Autism Spectrum Disorder (ASD) Overview - DSM-5 Diagnosis, Severity Levels, and Interventions PDF

Week 3: Autism & OT DSM-5 Autism Spectrum Disorder DSM-5: Must have persistent deficits in -​ each of 3 areas: social communication & interactions -​ at least 2/4 types of restricted: repetitive behaviours A. Persistent deficits in social comm...

Week 3: Autism & OT DSM-5 Autism Spectrum Disorder DSM-5: Must have persistent deficits in -​ each of 3 areas: social communication & interactions -​ at least 2/4 types of restricted: repetitive behaviours A. Persistent deficits in social communication & interaction across multiple context, manifested by all of the following, current/history: ​ Deficit in social-emotional reciprocity, ○​ e.g. ranging from abnormal social approach & failure of normal back-forth conversation; reduced sharing interests, emotions/affect; to failure to initiate/respond to social interactions ​ Deficits in non-verbal communication behaviours used for social interactions, ○​ e.g. ranging from poorly integrated verbal & non-verbal communication; to abnormalities in eye contact & body language/deficits in understanding & use of gestures; to total lack of facial expressions & non-verbal communication ​ Deficits in developing, maintaining & understand relationships ○​ e.g. ranging from difficulties adjusting behaviour to suit various social contexts, to difficulties in sharing imaginative play/in making friends, to absence of interest in peers. Severity is based on social communication impairments & restricted, repetitive patterns of behaviours B. Restricted, repetitive patterns of behaviours, interest, activities as manifested by at least 2 of following: ​ Stereotyped/repetitive patterns of behaviours, use of objects, speech ○​ e.g. simple motor stereotypes, lining up toys & flipping objects, echolalia, idiosyncratic phrases ​ Insistence on sameness, inflexible adherence to routine, or ritualised patterns of verbal/non-verbal behaviour ○​ e.g. extreme distress at small changes, difficulties w transitions, rigid thinking patterns, greeting rituals, need to take same route/eat same food everyday ​ Highly restricted, fixated interest that are abnormal in intensity/focus ○​ e.g. strong attachment to/ preoccupation with unusual objects, excessively circumscribed/ perseverative interest ​ Hyper-/hyporeactivity to sensory input/unsual interest in sensory aspects of environment ○​ e.g. apparent indifference to pain/temperature, adverse response to specific sounds/textures, excessive smelling/touching of objects, visual fascination with lights/movement. Viewed as autism → pervasive developmental delay, autism, asperger syndrome, PDD-NOS, childhood autism, atypical autism Specify current severity: C. Symptoms must be present in early development period ​ May not be fully manifest until social demands exceed limited capacities, ​ May be masked by learned strategies in later life 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 disorder/global developmental delay. ​ ID & ASD frequency co-occur; to make comorbid diagnosis of ASD & ID, social communciation shld be below expected for general developmental level. Specify if: -​ With/without accompanying intellectual impairment -​ With/without accompanying language impairment -​ Associated with known medical/genetic condition/environmental factor -​ With catatonia (dont talk move or much/have unusual behaviours; strange position/mimick others) *Note: individuals with DSM-4 diagnosis of autistic/asperger’s disorder, pervasive developmental disorder-NOS → given diagnosis of ASD. Individuals marked deficits in social communication but symptoms do not otherwise meet criteria for ASD → social (pragmatic) communication disorder Severity Levels for ASD Level 1: Requiring support Level 2: Requiring substantial support Level 3: Requiring very substantial support Social Communication: Social communication: Social communication: ​ Without supports in place, deficits in ​ Marked deficits in verbal & non-verbal ​ Severe deficits in verbal & non-verbal social communication cause social communication skills; social social communication skills cause noticeable impairments. impairment apparent even with supports severe impairments in functioning, ​ Difficulty initiating social interactions & in place; ​ Very limited initiation of social clear examples of atypical/ ​ Limited initiation of social interactions; interactions unsuccessful responses to social ​ Reduced/abnormal responses to social ​ Minimal response to social overtures overtures of others. overtures from others. from others.  ​ May have decreased interest in social For e.g. person speaks simple sentences, For e.g, person with few words of interactions. interaction is limited to narrow special intelligible speech who rarely initiates For e.g. person able to speak in full interest, & has markedly odd non-verbal interaction & when they do, makes sentences & engages in communication communication unusual approaches to meet needs & but to-&-fro conversation with others fails, & responds to very direct approaches attempts to make friends are odd & Restricted, repetitive behaviours typically unsuccessful ​ Inflexibility of behaviour Restricted, repetitive behaviours ​ Difficulty coping with change/other ​ Inflexibility of behaviour Restricted, repetitive behaviours restricted or repetitive behaviours ​ Extreme difficulty coping with change/ ​ Inflexibility of behaviour causes signif. appear frequently enough to be obvious other restricted or repetitive interference with functioning in 1/more to casual observer & interfere with behaviours markedly interfere with contexts. functioning in variety of context. functioning in all spheres. ​ Difficulty switching between activities ​ Distress &/ difficulty changing ​ Great distress/difficulty changing ​ Problems of organization & planning focus/action focus/action hamper independence. Facts about autism Identify ASD Screening Prevalence: How? ​ No screening ASD-specific tool ​ Worldwide (1.09 per 10000 → 436 per ​ Development surveillance identified 10000) ○​ Ongoing process of identifying child ○​ Checklist for Autism in Toddlers ○​ Median prevalence: 100 per 10000 at risk of developmental delay, (CHAT) / Modified Checklist for ○​ WHO: 1 in 100 deviance/abnormality Autism in Toddlers (M-CHAT) ​ Autism & developmental disabilities ○​ Aim to identify ASD early. ​ High risk population –? recommended monitoring network (USA) → 1 in 44 ○​ Early identification → opportunities to screen @ 18 mths & 24 mths children aged 8y for early referral & intervention → ​ Identical twins: 36-95% other twin child with ASD can have improved ​ Non-identical twin: 0-31% other twin functioning in later life. ​ Child with ASD: 2-18% next child ​ Polyclinic ​ Median of 33% → ID (IQ