Sunday, January 22, 2012

New DSM-V criteria for Autism Spectrum Disorder

DSM-V Criteria for Autism Spectrum Disorder

So, much has been floating around the internet about the new DSM-V criteria that will be lumping all autism-related diagnoses into one category "Autism Spectrum Disorder".

the criteria is as listed below, directly quoted from the link above...

Autism Spectrum Disorder
Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
   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:
   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. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as 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; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). 
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) 
D. Symptoms together limit and impair everyday functioning.

Fortunately, or maybe not, Ashton still falls well within the guidelines set forth. He's very classically autistic, though he's fairly high-functioning. But, upon reading this, it sounds like a subset of Autism (now known as Asperger's and/or PDD-NOS) will no longer full under the Autism Spectrum Disorder, and in fact, be cured! Imagine that, curing an entire population, just by changing the criteria needed for a diagnosis. The rates of Autism will dramatically shift and children who are now labelled as Aspergers will go back to being just bad kids who need more discipline. Those are not my thoughts.

Then, I read this quote from Ashton and Holden's doctor, Dr. Eric Madren, on Facebook:

"Here's the main problem with the proposed re-definition of autism in DSM-V: autism shouldn't even be in DSM-V. This is the diagnostic manual used by psychiatrists to define psychiatric disorders. Autism is not a psychiatric disorder. It is a systemic disorder that affects the brain as well as other organ systems including the gastrointestinal system and the immune system. Don't take my word for it. Ask Dr. Martha Herbert, pediatric neurologist at Harvard and Mass General. Defining autism according to criteria established by psychiatrists is nothing more than a historical relic. Psychiatrists are infrequently involved in the evaluation and treatment of individuals with autism, unless of course that individual has a co-existing psychiatric disorder. Much more often, the evaluation and treatment of individuals with autism is managed by neurologists, developmental pediatricians, and yes, primary care physicians. We should be the ones who establish the diagnostic criteria, not the American Psychiatric Association."
And I thought to myself, YES - he's absolutely and completely correct.  Why is a psychiatric association coming up with the diagnostic criteria for a neurological disorder? Why are the doctors who actually treat these patients not allowed to at least have some input on the criteria? Many times, these children and adults with autism spectrum disorders are never even seen by psychiatrists or psychologists, unless another disorder is manifesting itself along with the Autism. Many of these individuals have other body system symptoms that play a part in their autistic symptoms (whether it be gastrointestinal, immune system, sensory, etc).

So much has been posted about this, as this article points out...

So... my thoughts are this:

1. I do think in some cases, autism may be over-diagnosed. Some kids are so mildly autistic that they require no extra medical attention, no extra help in school and no outside help from parents, therapists, and don't require medication. Are these kids truly autistic? I don't know, but it does make me wonder, when I see so many children struggling and these others, who really truly do not have any struggles at all. I've also seen kids who were diagnosed when very young and seem to "grow out of it". This is not typical autism in my mind, it's a kid who may have been behind developmentally (behind the curve so to speak) and just caught up. There have always been kids like this, but I don't think they are truly on the spectrum.

2. With the above thought though, I do realize and know of many children who are not receiving the beneficial treatments, therapies and medication that could help them, because the diagnostic procedure has been very subjective over the years. One day they may seem mostly (or completely) typical and another they can seem very classically autistic. Insurance companies refusing to pay for beneficial treatment, doctors who refuse to diagnose, and parents who live in denial are all factors here.

3. I truly believe autism is on the rise. Changing the criteria for it isn't going to change that, but will only make it more difficult for families and medical professionals to assure that children and adults being diagnosed, are getting the help that they need to live in a society that is not meant for them.

4. No matter what anybody says, we need a consistent diagnostic criteria to identify all individuals with autism. Something that is precise and understood clearly, by everyone. Autism is not going to go away, and the parents and families of these individuals will not either.

Here's a petition to sign if you feel the changes are not in the best interest of the individuals it's supposed to help..... Maintain the current definition of Autism