DSM v ADOS

Lexicon [Measures] DSM, ADOS

DSM-5-TR (latest version of DSM) and ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition)  are two distinct tools used in assessment and dx of autism.

DSM-5-TR 

• Diagnostic manual that outlines the criteria for diagnosing ASD, including the presence of social communication deficits and RRB. 
• Serves as a reference for clinicians and researchers in making diagnostic decisions and ensures consistency in the diagnosis of ASD.

ADOS-2 

• Standardized observational assessment tool designed to aid in the diagnosis of ASD. 
• Administered by a trained professional and involves direct interaction with the individual  
• consists of a series of activities and social scenarios that allow the examiner to observe and evaluate the individual's communication skills, social interaction, play, and RRB. 
• It helps in determining whether an individual meets the diagnostic criteria for ASD and provides information to inform intervention and treatment planning.

ADOS-2 can be utilized as part of the diagnostic process, providing information to support the dx under DSM-5. Both tools are commonly used together to aid in the assessment and diagnosis of Autism Spectrum Disorder.

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A Simple Guide to the DSM and Autism

Lexicon [Measures] - DSM

PlainSpeak. In Plain Language for the Lay Reader

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a big book that doctors and mental health professionals use to diagnose and understand mental health conditions. 

Here’s a quick history of the DSM, focusing on how it has changed its understanding of autism over the years.

The Early Years: DSM-I and DSM-II

• DSM-I (1952): The first edition of the DSM didn’t include autism. Back then, people didn’t really know about autism.
• DSM-II (1968): The second edition mentioned “schizophrenic reaction, childhood type,” because people thought autism was related to childhood schizophrenia.

Autism Emerges: DSM-III and DSM-III-R

• DSM-III (1980): This edition was a big deal because it introduced "Infantile Autism" as its own category. This was the first time autism was seen as different from schizophrenia.
• DSM-III-R (1987): The revised edition changed the name to "Autistic Disorder" and provided more detailed criteria for diagnosing it, recognizing a wider range of symptoms.

Refining the Diagnosis: DSM-IV and DSM-IV-TR

• DSM-IV (1994): This edition added more details. Autism was now part of a group called Pervasive Developmental Disorders (PDD), which included:

  • Autistic Disorder
  • Asperger’s Disorder
  • Rett’s Disorder
  • Childhood Disintegrative Disorder
  • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

  This allowed doctors to better identify different types of autism.

• DSM-IV-TR (2000): This version didn’t change much but updated and clarified the existing information.

The Modern Era: DSM-5

• DSM-5 (2013): The most recent edition made major changes to how autism is diagnosed:
  • Autism Spectrum Disorder (ASD): The DSM-5 combined all the previous types of autism into one diagnosis called Autism Spectrum Disorder (ASD). This reflects the idea that autism is a single condition with different levels of severity.
  • Two Domains: The criteria for diagnosing ASD are now based on two main areas:
    1. Social Communication and Interaction: Problems with social communication and interaction in different situations.
    2. Restricted, Repetitive Behaviors: Repetitive movements, strict routines, very focused interests, and unusual reactions to sensory experiences.
  • Severity Levels: The DSM-5 includes levels to show how much support someone with ASD might need:
    • Level 1: Requires support
    • Level 2: Requires substantial support
    • Level 3: Requires very substantial support
  • Specifiers and Comorbidities: Doctors can add more details about a person’s ASD, like if they have intellectual or language difficulties. The DSM-5 also recognizes that people with ASD often have other conditions like anxiety, depression, or ADHD.

Summary

The DSM has changed a lot over the years to better understand and diagnose autism. From not recognizing autism at all to seeing it as a broad spectrum of conditions, these updates help doctors and families understand and support people with autism better.

Related Posts: [DSM], [Diagnosis],[Measures]

A Brief History of the DSM and Autism

Autism Lexicon [Measures] - DSM

A Brief History of the DSM and Autism 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a critical tool used by mental health professionals worldwide to diagnose and classify mental disorders.

The Modern Era: DSM-5

• DSM-5 (2013): The most recent edition introduced significant changes to the diagnosis of autism. Key updates include:

• Autism Spectrum Disorder (ASD): The DSM-5 combined the previously separate diagnoses of Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder, and PDD-NOS into a single diagnosis: Autism Spectrum Disorder (ASD). This change reflects the understanding that these conditions are part of a single continuum with varying degrees of severity.

• Two Domains: The DSM-5 criteria for ASD are based on two domains instead of three. These are:

• Social Communication and Interaction: Persistent deficits in social communication and social interaction across multiple contexts.

• Restricted, Repetitive Patterns of Behavior, Interests, or Activities: This includes repetitive movements, insistence on sameness, highly restricted interests, and hyper- or hypo-reactivity to sensory input.

• Severity Levels: The DSM-5 includes severity levels to indicate the level of support needed: Level 1 (requiring support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support).

• Specifiers and Comorbidities: The DSM-5 allows for specifiers to provide additional detail about the presentation of ASD, such as the presence of intellectual or language impairments, and acknowledges common comorbidities like anxiety, depression, and ADHD.

Refining the Diagnosis: DSM-IV and DSM-IV-TR

• DSM-IV (1994): This edition further refined the classification of autism under Pervasive Developmental Disorders, which included Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). This allowed for greater differentiation among various forms of autism.

• DSM-IV-TR (2000): The text revision did not significantly change the criteria but provided updated information and clarified diagnostic guidelines.

The Emergence of Autism: DSM-III and DSM-III-R

• DSM-III (1980): This edition marked a significant shift by introducing "Infantile Autism" as a distinct category under Pervasive Developmental Disorders (PDD). This was the first time autism was recognized as separate from schizophrenia.

• DSM-III-R (1987): The revised edition expanded the criteria and changed the term to "Autistic Disorder," providing more specific diagnostic criteria and acknowledging a broader range of symptoms.

The Early Years: DSM-I and DSM-II

• DSM-I (1952): The first edition of the DSM did not include autism. At the time, autism was not widely recognized as a distinct condition.

• DSM-II (1968): The second edition included a diagnosis of "schizophrenic reaction, childhood type," reflecting the early belief that autism was related to childhood schizophrenia.

A Simple Guide to the ICD and Autism: Understanding ICD-11

Lexicon [Measures] - DSM & ICD

PlainSpeak. In Plain Language for the Lay Audience

While the USA uses the DSM, most of the world uses another tool called the ICD. The ICD, or International Classification of Diseases, is a guide created by the World Health Organization (WHO) to help doctors all over the world diagnose and understand diseases and health conditions. 

The Early Years: ICD-6 to ICD-9

• ICD-6 (1948): The sixth edition of the ICD was the first to include mental disorders, but it didn’t mention autism. Autism wasn’t recognized as its own condition back then.
• ICD-7 (1955) and ICD-8 (1965): These editions added more mental disorders but still didn’t have specific criteria for autism. Autism was often mixed up with other psychiatric conditions.
• ICD-9 (1979): This edition started to recognize autism under a broader category called "Pervasive Developmental Disorders" (PDD), showing that people were beginning to understand autism better.

Defining Autism: ICD-10

• ICD-10 (1992): This edition made a big change by giving more detailed classifications for autism. Autism was listed under "Pervasive Developmental Disorders" (F84). It included:
  • Childhood Autism: Kids with problems in social interaction, communication, and repetitive behaviors.
  • Atypical Autism: Similar to childhood autism but with unusual age of onset or different symptoms.
  • Asperger's Syndrome: Problems in social interaction and repetitive behaviors, but no significant delays in language or thinking.
  • Other PDDs: Including Rett's Syndrome and Childhood Disintegrative Disorder.

The Modern Era: ICD-11

• ICD-11 (2018): The latest edition made important changes to how autism is diagnosed, similar to the DSM-5 used in the USA. Key updates include:
  • Autism Spectrum Disorder (6A02): The ICD-11 combined all previous types of autism into one category: Autism Spectrum Disorder (ASD). This shows that autism is a spectrum with different levels of severity and symptoms.
  • Two Core Domains:
    • Deficits in Social Communication and Social Interaction: Ongoing difficulties in social communication and interaction.
    • Restricted, Repetitive Patterns of Behavior, Interests, or Activities: Repetitive movements, strict routines, very focused interests, and unusual responses to sensory experiences.
  • Severity Specifiers: These help to indicate how severe the condition is and how much support a person might need in daily life.
  • Associated Features: This allows for noting extra features like intellectual development disorders and language impairments to give a fuller picture of each person’s unique situation.

Impact of ICD-11 on Autism Diagnosis

The changes in ICD-11 help make autism diagnoses more accurate and consistent worldwide. By recognizing autism as a spectrum disorder, the ICD-11 understands that people with autism can have a wide range of symptoms and levels of severity. This approach supports more personalized and appropriate treatments, tailored to what each individual needs.

As our knowledge about autism grows, the ICD will keep evolving to make sure people with autism get the right diagnosis and support. This evolution helps ensure that everyone with autism can live a fulfilling life.

RDoc vs DSM in the context of Autism

Lexicon [Measures] RDoc, DSM

RDoc v DSM

The RDoC (Research Domain Criteria) & DSM  (Diagnostic and Statistical Manual of Mental Disorders) are both tools used in the field of mental health, but they approach the understanding and classification of mental disorders from different perspectives. 

DSM is a clinically focused tool for diagnosing mental disabilities based on symptomatic criteria, while RDoC is a research-focused framework aiming to understand mental health disorders from a multidimensional, biopsychosocial perspective

• DSM : Published by the American Psychiatric Association. It provides clear diagnostic categories based on observable behavior and reported symptoms. However, the DSM is often criticized for its categorical approach, where a patient either has or does not have a particular disability.
• RDoC : Developed by NIMH. The RDoC is not a diagnostic tool;  it's a research framework. RDoC aims to integrate many levels of information (from genomics and circuits to behavior) to better understand basic dimensions of functioning that span the full range of human behavior . The goal of RDoC is to provide a more dimensional approach to understanding mental disabilities, based on neuroscience and behavioral science, rather than purely on observable symptoms.

Autism and RDoC

Autism, under the RDoC framework, is seen not as a single, homogeneous disorder but as a spectrum that includes a variety of symptoms and behaviors that can vary widely in challenge-level and impact-level. This aligns with the current understanding of autism as a "spectrum."

For example, RDoC organizes its research around several "domains" of human psychological functioning, including cognitive processes, social processes, and arousal/regulatory systems, all of which are areas where autistics may show differences. Within these domains, RDoC further identifies specific constructs - like social communication and perception, or cognitive systems related to attention and perception - that could be targets for research into the biological and behavioral underpinnings of autism.

Challenges in implementing RDoC
There are potential challenges to implementing RDoC principles more fully into research or clinical practice for autism.

• Trying to map a heterogeneous disability like Autism onto the specific domains and constructs defined by RDoC.
• Current lack of practical tools and measures available to clinicians, to assess the various domains and constructs defined by RDoC in a routine clinical setting. This includes standardized measures for assessing constructs like social communication and perception, or the cognitive systems related to attention and perception that are relevant to autism.
• Need for further research: to validate the constructs and domains defined by RDoC, and to understand how these relate to the symptoms and behaviors associated with autism. We need a deeper understanding of the relationships between the biological, psychological, and behavioral aspects of autism to fully implement the RDoC approach.
• Changing Existing Systems & Acceptance in the Clinical and Research Community:  Current diagnostic systems like DSM-5 are deeply rooted in many aspects of mental health care. It must gain acceptance not only among researchers, but also among clinicians, educators, and families. This requires education and evidence that the RDoC approach can improve outcomes for autistics.

Related Posts: [DSM], [ICD], [RDoC], [Diagnosis],[Measures]

A Brief History of the ICD

Lexicon [Measures] - ICD

While the USA follows the DSM, most of the world uses ICD. The International Classification of Diseases (ICD) is a globally used diagnostic tool maintained by the World Health Organization (WHO) to classify and code diseases and health conditions.

The latest edition (ICD-11) combined the previously separate diagnoses into a single category: Autism Spectrum Disorder (ASD). This change reflects the understanding that autism is a spectrum with varying degrees of severity and manifestations.

• ICD-11 (2018):  The latest edition combined the previously separate diagnoses into a single category: Autism Spectrum Disorder (ASD). This change reflects the understanding that autism is a spectrum with varying degrees of severity and manifestations.
• Two Domains: The criteria for ASD are based on two core domains:
• Deficits in Social Communication and Social Interaction: Persistent difficulties in social communication and interaction across multiple contexts.
• Restricted, Repetitive Patterns of Behavior, Interests, or Activities: This includes stereotyped movements, insistence on sameness, restricted interests, and sensory anomalies.
• Severity Specifiers: The ICD-11 includes specifiers to indicate the severity of the condition and the level of support needed in daily life.
• Associated Features: The classification allows for the inclusion of additional features such as intellectual development disorders and language impairments, providing a comprehensive understanding of each individual’s unique presentation.

• ICD-10 (1992): This edition marked a significant shift by introducing more detailed classifications for autism. Autism was listed under "Pervasive Developmental Disorders" (F84), which included:
• Childhood Autism: Defined by impairments in social interaction, communication, and restricted, repetitive behaviors.
• Atypical Autism: Similar to childhood autism but with an atypical age of onset or atypical symptomatology.
• Asperger's Syndrome: Characterized by impairments in social interaction and restricted, repetitive behaviors, without significant delays in language or cognitive development.
• Other PDDs: Including Rett's Syndrome and Childhood Disintegrative Disorder.

• ICD-9 (1979): The ninth edition began to recognize autism under the broader category of "Pervasive Developmental Disorders" (PDD), reflecting growing awareness of the condition.
• Defining Autism: ICD-10
• ICD-7 (1955) and ICD-8 (1965): These editions continued to expand the classification of mental disorders but did not provide specific criteria for diagnosing autism. Autism was still often misclassified under other psychiatric conditions.
• ICD-6 (1948): The sixth edition of the ICD was the first to include a section on mental disorders, but it did not specifically mention autism. At this time, autism was not widely recognized as a distinct condition.

Related Posts: [DSM], [ICD], [RDoc], [Diagnosis],[Measures]

DSM vs ICD

Lexicon [Measures]-DSM & ICD

The DSM (Diagnostic and Statistical Manual of Mental Disorders) and ICD (International Classification of Diseases) are two different systems used to classify mental disabilities. 

• The DSM is used in the US and the ICD is used internationally. 
• The latest version of the DSM is the DSM-5-TR, which was published in March 2022 (revision of the 2013 DSM-5). The latest version of the ICD is ICD-11. It was adopted by the World Health Assembly in 2019 and came into effect on January 1, 2022.
• The DSM is more focused on clinical dx, while the ICD is more focused on public health.

• Both systems use a multiaxial approach, which means that they assess mental disabilities on multiple dimensions, such as symptoms, severity, and functional impairment.
• Both systems are updated periodically to reflect new research and understanding of mental disorders. The DSM is more detailed and specific and updated more frequently than ICD. 

Related Posts: [DSM], [ICD], [RDoc], [Diagnosis],[Measures]

ICD - International Classification of Diseases

Lexicon [Measures] - ICD

The ICD (International Classification of Diseases), an international diagnostic tool by the WHO, classifies autism as a neurodevelopmental disorder characterized by deficits in social interaction and communication, and repetitive behaviors or interests. The USA primarily uses the DSM (Diagnostic and Statistical Manual of Mental Disorders) system for diagnosis.

PlainSpeak: The ICD (International Classification of Diseases), a global guide used by doctors, defines autism as a condition with social interaction and communication challenges, and repetitive behaviors or interests. In the USA, doctors mainly use the DSM (Diagnostic and Statistical Manual of Mental Disorders) system for diagnosis.

Related Posts: [DSM], [ICD], [RDoc], [Diagnosis],[Measures]

DSM-5 Diagnostic Statistical Manual

The DSM-5, a diagnostic tool published by the American Psychiatric Association, classifies autism as a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, along with restricted, repetitive patterns of behavior, interests, or activities.

PlainSpeak: The DSM-5, a guide used by doctors to diagnose mental health conditions, defines autism as a condition where people have challenges with social interactions and communication, and often have specific, repetitive behaviors or interests.

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