DSM-V changes, PDD-NOS, Asperger's no more...

[jodifla]

Here are the proposed changes to the DX. Public comment is until April 20.

http://www.dsm5.org/Pages/default.aspx .

Autism Spectrum Disorder

Must meet criteria 1, 2, and 3:

1. Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following:

a. Marked deficits in nonverbal and verbal communication used for social interaction:

b. Lack of social reciprocity;

c. Failure to develop and maintain peer relationships appropriate to developmental level

2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following:

a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors

b. Excessive adherence to routines and ritualized patterns of behavior

c. Restricted, fixated interests

3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

 

[bookwormde]

I have been following this. It is certainly an improvment for DSM-iv but still lacks 2 of the 3 primary characteristics of autism genetics (EF and sensory differentials).

bookwormde

 

[preschoolmom]

I'm not sure I agree with this. I'll be very interested in how they are going to label the severity...

What about kids like my son, with a PDD-NOS diagnosis? He is definitely not Asperger's like, but he also didn't have a language delay before the age of 3.

??? I guess he'll be considered High Functioning Autism, but mild PDD-NOS seems to describe him better (IMO).

 

[deerhart]

I'm not sure I agree with this. I'll be very interested in how they are going to label the severity...

What about kids like my son, with a PDD-NOS diagnosis? He is definitely not Asperger's like, but he also didn't have a language delay before the age of 3.

??? I guess he'll be considered High Functioning Autism, but mild PDD-NOS seems to describe him better (IMO).

There is no severity issue with any autism spectrum disorder. By all definitions for all current categories, it is ALL severe. The terms of clinically significant and marked are all over the current DSM IV. These terms = severe. By definition there is no mild form of autism.

That is one thing that has really gotten out of control lately and could be one of the factors in combining all the disorders into one. The term spectrum does indicate that your going to have a lot of kids who are severe but at different levels. Some will just meet the severe label, others will go way beyond it.

As for the language delay, under the current DSM IV, a language delay for autism is described as not putting together 2 word sentences by age 3. By speech/language standards, this is the equivalent of over a 50% language delay

Also there is no medical definition of high functioning autism. I have seen this used to describe pdd-nos kids, kids with classical autism but normal intelligence, aspies, kids with classical autism who are verbal etc..

 

[jodifla]

There is no severity issue with any autism spectrum disorder. By all definitions for all current categories, it is ALL severe. The terms of clinically significant and marked are all over the current DSM IV. These terms = severe. By definition there is no mild form of autism.

That is one thing that has really gotten out of control lately and could be one of the factors in combining all the disorders into one. The term spectrum does indicate that your going to have a lot of kids who are severe but at different levels. Some will just meet the severe label, others will go way beyond it.

As for the language delay, under the current DSM IV, a language delay for autism is described as not putting together 2 word sentences by age 3. By speech/language standards, this is the equivalent of over a 50% language delay

Also there is no medical definition of high functioning autism. I have seen this used to describe pdd-nos kids, kids with classical autism but normal intelligence, aspies, kids with classical autism who are verbal etc..

Yeah, but when they added in the word "spectrum" in lay terms that seemed to translate to level of severity, too. Too many people don't follow the actual terms of the DSM-IV, so we have this autism "explosion."

It's interesting in the rationale area of the new DSM that they are moving away from language delay as a marker for autism. This will be great news for a lot of kids who have MERLD, not autism.

 

[deerhart]

Yes in lay terms a spectrum does indicate a different level in severity, but in medical terms that is not what it necessarily means.

Rather, its a recognition, that while severe, different kids will present differently AND that even within the same diagnostic criteria the presentation will not be the same. Some kids will head bang as their self stimulating behavior, others will twirl things, some may hand flap. All three are severe behaviors, but they aren't even in the same category of each other except they are self stimulating.

Yes it is VERY nice they are moving away from the speech delay. Way to many people get caught up on a young child (especially male) who has a speech delay automatically means the child is autistic!

I haven't read to much in the last 2 years on the updates on the DSM V, but I would suspect that part of the reason to mash all forms of autism into one category is their way of dealing with the terms high functioning autism and the "explosion" that has occurred in the diagnosis which seem to be based more on correlation/assumptions then the DSM IV.

I won't even get started on the rate of incidence numbers that are put out by the CDC and just how misleading those numbers can be (as my son, who is clearly NOT autistic, yet is still considered by the CDC as one of the 1 in 100 kids with autism *sigh*)

 

[deerhart]

It's interesting in the rationale area of the new DSM that they are moving away from language delay as a marker for autism. This will be great news for a lot of kids who have MERLD, not autism.

What's TRULY hilarious, in a shake your head and can't understand the stupidity of people who actual work with the DSM IV everyday, is that under the current DSM IV, a MERLD diagnosis specifically requires all ASD's to be ruled out.

Now I have a child with a MERLD diagnosis and DESPITE the MERLD diagnosis (from both a psych, slp, AND a neuropsych) we STILL had docs try to add an autism diagnosis. Until I pointed out that the two, per the DSM IV diagnostic criteria, are mutually exclusive! *shakes her head*

Oh there are days that I KNEW that I knew the DSM IV and the diagnostic criteria better then the doc we were dealing with.

 

[jodifla]

What's TRULY hilarious, in a shake your head and can't understand the stupidity of people who actual work with the DSM IV everyday, is that under the current DSM IV, a MERLD diagnosis specifically requires all ASD's to be ruled out.

Now I have a child with a MERLD diagnosis and DESPITE the MERLD diagnosis (from both a psych, slp, AND a neuropsych) we STILL had docs try to add an autism diagnosis. Until I pointed out that the two, per the DSM IV diagnostic criteria, are mutually exclusive! *shakes her head*

Oh there are days that I KNEW that I knew the DSM IV and the diagnostic criteria better then the doc we were dealing with.

I know. There's such SLOPPY assessing going on, it's unbelievable. I had a mom tell me that you could have both MERLD and Autism. Uh, no, that's not how it is set up.

 

[DisDreaminMom]

MERLD? Please translate....

 

[SueM in MN]

MERLD? Please translate....

Mixed-Receptive-Expressive Language Disorder
which may not mean a lot more than the initials.
Receptive Language is comprehension of language, listening and understanding what is communicated to you.

Expressive language is using language and communicating with others.

Here's a link with a very simple explanation.

 

[SueM in MN]

This doesn't really have a lot to do with the subject of this thread, but is an interesting article about autism that a friend posted on Facebook:

Rethinking Autism: Implications of Sensory and Movement Differences

Anne M. Donnellan
http://www.dsq-sds.org/article/view/1060/1225

 

[deerhart]

One can never understand the sensory stuff until one knows the reason behind it.

For example, my oldest was a classical parrot/echolalia child (still does to some extent). His short term auditory memory is atrocious when we had him tested (he held less then 50% of words in short term memory). Thus the echolalia is actually a compensation skill for him in order to keep the sentence in auditory memory over and over until he could properly process it.

There is lots of research going on regarding sensory things in both autism, adhd, etc.. I know with ADHD they are still testing the theory that hyperactivity stems from the body not producing enough dopamine and the hyperactivity, risk taking, and sensory stuff are all ways of forcing higher dopamine production in the brain. As stimulants mimic the effect of dopamine, this is one theory on why they are successful at treating ADHD.

Dopamine and its effects on people is pretty widespread. It is involved in both the feeling of pleasure, pain, and other emotions. It has some connection with how people get addicted to things as well. It plays some part in overly emotional responses.

The questions start to come up on whether the issue with dopamine is because there is a problem with the transmitters in the brain, there is a problem with the creation of dopamine in the body, or if the level of dopamine the individual person needs is set well below what they are making OR it is set why above what their body is naturally producing (studies have indicated that if you have way to much dopamine you get similiar behaviors as when you have too little). These are questions that we dont yet know the answers to or completely understand what is going on