How Is Autism Spectrum Disorder Diagnosed
There are no laboratory tests to determine ASD. However, certain healthcare providers receive specific training and can do screenings and evaluations if needed and who might ask parents or teachers to record observations. These providers might include specialized physicians, psychologists and speech-language pathologists.
When Was Autism First Diagnosed
Autism had a lot of descriptions in the past decades. It was first thought of as a form of childhood schizophrenia. There was even a time where the disorder was thought to stem from cold parenting.
Throughout the years, the diagnostic criteria and the description of autism changed in the Diagnostic and Statistical Manual of Mental Disorders in its editions. This manual is used in the United States to guide physicians in their diagnoses, and it gives us a great idea about how autism diagnosis changed over the years.
An Austrian-American psychiatrist and physician, Leo Kanner first described autism in 1943 . In his article, he mentioned children with delayed echolalia as well as how they wanted to maintain sameness in their lives. He also wrote that these children were also gifted in terms of intelligence and they had an extraordinary memory.
This led Leo Kanner to consider autism a psychiatric condition. Kanner observed autism as an emotional disturbance rather than a developmental or cognitive one. In light of this information, the second edition of the DSM, DSM-II, was published in 1952 with the definition of autism as a psychiatric condition. The manual deemed autism a form of childhood schizophrenia . It was characterized by atypical and withdrawn behavior, general unevenness, gross immaturity and inadequacy in development, and failure to develop identity separate from the mothers.
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How Autism Has Changed From Dsm To Dsm
The first edition of the DSM was published in 1952. It was 130 pages and contained 106 diagnostic descriptions. The most recent edition, the DSM-5, published in 2013, is 947 pages and covers roughly 300 disorders. As the DSM has gotten bigger and broader, so too has the definition of autism.
Before 1980, the word autistic appeared in the DSM only as a trait to describe schizophrenia. But that doesnt mean diagnostic criteria for autism didnt exist. A 1956 article by Leo Kanner and Leon Eisenberg focused on two criteria: aloofness and a significant resistance to changes in routines, noticeable in a child by 24 months of age. These traits are still present in diagnostic criteria today, and are sometimes called classic autism or Kanners autism.
The DSM-III, released in 1980, introduced infantile autism, officially creating a separate diagnosis for autism for the first time. Seven years later, a revised edition, the DSM-III-R, changed the name to autistic disorder and placed it in the category of Pervasive Developmental Disorders along with other related conditions like Aspergers Disorder and Pervasive Developmental Disorders – Not Otherwise Defined .
The 1994 DSM-IV dropped the number of required traits for a diagnosis from eight to six. And the majority of behavioral examples included in earlier versions of the manual were removed, meaning that physicians had to interpret behavioral descriptions with less guidance.
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What Is Asperger Syndrome
Asperger syndrome, or Aspergers, is a previously used diagnosis on the autism spectrum. In 2013, it became part of one umbrella diagnosis of autism spectrum disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 .
Typical to strong verbal language skills and intellectual ability distinguish Asperger syndrome from other types of autism.
What Is Causing Autism
Genetics. Several different genes appear to be involved in autism spectrum disorder. For some children, autism spectrum disorder can be associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic changes may increase the risk of autism spectrum disorder.
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Autism As A Biological Condition
The conceptualization of autism changed course in the later part of the 1970s. In 1977, Susan Folstein and Sir Michael Rutter published a study on twins in which 21 same-sex twin pairs where at least one of the twins had autism were studied. The authors found that there was a 36% concordance rate between twins, meaning that if one twin had autism the probability of the identical twin also having autism is 36%. From this result, the authors concluded there is a significant hereditary component to autism.
In addition to the twin study methodology, the breakthroughs in understanding the hereditary nature of autism occurred due to scientific discoveries in molecular genetics. Scientists had finally answered the question of the physical features of hereditary units, called genes, and how genes are passed from one generation to the next. This concept allowed a greater understanding of a multitude of diseases, such as cancer and autoimmune disorders, but also gave a different explanation to complex behavioral and developmental disorders such as autism.
Also see: Autism and Twin Studies
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 .
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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.
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.
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Are Siblings At Greater Risk For Autism Spectrum Disorder
The truth is that genetics do play a role in autism. When one child is diagnosed with ASD, the next child to come along has about a 20% greater risk of developing autism than normal. When the first two children in a family have both been diagnosed with ASD, the third child has about a 32% greater risk of developing ASD.
What Was Autism Called Before It Was Called Autism
Autism as a Diagnosis, With all of the uses of the autistic terminology, youll likely be referred to a specialist who treats children with autism spectrum disorder, The DSM-5 replaced the old manual in May 2013, or Early Infantile Autism.If the autism umbrella and its disorders no longer officially exist, he continued to present with atypical behaviors.
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False Dichotomy Between Categorical And Dimensional Approaches
Many argue that categorical and dimensional approaches are fluid, such that dimensions can become categories by defining thresholds, and categories can become dimensions by combining constructs to allow for common core features with accompanying variation, as is seen in the transition from DSM-IV to DSM-5 . In the end, it may be helpful to conceptualize ASD as a single diagnostic condition consisting of various categories of symptoms that can be evaluated in terms of dimensional severity , where we choose to emphasize the dimensionality for some purposes and the category for others .
History Of Autism: Timeline And Diagnosis
Autism diagnosis has changed drastically over the years. Today, the DSM-5 describes the condition as autism spectrum disorder. Here is a timeline of events that lead to this diagnosis.
1911: Eugen Bleuler , a Swiss psychiatrist, was the first person to use the term autism to refer to a group of symptoms related to schizophrenia. The word autism comes from the Greek word autos, which means self.
1926: In a scientific German psychiatry and neurology journal , a child psychiatrist from Kiev, Russia, Grunya Sukhareva, wrote about six children with autistic traits.
1943: Leo Kanner, Austrian-American psychiatrist, published a paper about 11 children with high intelligence but who displayed a desire for aloneness and obsessive insistence on sameness. He later described their condition as early infantile autism.
1944: Hans Asperger, an Austrian pediatrician, described a milder form of autism, which is known as Aspergers Syndrome. He reported cases where the patients were all boys and had high intelligence but had problems in social interactions.
1967: Bruno Bettelheim, an Austrian-born psychologist, popularized the theory that autism was the result of cold and inattentive mothers, coining the term refrigerator mothers. This theory has been debunked solidly. At this time, researchers did not consider the biology or genetics involved, but only looked at the impact of life experiences.
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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.
Asperger Therapies And Services
Find the following services near you using the Autism Speaks Resource Guide.
Cognitive behavioral therapy can help address anxiety and other personal challenges.
Social skills training classes can help with conversational skills and understanding social cues.
Speech therapy can help with voice control.
Physical and occupational therapy can improve coordination.
Psychoactive medicines can help manage associated anxiety, depression and attention deficit and hyperactivity disorder .
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Will Diagnoses Of Autism Continue To Increase
There is no way to know for sure if autism rates will continue to rise. As diagnostic criteria evolve, it could lead to either more or fewer children being qualified for an autism diagnosis.
Some experts, for example, expected a decline in autism diagnoses once Asperger’s syndrome and PDD-NOS were eliminated as catch-all options. Others expected an increase as awareness and services improve. For now, the number and rate of children diagnosed with autism continue to rise.
Autism As A Social And Emotional Disorder
Autism was first characterized as a social and emotional disorder in 1943 by Dr. Leo Kanner, a child psychiatrist in the United States. In a paper published in the journal Nervous Child titled Autistic Disturbances of Affective Contact, Kanner describes a distinct syndrome characterized by children who are highly intelligent but have tendencies towards social withdrawal with emotional limitations.
Meanwhile, across the Atlantic in Germany, Hans Asperger was defining a different form of autism. Asperger published his autism psychopathology article in 1944, describing autism as a disorder of normal intelligence children who have difficulties with social and communication skills. Later thought of as a milder form of autism and now commonly known as Aspergers disorder, children with Aspergers tend to suffer similar challenges with social interactions but do not have the same language development challenges often found in Kanners disorder.
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Despite Broader Criteria Diagnostic Disparities Persist
In the case of autism, there is a higher demand for the diagnosis. Having an autism diagnosis can result in fairly good education services these days, such as smaller class sizes, in-school therapies, and one-on-one teacher attention for children with the diagnosis. Psychiatrist and researcher Judy Rappaport is quoted as saying:
Well call that kid a zebra if he needs to be called a zebra to get the educational and other services that he needs and deserves.
Even though the criteria for an autism diagnosis have gotten broader, many children who could and should be diagnosed arent. Studies have shown that many minority children, especially African-American kids, are misdiagnosed with conditions such as ADD or oppositional defiant disorder, which are suggestive of defiant emotional problems resulting from poor or neglectful environments. These discrepancies hold remnants of early claims from the mid-1900s that autism is a disorder of the white upper and middle class.
This discrepancy has continued: 12.3 per 1,000 African American kids are diagnosed with autism and 10.8 per 1,000 Hispanic children, compared to 15.8 per 1,000 among white children.
Dimensional Approach To Core Asd Symptoms And Dsm
The dimensional approach to DSM-5 captures the homogeneity of core ASD symptoms with the aim of relatively high specificity, while allowing for heterogeneity in the quantity and quality of these symptoms. For example, while individuals must meet two of the four broad principles within the RRBs domain to receive an ASD diagnosis, individuals can vary on the number of principles met and the quality or severity of these impairments. This flexibility was improved through DSM-5s addition of unusual sensory responses/interests as a principle within the RRBs domain, supported by research about its prevalence in ASD and its usefulness in differentiating ASD from other disorders . This new principle provides an additional symptom description through which individuals can meet diagnostic criteria.
Diagnosis Of Other Co
Sometimes autism comes with other conditions. These are called co-occurring conditions.
If children have signs or characteristics that meet the criteria for other conditions, theyll be diagnosed as having two or more conditions for example, autism spectrum disorder and attention deficit hyperactivity disorder or intellectual disability.
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 .
Use Of Principles Versus Examples
DSM-IV and ICD-10 criteria had included examples, derived from multiple levels of analyses, that described specific behaviors, such as shared enjoyment, general qualities, and important contexts , through which deficits in ASD could reliably be seen . Recognizing the myriad behavioral presentations among individuals with ASD of varying developmental levels, DSM-5 and ICD-11 introduced broad principles in place of specific examples to better define symptom subdomains. The new principles, each accompanied by a non-exhaustive list of similar examples, present deficits within each subdomain that are applicable across age ranges and developmental levels, thus providing greater systematic sensitivity and specificity. Notably, however, while conceptualized through clinical observation, the DSM-5 and ICD-11 criteria included within each domain are not empirically-defined dimensions .