Lecture Set 17 - Autism Spectrum Disorder (ASD) DSM-5 PDF

4/6/21 Autism Spectrum Disorder (ASD) DSM-IV Single Diagnosis Why Change the Diagnostic Criteria? • Validity of the PDD category • Consistency between diagnoses of high-functioning Autistic disorder vs. Asperger disorder • Appropriateness of PDD-NOS diagnoses • Pervasive Developmental Disorder...

4/6/21 Autism Spectrum Disorder (ASD) DSM-IV Single Diagnosis Why Change the Diagnostic Criteria? • Validity of the PDD category • Consistency between diagnoses of high-functioning Autistic disorder vs. Asperger disorder • Appropriateness of PDD-NOS diagnoses • Pervasive Developmental Disorders: – Autism – Asperger disorder – Rett syndrome – Childhood Disintegrative Disorder – PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified) DSM-IV (to) DSM-5 • Changes – The diagnostic category “pervasive developmental disorders” was omitted • ‘symptoms’ are not actually pervasive • There was an overuse of PDD-NOS (diagnostic confusion) • Considerable overlap between PDD-NOS and Asperger Disorder – New diagnostic category Autism Spectrum Disorder Must meet criteria A, B, C, and D* • Changes: DSM-IV (to) DSM-5 – Rhett Syndrome and Childhood Disintegrative Disorder are separate from Autism Spectrum Disorder (separate conditions) – Autism, Asperger and PDD-NOS collapsed into single diagnoses (Autism Spectrum Disorder) – 2 ‘symptom’ domains/categories (there were 3 in DSM-IV) • Social Communication Domain (separate domains in DSM-IV) • Restricted, repetitive patterns of behavior, interests, or activities DSM-5 Criteria for Autism Spectrum Disorder 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): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal backand-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 difficulties in sharing imaginative play or in making friends; to absence of interest in peers. 1 4/6/21 DSM-5 Criteria for Autism Spectrum Disorder Must meet criteria A, B, C, and D* Must meet criteria A, B, C, and D* B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life). Note* DSM-IV (symptoms had to be present before the age of 3) exhaustive): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day). DSM-5 Criteria for Autism Spectrum Disorder occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. 4. Hyper- or hyporeactivity to sensory input or unusual interests 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). DSM-5 Criteria for 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 (pragmatic) communication disorder (this is a separate disorder). Interventions Behavioral therapy Speech therapy and/or AAC Communication strategies Medication (hyperactivity, anxiety, etc.) • Social strategies • Coping with sensory issues • Routine • • • • E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co- 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 interest). • 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. D.Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. Please Note • Information on Slides 6 – 9 came directly from: http://www.autismspeaks.org/whatautism/diagnosis/dsm-5-diagnosticcriteria • This site also contains information on Social Communication Disorder Interventions • Team Approach: – Parents – School/Day care – Medical – Behavioral – Speech & Language Therapy – Child & Youth Services 2 4/6/21 Considerations for Physical Activity • Creating daily routines – Activity/lesson plans • Smooth transitions – Cues/warnings • Consistency/structure – Consistent environments and processes • Clear and simple instruction/ language • Shorter duration programming – Keeps attention • Visual, rather than auditory – Typically don’t respond to touch Benefits of Recreation (Coyne & Fullerton, 2014) • • • • • Increased quality of life – Leisure satisfaction, self-esteem, joy, choice and control Increased social relationships & acceptance – Primary means to to come in contact with others, form friendships Decreased inappropriate behaviors – Calm & relax during times of anxiety, reduce ‘stimming’ behaviors, re-focus through physical activity Increased physical well-being – Outlet for physical energy, higher physical fitness, improve gross/fine motor skills Increased skills for accessing the community – Promote independence, community inclusion, mastery of life skills, lifetime skills, social communication skills, successful transitions to adult life Autism Resource Centre (ARC) • ARC is a non-profit organization in Regina, SK • Serves adults with Autism Spectrum Disorder (ASD) • Empower individuals to realize potential, achieve independence, and maximize contribution to society through: – Evidence-based program delivery – Education and community building • Criteria to access: – 18-35 years of age, ASD diagnosis, committed to attending scheduled ARC sessions, have valid ARC membership 3