The Diagnostic & Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV, TR, 2006) is a clinical book that helps therapists, psychologists, doctors, and other mental health professionals (who are trained to diagnose clients) effectively diagnose clinically recognized disorders. The DSM-IV, TR defines Pervasive Developmental Disorders (PDDs) as disorders, "characterized by severe and pervasive impairment in several areas of development: reciprocal social interacion skills, communication skills, or the presence of stereotyped behavior, interests, and activities." Furthermore, the DSM-IV, TR notes that these impairments are "distinctly deviant for the individual's developmental level or mental age." In the case of children with PDDs, the child exhibits symptoms that are clinically considered abnormal compared to other children their actual age or mental age (meaning that diagnosticians have considered projected IQ and intellectual deficits if they are present). Different types of PDDs include: Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.
The following symptoms for Autistic Disorder are from the DSM-IV, TR (2006). At the time of this blog post, the DSM has released the 5th edition that includes modification to autism diagnostic criteria. I will address these changes in an upcoming blog.
*Notice that a specific number of criteria from specific letters must be identified to receive the diagnosis. **I have included my commentary behind the symptoms.
Autistic Disorder
I. A total of six (or more) items from heading (A), (B) and (C) with at least two from (A) and one each from (B) and (C):
(A) Qualitative impairment in social interaction as manifested by at least two of the following:
1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture and gestures to regulate social interaction.
**One of the more common types is poor eye contact. For a while Bradley would not make eye contact during with others he was communicating with or those communicating with him.
2. Failure to develop peer relationships appropriate to developmental level.
**This is tough for first time parents to recognize, because it's difficult to understand what the peer relationships norm is like if the child with autism is their first child to interact with.
3. A lack of spontaneous seeking to share enjoyment, interests or achievements with other people, (e.g. a lack of showing, bringing or pointing out objects of interest to other people).
**The child may not attempt to draw attention to exciting things or things that need attention.
4. A lack of social or emotional reciprocity.
**The child may not demonstrate or express feelings of love, frustration, embarrassment, confusion, or sadness and may not readily recognize these emotions in others.
(B) Qualitative impairments in communication as manifested by at least one of the following:
1. Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
**They are not effectively utilizing intelligible, expressive speech that is understandable to the lay person. This means that although Mom or Dad may understand some of their speech, the average person will not understand most of what the child is saying. In more severe cases of autism, speech may be completely absent, with no effort for expressive speech.
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
**This child may not initiate conversation with others or may not understand the dynamics of social conversation, like ending the communication abruptly.
3. Stereotyped and repetitive use of language or idiosyncratic language
**Ecolalia is one example- this is a repeating of language the child heard from a person, movie, or television show. This phrase may be repeated multiple times, could be repeated long after the timing of the initial hearing, and at times may appear to sound like meaningful language. For example, if a child repeats movie lines, sometimes adults may mistake that repetitive speech as an attempt to express needs. It may be fitting of the situation and seem appropriate, but at other times it may not make sense to the current situation.
Echolalia link: http://www.autism-help.org/communication-echolalia-autism.htm
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities as manifested by at least two of the following:
-Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
**The child may be limited in the type of toys they like to play with and may often appear "absorbed" in that particular area of play.
-Apparently inflexible adherence to specific nonfunctional routines or rituals
**Transitioning from a desired to a non-desired activity can be very difficult for this child when compared to others their age. Someone unaware of their autism diagnosis may unfairly and mistakingly label the child as a "spoiled brat, throwing a tantrum to get their way." The truth is, this child may not actually understand why the transition is occurring or the dynamics of waiting in line, taking turns, and group play.
-Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
**These behaviors may not seem extreme or abnormal in younger children, but if they continue it will be more apparent how they can interfere with learning or may become socially awkward among peers.
-Persistent preoccupation with parts of objects
**An example of this is being very interested in wheels and spinning. Rather than pushing a truck or car along a table or floor like age-appropriate play, the child repeatedly spins a wheel around and around and around. They are more interested in this aspect of the truck/car, rather than the intended function of the toy.
II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) Social interaction
(B) Language used in social communication
(C) Symbolic or imaginative play
My son, Bradley, received a PDD-NOS rather than an Autism diagnosis because his symptoms were subthreshold, meaning they were relatively mild compared to the Autism spectrum, but (left untreated) impair his social development and learning process. For more information about PDD-NOS check out this link:
http://www.autismspeaks.org/what-autism/pdd-nos
No comments:
Post a Comment