Autism Spectrum Disorder DSM-5 299.00 (F84.0)
DSM-5 Category: Autism Spectrum Disorder
Introduction
Autism Spectrum Disorder is a developmental disorder in which the person affected exhibits impaired development in communication, interaction with others, and in
behavior (Dryden-Edwards, 2014). People suffering from this class of disorders may show a wide range of symptoms, deficits in skills, and levels of impairment
(National Institute of Mental Health, n.d.). Autism Spectrum Disorder is currently being diagnosed more frequently than ever. Some researchers suggest as many as 1 in 68 children in the United States may qualify for this diagnosis (Centers for Disease Control and Prevention, 2010). Four to five times more boys than girls qualify for the
diagnosis. There is disagreement among professionals as to whether this indicates more children actually having the diagnosis, whether the change in diagnostic guidelines has made a difference in reporting, or whether parents and professionals are more aware of the disorder.
Symptoms
There are two general areas in which symptoms are found. These are social impairment, especially communication, and behavior. In this latter area, repetitive
behaviors are most often seen.
The DSM-5 has specific symptoms listed in both of these areas (American Psychiatric Association, 2013). Social communication and interaction must occur across
several aspects of life. For example, inability to follow the course of normal back-and-forth conversation, limited sharing of interests, and failure to start or continue interactions with others. There may also be significant differences from the norm in eye contact and body language, use or understanding of gestures, and a complete lack of facial expression and nonverbal communication. Relationship difficulties including changing behavior to meet social context, problems engaging in imaginative play, or an absence of interest in peers.
Behavioral deficits may be shown as repetitive patterns of behavior, such as stereotyped motor movements or echoing the speech of others with no indication of meaning
or understanding of meaning of the words. Rigidity in routines is also seen, along with displays of frustration, anger, and possibly aggression if routines are changed. Strong preoccupation with objects may be seen. Over or under reactions to input from various senses.
Three levels of severity of these symptoms are also given. The lowest level, Level 1, is“requiring support”. Communication problems create obvious limitations in this
level. In addition, functioning across at least one life area is brought on by the person’s difficulty switching from one behavior to another or difficulty in planning and organization.
Level 2, “requiring substantial support”, indicates the person’s deficits in communication leads to very apparent impairments even with support in place. Behavioral difficulties at this level are apparent to everyone and interfere with functioning in many life areas.
Level 3, “requiring very substantial support”, indicates the person’s communication and behavioral difficulties make functioning very limited across all spheres of life.
Further requirements in the DSM-5 include the symptoms to be present in early developmental periods. These symptoms may not fully show themselves until demands on the person from social interactions are greater than the person’s limited abilities.
Onset
Autism Spectrum Disorder is a complex disorder that may not be accurately diagnosed until the child has exhibited some of the symptoms of the disorder for quite
some time. Parents often see the symptoms in their children but believe the child will catch up developmentally to peers. Many times, parents will see normal development in the first year of life, then begin seeing less normal development as the child ages. When there is normal development, it doesn’t extend beyond age 3 (Dryden-Edwards, 2014).
Early onset of the disorder is primary in diagnosing it. Some of the signs parents can look for include focusing on objects to the exclusion of most other things, little
eye contact, not engaging in play and babbling with parents. These signs may be seen even in the first year (NIMH, n.d.). Children who do develop normally for the first two or three years tend to begin losing interest in other people, in communicating, and may withdraw.
Diagnosis
Early diagnosis is critical to the efforts to lessen the impact of Autism Spectrum Disorder. A child with delayed or regressed language and/or social interaction prior to age 3 should be considered for the diagnosis of autism spectrum disorder (Dryden-Edwards, 2014). A complete medical history and physical exam begin the process of diagnosis. Formal hearing evaluation is recommended for language delayed children. Behavioral audiometry and the brainstem auditory evoked responses test are the types often used in diagnosing autism spectrum disorder.
The American Academy of Pediatrics recommends screening for autism spectrum disorder at 18 months and 24 months. These screenings will show practitioners the need for further, more specific evaluations.
A team of experts may be needed in order to ascertain the presence of autism spectrum disorder. A reliable diagnosis may be made with children as young as two years
of age (NIMH, n.d.). Because this disorder is a complex one, evaluation could include brain imaging, genetic testing, and in-depth evaluation of memory and language.
Differential Diagnosis
Because of the potential for misdiagnosis and the significant results in inappropriate treatment efforts should this occur, the criteria for diagnosing autism
spectrum disorder should be carefully followed. Early accurate diagnosis is invaluable for early interventions that can slow development of the disorder and possibly decrease the impact of the symptoms.
The Checklist for Autism in Toddlers (CHAT) has been developed for screening young children by pediatricians. Unfortunately, the cultural bias (Brasic, 2014)
makes its use outside the United Kingdom inappropriate. However, adaptations that overcome this bias have been developed. In any case, pediatricians can use items on the CHAT that predict development of autism in their well-baby checkups.
Cultural differences can have an impact on the diagnosis of autism spectrum disorder, also (Brasic, 2014). When English is not a family’s first language, practitioners must be aware of unique cultural factors that impact a child’s behavior and language. Translators may be necessary.
Some disorders that must be considered when diagnosing autism spectrum disorder are (DiBattisto, 2011): hearing impairment, Rett syndrome, developmental language
disorder, selective mutism, intellectual disability, complex motor tics, schizophrenia, and reactive attachment disorder.
Treatment
At this time, there are no medications that either cure autism spectrum disorder or effectively treat the core symptoms (Centers for Disease Control and Prevention, 2014). However, some medications are effective for helping these patients function better in some life areas. For example, to control high energy levels, to alleviate depression, to control seizures, and to regain ability to focus.
There appears to be evidence that early intervention with behavioral therapy in the preschool years can increase cognitive and language skills in children with autism spectrum disorder (NIMH, n.d.). Therapy to help children learn to talk, walk, and interact with others should be included in these early interventions (CDC, 2014).
Other types of early interventions include small classes that allow children one-on-one time with the therapist or teacher, special training for parents and family
members, providing a lot of structure, routine, and visual cues, and helping the child to maintain skills learned in a variety of situations and settings.
Other treatment approaches include modifying diets to improve vitamin and mineral intake and removing some types of foods from the child’s diet (CDC, 2014). This
approach does not have the research base to justify its use in all cases.
Behavioral approaches such as Discrete Trial Training (DTT) and Early Intensive Behavioral Intervention (EIBI) are also used. DTT teaches behaviors step-by-step with
positive reinforcement to reward correct answers. EIBI is used for very young children with autism spectrum disorder.
Developmental, Individual Differences, Relationship-based Approach (DIR or Floortime) is useful for helping caregivers focus on how the child deals with sights, sounds, and smells. In some cases, children with autism spectrum disorder have difficulty with sensory input.
Living With Autism Spectrum Disorder
Every person with autism spectrum disorder experiences it uniquely. The impact of the disorder on the individual, the family, and significant others is felt differently in nearly every case (Autism Initiatives, n.d.). But in every case, the family and significant others are affected as surely as the person with the diagnosis.
The needs of the person with autism spectrum disorder are very complex (CDC, 2014). This level of complexity brings with it a significant amount of stress on all who
are involved. This stress may manifest itself in emotional, financial or physical areas.
Basic healthcare is important for people with autism spectrum disorder. They are more susceptible to seizures and infections than the normal population (Dryden-Edwards, 2014). Also, they appear to be more vulnerable to nutritional problems due to variable appetite, refusal of some foods, and side effects of medications that affect the appetite. Respiratory problems are more likely to be experienced. Emotional issues such as anxiety, depression and attention problems are struggles for those diagnosed with autism spectrum disorder.
Working to understand, accept, and prepare for the difficulties of caring for and living with an Autism Spectrum Disorder. But for many, there still is a lack of understanding of what living with the disorder really means.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Autism Initiatives. (n.d.) Living with autism spectrum condition. Retrieved from http://www.autisminitiatives.org/about-autism/what-is-autism/living-with-autism.aspx.
Brasic, J.R. (2014). Autism differential diagnoses. Retrieved from http://emedicine.medscape.com/article/912781-differential.
Centers for Disease Control and Prevention. (2014). Treatment. Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html.
Centers for Disease Control and Prevention. (2014). Living with ASD. Retrieved from http://www.cdc.gov/ncbddd/autism/living.html.
DiBattisto, C. (2011). Autism spectrum disorder: differential diagnosis. Retrieved from http://www.medmerits.com/index.php/article/autistic_disorders/P8.
Dryden-Edwards, R. (2014). Autism spectrum disorder (in children and adults). Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=80415&pf=2.
National Institute of Mental Health. (n.d.). Autism Spectrum Disorder. Retrieved from http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-ask/index.shtml.
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