Thursday, December 1, 2022

What Are The 5 Disorders On The Autism Spectrum

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Autism Spectrum Disorder and DSM-5 with Martin Lubetsky, MD | UPMC Video Rounds

Every person on the autism spectrum is different, and Alter appreciates this. Our priority isnt applying or rejecting specific autism diagnoses, but understanding each patient and giving them the best care possible. If you or someone you know is an adult with autism, come to us to learn more about how we can help.

Cultural And Linguistic Considerations

Awareness of individual and cultural differences is essential for accurate diagnosis. For example, direct eye contact with an authority figure may be considered disrespectful in some cultures, and silence may be valued as a sign of respect. In a U.S. school system, these behaviors could easily be misinterpreted as socially inappropriate.

The core characteristics of ASD may be viewed through a cultural lens leading to under-, over-, or misdiagnosis . Signs and symptoms that are clearly “red flags” in the U.S. health care or educational system may not be viewed in the same way by someone from a culture that does not formally define the disorder.

Cultural and linguistic variables may contribute to the disparity in the diagnosis of ASD among some racial/ethnic groups . For example, Begeer et al. found that Dutch pediatricians might be inclined to attribute social and communication problems of non-European minority groups to their ethnic origin, while attributing these same characteristics to autistic disorders in children from majority groups.

Early Signs And Symptoms

Diagnostic features of ASD are present in very young children. Most families and caregivers report observing symptoms within the first 2 years of life and typically express concern by the time the child reaches 18 months of age.

Studies of children with ASD found the following:

  • Parents of children with ASD reported first noticing abnormalities in their children’s developmentâparticularly in language development and social relatednessâat about 14 months of age on average .
  • Infants at risk forâand later diagnosed withâASD showed a decline in eye fixation within the first 2â6 months of age. This pattern was not observed in typically developing infants .
  • Children with autism used fewer joint attention gestures and behaviors as infants and toddlers than did age-matched peers who were typically developing .
  • Children with autism showed subtle differences in sensoryâmotor and social behavior at 9 to 12 months of age when compared with typically developing peers .
  • Children with autism showed lower rates of canonical babbling and fewer speech-like vocalizations across the 6- to 24-month age range than did typically developing peers .
  • Infants at risk forâand later diagnosed withâASD used significantly more distress vocalizations than did children who were typically developing and children who were developmentally delayed this may reflect the difficulties that children with ASD have with emotional regulation .

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Is There Help Available

Yes, theres a lot of help available, beginning with the free evaluation of the child. The nations special education law, the Individuals with Disabilities Education Act , requires that all children suspected of having a disability be evaluated without cost to their parents to determine if they do have a disability and, because of the disability, need special services under IDEA. Those special services are:

Under IDEA, children with a disorder on the autism spectrum are usually found eligible for services under the category of autism. In the fall of 2005, more than 160,000 school-aged children received special education and related services in the public schools under the autism category.

IDEA specifically defines autism as follows:

..a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a childs educational performance.

A child who shows the characteristics of autism after age 3 could be diagnosed as having autism if the criteria above are satisfied.

What Are The Signs And Symptoms Of Asd

Autism Spectrum Disorder Overview Autism Spectrum Disorder ...

Every person with ASD is unique, so the timing and severity of the first signs and symptoms can vary widely. Some children with ASD show signs within the first few months of life. In others, symptoms may not become obvious until 24 months or later. Some children with ASD appear to develop normally until around 18 to 24 months of age and then stop gaining new skills and/or start losing skills.

During infancy , a child may show symptoms that include:

  • Limited or no eye contact
  • No babbling
  • Appearing not to hear
  • Playing with toys in an unusual or limited manner
  • Showing more interest in objects instead of people
  • Starting language skills but then stopping or losing those skills
  • Showing repetitive movements with their fingers, hands, arms or head

Up to 2 years of age, there may be continuing symptoms from infancy. A child may also:

  • Focus only on certain interests
  • Be unable to have reciprocal social interactions
  • Move in unusual ways, such as tilting their head, flexing their fingers or hands, opening their mouth or sticking out their tongue
  • Have no interest in playing with other children
  • Repeat words or phrases without appearing to understand them
  • Have behavioural issues, including self-injury
  • Have trouble controlling their emotions
  • Like to have things a certain way, such as always eating the same food

Possible signs of ASD at any age:

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Level : Requiring Substantial Support

The communication issues that a person with Level 2 ASD may face include:

  • noticeable issues with verbal and nonverbal social communication skills
  • social issues being apparent despite supports in place
  • limited initiation of social interaction
  • reduced response to social interactions from others
  • interactions that are limited to narrow special interests
  • more significant differences in nonverbal communication

The repetitive behavioral issues a person with Level 2 ASD may face include:

  • inflexible behavior
  • struggling to cope with change
  • restricted or repetitive behaviors that are obvious to a casual observer and interfere with functioning in several contexts
  • difficulty changing focus or action

Diagnostic Criteria For Autism Spectrum Disorder In The Dsm

DSM stands for Diagnostic and Statistical Manual of Mental Disorders, which is a manual published by the American Psychiatric Association. The manual includes classifications of psychiatric disorders for use by medical and mental health professionals. Clinicians may refer to versions of the DSM to look for diagnostic codes of different disorders and examine criteria for diagnosis. About 25% of the disorders are specific to children and are in the section of Disorders Usually First Diagnosed in Infancy, Childhood and Adolescence. Autism and related disorders have been specifically included in different versions of the DSM since 1980.

The latest edition of the DSM, DSM-5, made significant changes to the diagnostic criteria for autism and related disorders. In DSM-IV, five separate diagnoses were classified under the heading Pervasive Development Disorders: Autistic disorder, Asperger Syndrome, Pervasive Development Disorder Not Otherwise Specified , Rett Syndrome, and Childhood Disintegrative Disorder. The Pervasive Development Disorder category no longer appears in DSM-5, and Autistic disorder, Asperger Syndrome, and PDD-NOS have now been combined into one label: Autism Spectrum Disorder .

  • Difficulties in social emotional reciprocity, including trouble with social approach, back and forth conversation, sharing interests with others, and expressing/understanding emotions.
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    Do Symptoms Of Autism Change Over Time

    For many children, symptoms improve with age and behavioral treatment. During adolescence, some children with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with ASD usually continue to need services and supports as they get older, but depending on severity of the disorder, people with ASD may be able to work successfully and live independently or within a supportive environment.

    Social And Communication Skills

    Autism Spectrum Disorder and DSM-5: Darrel Regier, MD, MPH Discusses Changes

    Impairments in social skills present many challenges for individuals with ASD. Deficits in social skills may lead to problems with friendships, romantic relationships, daily living, and vocational success. One study that examined the outcomes of adults with ASD found that, compared to the general population, those with ASD were less likely to be married, but it is unclear whether this outcome was due to deficits in social skills or intellectual impairment, or some other reason.

    Prior to 2013, deficits in social function and communication were considered two separate symptoms of autism. The current criteria for autism diagnosis require individuals to have deficits in three social skills: social-emotional reciprocity, nonverbal communication, and developing and sustaining relationships.

    Social skills

    Some of the symptoms related to social reciprocity include:

    • Lack of mutual sharing of interests: many children with autism prefer not to play or interact with others.
    • Lack of awareness or understanding of other people’s thoughts or feelings: a child may get too close to peers without noticing that this makes them uncomfortable.
    • Atypical behaviors for attention: a child may push a peer to gain attention before starting a conversation.

    Symptoms related to relationships includes the following:

    • Defects in developing, maintaining, and understanding relationships.
    • Difficulties adjusting behavior to fit social contexts.

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    Diagnosis In Older Children And Adolescents

    ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the schools special education team. The schools team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in ASD for additional testing.

    Parents may talk with these specialists about their childs social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.

    Does Autism Run In Families

    We have learned a lot about autism since it was first diagnosed in the 1940s by Dr. Kanner. There is still a lot we dont know but one thing that seems to be true about autism is that it does have some genetic tendency to run in families. To put it very simply without summarizing entire studies, the average risk of a subsequent child being born after one child with ASD has been born into a family is 10% based on group averages. This is a very loose number, but the point is that it has been well established that the tendency is there.

    It is not unusual for therapists who work in the field to serve families who have more than one sibling who has been diagnosed with an ASD.

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    The Pacific Symposium On Biocomputing Asd Workshop

    Many studies have been investigating the connection between genetic variation and ASD. Twin studies have indicated that ASD are highly heritable,. Linkage studies have implicated a polygenic basis for autistic disorder. However, genome-wide association studies for ASD have identified few potential loci associated with ASDâ. Copy-number variation studies, in contrast, have been more successful in identifying genomic regions associated with an increased risk for autism, and also other neurodevelopmental disabilities such as schizophrenia and epilepsy, with overlap of several genomic regions,,. Copy number variations can be deletions, duplications, inversions, or translocations. While the location of CNVs may differ from individual to individual with ASD, these CNVs can still result in similar clinical features and outcomes.

    During the workshop, Dr. Santhosh Girirajan and Dr. Evan Eichler will describe work investigating the genetic and phenotypic heterogeneity of neurodevelopmental disorders in the context of CNVs, particularly for ASD,â. Dr. Girirajan’s research has been focused on the discovery of genetic variants associated with the causation, diagnosis, and biological interpretation of ASD. A recent manuscript by Girirajan et al. showed evidence that individuals with autism have higher numbers of larger copy-number variants, and that these are more duplication based instead of deletion events.

    What Is The Difference Between Autism And Autism Spectrum Disorder

    Autistic spectrum disorders adapted from [17].

    The term autism was changed to autism spectrum disorder in 2013 by the American Psychiatric Association. ASD is now an umbrella term that covers the following conditions:

    • Autistic disorder.
    • Pervasive developmental disorder not otherwise specified .
    • Asperger syndrome.

    People with ASD have trouble with social interactions and with interpreting and using non-verbal and verbal communication in social contexts. Individuals with ASD may also have the following difficulties:

    • Inflexible interests.
    • Insistence on sameness in environment or routine.
    • Repetitive motor and sensory behaviors, like flapping arms or rocking.
    • Increased or decreased reactions to sensory stimuli.

    How well someone with ASD can function in day-to-day life depends on the severity of their symptoms. Given that autism varies widely in severity and everyday impairment, the symptoms of some people arent always easily recognized.

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    An Insight Into The Various Types Of Autism

    Let us now get a deeper insight into each of the following forms of Autism.

    Fig 3:

    As mentioned at the beginning of this article, the various types of autism spectrum disorders present a significant overlap with one another. The following 3 characteristics are carefully evaluated to arrive at the right conclusion:

    • Social skills within families coping with Autism and externally
    • Autism Communication Skills

    For example, it is extremely hard to discriminate between mild PDD and moderate Aspergers symptoms as a patient may demonstrate both characteristics in the autism spectrum quotient.

    What Are The Types Of Autism

    In the past, doctors diagnosed autism according to four different subtypes of the condition. However, healthcare professionals now classify autism spectrum disorder as one broad category with three different levels to specify the degree of support an autistic person needs.

    Before 2013, healthcare professionals defined the four types of autism as:

    • childhood disintegrative disorder
    • pervasive developmental disorder-not otherwise specified

    However, the American Psychiatric Association revised their Diagnostic and Statistical Manual of Mental Disorders in 2013, which did not include these four subtypes of autism. They now all fall under the one umbrella term of ASD.

    Keep reading to learn more about how we categorize ASD, including the various levels, and how doctors diagnose the condition.

    ASD is now the umbrella term for the group of complex neurodevelopmental disorders that make up autism. It is a condition that affects communication and behavior.

    The autism spectrum refers to the variety of potential differences, skills, and levels of ability that are present in autistic people.

    According to the Centers for Disease Control and Prevention , around in the United States are on the autism spectrum.

    The differences in autistic people are often present from early childhood and can impact daily functioning.

    Autistic people can experience the following challenges:

    According to the National Institute of Mental Health, early signs of ASD can include:

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    Level : Requiring Very Substantial Support

    The communication issues a person with Level 3 ASD may face include:

    • severe issues in both verbal and nonverbal social communication, which severely impair functioning
    • very limited initiation of social interactions
    • minimal response to social interaction from others
    • using few words of intelligible speech
    • unusual methods of meeting social needs and responding to only very direct approaches

    The repetitive behavioral issues a person with Level 3 ASD may face include:

    • inflexible behavior

    The levels of ASD correspond to the severity of the autism symptoms described above and the degree of support required.

    In addition, it is important to keep in mind that the amount of support an autistic person needs can vary according to different ages or situations.

    Terms For Types Of Autism That Are No Longer Used Today

    What Is Autism Spectrum Disorder?

    When autism was categorized by types, the lines between the different types of autism could be blurry. Diagnosis was, and still is, complicated and often stressful for families.

    If you or your child received a diagnosis before the DSM-5 changed, you may still be using the older terminology . Thats OK. Your doctor may continue to use those terms if they help.

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    Why Was The New Edition Needed

    The American Psychiatric Association periodically updates the DSM to reflect new understanding of mental health conditions and the best ways to identify them.

    The goals for updating the criteria for diagnosing autism included:

    • More accurate diagnosis
    • Identification of symptoms that may warrant treatment or support services
    • Assessment of severity level

    Understanding Autism Spectrum Disorders

    Autism is not a single disorder, but a spectrum of closely related disorders with a shared core of symptoms. Every individual on the autism spectrum has problems to some degree with social interaction, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.

    If youre a parent dealing with a child on the autism spectrum, you may hear many different terms including high-functioning autism, atypical autism, autism spectrum disorder, and pervasive developmental disorder. These terms can be confusing, not only because there are so many, but because doctors, therapists, and other parents may use them in dissimilar ways.

    But no matter what doctors, teachers, and other specialists call the autism spectrum disorder, its your childs unique needs that are truly important. No diagnostic label can tell you exactly what challenges your child will have. Finding treatment that addresses your childs needs, rather than focusing on what to call the problem, is the most helpful thing you can do. You dont need a diagnosis to start getting help for your childs symptoms.

    Whats in a name?

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    How Common Is Autism Spectrum Disorder

    Based on most recent CDC report, ASD is estimated to affect about 1 in 54 children, with boys being more likely to have ASD than girls. There were more than 5 million adults in the US, or 2.21% of the population, with ASD as of 2017. Government statistics suggest that the prevalence of ASD has risen 10% to 17% in recent years.

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