Understanding DSM-5 Changes and Autism Spectrum Disorder Treatment

Posted on Sep 10, 2024 in Psychology and Sociology

Understanding DSM-5 Changes

DSM-5 has transitioned to a nonaxial documentation of diagnosis, eliminating the multiaxial system used in DSM-IV. This change reflects the understanding that mental disorders are fundamentally conceptualized similarly, integrating biological, physical, behavioral, and psychosocial factors.

Key Changes in DSM-5:

  • Merging of Axes I, II, and III for a more integrated approach.
  • Separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).
  • Emphasis on lifespan approach, with disorders organized by age-related presentations.
  • Inclusion of age-related factors in diagnostic criteria.
  • Greater integration of sex, gender, and cultural considerations.

Addressing Criticisms:

While the DSM-5 offers improvements, some criticisms remain, particularly regarding its application to child psychopathology. These include:

  1. Limited capture of complex adaptations, transactions, and environmental influences crucial for understanding and treating children.
  2. Insufficient attention to disorders specific to infancy and childhood.
  3. Failure to fully address the interrelationships and overlap among childhood disorders.

Autism Spectrum Disorder (ASD) in DSM-5

ASD in DSM-5 consolidates four previously separate disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and PDD-NOS. This change recognizes these diagnoses as points on a severity continuum rather than distinct entities.

Key Changes in ASD Diagnosis:

  • Requirement for symptoms to be present from early childhood, even if recognized later.
  • Encouragement of earlier diagnosis and broader recognition of symptom presentation.
  • Elimination of Asperger’s Disorder, with individuals potentially receiving an ASD diagnosis or a new diagnosis like Social Communication Disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) in DSM-5

Changes in ADHD criteria include:

  • Requirement for symptoms to be present before age 12 (compared to 7 in DSM-IV).
  • Slight broadening of criteria for adult ADHD, potentially leading to increased diagnoses.
  • Emphasis on biological factors, which has sparked debate about potential overemphasis on medication over behavioral interventions.

Ethical Considerations in Child Treatment

Clinicians working with children must adhere to ethical guidelines, including those from the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychological Association (APA). Key principles include:

  • Prioritizing the best interests of the child.
  • Ensuring active and voluntary participation.
  • Maintaining confidentiality.
  • Documenting treatment effectiveness.
  • Practicing within one’s qualifications and competencies.
  • Exercising caution with potentially ineffective or harmful treatments.

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Treatment Strategies for ASD

Creating a Supportive Environment:

  1. Establish structure and routine with an organized environment.
  2. Prepare the child for changes in routine.
  3. Use clear and concise language with small sentences and repetition.
  4. Recognize visual processing strengths and utilize images for engagement.
  5. Be mindful of potential difficulties with nonverbal communication and ensure clarity.

Treatment Goals and Approaches:

Treatment aims to minimize core ASD challenges, maximize independence and quality of life, and support both the child and family. This involves:

  • Engaging the child in treatment.
  • Reducing disruptive behaviors.
  • Teaching appropriate social skills (joint attention, imitation, reciprocal interaction).
  • Enhancing functional and spontaneous communication.
  • Promoting cognitive skills (symbolic play, perspective-taking).
  • Developing adaptive skills for increased independence.

Specific Techniques:

  • Building a strong therapeutic relationship.
  • Using play-based interventions to enhance engagement and social interaction.
  • Discrete trial training to break down skills into manageable steps.
  • Incidental teaching to capitalize on naturally occurring learning opportunities.
  • Reward systems and mild punishment (e.g., ignoring) to manage behavior.
  • Social skills training through peer and sibling interactions.
  • Operant speech training to develop communication skills.

Assessing Intellectual and Educational Functioning: The WISC-V

The Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) is a widely used tool for assessing intellectual and educational functioning in children. It provides a comprehensive evaluation of cognitive abilities and helps identify strengths and weaknesses.

Key Features of the WISC-V:

  • Comparison of a child’s scores to a norm group.
  • Emphasis on fluid reasoning, higher-order thinking, and processing speed.
  • Generation of a Full-Scale IQ score and five primary index scores (Verbal Comprehension, Visual-Spatial, Fluid Reasoning, Working Memory, Processing Speed).
  • Usefulness in assessing learning disabilities, executive functioning, attention disorders, giftedness, and neurological issues.

Considerations for Interpretation:

  • Scores should be interpreted within the context of other assessment information.
  • Limitations related to race, ethnicity, culture, and language background should be considered.
  • The Full-Scale IQ score is generally preferred over individual subtest scores for interpretation.
  • Test results should inform treatment and educational planning.

Subtests of the WISC-V:

The WISC-V includes subtests such as Similarities, Vocabulary, Block Design, Picture Arrangement, Matrix Reasoning, Word Reasoning, Picture Completion, Digit Span, Coding, and Symbol Search.