A second look at the signs of autism (Last part)

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Wednesday, December 4, 2013


ACCORDING to Dr. Alexis Reyes, a developmental pediatrician and resource speaker during the 13th Annual Autism Conference held in Manila in October 2013, four criteria under the DSM V must be met before an individual may be diagnosed as having autism spectrum disorder.

These are: Criterion A: Persistent deficits in social communication and social interaction; Criterion B: Restricted, repetitive patterns of behavior; Criterion C: Symptoms must be present in early childhood; and Criterion D: Symptoms together impair and limit everyday functioning.

One might say that these criteria tend to become obvious or can be observed only at around age three and onwards. Sometimes, the parents may already observe speech delay as early as two years old, but some would say that it is normal in boys to talk a little later than girls. There are early warning signs for parents to take note during the first 12 months of the child.

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For example, try to observe if the child does not look much at people’s faces, especially when being talked to. Some young children are not interested in social games and show little affection. Or the child may not like being touched and is happy to be left alone. The child may also have poor response to his own name.

After 12 months, early warning signs of autism spectrum disorder include: abnormal eye contact, limited pleasure in games, poor play skills, poor response to name, does not respond to gestures, takes hand of parent to get object, emits unusual sounds and hand/finger mannerism.

During diagnosis, which usually takes place when the child is around three years old, the development pediatrician usually asks the parents if the child exhibited these signs during early childhood.

Another key difference between the DSM IV and the DSM V criteria for autism is the shift from categorical to dimensional method of diagnosis. Before, there were distinctions between individuals with autism, Asperger’s syndrome and pervasive developmental disorders-not otherwise specified (PDD-NOS).

Under the DSM V criteria, all these clinical distinctions were grouped into just one diagnosis called autism spectrum disorder or ASD. Attention deficit/hyperactivity disorder (ADHD) can now be diagnosed with ASD.

For individuals who have marked deficits in social communication but whose symptoms do not otherwise meet criteria for autism spectrum disorder, they should be evaluated for social (pragmatic) communication disorder.

It is important to note that all individuals who currently have a diagnosis as having autism, including those with Asperger syndrome or PDD-NOS using the DSM IV, do not need re-evaluation under the DSM V.

Lastly, the DSM V already indicates the severity level of an individual’s autism spectrum disorder. Level 1 is for individuals who are highly functional and require minimal support. Level 2 is for individuals with marked deficits in social communications and obvious restricted interests and behavior that require substantial support. Level 3 is for individuals who have minimal social communication and marked interference in daily life and who require very substantial support.

Dr. Reyes also clarified on the debate on the prevalence of autism spectrum disorder. The Centers for Disease Control and Prevention USA (2012) indicates a prevalence ratio of 1:88; the UK National Neuropsychiatry Screen (2011) indicates 1:100 and the Autism Speaks South Korea (2011) indicates 1:38. Accordingly, these prevalence ratios are all correct considering the geographical areas where the studies or surveys were conducted.

A final thought was imparted by Dr. Reyes. For more than 70 years, the criteria for diagnosis of autism have evolved and have been changed through time. The terminologies, concepts and descriptions have been modified. Even the name of the disorder has been reworded several times.

But from 1943 to 2013, photos of mothers and fathers hugging their child with autism spectrum disorder depict the same genuine love and care through time. Pictures of families supporting each other and of professionals working as teams have remained the same. The mystery of autism still affects hundreds of individuals all over the world, but it has definitely not defeated the spirit of hope and love that every parent and family has for individuals with ASD.

*****

Jane Ann S. Gonzales is a mother of a youth with autism. She is an advocate/core member of the Autism Society Philippines and Directress of the Independent Living Learning Centre (ILLC) Davao, a centre for teenagers and adults with special needs. For comments or questions, please email janeanngonzales@yahoo.com).

Published in the Sun.Star Davao newspaper on December 04, 2013.

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