dsm 5 the diagnostic criteria for autistic spectrum …...dsm iv tr 2 impair in social interaction 1...

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DSM 5

Suwannee Putthisri, M.D.Department of Psychiatry

DSM 5

• DSM-I(1952) DSM-II(1968)Schizophrenic reaction ( childhood type)

• DSM-III(1980)Pervasive developmental disorder(PDD)

Childhood onset PDD, Infantile autism, Atypical autism

• DSM-III-R(1987)Pervasive developmental disorder(PDD)

PDD-NOS, Autistic disorder

• DSM-IV(1994)Pervasive developmental disorder(PDD), PDD-NOS, Autistic disorder,

Asperger’s syndrome, childhood disintegrative disorder, Rett’s syndrome

• DSM-IV-TR(2000)Same diagnosis

Pervasive Developmental Disorder

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DSM-IV-TR

2 Impair social interaction

1 Impair communication

1 Stereotype Behavior

Sensitivity

• Measure a test’s ability to find those

patients with a disease

• Find true positive

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Specificity• Measure a test’s ability to find those

patients without a disease

• Find true negative

DSM IV TR

2 Impair in social interaction

1 Impair in communication

1 Stereotype Behavior

DSM 5 simplicity

DSM -IV-TR

• 2,027 different combinations

DSM 5

• วยรนชายอาย 13 ป ชอบเขาหาเพอนผหญง ท าหนาตากรมกรม ชวนใหเปนแฟน บางครงขอเขาไปกอด ไมไดท าเพราะมความตองการทางเพศแตแครสกอยากอยใกลเพอนผหญง ไมมเพอนสนท แตมเพอนในเกม online พดมาก พดไมถกกาลเทศะ ไมเขาใจวาท าไมเพอนรงเกยจ

• พดคยกบพอแมได มแยกตวบอยๆ และไมคอยเขาใจเวลาพอแหย

ผลการเรยนดมาก แตครจะใหพกการเรยนเพราะผปกครองคนอนกลว กจวตรประจ าวนท าไดปกต

• ไมมเพอนมาตงแตเดก หมกมนกบเรองรถ

พดไดเปนค าทมความหมาย อายเกอบ 2 ขวบ

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Neurodevelopmental Disorders

• Intellectual Disabilities

• Communication Disorders

• Autism Spectrum Disorder

• Attention-Deficit/Hyperactivity Disorder

• Specific Learning Disorder

• Motor Disorders

Autism Spectrum Disorder 299.00 (F84.0)

• A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history :

• 1. Deficits in social-emotional reciprocity,

• 2. Deficits in nonverbal communicative behaviors used for social interaction.

• 3. Deficits in developing, maintaining, and understanding relationships.

• B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history

• 1. Stereotyped or repetitive motor movements, use of objects, or speech

• 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior

• 3. Highly restricted, fixated interests that are abnormal in intensity or focus

• 4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment


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. These disturbances are not better explained by intellectual disability

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• A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history :

• 1. Deficits in social-emotional reciprocity,

• 2. Deficits in nonverbal communicative behaviors used for social interaction.

• 3. Deficits in developing, maintaining, and understanding relationships.

• B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history

• 1. Stereotyped or repetitive motor movements, use of objects, or speech

• 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior

• 3. Highly restricted, fixated interests that are abnormal in intensity or focus

• 4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment

DSM 5 simplicity

DSM -IV-TR

• 2,027 different combinations

DSM 5

• 11 different combinations

Specificity vs Sensitivity

DSM-IV-TR DSM-5

sensitivity 0.95 0.81

specificity 0.86 0.97

•14,744 siblings from the interactive autism network

• “ superior specificity”• at risk for false negative: female, Asperger’s disorder

Frazier et al, JAACAP,Jan2012;51(1):28-40

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Specify if:

• With or without accompanying intellectual impairment

• With or without accompanying language impairment

• Associated with a known medical or genetic condition or environmental factor

• Associated with another neurodevelopmental, mental, or behavioral disorder

• With catatonia

Singer diagnosis

Reevaluate

•ASD

5-2013)

ASD c CDD ASD •ASD•SCD

ASD c Rett’sdisorder

Autistic Spectrum Disorder

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• Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for ……..

.. social (pragmatic) communication disorder.

Social (pragmatic) Communication Disorder

Neurodevelopmental Disorders

• Intellectual Disabilities

• Communication Disorders

• Autism Spectrum Disorder

• Attention-Deficit/Hyperactivity Disorder

• Specific Learning Disorder

• Motor Disorders

Social/Communication Disorder

A. Persistent difficulty in the social use of verbal and non verbal communication as manifested by all of the following:

1. Deficit in using communication for social purpose

2. Impairment of the ability to change communication to match context or the needs of the listener

3. Difficulties following rules for conversation and storytelling

4. Difficulties understanding what is not explicitly states and nonliteral or ambiguous meanings of language

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Social/Communication Disorder

B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination

C. The onset of symptom is in the early developmental period

D. The symptom is not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by ASD , intellectual disability, global developmental delay, or another mental disorder

DSM 5 Neurodevelopmental DisordersWork group (2007-2013)

• Gillard Baird• Ed Cook• Francesca Happe• James Harris• Walter Kaufmann• Bryan King• Catherine Lord• Joseph Piven• Rosemarry Tannock• Sally Rogers• Sarah Spence• Susan Swedo• Fred Volkmar• Amy Wetherby

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Pros of DSM 5

• Improved specificity

• Dimensional approach

• Measures of severity

• Increased homogeneity

Cons of DSM 5

• Decreased sensitivity

• Compatibility with prior research subtypes

• Fit with ICD -11

Summery

• Singer diagnosis

• ASD diagnosis bases on 2 areas

• Sensory integration

• Symptom from early childhood

• Severity ranking

• Associated disorders

• Social /Communication Disorder

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Implication

who already has diagnosis who waiting for diagnosis

Labeling won’t cure my autism understanding might

dsm 5 the diagnostic criteria for autistic spectrum …...dsm iv tr 2 impair in social interaction 1...

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