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Diagnosis & ASD Tom Berney Educa/on & Services for People with Au/sm (ESPA) Brain Bank for Au/sm Newcastle University Northumberland, Tyne & Wear NHS Trust Diagnosis What is diagnosis? What is its purpose / effect? What are its drawbacks? What is diagnosis? (diagnosis ≠ assessment) Name > descrip/on (categorical) Ø  Make sense of the symptoms Ø  Seek other (unno/ced) symptoms other (associated) condi/ons Ø  Appreciate the person s perspec/ve, difficul/es & strengths Ø  Fit the person into our frame of reference Ø  Consider possible causa/on Ø  ª management Diagnosis What is diagnosis? What is its purpose / effect? What are its drawbacks? What is diagnosis? Ø  Joint explora/on – person, family, clinician Ø  Gathering key symptoms matching with agreed criteria What defines au/sm? Diagnos-c Criteria Grunya Sukhareva (1926) Schizoid Children Extreme aloneness &
Kanner / Asperger concept Insistence on sameness
DSM II (1968) Childhood schizophrenia (Creak s 9 points)
(unitary psychosis) ICD-­‐9 (1977) Au/sm Onset < 3 years old
DSM III (1980 R 1987) Wing s triad (1981) Social interac/on Social interac/on Communica/on Communica/on Restricted & repe//ve behaviour ” Imagina/on Michael Rutter
Lorna Wing
Diagnos-c Criteria Grunya Sukhareva (1926) Schizoid Children Extreme aloneness &
Kanner / Asperger concept Insistence on sameness
DSM II (1968) Childhood schizophrenia (Creak s 9 points)
(unitary psychosis) ICD-­‐9 (1977) Au/sm Onset < 3 years old
DSM III (1980 R 1987) Wing triad (1981) Social interac/on Social interac/on Communica/on Communica/on Restricted & repe//ve behaviour Imagina/on DSM IV & ICD-­‐10 (1994) PDD-­‐NOS / Atypical Au/sm Asperger syndrome Diagnos-c Criteria: Reciprocal Social Interac/on DSM IV ICD-­‐10 Non verbal behaviour ↓ Develop peer rela/onships ↓ 0 seeking to share Social / emo/onal reciprocity ↓ Communica/on Development of speech Conversa/on ↓ Stereotyped, repe//ve language 0make-­‐believe play Encompassing preoccupa/on Restricted / repe//ve stereotyped Rigid /r ou/nes/rituals paeerns of behaviour / interests ac/vi/es Repe//ve motor /b ehaviour Preoccupa/on with parts of objects Onset < 3yrs. Diagnos-c Criteria: Reciprocal Social Interac/on & Social Communica/on DSM IV DSM 5 Non verbal behaviour ↓ Develop peer rela/onships ↓ Social / emo/onal reciprocity ↓ Restricted / repe//ve / stereotyped paeerns of behaviour / interests / ac/vi/es Encompassing preoccupa/on Rigid rou/nes/rituals Repe//ve behaviour Sensory anomalies Onset early childhood. Diagnos-c Criteria: DSM 5 Single diagnos/c category Au/sm Spectrum Disorder but both components essen/al Clinical specifiers Severity Language Associated features Epilepsy Gene/c disorder Intellectual disability A new category – Social communica-ve disorders Diagnos-c Criteria: DSM IV Comm
Comm
Repet
Repet
DSM 5 Social
Social
Comm
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Repet /
Sensory
Social
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Asperger syndrome Au/sm Au/sm Spectrum Disorder Social Communica/on Disorder What is diagnosis? Ø  Joint explora/on – person, family, clinician Ø  Gathering key symptoms matching with agreed criteria Ø  Symptom collec/on Ø  Change of defini/on Defini/on Number / intensity Which symptoms relevant Age/gender specific Who to interview Explore hypothesis ª altered prevalence What is diagnosis? Social/cultural pressures Classifica/on (ICD, DSM) Service demands ASD Diagnosis What is diagnosis? What is its purpose / effect? What are its drawbacks? What is its purpose / effect? Ø  Understand themselves (& how others differ) Reassurance Absolu/on & anger Iden/ty Ø  Change perspec/ve ASD/ADHD > Naughty Ra/onale for offending Ø  Resources – educa/on, support, benefits Ø  Escape from inappropriate diagnoses (Mental illness / personality disorder) What is its purpose / effect? Ø  Compassion Ø  Comprehension Ø  Understand bits of behaviour Ø  Absolu/on & guilt Ø  Management strategy What is its purpose / effect? Ø  Understanding – Meaning, Broader condi/on Ø  Summarise & dis/nguish from other condi/ons Ø  Communicate with others (agreed conven/ons) Ø  Management Diagnosis & Review Assessment Diagnosis Management plan Revised plan What is its purpose / effect? Ø  Understanding – Meaning, Broader condi/on Ø  Summarise & dis/nguish from other condi/ons Ø  Communicate with others Ø  Management Ø  Purpose Research Clinical Administra/ve Diagnosis What is diagnosis? What is its purpose / effect? What are its drawbacks? What are its drawbacks? See the label, not the person Unrealis/c expecta/ons (savant /disabled) Restric/ons – work / migra/on S/gma -­‐ innate difficulty with difference Dimensional diagnosis > categorical Confiden/ality Undiagnosis of a lifelong condi-on