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2 Diagnosis

I am hoping that people will read my blog out of interest, even if they have not been touched with autism directly or have no prior knowledge. Just because. Therefore, I think it is important to provide a light interpretation of the diagnosis of Autism Spectrum Disorders.

Briefly, there are two main bodies outlining diagnostic criteria; the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD).

DSM

The DSM is a publication by the American Psychiatric Association (APA) for the classification of mental health illness and disorders [Wikipedia, 2020]. The current edition in use, DSM-5 was published in 2013. ASD sits in Section II, Neurodevelopmental Disorders 299.00.

It states that autism spectrum disorder is characterized by:

1. Persistent deficits in social communication and social interaction across multiple contexts, including;

1.1. deficits in social reciprocity- this means there may be a lack of the normal back-and-forth of a conversation, or that the individual doesn’t share much about their feelings and emotions, or they failure to initiate or respond to interactions.

1.2. nonverbal communicative behaviours used for social interaction- this is a reference to the integration of verbal and non-verbal forms of communication like gestures and facial expressions which are recognisable to most as a lack of eye-contact and facial expression.

1.3. skills in developing, maintaining, and understanding relationships- ranging from making friends to sustaining friendships due to an absence of interest in others, lack of imaginative play or a lack of ability to adjust behaviours to the social situation.

2. Restrictive, repetitive patterns of behaviour, interests, or activities.

2.1. Repetitive movements, speech or use of objects- these can be obvious and distressing like head-banging, but they can also be subtle like finger-flicking or coin spinning, interpreted as ‘quirky’.

2.2. Insistence on routines and rituals- eating the same foods every day or traveling the same route with great distress being caused upon even a small change in schedules.

2.3. Fixated interests with abnormal intensity- watching the same movie a hundred times over or taking a hobby to the extreme.

2.4. Sensory issues- these maybe an increased awareness, e.g. sounds and smells, or an apparent indifference, e.g. pain or temperature.

3. Symptoms should be apparent from a young age but as they may change with development and be masked by compensatory mechanisms, the diagnostic criteria may be met based on historical information.

4. The symptoms cause significant impairment in life, whether socially, at school with academics or at work- the age may vary according to the characteristics of the individual and their environment.

5. The symptoms don’t fit into the criteria for intellectual disability or global developmental delay but the two make co-exist [American Psychiatric Association, 2013].

To summarise further, in order to meet diagnostic criteria for ASD, a child must have:

- persistent deficits in each of three areas of social communication and interaction mentioned above, plus

- at least two of four types of restricted, repetitive behaviours,

- from an early age,

- causing significant impairment in daily functioning.

It should be noted that the impairment may not become obvious until later in life, if the individual is not struggling intellectually and has a stable environment, as they develop compensatory mechanisms and learn to mask traits early on. Coping strategies may only start to crack under the pressure of extreme stress, in my case a sudden break in routines filled with ongoing uncertainty, caused by a global pandemic! Hence, an assessment should enquire about behaviours from a young age even if they are not currently present.

Within the diagnosis of ASD individual clinical characteristics are noted through the use of specifiers (with or without accompanying intellectual impairment; with or without accompanying structural language impairment; associated with a known medical/genetic or environmental/acquired condition; associated with another neurodevelopmental, mental, or behavioral disorder), as well as specifiers that describe the autistic symptoms (age at first concern; with or without loss of established skills; severity). These specifiers provide clinicians with an opportunity to individualize the diagnosis and communicate a richer clinical description of the affected individuals. Consequently, many individuals previously diagnosed with Asperger's disorder would now receive a diagnosis of ASD without language or intellectual impairment. You may now be getting a sense of why autism is termed a spectrum disorder!

ICD-10

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO) [Wikipedia, 2020]. It is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD contains codes for diseases, and ASD sits in Chapter 5 within the category of Mental and Behavioural Disorders with the code F84.0.

The criteria are similar to the above with an emphasis on social communication issues and repetitive behaviours noted below the age of three years but with additional criteria outlined for individuals with atypicality of age and/or symptoms.

I know the above is heavy on science but whilst researching, it solidified my diagnosis in my own mind and may cause other to question their own characteristics. If so, what’s the next step I hear you ask? Well, for me it started though the school counsellor with a presentation of anxiety and sensory issues but that’s a story for another time. Suffice to say, that led to a referral to the learning support department and on to an educational psychologist. She had a consult with my parents and me, asking about everything from the pregnancy to birth to early years to date, hence the need for my parents. The questions ranged from: dates of milestones like when I walked and talked, friendships I made (or didn’t), perceptions of others, sensitivities and quirks amongst other things. My parents filled out lots of questionnaires and I was engaged in several hours of standardised tests, even one where I had to recite a story about a frog from a picture book- I felt like I was in primary school. Two weeks later, at the feedback session my predictions were confirmed with evidence from the psychological consult and tests. There was no emotion on my part. I wasn’t happy but neither was I sad. It was a weird feeling- one I can only explain by saying it wasn’t new knowledge to me. There was no surprise in the reasoning and explanations I heard from the psychologist in support of the diagnosis, but neither was there relief. Just it is what it is and I am who I am.

I am Nidhi and I am autistic.

Thanks for reading,

Nidhi :)

 

References


American Psychiatric Association. “American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).” Classification and Diagnosis of Mental Disorders, 18 May 2013, doi:10.1007/springerreference_179660. [Accessed October 19, 2020].


Wikipedia, 2020. DSM-5. Available at: https://en.wikipedia.org/wiki/DSM-5 [Accessed October 23, 2020].

Wikipedia, 2020. International Classification of Diseases. Available at: https://en.wikipedia.org/wiki/International_Classification_of_Diseases [Accessed October 19, 2020].

Cover image: Independent.ie, 2019. How to identify and support neurodiversity. Available at: https://www.independent.ie/life/family/learning/how-to-identify-and-support-neurodiversity-38496974.html [Accessed September 15, 2021]

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