The New Diagnostic Criteria for Autism

The publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will have a huge impact on Autism Spectrum Disorders (ASDs). Aspergers and PDD-NOS will disappear, new criteria will be used to diagnose ASD, and new categories have been developed which are likely to absorb many individuals now diagnosed with ASD.

Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).

D. Symptoms together limit and impair everyday functioning.

The DSM is a manual that organizes behaviors and symptoms into diagnostic groups for the purposes of clinical diagnosis and recommended treatment. Over time, the DSM has changed significantly. The concept of an "Autism spectrum" is relatively recent, and major changes to criteria for Autism diagnoses will change what we presently think of as the "spectrum." Most significant for individuals in the autism community will be the removal of two existing Autism spectrum diagnoses from the manual: PDD-NOS and Aspergers.

Treatments will probably not vary much as a result of the DSM change. Also, there should not be a shake-up in terms of services and therapies. People and their needs aren't changing, just the way we capture their diagnoses.



The new criteria attempt to better describe and identify what Autism is, including what social communication is (separate from general learning disabilities). The DSM will also incorporate a dimensional aspect to ASD, indicating how much support an person needs in his/her community to focus on what the person should be doing at their age and developmental levels. This acknowledges that there is a range of causes in ASD, with a different range of functions.

An individual with present symptoms of Aspergers will fall in the diagnosis of Autism Spectrum Disorder, and there will probably be additional “specifiers” (e.g., without intellectual disability, with fluent speech, etc.), which may better describe the diagnostic picture for such an individual than is currently done with the term Aspergers alone.

Preventing Meltdowns: Diversion Tactics for Parents

When it comes to parenting a child with an Autism Spectrum Disorder (ASD), there are a few scenarios that are fertile ground for meltdowns. Some examples include (but are definitely not limited to):

• all afternoon shopping trips
• an endless car ride
• long wait at the doctor's office
• slow service at a restaurant
• too many homework problems

These are moments where a meltdown is coming on fast, but can still be diverted. These are the times when moms and dads need “diversion tactics” (i.e., a supply of items and ideas that can fill a moment or turn a head).

While diversion tactics come in handy with any youngster, it's particularly imperative for kids with an Autism Spectrum Disorder who are often significantly less able to amuse themselves, negotiate transitions, or avoid meltdowns. A parent needs to be quick, versatile, creative, and resourceful to keep things running smoothly. Planning ahead can help.



Here's how to make sure you always have plenty of tricks in your bag:

1. Your diversion tactics should do one of these (and preferably more than one): Soothe, Entertain, and Distract. They must be deployable at a moment's notice, especially in stressful situations. The space of time between the need for soothing, entertainment and distraction, and the onset of complete disaster can be brutally short.

2. Some of the tactics in your “diversion kit” will be actual items (i.e., things you keep in your purse or pockets for emergencies). It doesn't hurt to have some on hand at all times (that's why most of these are small) and then to load up with extras when you know you might need them. Some possibilities (depending on the age of your ASD child) include:

• Animal crackers
• Coins
• Crayons/coloring book
• Deck of cards
• Dice
• Doll
• Fidget toys
• Finger puppets
• Flash cards
• Hard candy
• iPad
• iPhone
• iPod
• Keys
• Little notepad and pen
• Magnetic travel game
• Photos
• Pretzels
• Puzzle book
• Raisins
• Small storybook
• Stickers
• Toy cars

3. Some of the tactics in your “diversion kit” will be ideas that you can implement without any need for props. You may have to go through a few before you find one your ASD youngster will run with, so keep a list if you can't keep them all in your head. Some possibilities include:

• 20 Questions
• A is for ..., B is for ...
• Blowing a raspberry on his or her arm
• Clapping games
• Getting a drink from a water fountain
• Hide something in fist -- guess which hand?
• I Spy
• Let youngster choose what to do next
• Looking out window
• Math facts
• Play with youngster's hair
• Pushing hard against each other's hands
• Rock-paper-scissors
• Saying something silly
• Taking a walk
• Tell me three things you did today
• Tickling
• What color am I looking at?
• Whispering secrets
• Word games where each person adds an item, alphabetically, and the next person must remember the whole string of words

Putting together a good list of diversion tactics is one thing, maintaining it is another. As your ASD youngster gets older, changes interests, gets bored with some things and taken by others, you'll want to keep changing and replenishing the tactics in your "diversion kit." Remember, the objects don't have to be big, they don't have to be fancy, and they only have to be able to run your youngster past a bit of boredom, anxiety, or a little rough behavioral spot. But they do have to soothe, entertain, and distract.

Note: If you only have a couple diversion tactics, they can fade with overuse. The more tactics you've got in your “bag of tricks,” the better.

==> Preventing Meltdowns and Tantrums in Kids on the Autism Spectrum

Raising Kids on the Spectrum: Dealing with Parental Stress

Of course, not all moms and dads of children with ASD level 1, or high functioning autism (HFA), are under stress, but many are. As one mother states, “You learn to live with a significant amount of stress and you throw yourself into your everyday job as a parent when you have a youngster with an Autism Spectrum Disorder. If you work outside the home, you work even harder - and you don't think much about taking care of yourself.”

 

Click here for the full article...

Getting Your Child with ASD to Obey: The "Silent 30 Count"

When it comes to getting "typical" children to do what they're told, “3” seems to be the magic number in most cases. The success of your own mother or father in telling you when you were a kid “you’ve got until the count of 3 to hop to” may make you assume that if your child doesn't get moving in a similar time-frame, he’s being defiant.

But for kids with ASD level 1 [High-Functioning Autism], three may not be a very realistic number. Think about what you're asking your youngster to do when you give an order and start counting. He has to (a) decipher what it is you want done, (b) think about how to do it, and (c) try to do it – quickly. Can your youngster accomplish these 3 steps in 3 seconds? Don't be too quick to say “sure he can!”

Consider these possible challenges:

• Stress management: Some kids on the autism spectrum find deadlines energizing, but others can become paralyzed by them. Anxiety caused by “deadline pressure” can take over your youngster and cause her to be unable to focus on the task at hand. Then, since she’s not doing what you want fast enough, you may become even more impatient, thus paralyzing her even more.
• Motor planning: For some of these special needs kids, contemplating how to physically do something (even something as obvious as stopping what they're already doing) can be a multi-step process. Planning and sequencing that activity may be a bigger job than a count of 3 will allow.
• Frustration tolerance: If your youngster seems unable to obey for some reason, it may seem easier to just issue a consequence than to do what's called for. A count of 3 gives your youngster very little time to work through other possibilities.
• Auditory processing: If he or she has trouble processing language, it may take more than a count of 3 for him to figure out what you want done, much less how to accomplish it.

If any of these are issues for your youngster, you may find you will have more success if you do two very important things:

1. extend that “3 count” to a “30 count” (i.e., 30 seconds)
2. count silently (under your breath)

Counting to 30 gives your youngster adequate time to (a) process your request or ask for clarification, (b) transition from what he is doing to a different activity, and (c) deal with frustration without becoming overly anxious. Counting to yourself (rather than out loud) helps him or her to be able to focus on the task at hand rather than on your "distracting" voice.

You may find that your youngster sometimes needs less than 30, at which point you can provide praise and encouragement. But if your “silent 30 count” is reached and the behavior hasn't changed, you can then issue a consequence.

Alternative to the “silent 30 count”:

Depending on the situation, you may want to opt for the “0 count” method (that’s right …the ‘zero’ count method). How does that work, you ask?

When requesting your child to follow your directions, you can allow him to decide when he will comply. Let’s use “doing chores” as an example:

The parent asks her child to clean his room before he takes-off over to a friend’s house. Five minutes later, the child declares that he is finished and starts to leave. Upon quick inspection, mom notices that his room is still a mess. So she says, “Hey …before you leave, I need to tell you something. Your chore isn’t done yet. Take as much time as you need, but you can’t leave until your room is cleaned-up.”

Statements like “take as much time as you need” are powerful in helping the child understand that his behavior determines when he may have the things he wants (in this case, the privilege of spending time with a friend).

Giving your youngster more time to do what you ask may seem like a sign of weakness on your part, but if you have reason to believe that she can't comply in short order, it's not only compassionate - but sensible - to extend the deadline. Your goal, after all, is to have your directions followed. In the end, it's far more time efficient to spend 30 seconds and get what you want, than to spend hours seeing to it that your child follows through with the consequence for non-compliance.

Resources for parents of children and teens on the autism spectrum:
 

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social-Skills and Emotion-Management to Children with Autism Spectrum Disorder

==> Parenting Children and Teens with High-Functioning Autism: Parents' Comprehensive Handbook

==> Unraveling the Mystery Behind High-Functioning Autism: Audio Book

==> Crucial Research-Based Parenting Strategies for Children and Teens with High-Functioning Autism

 

Comments:

 

Anonymous said...This is a hard one for me since the counting method is my old standby My son tells me "Don't count Mom unless you're doing math!" I will try the Silent 30 count see if it helps

Anonymous said...I do the back counting method and it works better with my kid.

Anonymous said... THANK YOU for your website! It is the only one I recommend over and over. I have searched and searched for information and help with raising our daughter with Asperger's and your site has been the one that I've subscribed to. The information is well researched and very insightful and most importantly, it works!

Anonymous said... I usually count to 5. It usually works. It doesn't work when my son is angry. I usually have to let him finish being angry, then I can get him do what do is requested.

Anonymous said... i have found that to be very frustrating as at 3 my 10 yr old still doesnt do as asked so he starts a half hr - hr screeming fit that me or partner cant control does anybody else have child like that how do u deal with them any help/ tips would be much appreciated .....

Anonymous said...we have had that problem in the past with our 7 yr old. Breaking the meltdowns was very difficult not that he never has one but they are few and far between now. I will say for us we had to watch our tone ( I especially tend to yell and get stressed & frustrated which just agitates him) when he starts losing it I tell him I cannot understand him and refuse to talk to him until he is calm. I think that appeals to his rational side the most. He still gets mad and cries but it brings the volume down. If he is REALLLY out of control I hold him against me and whisper to him to do his breathing until he calms down. Right now I am trying to work on a system of earning things like TV & video game time with him. That is one of our major issues because he doesn't want to turn things off to do homework or eat dinner etc. Trying to make it more of a routine for him so he knows ok my time is up I think will help.

 

Anonymous said...we do the holding and the talking to him as we do find that helps..... sometimes and the working towards ds time or tv etc but when he doesnt seem to calm down and help with things asked of him he turns violent and starts smashing things or slamming/kicking doors. I feel like we r fighting a loosing battle :-(

 

Frank L. Ludwig said...As someone who grew up without being diagnosed, I distincly remember that the best (if not the only) way to break my defiance was a plausible explanation why I was supposed to do (or not to do) something.