Comparing Rates of Diagnosis Using DSM-IV-TR Versus DSM-5 Criteria for Autism Spectrum Disorder

Nurse participation in detecting signs of childhood autism in Primary Health Care

OBJECTIVES

to understand nurse participation in the process of early detection of warning signs of autism spectrum disorders (ASD) in childcare consultations.

METHODS

qualitative, exploratory research, conducted through semi-structured interviews conducted between August and November 2022 with 27 nurses from family clinics in the city of Rio de Janeiro. The IRaMuTeQ® software was used for data treatment. Interpretations and theorizing were guided by Hildegard Peplau's Theory of Interpersonal Relations.

RESULTS

lexical analysis pointed out thematic aspects related to the dynamics of development assessment, interpersonal relationship practices between nurses and family members as well as limits and interrelationships between healthcare professionals involved in early detection.

FINAL CONSIDERATIONS

childcare consultations are characterized as a unique resource for the early detection of warning signs of ASD. Nurses need to be recognized as strategic agents in the face of this demand, especially in caring for socioeconomically vulnerable families.

A Systematic Review of Treatment for Children with Autism Spectrum Disorder: The Sensory Processing and Sensory Integration Approach

BACKGROUND/OBJECTIVES

The prevalence of the diagnosis of autism spectrum disorder (ASD) has been increasing globally, necessitating updates to the Diagnostic and Statistical Manual of Mental Disorders with respect to ASD diagnosis. It is now recognised that ASD is related to sensory processing disorder, and sensory integration is considered a suitable intervention for treating children diagnosed with ASD.

METHODS

This paper provides a systematic review on a timeline from 2013 to 2023, based on the PRISMA model. Evidence was sought in the academic search engines Pubmed, Scielo, Eric, Dialnet, Springer, Base Search and Google Scholar, which produced 16 articles according to the inclusion criteria.

RESULTS

According to the results of this review, intervention with sensory integration in infants with ASD meets the criteria to be considered an evidence-based practice. The studies reviewed focused mainly on clinical settings and, therefore, we highlight the urgent need for further research to evaluate the effectiveness of sensory integration interventions in naturalistic settings such as homes and schools.

CONCLUSIONS

This will help to obtain more representative data on how these interventions affect the daily lives of children with ASD.

Intellectual disability and autism prevalence in Western Australia: impact of the NDIS

Introduction

Estimates of the prevalence of intellectual disability or autism spectrum disorder (ASD) may vary depending on the methodology, geographical location, and sources of ascertainment. The National Disability Insurance Scheme (NDIS) in Australia was introduced progressively from 2016 to provide individualized funding for eligible people with a significant and permanent disability.

Methods

Its recent inclusion as a source of ascertainment in the population-based Intellectual Disability Exploring Answers (IDEA) database in Western Australia has allowed comparisons of the prevalence of intellectual disability and ASD before and after its introduction.

Results

Prevalence of intellectual disability in 2020 was 22.5 per 1,000 (/1,000) live births compared with previous estimates in 2010 of 17/1,000, and for ASD, the estimate was 20.7/1,000 in 2020 compared with 5.1 /1,000 in 2010. Whilst the prevalence of ASD in Aboriginal individuals was about two-thirds that of non-Aboriginals, there was an increased prevalence of ASD in Aboriginal children under 10 years compared with non-Aboriginal children.

Discussion

The concurrent relaxation of ASD diagnostic practice standards in Western Australia associated with the administration of access to the NDIS and the release of the National Guidelines empowering single diagnosticians to determine the appropriateness of engaging additional diagnosticians to form a multidisciplinary team on ASD diagnosis, appear to be important factors associated with the increase in ASD diagnoses both with and without intellectual disability.

Reliability and validity of the Autism Screen for Kids and Youth

LAY ABSTRACT

It is important that autistic children be diagnosed as early as possible so their needs can be met and their families can gain important insights into their behavior and interact with them appropriately. However, very few autism screening instruments are appropriate for children who have outgrown early childhood. The Autism Screen for Kids and Youth (ASKY) presents parents of children aged 4-18 years with 30 items that relate to autistic behaviors as defined by the current clinical diagnostic criteria for autism spectrum disorder (DSM-5 ASD). We evaluated the Hebrew instrument's performance on 167 autistic and non-autistic children and adolescents. We found that the ASKY algorithm correctly identified 92% of the autistic individuals as "probable ASD" and correctly identified 72% of the non-autistic individuals as "probable non-ASD," with these classifications showing excellent stability over time. Using total questionnaire score instead of the algorithm improved the ASKY's ability to correctly identify autistic individuals as "probable ASD" and non-autistic individuals as "probable non-ASD" to 93% and 78%, respectively. Overall, the ASKY is a promising instrument for ASD screening of older children.

Research utility of a CAPS-IV and CAPS-5 hybrid interview: Posttraumatic stress symptom and diagnostic concordance in recent-era U.S. veterans

The Clinician-Administered PTSD Scale (CAPS) is used to measure posttraumatic stress symptoms (PTSS) and diagnose posttraumatic stress disorder (PTSD). However, its use, particularly in settings involving longitudinal assessment, has been complicated by changes in the diagnostic criteria between the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-IV and DSM-5, respectively). The current sample included trauma-exposed U.S. veterans who were deployed in support of military operations following the September 11, 2001, terrorist attacks (N = 371) and were enrolled in a longitudinal study focused on deployment-related stress and traumatic brain injury. A hybrid clinical interview using item wording from the CAPS for DSM-IV (CAPS-IV) with the addition of items unique to the CAPS for DSM-5 (CAPS-5) was used to assess both DSM-IV and DSM-5 PTSD diagnostic criteria, allowing for the calculation of separate total scores and diagnoses. Diagnostic agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and interrater reliability between CAPS-IV and CAPS-5 were evaluated for the entire sample and stratified by gender. We found high diagnostic agreement (92.9%-95.4%), sensitivity (94.4%-98.2%), specificity (91.7%-92.8%), PPV (89.5%-93.0%), NPV (95.7%-98.1%), and interrater reliability,κ = 0.86-0.91,) for both men and women. The current study supports the use of a hybrid PTSD diagnostic interview assessing both DSM-IV and DSM-5 diagnostic criteria, particularly in situations such as longitudinal studies that may require a feasible method of incorporating changes in diagnostic criteria from the DSM-IV to the DSM-5.

The Impact of Birth Order on Language Development in Autistic Children from Simplex Families

The current study investigated the impact of birth order on vocabulary and social language development in 1338 first-born and 1049 s-born autistic youth (M age = 9.03 years, SD = 3.57; 86.4% male) from the Simons Simplex Collection. Frequentist and Bayesian analyses revealed mixed findings in language development. There were no differences in vocabulary or social language between first-born and second-born children. However, birth order and income together predicted expressive vocabulary and inappropriate speech such that birth order had a greater impact on language in lower-income families. This is the first study to investigate the impact of birth order on language outcomes in autistic youth and has implications for early intervention in lower-resourced communities.

DSM-5 symptom expression in toddlers

LAY ABSTRACT

Children with autism show more social-communication symptoms and repetitive behaviors than children with typical development or those diagnosed with other developmental disorders; however, non-autistic children often show some behaviors that are associated with autism. We compared the behavioral reports from caregivers of children in these three groups to identify the behaviors that were specific to autism. Children with autism were found to show more of these behaviors, and behaviors that are particularly indicative of autism were identified. These behaviors included social symptoms (approaching others to interact, showing things, looking back while showing, responding to an approaching child, spontaneous imitation) and repetitive behavior symptoms (specific, inflexible play, unusual body movements, strong specific interest, carrying around an unusual object, sensory seeking, and sensory hyper-reactivity).These findings may aid professionals in determining the most appropriate diagnosis for a child between the ages of 12 and 36 months.

Research, Clinical, and Sociological Aspects of Autism

The concept of autism continues to evolve. Not only have the central diagnostic criteria that define autism evolved but understanding of the label and how autism is viewed in research, clinical and sociological terms has also changed. Several key issues have emerged in relation to research, clinical and sociological aspects of autism. Shifts in research focus to encompass the massive heterogeneity covered under the label and appreciation that autism rarely exists in a diagnostic vacuum have brought about new questions and challenges. Diagnostic changes, increasing moves towards early diagnosis and intervention, and a greater appreciation of autism in girls and women and into adulthood and old age have similarly impacted on autism in the clinic. Discussions about autism in socio-political terms have also increased, as exemplified by the rise of ideas such as neurodiversity and an increasingly vocal dialogue with those diagnosed on the autism spectrum. Such changes are to be welcomed, but at the same time bring with them new challenges. Those changes also offer an insight into what might be further to come for the label of autism.

Implications of Applying "Clinically Significant Impairment" to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice

The addition of 'clinically significant impairment' (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, Author, 2013) to the diagnostic criteria for autism in DSM-5 attempts to establish a threshold for the condition. However, the increased prominence of the neurodiversity paradigm and social model of disability runs counter to the idea that characteristics of autism are fundamentally impairing. Consequently, diagnostic criteria for autism are becoming misaligned with the contemporary views of 'disorder' and 'disability'. In this commentary, we outline six clinical issues that arise from this misalignment during diagnostic assessment for autism, and the tension this creates in making diagnostic decisions. We conclude by considering ways the 'clinically significant impairment' criterion could be changed, and the implications this would have on clinical practice, and the concept of autism.

Diagnóstico de autismo no século XXI: evolução dos domínios nas categorizações nosológicas

Resumo Os critérios que subsidiaram o diagnóstico do autismo passaram por diversas mudanças ao longo dos anos, acompanhando os pressupostos conceituais hegemônicos no período. O objetivo deste estudo é analisar a evolução do diagnóstico do autismo no século XXI, a partir dos domínios e subdomínios em que se baseiam as categorizações nosológicas. Adicionalmente, são sinalizados instrumentos auxiliares utilizados e algumas tecnologias diagnósticas em desenvolvimento, além de modelos conceituais que tratam do perfil neuropsicológico. Trata-se de pesquisa documental, tendo como referência os manuais diagnósticos existentes no período. Os domínios de interação social, comunicação e padrão restrito e repetitivo de comportamento foram mantidos nos diferentes manuais diagnósticos abordados. Os subdomínios de interação social e comunicação foram reduzidos, enquanto o padrão restrito e repetitivo teve consolidação no DSM-5. Compreender a evolução dos critérios diagnósticos tende a promover o desenvolvimento da clínica, potencializando a antecipação do diagnóstico e as intervenções necessárias para um melhor prognóstico.