-10 is the most commonly-used diagnostic manual in the UK.
It presents a number of possible autism profiles, such as childhood autism, atypical autism and Asperger syndrome. These profiles are included under the Pervasive Developmental Disorders heading, defined as A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individuals functioning in all situations.
A revised edition is expected in January 2022 when it will start being used and is likely to closely align with the latest edition of the American Diagnostic and Statistical Manual .
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Autism In Developing Countries
While a recent global burden study reported that 95% of all young children with developmental disabilities live in low and middle income countries , the majority remain undiagnosed . Furthermore, relatively little research originates from these countries, which results in their underrepresentation in the broader ASD literature . The low diagnostic rates in poor countries likely stem from the lack of dedicated infrastructure to assist people with ASD , difficulty obtaining referrals to meet with the limited number of specialists , and low levels of parental literacy that limit a parents ability to understand the disorder and to locate services . Families are often forced to manage the care of an individual with ASD on their own, which often involves enlisting the help of extended family and community members . Among the lucky families who find an available and appropriate assessment center, the target children may be brought to the clinic by non-parent adults, which limits the quality and quantity of relevant developmental information that can be shared with the specialist. Thus, given the numerous barriers to assessment, the children who ultimately receive ASD diagnoses are often the children with the most significant impairments and complex phenotypic profiles .
Diagnostic Criteria For 29900 Autism Spectrum Disorder*
*This is not the full criteria. It is a representative selection from the full text
All of the following should be understood as a speculative story from a dominant cultural group about a minority cultural group presented with deep bias and without any attempt to understand how that minority cultural group perceives their differences.
To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction plus at least two of four types of restricted, repetitive behaviors .
A. Persistent deficits in social communication and social interaction:
- 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.
- 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.
- 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.
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