Diagnostic Criteria

Raoa, Bettina
Diagnostic Criteria
DSM-IV-TR included five Pervasive Developmental Disorders (PDDs)
In the DSM-5, Autistic Disorder, Aspergers Disorder and PDD-NOS are
replaced by the diagnosis of Autism Spectrum Disorder
Causes
No single known cause
Generally accepted that it is caused by abnormalities in brain structure
or function
Researchers do not know the exact cause of autism but are investigating
a number of theories, including the links among heredity, genetics and
medical problems
No one gene has been identified as causing autism
Differential
Diagnosis
Differential Diagnosis
Cornelia de Lange syndrome
Similar in levels of impairment in terms of overall communiation & social interaction skills,
Individuals with CdLS showed fewer repetitive behaviors & less stereotyped speech &
impaired use of gestures & eye contact but showed higher levels of anxiety

Congenital Rubella syndrome

May cause ASDs

Down syndrome
More sociable than children with autism
People with autism can function better than those with down syndrome
People with autism can learn from mistakes when told while those with DS may seem to
lack the mental capacity to do so
Differential Diagnosis
Fragile X syndrome
Leading known single gene cause of ASD
People with FXS are more social but their social anxiety prevents them from
socializing
Both have poor eye contact
Both show repetitive behaviors

Untreated Phenylketonuria
May cause mental retardation and some symptoms of autism
Differential Diagnosis
Angelman syndrome
Resembles autism superficially in that kids with angelman syndrome are
profoundly retarded but do not exhibit the lack of empathy, eye contact etc

Tourette syndrome
Characterized by multiple motor tics & one vocal tic

Williams syndrome
More sociable
Has strong language skills
Medical Diagnosis
There are no medical tests for diagnosing autism
Many behaviors associated with autism are common to other disorders,
some medical tests can be performed in order to identify other causes
or diagnoses
How is autism diagnosed?
In the past, diagnosis of autism was often not made until late preschool-
age or later
All children before 24 months of age should routinely be screened for
autism and other developmental delays at their well-child check-ups
According to the guidelines, less than 30% of children undergo age-
appropriate screening at their well-child check-ups
What are the guidelines?
No babbling, pointing or gesturing by 12 months
No single words spoken by 18 months
No two-word spontaneous (non-echolalic, or not merely repeating the
sounds of others) expressions by 24 months
Loss of any language or social skills at any age
Other key behaviors
Lack of joint attention
Joint attention occurs when a person shares an experience with another

Lack of affective reciprocity

Affective reciprocity occurs when a child shares a moment with a parent

Limited imitation
Imitation occurs very early in children, usually by 15 months of age

Little evidence of pretend play

Pretend play develops over the preschool years
Second level of screening
May include more formal diagnostic procedures by clinicians skilled in
diagnosing autism including
Medical history
Neurological evaluation
Psychological testing
Screening & Assessment
Early identification is associated with dramatically better outcomes for
people with autism
Current Autism Rating Scales
The Autism Behavior Checklist
57-item behavior scale
Five diagnostic scale
Sensory
Relating
Body and object use
Language
Social and self-help skills
Each item is weighted from 1 4
A score of 67 or above is considered to indicate autism
Current Autism Rating Scales
Real Life Rating Scale
Behavior observation instrument completed by training raters following a 30
minute observation of a subject in a naturalistic setting
5 subscales
Sensory motor behavior
Social relationship to people
Affectual reactions
Sensory responses
Language
Current Autism Rating Scales
Childhood Autism Rating Scales
Consists of 15 general behavior scales/items
Raters are instructed to note the peculiarity, frequency, intensity, and duration of
scale items
Later, each score is coded 1-4 depending on whether behaviors are within normal
limits for that age group or are severely abnormal
Current Assessments of Autism
MRC Childrens Handicaps, Behavior, and Skills Structured Schedule
Intended to survey a wide range of developmental and behavioral strengths and
weaknesses in children with developmental disabilities
Areas surveyed
Self-care
School work
Social development
Language
Stereotyped activities
Current Assessments of Autism
Autism Diagnostic Interview (Revised)
Takes 1 hr & 30 mins to 2 hrs to administer
Can be used with children as young as two years of age
Focus on getting maximal information from the parent in the 3 key areas defining
autism
Reciprocal social interaction
Communication & language
Repetitive, sterotyped behaviors
Current Assessments of Autism
Autism Diagnostic Observation Schedule
Semi-structured, standardized assessment of communication, social interaction,
play and restricted and repetitive behaviors
5 modules
Needs 40-60 mins to administer
Toddler module for children between 12-30 months of age who do not consistently use
phrase speech
Module 1 for children 31 months and older who do not consistently use phrase speech
Module 2 for children of any age who use phrase speech but are not verbally fluent
Module 3 for verbally fluent children and young adolescents
Module 4 for verbally fluent older adolescents and adults
ASPERGER'S
SYNDROME
DEFINITION

An autism spectrum disorder characterized by difficulties in social interaction

and restricted, stereotyped patterns of behavior and interests.

An autism spectrum disorder (ASD) considered to be on the high functioning

end of the spectrum.

Less severe symptoms and absence of both cognitive and language delays.

Lifelong developmental condition in which people have difficulties

understanding how to interact socially and how they perceive the world.
DEFINITION

Distinguished by a pattern of symptoms rather than a single

symptom, not an illness or disease and cannot be cured.

People with Aspergers demonstrate high cognitive abilities

or at least, average IQ

May extend into the superior range of cognitive ability and

could sometimes be identified as gifted.
HISTORY
Named after the Austrian pediatrician Hans
Asperger

As a child, Asperger appears to have exhibited some

features of the very condition named after him,
such as remoteness and talent in language.

In 1944, he studied children in his practice who

lacked nonverbal communication skills, limited
empathy with their peers, and were physically
clumsy.
HISTORY
Asperger called the condition "autistic psychopathy" and is
characterized by social isolation

In the same year he published his paper describing autistic symptoms

Aspergers Syndrome (AS) was recognized in the DSM-IV in 1993

PREVALENCE
Prevalence of Asperger's syndrome (AS) is not well established

The ratio of autism to Asperger syndrome averaging 5:1

Estimates range from 1 in 250 to 1 in 5,000 children

Conservative estimates indicate that two out of every 10,000

children have Asperger's syndrome

Boys are three to four times as likely as girls to have the disorder.
CHARACTERISTICS

AS reflects abnormalities in certain aspects of development:

Social relatedness and social skills

Use of language for communication purposes

Certain behavioral and stylistic characteristics such as repetitive or persevering

features

Limited, yet highly focused, range of interests

SOCIAL INTERACTION

Described as being in our world, but, on their

own terms

Appears to lack empathy and behave strangely

Want to fit in and have interaction with others,

but often they dont know how to do it.
 Desire to have friends without knowing how
to make and keep them.

Difficulty in understanding non-verbal

signals like facial expressions.

Marked impairment in the use of multiple

nonverbal behaviors
SOCIAL COMMUNICATION

Demonstrate good language skills and may

sometimes speak fluently

Speech and language skills impaired in the area of

semantics, prosody, and pragmatics.

Problems understanding language in context and

are very literal in their use of language, which then
result in communication difficulties.
SPECIAL INTERESTS

While people with Asperger's often excel at learning facts and

figures they find it hard to think in abstract ways.

Usually their interest involves arranging or memorizing facts

about certain subjects

Develop an almost obsessive interest in a hobby or collection.

Pursuit of such interests is essential to their well-being

PHYSICAL AND SENSORY DIFFICULTIES

Children diagnosed with Asperger's are often delayed in their

physical and sensory development

Fine motor skills like handwriting or tying shoes can be difficult

for adults with Asperger's

Have heightened sensitivity and become overstimulated by

loud noises, lights, or strong tastes or textures
REPETITIVE PATTERNS OF BEHAVIOR

For people with Asperger's any unexpected

change in a routine can be upsetting

They may stick to inflexible routines, move

in stereotyped and repetitive ways, or
preoccupy themselves with parts of objects
 THIS STUDENT WITH ASPERGER'S SYNDROME
DELIVERED A POWERFUL GRADUATION SPEECH

When I was in first year, I almost got kicked out

because of Chem 16. I wasnt even bad at the class. I
just had a habit of scribbling on my forearm during
exams, which wasin hindsight, understandably
interpreted as cheating. After an unchecked exam and
a lot of stress, I ended up with a diagnosis of
Aspergers syndrome. On the whole, it was a less than
ideal way to get psychological support and an 1.00 in
Chem 16, but I didnt fail the class, I didnt get
dismissed from UP, and I didnt jump off a bridge. I
could have, but I didnt. That might not sound a lot like
honor and excellence to you, but thats the point.

Isaiah Paolo A. Lee

BS Molecular Biology and Biotechnology
Summa cum laude
UP Diliman Batch 2016
 CAUSATION

The exact cause of Asperger's syndrome is not known.

It tends to run in families.
Males > Females
1 in 68 children has been identified with Autism Spectrum Disorder (ASD).
However, there are few studies available that determine what percentage of
these individuals would have previously fallen under the designation of Asperger
Syndrome.
 DIFFERENTIAL DIAGNOSIS
ADHD
alexithymia
avoidant personality disorder
antisocial personality disorder
borderline personality disorder
narcissistic personality disorder
nonverbal learning disorder
PTSD
schizoid personality disorder
schizophrenia simplex
residual schizophrenia
schizotypal personality disorder
social phobia
compulsive (anankastic)
personality disorder
obsessive-compulsive disorder
 DIFFERENTIAL DIAGNOSIS

ASPERGERS SYNDROME VS OCD

o Persons with AS, unlike those with OCD, usually perceive the repetitive
actions as reasonable and appropriate;
o It is possible to have both disorders at the same time.
 DIFFERENTIAL DIAGNOSIS

ASPERGERS SYNDROME VS ADHD

o AS is distinguishable with ADHD by being characterized by:

more severe impairment in social and emotional communication,

characteristically restrictive behavior patterns and special interests,
a detail-oriented perceptual style
 DIFFERENTIAL DIAGNOSIS

ASPERGERS SYNDROME VS ADHD

o AS is distinguishable with ADHD by being characterized by:

lack of volatility of thought and behavior,

more severe impairment of communicative modes of expression, and
a rarer tendency toward disorganization.
 DIFFERENTIAL DIAGNOSIS
ASPERGERS SYNDROME VS SCHIZOPHRENIA-LIKE PD

o Persons with AS are hypo-mentalizers

o Persons with schizophrenia-like PD tend to be
hyper-mentalizers
 DIFFERENTIAL DIAGNOSIS

ASPERGERS SYNDROME VS AUTISM

o AS is a milder form of autism

o People with Asperger's syndrome typically function better than do
those with autism
o What distinguishes Aspergers from classic autism are its less
severe symptoms and the absence of language delays
 ASSESSMENT

Parents of children with Asperger syndrome can typically trace

differences in their children's development to as early as 30 months of
age.
Developmental screening during a routine check-up by a general
practitioner or pediatrician may identify signs that warrant further
investigation.
 ASSESSMENT

The diagnosis of AS is complicated by the use of several

different screening instruments
Asperger Syndrome Diagnostic Scale (ASDS),
Autism Spectrum Screening Questionnaire (ASSQ),
Childhood Autism Spectrum Test (CAST)
Gilliam Asperger's disorder scale (GADS),
Krug Asperger's Disorder Index (KADI), and the Autism-
spectrum quotient (AQ; with versions for children,
adolescents and adults)
 ASSESSMENT - GADS

It comprises 32 diagnostic characteristics, divided into

four sub-scales.
The four sub-scales are:
Social Interaction,
Restricted Patterns of Behaviour,
Cognitive Patterns, and
Pragmatic Skills.
An optional additional sub-scale of eight items, Early
Development, can also be included.
 ASSESSMENT - ASDS

The ASDS examines specific behaviors to help you

quickly assess the likelihood of Asperger Syndrome.
Document behavioral progress, target goals for change
and intervention, and measure Asperger Syndrome for
research purposes.
The scale can be completed in approximately 15
minutes by anyone who knows the individual well.
 DIAGNOSIS
ETIOLOGY
ASSESSMENT
SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Several disorders are included

under the DSM IV heading of
Pervasive Developmental
Disorders.
Asperger's Disorder
Autistic Disorder
Retts Disorder
Childhood Disintegrative
Disorder
PDD (NOS)
SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

DSM-5

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

DSM-5
Reasons for the changes:

Symptoms are not pervasive-- they are specific to social-

communication domain plus restricted, repetitive behaviors/fixated
interests
Diagnostic confusion
Overlapping the different PDDs with each other
(ex. PDD-NOS and Asperger disorder)

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

299.80 Pervasive Developmental Disorder, Not Otherwise

Specified (PDD-NOS)

Severe and pervasive impairment in the development of reciprocal

social interaction
Presence of stereotyped behavior, interests and activities, but the
criteria for specific pervasive developmental disorder, schizophrenia,
schizotypal personality disorder, or avoidant personality disorder is
not met.

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

The diagnosis of a PDD-NOS is given to individuals with

difficulties in the areas of:
social interaction
communication, and/or
stereotyped behavior patterns or interests

.but who do not meet the full DSM-IV criteria for

autism or another PDD.

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Diagnosis
At one time, conditions now referred to as Pervasive
Developmental Disorders were thought to be reflective of
Child Psychosis.
As these disorders generally bear little relationship to the
psychotic conditions of adulthood (e.g. Schizophrenia,
Bipolar Disorder), they are now referred to as
"developmental rather than "psychotic" disorders.

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Intellectual Disabilities
Anxiety Disorder
Disruptive Behavior Disorder
ADHD
Depression

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Both behavioral and biological studies have generated

sufficient evidence to suggest that PDD-NOS is caused by a
neurological abnormality. However, no specific cause or causes
have been identified.
Children are either born with PDDNOS or have the potential to
develop it

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Theoretically, there may be a

genetic basis for PDDNOS
In some families, a pattern of
Pervasive Developmental Disorders
is apparent
A single gene or cluster of genes
has not been identified
A lot of research still needs to be
conducted in order to determine a
genetic or inherited cause for
PDDNOS
SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

A lot of attention has been focused on Autism

(PDDNOS falling under this label) being caused by the
MMR vaccine
There is no scientific evidence that supports this
theory
A possible explanation for the onset of a
developmental disorder at the time of the MMR
vaccine is timing
SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Two-fold purpose:
To gather information to formulate an accurate
diagnosis
To provide information that will form the basis
of an appropriate intervention plan for the
individual child and family.

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Doctors should be conducting regular

developmental screenings during the 9-, 18-,
and 24- or 30-month appointments
Children are generally 3 to 4 years old before
they exhibit enough symptoms for a diagnosis.
There is no set pattern of symptoms or signs
in children with PDD-NOS.

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Medical assessment
Interviews with the parents, child and childs teacher
Behavior rating scales
Direct behavioral observations
Psychological assessment

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Educational assessment
Formal or informal
Evaluation on:
Pre-academic skills, Academic skills, Daily living skills, Learning
style and Problem solving approaches
Communication assessment
Formal testing, Observational assessment, and Interviewing the
childs parents
Why, how & how well the child communicates
Development of communication program
SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Occupational assessment
Nature of sensory integrative functioning
Fine and gross motor skills
Visual skills

Evaluation summary
Integration of all collected information from various elements of
assessment

SAHAGUN, Cirila
DIAGNOSTIC CRITERIA DIAGNOSIS ETIOLOGY ASSESSMENT

Assessing and treating

PDDNOS is a lot like trying
to put together a puzzle
whose pieces do not quite
fitno child is the same or
has the same combinations of
symptoms, which makes
understanding this disorder
quite challenging.

SAHAGUN, Cirila
- also called Hellers syndrome and disintegrative psychosis
- Most severe Autistic Spectrum Disorder but also the least
common.
- was described in 1908 as a deterioration over several
months of intellectual, social, and language function
occurring in 3- and 4-year-olds with previously normal
function
A pervasive developmental disorder (other than Rett's
syndrome) that is defined by a period of normal
development before onset, and by a definite loss, over the
course of a few months, of previously acquired skills in at
least several areas of development, together with the onset
of characteristic abnormalities of social, communicative,
and behavioral functioning
There is uncertainty about the extent to which this condition
differs from autism. In some cases the disorder can be
shown to be due to some associated encephalopathy, but
the diagnosis should be made on the behavioral features.
Any associated neurological condition should be
separately coded.


Comparison with
autism
Comparison

with autism

CAUSES OF CDD
 CAUSES
No single Causative factor
for CDD has been
identified.
Genetic
factors Possible susceptibility to
chromosomal breakage or
disruption
Family history of autism or
Asperger disorder
A specific polysaccharide
antibody deficiency.
Environmental
risk Viral exposure
factors Birth trauma
Toxin exposure
Prematurity
Teratogenicity
Increased risk of ASD
 CDD has been
associated with other
conditions/disorder
Autoimmune disorders
Allergies
Insomia
Vitamin B-12 deficiency
Hyperhomocystenemia
Anti-NMDA-receptor
encephalities
Laboratory
studies Complete blood count (CBC)
Thyroid functioning tests
Glucose testing
Liver functioning tests
Kidney function test
Heavy metal screening
HIV test
Urine for aminoacidopathy screening
Psychological
tests Childrens Autism Rating Scale (cars)
Kaufman Assessment Battery for
Children
Vineland Adaptive Behavior Scale
PDD behavior inventory
Intelligence Scales
MRT, PET, and
Ct Magnetic resonance imaging (MRI),
positron emission tomography (PET) or
computed tomography (CT) may be
used to exclude brain tumors or
obstructive abnormalities in the brain.

MRIs is helpful in localizing
the areas of the brain
experiencing audiovisual
asynchrony
Other tests
Electoencephalography (EEG) may be
performed as part of the neurologic
workup to exclude seizure disorders.
Balatay, Mia Francia SG.
 Rett Syndrome
Prevalence

U.S. Japan 1:45,000

1:23,000

Balatay, Mia Francia SG.

Educational & Therapeutic
Psychological & Medication

SAHAGUN, Cirila
 Improves overall prognosis for children with ASD
Before the age of 5, healthy parts of the brain are often able to
compensate
It is shown with Intensive Direct Instruction, such as DTI or Discrete
Trial Instruction, some are able to be included in typical classrooms

SAHAGUN, Cirila
 Age
Diagnosis
Availability of Services
Prioritized Goals
Changes through the years

SAHAGUN, Cirila
 EFFICACY &
EFFECTIVENESS

SAHAGUN, Cirila
SAHAGUN, Cirila
 Early, intense treatments have long-lasting positive effects
At age 3, may qualify for early childhood SPED, or a typical
preschool program with specialized support or programs
specialized for students with ASD
Most preschoolers receive speech therapy, OT, etc

SAHAGUN, Cirila
ULTIMATE GOAL
Prepare all students, and not just those who have high-
functioning ASD, to live a high-quality life in their home
communities

SAHAGUN, Cirila
 Shown to be effective through research
Every identified practice is not appropriate for every
learner
Most effective when matched with learners specific needs
and characteristics

SAHAGUN, Cirila
 Most critical and frequently used therapeutic approach
Augmentative and Alternative Communication: use of aided and
unaided strategies to communicate wants and needs to transfer
information
Picture Exchange Communication System (PECS): for students
with ASD who are nonverbal or who have little to no
communication initiation skills
teaches children to initiate a communicative exchange with a partner by using pictures

SAHAGUN, Cirila
 Scientific approach to designing, conducting, and evaluating
instruction based on empirically verified principles describing
functional relations between events in the environment and
learning
Uses behavioral principles such as positive reinforcement to teach
children skills in a planned, systematic manner

SAHAGUN, Cirila
 What ABA is not
Individualized Does not prescribe
instructional settings,
Data-based teaching, formats, or
evaluation and materials
decision making
Not bribery
Designed to be
effective Not punitive

Doable

SAHAGUN, Cirila
Involve visual cues and prompts that help students to
perform skills with greater independence and accuracy
2 Strategies
Picture Activity Schedules
Social Stories

SAHAGUN, Cirila
 Children with Autism can be
taught to use PAS to increase
their independence in selecting
and carrying out a sequence of
activities in the classroom
Teachers can also incorporate
videos into activity schedules

SAHAGUN, Cirila
 Explain social situations and
concepts
Teachers can use this to:
Describe a situation and expected
behaviors
Explain simple steps for achieving
certain goals or outcomes
Teach new routines and anticipated
actions

SAHAGUN, Cirila
 Providing social stories before an event or activity can
decrease a childs anxiety, improve his behavior, and help
him understand the event from the perspective of others
Written at the students level of comprehension and
usually contain 4 basic types of sentences:
Descriptive sentences
Directive sentences
Perspective sentences
Affirmative sentences

SAHAGUN, Cirila
 Based upon developmental theory and can be delivered in
a variety of settings
Teaching social skills to students with ASD is critical
because they are likely targets for bullying

SAHAGUN, Cirila
 Creative, innovative and positive teachers are particularly
important in providing effective education
To capitalize on the unique characteristics of students with ASD,
teachers need to plan in advance
Parental participation in preparing children with ASD for school
and other aspects of life is critical

SAHAGUN, Cirila
INTERVENTIONS:

SAHAGUN, Cirila
 Primary purpose: medical treatments do not necessarily
cure autism but alleviate or eliminate symptoms.
Can be used to treat certain conditions such as:
- hyperactivity
- short attention span
- impulsive behaviors
- irritability
- aggression
- sleep problems

SAHAGUN, Cirila
 Psychostimulants (Ritalin and Adderall)

- treat
hyperactivity, short attention span and impulsive
behavior
Antianxiety (Prozac, Luvox and Zoloft)

- treat depression, anxiety and obsessive compulsive behaviors

SAHAGUN, Cirila
 Antipsychotics (Risperdal and Zyprexa)
treat irritability, aggression and sleep problems

SAHAGUN, Cirila
Positive Behavior Intervention and Support (PBIS)
 Parents of children with ASD have
increased caregiver burden than other
families
Often leave their jobs
Extended care often lead parents to be
isolated from others
Responsibility are limited to daytime
hours
Demands are physically and emotionally
draining sometimes resulting in high
stress levels and depression
 Parents may experience symptoms
of parenting stress, depression, and
other psychopathology
Parents frequently experience lower
marital satisfaction status than other
families
Siblings of a child with ASD may
have difficulty in understanding the
level of attention given to their
sibling with ASD


Obtaining Services
and Support