The video below is the section for Autistic Disorder (Psychological Assessment Domain) from Part 5 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 5, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Autistic Disorder (Psychological Assessment Domain)
NARRATIVE DEFINITION:
Autism Spectrum Disorder is a neurodevelopmental disorder characterized by difficulties communicating and interacting in a variety of social contexts, restricted and repetitive behaviors, and early onset of symptoms that ultimately cause clinically significant impairment in everyday functioning. A reliable diagnosis of Autism Spectrum Disorder may be made as early as age 2, depending on severity of symptoms.
Autism Spectrum Disorder is used to diagnose disorders that were previously classified separately including: autism, asperger’s syndrome, pervasive developmental disorder NOS, and childhood disintegrative disorder. The term “spectrum” is used with respect to the wide range of manifestations of the disorder that are determined by developmental level, chronological age, and severity of the autistic condition.
Children with autism spectrum disorder demonstrate superior abilities on tests of local processing and visual search. They accomplish this largely by using featural processing and relying on the visual systems for object feature analysis and controls to engage working memory. Children with autism spectrum disorder score higher than controls on the Embedded Figures Test, an instrument that measures field dependence/independence. This area of functioning is considered the perceptual component of personality. Other assessments include the Child Autism Rating Scale, the Autism Behavior Checklist, and the Autism Diagnostic Observation Schedule.
Specific cognitive deficits can be evaluated using the Stanford-Binet or WISC-IV. On the WISC-IV, children with autism spectrum disorder will usually have a higher performance score than verbal score. In addition, the block design subtest usually has the highest score and the comprehension subtest the lowest. If a child is mute, minimally verbal, or deaf, the Leiter-R can be used as an alternative to the Stanford-Binet or WISC-IV.
In diagnosing children younger than 18 months, problems with eye contact, verbal and nonverbal language are considered. For children 18 months and older, the Checklist for Autism in Toddlers is used in conjunction with nine brief questions for parents and five brief interactions for the clinician and child. Children with this disorder are frequently diagnosed with intellectual disability (intellectual developmental disorder) as well.
FLASHCARD:
Autistic Disorder
1. A neurodevelopmental disorder characterized by:
A. Difficulties in communication and interacting in social contexts
B. Restricted and repetitive behaviors
C. Early symptom onset causing clinically significant impairment in functioning
2. Reliable diagnosis:
A. As early as age 2, some symptoms recognizable before 12 months
B. Boys four to five times more likely diagnosed; girls diagnosed are more likely to have co-occurring intellectual disability
C. Better prognosis: IQ over 70 and begin spoken language by age 5
D. Symptoms and impairments occur across lifespan
3. Demonstrate superior abilities on tests of local processing and visual search (use featural processing and rely on visual systems for object feature analysis)
4. Score higher on Embedded Figure Test
5. Other assessments: Child Autism Rating Scale, Autism Behavior Checklist, and Autism Diagnostic Observation Schedule
6. Specific cognitive deficits measured by: Stanford-Binet or WISC-IV (higher performance then verbal score; block design highest score, comprehension lowest score); mute/minimally verbal/deaf: use Leiter-R
7. Diagnosing children younger than 18 months: consider problems with eye contact, verbal and nonverbal language
8. 18 months and older: Checklist for Autism in Toddlers
9. Children with disorder frequently have intellectual disability
QUESTION:
A 6-year-old child begins to demonstrate severe deficits in cognitive, emotional, and social abilities. Her parents commented that the child has always seemed distant, not making eye contact when she was a baby and seemingly disintereted with playing with others her age. Since starting school, the difference between her and other children is more apparent. This child would be a candidate for which diagnosis?
ANSWERS:
A. Childhood Disintegrative Disorder
B. Asperger’s Disorder
C. Pervasive Developmental Disorder
D. Autism Spectrum Disorder
RATIONALE: D is the correct answer. Answers A, B, and C are all disorders that are now listed under the diagnosis Autism Spectrum Disorder. The description listed represents characteristics of ASD (D).