Autism Spectrum Disorder: DSM-5 Criteria and Treatment

Background and History of Autism Spectrum Disorder

The mental illness examined in this paper is Autism Spectrum Disorder (ASD), a condition generally first observed in children. ASD represents a brain dysfunction with the potential to affect the emotions, learning abilities, and memory of those diagnosed. It is considered a neurodevelopmental disorder because it tends to manifest gradually as an individual grows, making it most visible in early childhood. While adults are less commonly diagnosed, ASD can manifest in adulthood if it goes undetected and untreated during childhood. Intellectual developmental disorder, brain dysfunctions due to fetal alcohol spectrum disorder, and Down syndrome are all included within the autism spectrum. According to modern medicine and medical diagnosis, the spectrum also encompasses Autism and ADHD (aadmd.org, 2015).

Medical practitioners and researchers have sought to identify the root causes of autism, which they suggest may originate in the very early stages of brain development. Researchers note that the most obvious signs and symptoms of autism tend to emerge in individuals between the ages of 2 and 3 years, consistent with its nature as a brain developmental condition that becomes more prominent as an individual continues to grow. Medical practitioners and researchers agree that appropriate behavioral management measures can help achieve relatively normal development and reduce undesirable behaviors, even as they concede that there is no absolute cure for autism. Despite the associated dysfunctions, it is generally accepted that individuals affected by autism have a normal life expectancy.

DSM-5 Diagnostic Criteria for ASD

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) primarily provides diagnostic criteria for the social communication disorder (SCD) of patients with autism spectrum disorder (ASD). Psychologists and psychiatrists have used these criteria for diagnosis since May 2013, evaluating individuals to identify the extent of their developmental disorders ("DSM-5 Diagnostic Criteria").

The diagnostic criteria for ASD according to DSM-5 are as follows:

a) The following indications are manifestations of persistent difficulties in the use of verbal and nonverbal communication for social purposes:

1) Difficulty communicating for social purposes — such as greeting and sharing information — in ways that are unlike what is appropriate in a given social context.

2) Inability to adjust communication to match the context and the needs of the listener; for example, speaking differently in a classroom compared to on a playground (Barbaro and Dissanayake 64–86).

3) Inability to follow the rules of conversation and storytelling, such as rephrasing when misunderstood, and inappropriate use of verbal and nonverbal signals to regulate interaction.

4) Inability to make inferences and to understand what is implied.

b) The deficiencies described above result in limited functioning and affect communication, participation in society, social relationships, academic achievement, and job performance, individually or in combination.

c) Another indication for ASD diagnosis is the onset of symptoms in the early developmental period. Deficits, however, may only become fully apparent when social communication demands exceed the individual's limited capacities (Huerta et al. 1056–1064).

d) Such symptoms cannot be attributed to other medical or neurological conditions, or to decreased abilities related to word structure and grammar.

The severity of this condition can be diagnosed using DSM-5 by evaluating impairments in social communication and restricted or repetitive patterns of behavior.

Severity of ASD: Restricted and Repetitive Behaviors

Severity with respect to restricted or repetitive patterns of behavior, interests, or activities can be judged by the presence of at least two of the following, either currently or by history (Barbaro and Dissanayake 64–86):

1) Stereotyped or repetitive motor movements and use of objects, or repetitive and restricted speech — such as simple motor stereotypies, lining up toys, flipping objects, echolalia, and idiosyncratic phrases — can indicate and help diagnose severity.

2) Insistence on sameness, inflexible adherence to routines, or ritualized patterns in verbal or nonverbal behavior — such as extreme distress at small changes, difficulty with transitions, rigid thinking patterns, fixed greeting rituals, or the need to take the same route or eat the same food every day (Huerta et al. 1056–1064).

3) Highly restricted or fixated interests that appear abnormal in their intensity or focus — for example, a strong attachment to or preoccupation with unusual objects, or excessively circumscribed and perseverative interests.

4) Hyperreactivity or hyporeactivity to sensory input, or unusual interest in certain sensory aspects of the environment — for example, apparent indifference to pain or temperature, adverse reactions to specific sounds or textures, excessive smelling or touching of objects, or visual fascination with lights or movement (Gammer et al. 107–115).

According to DSM-5, symptoms must be present during the early developmental period to confirm the diagnosis and understand severity. The symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning. It must also be established that the disturbances are not better explained by intellectual disability or global developmental delay. Because intellectual disability and ASD frequently co-occur, DSM-5 recommends making comorbid diagnoses of both conditions. In such cases, social communication should be evaluated against what is expected for the individual's general developmental level (McPartland, Reichow, and Volkmar 368–383).

DSM-5 further notes that a diagnosis of ASD should be applied to patients who have received a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified. Additionally, DSM-5 specifies that individuals who show marked deficits in social communication but do not otherwise meet the full criteria for ASD should be evaluated for social (pragmatic) communication disorder.

Conclusion

The diagnosis of ASD according to DSM-5 and its approach to treatment closely coincide with each other. Both the diagnosis and the treatments involve behavioral aspects and therapies. A particularly notable feature of the DSM-5 approach is the importance it places on identifying the severity of the condition according to three levels of impairment, and tailoring treatment to the level diagnosed. This alignment between classification and care ensures that individuals with ASD receive interventions appropriately matched to their functional needs.

References

Barbaro, J. and C. Dissanayake. "Early Markers of Autism Spectrum Disorders in Infants and Toddlers Prospectively Identified in the Social Attention and Communication Study." Autism 17.1 (2012): 64–86. Web.

"DSM-5 Diagnostic Criteria." Autism Speaks. N.p., 2016. Web. 21 June 2016.

Gammer, Isobel et al. "Behavioural Markers for Autism in Infancy: Scores on the Autism Observational Scale for Infants in a Prospective Study of At-Risk Siblings." Infant Behavior and Development 38 (2015): 107–115. Web.

Huerta, Marisela et al. "Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children with DSM-IV Diagnoses of Pervasive Developmental Disorders." American Journal of Psychiatry 169.10 (2012): 1056–1064. Web.

McPartland, James C., Brian Reichow, and Fred R. Volkmar. "Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder." Journal of the American Academy of Child & Adolescent Psychiatry 51.4 (2012): 368–383. Web.

Rogers, Sally J. "What Are Infant Siblings Teaching Us About Autism in Infancy?" Autism Research 2.3 (2009): 125–137. Web.