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Using the Diagnostic Statistical Manual of Mental Disease in the Diagnosis of Autism Spectrum Disorder PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Using the Diagnostic Statistical Manual of Mental Disease in the Diagnosis of Autism Spectrum Disorder" by Richard E. Frye, M.D., PhD.
This medical PowerPoint presentation talks about Using the Diagnostic Statistical Manual of Mental Disease in the Diagnosis of Autism Spectrum Disorder.
The Diagnostic Statistical Manual of Mental Disorders (DSM) is a standard reference used by mental health professionals to diagnose and classify mental disorders. The fifth edition of the DSM (DSM-5) provides specific criteria for the diagnosis of Autism Spectrum Disorder (ASD).
To diagnose ASD, the DSM-5 requires that an individual must exhibit persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. Additionally, these symptoms must be present in early childhood, but may not become fully manifest until social demands exceed the individuals limited capacities.
The DSM-5 also includes severity levels for ASD based on the degree of support an individual requires for their symptoms. Severity levels are determined by the amount of support an individual needs in the areas of social communication, social interaction, and restricted, repetitive behaviors.
It is important to note that a diagnosis of ASD should not be made based solely on the DSM-5 criteria. A comprehensive evaluation, including developmental history, clinical observation, and other assessment tools, should be used to confirm the diagnosis of ASD.
Furthermore, it is important to remember that the DSM-5 is just one tool used to diagnose and classify mental disorders. Mental health professionals should also consider an individuals unique strengths, challenges, and cultural context when making a diagnosis of ASD or any other mental disorder.

Tags : Mental Disease, Diagnosis of Autism Spectrum Disorder, Diagnostic Statistical Manual of Mental Disorders, DSM, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 1184 | Downloads : 1

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Using the Diagnostic Statistical Manual of Mental Disease in the Diagnosis of Autism Spectrum Disorder Richard E. Frye, M.D., Ph.D. Chief, Section on Neurodevelopment Disorders Director, Autism and Fragile X Programs Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix AZ Professor of Child Health University of Arizona College of Medicine, Phoenix AR
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Disclosures None
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“Autism” termed Derived from Freud’s ‘autoerotism’ hallucinatory thinking with self-soothing which preceded the infant’s engagement with external reality Bleuler described as “thinking…no longer bound by the rules of logic” Book: Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior Founder Autism Research Institute Autism Society of America Book: The Empty Fortress: Infantile Autism and the Birth of the Self Refrigerator mothers theory Traumatized unloved child retreated into autism
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Early Abnormalities in Development Related to Autism Spectrum Disorder
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Typical Child Development Motor Cephalocaudal, proximo-distal Not typically major delays with ASD Language Receptive and Expressive Receptive good “window” into cognitive
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Pointing Starts Around 8-10 Months Majority of Gestures at 12 Months Other Protodeclarative Gestures Showing Giving:
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Play Skill Development is a Excellent Sign of Typical Development. More advanced play such as representational and symbolic play are deficient in autism.
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Retrospective Videotape Analysis of First Birthday Landmark study in 1994 by Osterling and Dawson Decrease in four behaviors differentiated 10 of 11 ASD children from 11 normally developing children Pointing Showing objects Looking at Other People Orienting to Name Osterling 2002 compared Autism vs Intellectual Disability vs Typically Developing Only Autism vs Typical Looked at Other People Less Oriented to their Names Less Autism and/or Intellectual Disability vs Typical Used Gestures Less Looked at Objects Held by Other People Less Engaged in Repetitive Motor Movements More
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Retrospective Parental Questionnaires Vostanis et al (1998) Compared ASD vs Learning Disabilities vs Language Disorders Questionnaire about behaviors at 12 to 18 months of age ASD children more problems with social attention and communication Imitation Pointing at objects Playing Peek-a-boo Seeking and enjoying cuddling Checking for parents Interest in other children Waving bye-bye without being asked
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Retrospective Parental Questionnaires Early Development Interview (2006) Structured Interview regarding development between birth and 2 years of age ASD compared to Developmental Delay vs Typical More Social Deficits than Typically Developing at 3-6 months More Social Deficits than Developmental Delayed at 13-15 months Poor Eye Contact Reduced Orienting to Name Decreased Joint Attention Decreased Social Interactions
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Retrospective Parental Questionnaires First Year Inventory (2003) Questionnaire focusing on development before 12 months ASD compared to Developmental Delay vs Typical ASD vs Developmental Delay Responding to Name Following someone pointing Social orientation Social Smiling Playing Peek-a-boo Demanding attention ASD and Developmental Delay vs Typically Developing Imitation Expressive Communication Repetitive Behaviors
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Early Abnormalities in Cognitive Development in Autism Spectrum Disorder
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Landa and Garrett-Mayer (2006) Assessed 87 Infants at 6, 14 and 24 Months using the Mullen Scales of Early Learning Gross and Fine Motor Development Visual reception Receptive and Expressive Language Typically Developing, Language Delayed and ASD 6 Months: No Difference Between Groups 14 Months: ASD was worse than Typically Developing Gross and Fine Motor Development Receptive and Expressive Language 24 Months: ASD worse than Typically Developing All Areas 24 Months: ASD worse than Language Delayed Gross and Fine Motor Development Receptive Language
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Early Abnormalities in Visual Attention In Autism Spectrum Disorder
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Upright Inverted Point-Light Animation
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Movie of a Familiar Caregiver Autism, 15 Months Typical, 15 Months Typical, 9 Months
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ASD, 6 Months Typical, 6 Months Fixation on Eyes in Movie
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The Diagnosis Criteria:The Diagnostic StatisticalManual of Mental Disorders
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DSM IV Criteria: Pervasive Developmental Disorders Autistic Disorder Asperger’s Disorder Rett’s Disorder Childhood Disintegrative Disorder Pervasive Developmental Disorder Not Otherwise Specified
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DSM-IV-TR
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DSM IV Criteria: Autistic Disorder CORE SYMPTOM DOMAINS 1) Impairment in Social Interaction 2) Impairment in Communication 3) Restricted repetitive patterns of behavior, interests, and activities Leo Kanner
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Autistic Disorder Symptom criteria met before the age of 3 years Boys:Girls = 4:1 75% have comorbid intellectual disability Nearly 30-50% never develop functional verbal communication 33% eventually develop seizure disorder
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Age of Onset Autistic Disorder and Pervasive Development Disorder By Definition (DSM-IV/ICD-10) – Before 36 Months – Three patterns 33% Regression from normal development Usually Between 12 and 24 months 33% Symptoms from Early Infancy 33% Symptoms obvious after 1 year old – developmental plateau Onset after 36 months – other diagnosis Regression after 36 months Childhood Disintegrative Disorder Asperger’s Syndrome No Age Criteria for diagnosis Typically not diagnosed until later childhood because less obvious when language development is normal.
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DSM IV Criteria: Asperger’s Disorder Impairment in Social Interaction Restricted repetitive patterns of behavior, interests, and activities No clinically significant delay in language No clinically significant delay in cognitive development “All-encompassing” preoccupation Hans Asperger
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Rett’s Syndrome Females Deceleration of head growth Stereotyped hand movements Loss of purposeful hand skills Loss of social engagement Severe language disorder Severe to profound intellectual disability Andreas Rett
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Childhood Disintegrative Disorder Normal Development for ≥ 2 years Significant loss of previously acquired skills (before age 10 years) Abnormalities in 2 of 3 areas: - Social - Communication - Repetitive behavior
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DSM IV Criteria: PDD NOS Presentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.
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DSM-IV-TR Autistic Disorder DSM-5 Autism Spectrum Disorder CORE SYMPTOM DOMAINS 1) Impairment in Social Interaction 2) Impairment in Communication 3) Restricted repetitive patterns of behavior, interests, and activities CORE SYMPTOM DOMAINS 1) Impairment in Social Communication and Interaction (all 3) a) Deficits in reciprocity b) Deficits in nonverbal communication c) Difficulties in relationships 2) Restricted repetitive patterns of behavior, interests, and activities a) Stereotyped/repetitive movements, play, speech b) Insistence on sameness c) Restricted, fixed interests d) Hyper/hyporeactivity to stimuli
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A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by ALL of the following Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 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. 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.
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B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least TWO of the following: Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). Insistence on sameness, inflexible adherence to routines, or ritualized patterns of 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). 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). 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).
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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. – NO SPECIFIC AGE D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. –Functional Impairment E. These disturbances are not better explained by: 1) Intellectual disability Can co-occur but social communication should be below that expected for developmental level. 2) global developmental delay.
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Need to Specify: With or without accompanying intellectual impairment With or without accompanying language impairment (Coding note: Use additional code to identify the associated medical or genetic condition.) Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].) With catatonia Associated with a known medical or genetic condition or environmental factor
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Level 1 "Requiring support” Social-Communication Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Restricted, repetitive behaviors Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning.
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Level 2 "Requiring substantial support” Social-Communication Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication. Restricted, repetitive behaviors Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors 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 action.
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Level 3 "Requiring very substantial support” Social-Communication Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches Restricted, repetitive behaviors Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
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Major Diagnostic Changes 1) PDD NOS, Autistic Disorder and Asperger’s Disorder are all combined into one disorder Autism Spectrum Disorder 2) Impairment in verbal communication is no longer a diagnostic criterion 3) A new diagnostic criterion is the presence of hyper or hyporeactivity to sensory stimuli or unusual sensory interest 4) No Specific age of onset is defined, simply symptoms need to be present in early developmental period
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Major Diagnostic Changes 5) ASD has mild, moderate, severe modifier depending on support needed for each core symptom domain 6) Functional impairment needs to be considered and documented 7) Attention-Deficit Hyperactivity Disorder can Co-Occur
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Social (Pragmatic) Communication Disorder Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
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Social (Pragmatic) Communication Disorder B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.
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ICD-10: F84: Pervasive Developmental Disorders F84.0: Childhood autism (< 3 years of age; DSM-IV-TR Autistic Disorder) Autistic disorder, Infantile Autism, Infantile Psychosis, Kanner syndrome F84.1: Atypical autism (> 3 years of age; DSM-IV-TR PDD-NOS) Atypical childhood psychosis, Mental retardation with autistic features F84.2: Rett syndrome F84.3: Other childhood disintegrative disorder Dementia infantilis, Disintegrative psychosis, Heller syndrome F84.4: Overactive disorder associated with mental retardation and stereotyped movements F84.5: Asperger syndrome Autistic psychopathy, Schizoid disorder of childhood F84.8: Other pervasive developmental disorders F84.9: Pervasive developmental disorder, unspecified
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Leucovorin for social communication in young children diagnosed with ASD 26-week long clinical trial investigating the relationship between liquid leucovorin and social communication in children with ASD. Opportunity for neuroimaging with Magnetoencephalography (MEG)* * Not required Eligibility: Children 2.5-5.5 years old Diagnosed with ASD Minimum of 10 hours of behavioral therapy per week Not Diagnosed with epilepsy, genetic syndromes or severe prematurity Known FRAA Status If interested, please contact Sallie McLees at smclees@phoenixchildrens.com or (602) 933-0964
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Leucovorin to develop language for children diagnosed with ASD 26-week long clinical trial investigating the relationship between leucovorin calcium and language impairment in children with ASD Eligibility: Children 5.5-12.5 years old Diagnosed with ASD Moderate Language Delay Not Diagnosed with epilepsy, genetic syndromes or severe prematurity Mental age of at least 18 months If interested, please contact Sallie McLees at smclees@phoenixchildrens.com or (602) 933-0964
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TENS Treatment on anxiety and sleep in high functioning ASD One week long study investigating whether high frequency transdermal neuromodulation can decrease anxiety symptoms and improve sleep in adolescents and young adults with high functioning ASD. Eligibility: 10-25 years of age Official diagnosis of ASD Self reported and observed complaints of anxiety and/or sleep disorders High functioning – able to do simple addition, image search and memory tasks Stable medications for at least 3 months If interested, please contact Amanda Jensen at ajensen1@pheonixchildrens.com or (602) 933-2979
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Questions?