Tuesday, December 10, 2013

Diagnostic Criteria for ASD (now officially including Asperger's)

Since many people are posting the new diagnostic criteria for Autism Spectrum Disorder online, we may as well get it right.  Every version I've found online is from the DRAFT criteria; you can tell because there are only categories A,B,C,D, missing the 5th area which relates to Intellectual Disability.  I've got the full criteria summarized below, with some wording about examples and about severity ratings left out.

I am posting these now because the parents of a child with probable Asperger's/ASD today asked for online resources, and I linked them to my list of websites, but along with inviting them to dive into all of those links, I thought I'd provide some concrete starter information:  the criteria used by mental health professionals to make the diagnosis (assuming they've updated their methods this summer to account for the change in criteria in May, the first change in criteria in 19 years).

DSM-5 Thinking about Autism:   
no more strict age rules or limits on dual diagnosis, 
no more requirement for cognitive disability or language impairment, 
and 2 General categories of symptoms:
A. Social Impairment: Persistent deficits in social communication and social interaction

B. RRBs:  Restricted, repetitive patterns of behavior. 

Autism Spectrum Disorder, DSM-5 Diagnostic Criteria
 Must meet criteria A, B, C, D, and E:
A. Persistent deficits in social communication and social interaction across contexts, as manifested by the following examples, currently or by history:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following illustrative examples, currently or by history:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior, (e.g. extreme distress at small changes, difficulty with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. 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 interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of 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 spinning objects).
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)
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E.  Symptoms are not better explained by Intellectual Disability or Global Developmental Delay.  √† To diagnose ASD with ID or GDD, social communication ability must be below that expected for the intellectual/developmental level.

In case I get accused of copyright violation (taking away DSM-5 sales by giving you this information, and selling it myself):  I'll say that I get no money from this blog, and also that I'm happy to plug the DSM-5, since there are many more resources related to autism spectrum disorders besides the criteria itself, including a new set of standards for describing 3 severity levels in the two main symptom areas, plus information about prevalence, differential diagnosis, and more.

I'll be publishing more explanations and examples about some of the terms and symptoms listed above, and about some more intuitive ways of understanding the mind of someone with ASD, and of course some ideas about what to do with these understandings to help reduce relationship, educational, emotional, occupational, and other problems related to ASD.  But for now, I hope the criteria are a start at correctly diagnosing and, more importantly, a start at understanding.

1 comment:

  1. I read this and a recent post by you on ASd diagnoses and seems to confirm every thing I have come to realize lately which is..

    If you are a high functioning adult and have successfully compensated with all your autism related issues, there actually is no reason to get an official diagnoses...

    So, i guess you can can now say, "Yes josh.. you have learned to read.."

    Of course, the aspie in me is very unsatisfied with such a non-concrete answer. :)


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