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Autism Spectrum Disorder  DSM –V Diagnosis
 
Autism Spectrum Disorders are significant and complex neurodevelopmental disorders impacting on reciprocal relationships which are usually evident and diagnosed by early childhood or adolescence.  Difficulties in practical verbal and nonverbal social communication, repetitive or stereotyped interests and mannerisms are common manifestations of the disorders. Delays in developmental milestones, escpecially for communication are often evident.   For a discussion of the origins of the diagnosis of autism, theories about causes of Autism Disorders, DSM-IV criteria and assessment see this article from our neuropsycholgycentral.com website: Autism Etiology and Assessment.
 
autism brainDSM-V, the official, though controversial, Diagnostic and Statistical Manual published by the American Psychiatric Association will be adopted before mid-2013.  One of the major changes has been how it classifies a group of disorders which usually manifest in childhood and adolescence.  Autism Spectrum Disorder now encompasses former DSM-IV distinct categories of “classic” Autism, Asperger’s Disorder, a rather loosely formulated disorder referred to as Pervasive Development Disorder (PDD), and Childhood Disintegrative Disorder. 
 
Some major changes in exclusionary criterion involve removal of much of the references to language delays or disorders.  Though there have been some concerns as to whether or not criteria will include or exclude more children, which does have important implications for healthcare coverage and accommodations, DSM-V incorporates emerging research and conceptual trends which view these childhood disorders as a range, or spectrum of disorders, of varying severity.  The more specific criteria most likely will exclude some children previously diagnosed in the rather loosely-defined “wastebasket” term of Pervasive Developmental Disorder and it may have further benefit of preventing some children with Attention-deficit Hyperactivity Disorder, who typically have milder social skill deficits from being misdiagnosed or “over-diagnosed” as suffering an Autism Spectrum Disorder.
 
While the labels or conceptualization as a continuum is rather new, what remains true is that these are complex neurodevelopmental neuropsychiatric disorders which many pediatric neurologist, child psychiatrists and pediatric neuropsychologists have quite a bit of experience with.  Pediatric neuropsychological assessment or evaluation of such children should address issues of ruling out general developmental delays, assessing language functioning, general intelligence, specific learning disabilities, ruling out co-morbid psychiatric conditions, and assessing nonverbal as well as verbal communications skills.  Such evaluation may assess ability to recognize emotion in facial expression, tone of voice, and level of interest in reciprocal social interaction.   Assessment of sensory-perceptual integration skills, fine and gross motor skills, attention, memory and executive functions will help with differential diagnosis, determine level of disability and guide treatment or Individualized Educational Plans (IEP).
 
The shift from DSM-IV to DSM-V also reflects recognition that for some children, the deficits in reciprocal social interaction may not manifest until expectations for social roles, demands and interactions exceed limited capacities.  The DSM-V emphasis on the limitation and impairment of everyday activities also suggests emphasis on a more empirical assessment of adaptive behavior.
 
While final publication of DSM-V is pending, drafts of the final criteria suggest the following changes:
 
All common symptom clusters must be met for Autism Spectrum Disorder.  This includes persistent deficits and social interaction across contexts including 1) deficits in social-emotional reciprocity. 2. Deficits in nonverbal communicative behaviors; and 3. Deficits in developing and maintaining relationships.  Children must demonstrate restricted and repetitive patterns of behavior, interests or activities.  Symptoms must be present in early childhood.  Symptoms must also together limit and impair everyday activity.
 
While we await final publication of DSM-V in May 2013, the needs for comprehensive pediatric neurological and pediatric neuropsychological assessment of these complex children, adolescents and adults will remain.  Children, adolescent and adults who suffer from a mild to severe spectrum of disorder can vary quite a bit on some specific areas of functioning including general  intelligence, attentional deficits, ability to recognize emotional tone or affect from speech or visual cues, sensory-motor integration, processing and learning styles, expressive and receptive language skills, motor functioning, and executive function skills.  Getting the overall picture of this complex disorder by comprehensively assessing the unique needs of a specific child is often critical in guiding educational and treatment planning.
 
Issues of severity and general adaptive functioning may play a critical role in diagnostic inclusion with implications for disability determinations, educational determination and accommodations, and individual needs for treatment and therapies. 
The Florida Department of Education defines Autism Spectrum Disorder in the following manner: "Autism Spectrum Disorder is defined to be a range of pervasive developmental disorders that adversely affects a student's functioning and results in the need for specially designed instruction and related services. Autism Spectrum Disorder is characterized by an uneven developmental profile and a pattern of qualitative impairments in social interaction, communication, and the presence of restricted repetitive, and/or stereotyped patterns of behavior, interests, or activities. These characteristics may manifest in a variety of combinations and range from mild to severe. Autism Spectrum Disorder may include Autistic Disorder, Pervasive Developmental Disorder Not Otherwise Specified, Asperger’s Disorder, or other related pervasive developmental disorders. The corresponding definition is found in State Board of Education Rule 6A-6.03023, F.A.C."
RESOURCES:
 
Clinical Psychology Associates of North Central Florida offers more than 20 years of experience in conducting complex pediatric neuropsychological assessment of children, adolescents and adults with autism spectrum disorder, ADHD, learning disorders, brain injuries and developmental pediatric neurological disorders.  We offer assessments in our Gainesville and Ocala, Florida offices.  (352) 336-2888  info@cpancf.com
Florida Centers for Autism Related Disorders (CARD) is a regional list of Universities provide individuals with Autism or related disabilities, their families, and professionals who work with them, free consultation, resources, and educational support to build knowledge, confidence, infrastructure, and sustainability within the community
 
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Clinical Psychology Associates of North Central Florida
2121 NW 40th Terrace Suite B  Gainesville, FL 32605
(352) 336-2888                                                                      
 

 
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