Autism Spectrum Disorder--DSM + Guidelines (2014) Flashcards
How many criteria are there for ASD
5
How many elements are there in criterion A for ASD (all of which must be present)
3
what is criterion A for ASD
persistent deficits in SOCIAL COMMUNICATION and social INTERACTION across multiple contexts, as manifested by ALL of the following, currently or historically:
- deficits in SOCIAL-EMOTIONAL RECIPROCITY
–can range, for example, from abnormal social approach and failure or normal back and forth conversation; to reduced sharing of interests, emotions or affect; to failure to initiate or respond to social interactions - deficits in NON VERBAL COMMUNICATIVE BEHAVIOURS used for social interaction
–can range, 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
–can range, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
how many elements are there to consider in criterion B for ASD? how many of these do you have to have for a diagnosis to be made of ASD?
there are 4 elements, and you must have 2 present to make the diagnosis
what is criterion B for ASD
restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following, currently or by history:
- STEREOTYPED or REPETITIVE MOTOR MOVEMENTS, use of objects, or speech
–(i.e simple motor stereotypies, lining up toys, flipping objects, echolalia, idiosynchratic phrases) - insistence on SAMENESS, inflexible ADHERENCE TO ROUTINES or RITUALIZED PATTERNS of verbal or nonverbal behaviour
–(i.e extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day) - highly RESTRICTED, FIXATED INTERESTS that are abnormal in intensity or focus
–(i.e strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests) - HYPER- or HYPOREACTIVITY to SENSORY INPUT or unusual interest in sensory aspects of the environment
–(i.e apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)
how do you specify severity in ASD
based on (1) social communication impairments and (2) restricted, repetitive patterns of behaviour
what is criterion C for ASD
symptoms must be present in early developmental period (but may not become fully manifest until social demands exceed limited capacities; may be masked by learned strategies later in life)
what is criterion D for ASD
symptoms cause clinically significant impairment in social, occupational or other important areas of CURRENT functionign
what is criterion E for ASD
not better explained by intellectual disability or global developmental delay
ID and ASD frequently co-occur –> to make both diagnoses, social communication should be below that expected for general developmental level
which DSM IV diagnoses should now fall under the dx of ASD?
those with a WELL ESTABLISHED dsm IV dx of:
autistic disorder
aspergers disorder
pervasive developmental disorder not otherwise specified
what are the specifiers in the diagnosis of ASD?
- with or without accompanying intellectual impairment
- with or without accompanying language impairment
- associated with a known medical or genetic condition or environmental factor
- associated with another neurodevelopmental, mental, or behaviour disorder
- with catatonia
how many severity levels are there for ASD
3
what do each of the severity levels indicate with regard to need for support
level 1–requiring support
level 2–requiring substantial support
level 3–requiring very substantial support
describe the deficits in social communication associated with ASD level 3
SEVERE deficits in verbal and nonverbal social communication skills
causes severe impairments in functioning, very limited initiation of social interactions, minimal response to social overtures from others
i.e a person with few words of intelligible speech who rarely initiates interaction and, when they do, makes unusual approaches to meet needs only and response only to very direct social approaches
describe the restricted, repetitive behaviors associated with ASD level 3
inflexibility of behaviour, EXTREME difficulty coping with change or other restricted/repetitive behaviours MARKEDLY interfere with functioning in ALL spheres
great distress/difficulty changing focus or action
describe the deficits in social communication associated with ASD level 2
MARKED deficits in verbal and nonverbal communication skills
social impairments evident even with supports in place
limited initiation of social interactions and reduced or abnormal responses to social overtures from others
ie. a person who speaks simple sentences, whose interaction is limited to narrow special interests and who has markedly odd nonverbal communication
describe the restricted, repetitive behaviours associated with ASD level 2
inflexibility of behaviour, difficulty coping with change, or other restricted/repetitive behaviours appear FREQUENTLY ENOUGH to be OBVIOUS to the casual observer and interfere with functioning in a VARIETY of contexts
distress and/or difficulty changing focus or attention
describe the deficits in social communication associated with ASD level 1
without supports in place, deficits in social communication cause noticeable impairments
difficulty initiating social interaction, and clear examples of atypical or unsuccessful responses to social overtures of others
may appear to have decreased interest in social interactions
ie. a person who is able to speak in full sentence and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful
describe the restricted, repetitive behaviours associated with ASD level 1
inflexibility of behaviour causes significant interference with functioning in ONE OR MORE contexts
difficulty switching between activities
problems of organization and planning hamper independence
what might need to be recorded diagnostically along with the diagnosis of ASD
record if the ASD is associated with a known medical/genetic/enviro factor or with another neurodevelopmental/mental/ behavioural disorder
i.e ASD associated with Rhett syndrome or ASD with/without accompanying intellectual impairment
how do you record severity in the chart
record as level of support needed for each of the two psychopathological domains (social communication and restricted/repetitive behavious)
note, the severity levels can be different for the two domains and recorded as such
with regard to recording diagnosis of ASD in the medical record, what are the 5 elements to consider
- whether the ASD accompanies a known medical/genetic/enviro factor or with another neurodevelopmental/mental/ behavioural disorder
- severity
- with/without accompanying intellectual impairment
- with/without accompanying language impairment (and severity of the language impairment)
- catatonia (recorded separately as catatonia associated with ASD)
how do receptive and expressive language domains develop differently in those with ASD
receptive language abilities may lag behind expressive language development in those with ASD
thus, they should be considered separately
what are some known genetic disorders associated with ASD
Rhett syndrome
Fragile X syndrome
Down Syndrome