5. Diagnostic Criteria

Transcription

1 5. Diagnostic Criteria The questions that are going to be answered in this chapter are: What are the diagnostic criteria of ASD? Are the diagnostic criteria laid down in the DSM-IV-TR or ICD-10 manuals useful for the diagnosis of ASD? The diagnostic manuals are used at both Primary Care and Specialised Care, although it is necessary to comment that there is limited evidence on their use to improve the diagnostic process of children with ASD. There are studies referring to the use of diagnostic criteria according to DSM-IV-TR and ICD-10; these showed that using the DSM-IV-TR and ICD-10 diagnosis the reliability of the diagnostic process increased, and the effects were greater if an inexperienced professional was involved in making the diagnoses. They also noted that the current criteria for Asperger disorder and autism have little discriminatory validity Here, we present the diagnostic criteria to be met by autism spectrum disorders to be considered as such by the DSM-IV-TR. The numerical codes next to each diagnostic category correspond to ICD-10 and ICD-9 consecutively 6. CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS 39

2 Diagnostic Criteria of F84.0 Autistic Disorder [299.00] A. total of six (or more) items from (1), (2) and (3), with at least two of (1), and one of (2) and (3): (1) qualitative impairment in social interaction, as manifested by at least two of the following (a) marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to developmental level (c) lack of spontaneous seeking to share enjoyment, interests and objectives with others (i.e., not showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2) qualitative impairments in communication as manifested by at least one of the following (a) delay in, or total lack of, development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (a) encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus. (b) apparent inflexible adherence to specific, non-functional routines or rituals,. (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements). (d) persistent preoccupation with parts of objects. B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age of 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. C. The disturbance is not better accounted for by Rett Disorder or a Childhood Disintegrative Disorder. 40 CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF PATIENTS WITH AUTISM SPECTRUM DISORDERS IN PRIMARY CARE

3 Criteria for the diagnosis of F84.2 Rett s Disorder [299.80] A. All of the following (1) apparently normal prenatal and perinatal development (2) apparently normal psychomotor development through the first five months after birth (3) normal head circumference at birth B. Onset of all of the following after the period of normal development: (1) deceleration of head growth between the 5 and 48 months of age (2) loss of previously acquired purposeful hand skills between the 5 and 30 months of age, with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing) (3) loss of social engagement early in the course (although often social interaction develops later) (4) poor coordination of gait or trunk movements (5) severely impaired expressive and receptive language development with severe psychomotor retardation. Criteria for the diagnosis of F84.3 Childhood disintegrative disorder [299.10] A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior. B. Clinically significant loss of previously acquired skills (before the age 10) in at least two of the following areas: (1) expressive or receptive language (2) social skills or adaptive behaviour (3) bowel or bladder control (4) play (5) motor skills C. Abnormalities of functioning in at least two of the following areas: (1) qualitative impairment in social interaction (i.e., impaired nonverbal behaviours, failure to develop peer relationships, lack of social or emotional reciprocity) (2) qualitative impairments in communication (i.e., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-beieve play) (3) restricted, repetitive and stereotyped patterns of behaviour, interests and activities, which include motor stereotypies and mannerisms D. The disturbance is not better accounted for by another Pervasive Developmental Disorder or Schizophrenia. CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS 41

4 Criteria for the diagnosis of F84.5 Asperger disorder [299.80] A. Qualitative impairment in social interaction, as manifested by at least two of the following (1) marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction (2) failure to develop peer relationships appropriate to developmental level (3) lack of spontaneous seeking to share enjoyment, interests or achievements with other people (i.e., by a lack of showing, bringing, or pointing out objects of interest to other people) (4) lack of social or emotional reciprocity B. Restricted, repetitive and stereotyped patterns of behaviour, interests and actions manifested by at least one of the following (1) encompassing preoccupation with one or more stereotyped and restrictive patterns of interest that is abnormal either in intensity or focus (2) apparently inflexible adherence to specific, non-functional routines or rituals (3) stereotyped and repetitive motor mannerisms (i.e., hand or finger flapping or twisting, or complex whole-body movements) (4) persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. D. There is no clinically significant general delay in language (i.e., at 2 years of age using simple words, at 3 years communicative phrases are used). E. There is no clinically significant delay in cognitive development or the development of self-help skills appropriate for the age, adaptive behaviour (other than social interaction) and curiosity about the environment in childhood. F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. Diagnosis of F84.9 Pervasive Developmental Disorder not otherwise specified (including atypical autism) [ This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia. For example, this category includes atypical autism, cases that do not meet the criteria for Autistic Disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these. 42 CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF PATIENTS WITH AUTISM SPECTRUM DISORDERS IN PRIMARY CARE

5 Summary of evidence II, III The diagnostic criteria of DSM-IV-TR and ICD-10 increases the reliability of the diagnostic process, especially in inexperienced professionals The diagnostic criteria of DSM-IV-TR and ICD-10, alone, have little discriminatory validity for the Asperger disorder and autism Recommendations C It is recommended that professionals involved in the detection of children with ASD, especially those with little experience, use the diagnostic DSM-IV-TR and / or ICD-10 manuals CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS 43