The document summarizes key information about autism spectrum disorder (ASD) including its definition, prevalence, characteristics, diagnosis, and changes made in the DSM-5 criteria. Some main points include: - ASD is a pervasive neurological developmental disorder that affects approximately 1% of people. - It involves difficulties with social interaction and communication as well as restricted repetitive behaviors. - The DSM-5 consolidated previous ASD diagnoses into one category of ASD and made changes to the diagnostic criteria. - Diagnosis of ASD can be difficult and involves assessing language, sensory responses, resistance to change, and atypical social interactions and play patterns.

1. Autism Spectrum Disorder
By Agustin J. Cruz, MPA, MS, LPC
DITRYFS Training
001

2. Current & Evolving Definition
1. Pervasive
2. Neurological
3. Developmental Disorder (Condition/Diagnosis/Disability)
4. Autism is Impacts 1% of Humans (See Prevalence Slide coming up)
Autism is a Pervasive, Neurological, Developmental Disorder that effects 1% of all human beings.
Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder NOS now termed
“Autism Spectrum Disorder”
CDD eliminated: “not being used” “age of onset specifier added”
- http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-changes-to-autism-spectrum-
disorder)
Rett syndrome, if associated with ASD, is now specified as “Known Genetic Condition”

3. Pervasive
• Autism is present in EVERYTHING the ASD
person does in their lives:
• Thinking
• Memories
• Feelings
• Interactions

4. Neurological
• An ASD Person’s Brain is DIFFERENT:
• Some ASD Brains do not function the way a
Neuro-Typical person’s brain functions
• ASD Brains may not work in unison with other
parts of their brains
• ASD Brains think UNIQUELY about the
world around them and in many ways
sense/process and think in unique ways.

5. Developmental
• As in BEFORE BIRTH!
• There have always been ASD People and throughout
history, they are
• MISUNDERSTOOD
• STIGMATIZED
• ASD People have been Marginalized and Ignored in terms
of assisting with Information, Modalities to help ASD
people advance in Corporate America, Academia and other
areas of Society.
• The prevailing theme is still that Nuero-typical (non-autistic
people) know better then ASD people…
• Simply not true and needs to change.

6. • About 1 in 68 children has been identified with autism spectrum disorder (ASD) according to estimates from
(CDC's
- Autism and Developmental Disabilities Monitoring (ADDM) Network).
• ASD is reported to occur in all racial, ethnic, and socioeconomic groups.
- PLoS One. 2010 Jul 12;5(7):e11551. doi: 10.1371/journal.pone.0011551.
• Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional
study.
- Durkin MS1, Maenner MJ, Meaney FJ, Levy SE, DiGuiseppi C, Nicholas JS, Kirby RS, Pinto-Martin JA, Schieve LA.
• ASD is almost 5 times more common among boys (1 in 42) than among girls (1 in 189)
- Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities
Monitoring Network, 11 Sites, United States, 2010 (Surveillance Summaries March 28, 2014 / 63(SS02);1-21).
• Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence
of about 1%. A study in South Korea reported a prevalence of 2.6%. The following link is excellent and
useful information hard data.
- http://www.cdc.gov/ncbddd/autism/documents/asd_prevalence_table_2013.pdf.
• About 1 in 6 children in the United States had a developmental disability in 2006-2008, ranging from mild
disabilities such as speech and language impairments to serious developmental disabilities, such as
intellectual disabilities, cerebral palsy, and autism.
- Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the
Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011 [epub ahead of print].
Prevalence & Additional Data to Aid in Further Reading

7. Goal of DSM-5
• APA DSM-5 workgroups formed in 2007 with the
goals of:
– Creating a more “dimensional” classification system
– Separating constructs of impairment and disorder (e.g.,
with the use of Severity Scales)
– Reducing “-NOS” diagnoses in favor of broad categories
with dimensional specifiers
– Representing greater reflection of (and easier incorporation
of) neurobiological findings
(Gotham, K. (July 11, 2013). Autism Spectrum Disorder in DSM-5: Overview of Updates to the Diagnostic and Statistical Manual and to the Autism
Diagnostic Observation Schedule (ADOS-2). Webinar hosted by the New Hampshire Autism Council Screening & Diagnosis workgroup).

8. DSM-5 Changes
• DSM-5 Changes combines the first three DSM-IV-TR axes
into one list that contains all mental disorders, including
personality disorders and intellectual disability, as well as
other medical diagnoses.
• Contributing psychosocial and environmental factors or other
reasons for visits are now represented through an expanded
selected set of ICD-9-CM V-codes . . .
• The DSM-5 includes separate measures of symptom severity
and disability for individual disorders, rather than the Global
Assessment of Functioning (GAF) scale.
APA. (2013). Insurance Implications of DSM-5

9. Role of ICD-10 Pervasive Developmental Disorders
Pervasive developmental disorders
– F84.0 - Autistic disorder
– F84.2 - Rett's syndrome
– F84.3 - Other childhood disintegrative disorder
– F84.5 - Asperger's syndrome
– F84.8 - Other pervasive developmental disorders
– F84.9 - Pervasive developmental disorder,
unspecified
(Source: ICD-10-CM TABULAR LIST of DISEASES and INJURIES – 2014)

10. Symptom Detailed Cluster Information
• “(A) qualitative impairment in social interaction”
and
• “(B) qualitative impairments in communication”
• (from DSM-IV)
• “A. Persistent deficits in social communication
and social interaction”
• (in DSM-5)
• The restricted repetitive behavior cluster is
retained.

11. ASD MYTHS
• ASD was previously thought of as a child of “Cold Mother’s” (This Book Changed Infantile Autism: The Syndrome
and Its Implications for a Neural Theory of Behavior (1964), by Bernard Rimland - See more at:
https://embryo.asu.edu/pages/infantile-autism-syndrome-and-its-implications-neural-theory-behavior-1964-bernard-
rimland#sthash.tTU3cb2h.dpuf.
• Vaccinations Causes ASD (Retracted Study, 1998, Andrew Wakefield).
• ASD people are “Retarded.”
• ASD People are “Faking it”
• ASD people are “Weirdo’s/Freaks.”
• We need a “Cure” for ASD.
• “Autism Speaks National Organization” is the only voice for all ASD people.
• ABA is the only modality to use to help ASD get “Normal.”
• Nuero-typical (non-autistic people) know better about Treatment Modalities than ASD people.
• Gluten Free Diet Cures Autism: (New Discoveries In Autism, Some new information about the diet of ASD People is
playing a role in the Autism debate. Some research has shown substantial evidence that diet can play a role in the
source of Autism. Two proteins - Gluten and Casein (Autism Web, 2001).
• Bottom line is there is no CURE and doesn't’t need to be a cure. This is a “Natural Occurrence of the Brain.”

12. Two Factor vs. Three Factor
• Empirical data suggests the DSM-5 Two
Factor (Social Communication and
Restricted/Repetitive ) was superior to the
Three-Factor DSM-IV-TR model

13. Technical Data for ASD/DSM-5
A. Persistent deficits in social communication and
social interaction across multiple contexts, as
manifested by the following currently or by history
(examples are illustrative, not exhaustive):
1. Deficits in social-emotional reciprocity, ranging, for
example, from abnormal social approach and failure of
normal back and forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or
respond to social interactions.

14. Technical Data for ASD/DSM-5
2. Deficits in nonverbal communicative behaviors used for
social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to
abnormalities in eye contact and body-language or
deficits in understanding and use of gestures; to a total
lack of facial expression and nonverbal communication.
3. Deficits in developing, maintaining and understanding
relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making
friends; to absence of interest in peers.

15. Technical Data for ASD/DSM-5
B. Restricted, repetitive patterns of behavior,
interests, or activities, as manifested by at least
two of the following, currently or by history
(examples are illustrative, not exhaustive):
1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).
2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulty with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food everyday).

16. Technical Data for ASD/DSM-5
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g.,
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 (e.g., apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive smelling or touching of
objects, visual fascination with lights movement).
C. Symptoms must be present in the early developmental period (but may not become
fully manifest until social demands exceed limited capacities, or may be masked by
learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual
developmental disorder) or global developmental delay. Intellectual disability and
autism spectrum disorder frequently co-occur; to make comorbid diagnoses of
autism spectrum disorder and intellectual disability, social communication should
be below that expected for general developmental level.
(Specify If: See next Slide)

17. Specify if:
• With or without accompanying intellectual
impairment
• With or without accompanying language
impairment
• Associated with a known medical or genetic
condition or environmental factor
• Associated with another neurodevelopmental,
mental, or behavioral disorder
• With Catatonia (Will be gone soon)

18. Level of Support/DSM-5
• Level 1: "Requiring Support"
• Level 2: "Requiring Substantial
Support"
• Level 3: "Requiring Very Substantial
Support”

19. Allowance of Dual Diagnosis
• ADHD and ASD
• (In my field of work, this effectively allows
private providers to work with ASD children
despite weak treatment modalities for ASD
endemic within the industry).

20. What If I Was Diagnosed Under DSM-V-TR
• The following studies have suggested that you may not initially be be diagnoses ASD from DSM-IV-TR to DSM-5
The following studies by:
• McPartland et al. (2012), Matson, Belva et al. (2012), Matson, Kozlowski et al. (2012), and Worley and Matson (2012) . . .
All suggest that children, adolescents, and adults
classified with ASDs according to DSM-IV-TR
criteria will not meet DSM-5 criteria for ASD.
(Matson, Hattier, & Wiliams, 2012)

21. Contradictions/Issues in Diagnosis from
DSM IV-TR to DSM-5
• Many studies point to a similar conclusions,
i.e., The DSM-5 Symptom Criteria for ASD
are too restrictive to be acceptable for use with
young children*.
(Reported response by Susan Swedo, MD, of the National Institute of Mental Health, head of the American Psychiatric Association
committee rewriting the diagnostic criteria for autism spectrum disorders) See also Retrospective, using existing assessment data
McPartland et al. (2012), Matson, Belva et al. (2012), Matson, Kozlowski et al. (2012), and Worley and Matson (2012) . . . All of
these studies show that according to the proposed algorithm, 30–45 % of children, adolescents, and adults classified with ASDs
according to DSM-IV-TR criteria will not meet DSM-5 criteria for ASD. (Matson, Hattier, & Wiliams, 2012).

22. Note about Social (Pragmatic) Communication Disorder
• "Note: Individuals with a well established DSM-
IV diagnosis of autistic disorder, Asperger's
disorder, or pervasive developmental disorder not
otherwise specified should be given the diagnosis
of autism spectrum disorder. Individuals who
have marked deficits in social communication,
but whose symptoms do not otherwise meet
criteria for autism spectrum disorder, should be
evaluated for Social (Pragmatic) Communication
Disorder."

23. Diagnosing Autism
• Difficulty with Language
• Abnormal Responses to Sensory Stimuli
• Resistance to change and difficulty with Social
Interaction.
• Other characteristics of autism “MAY” include:
making the same repetitive motion for hours,
repeating a sound or phrase, inability to hold a
conversation, practicing unusual play patterns,
and extreme sensitivity to sound and touch.
• No two Autistic people are the same, Hence they
are “Unique.”

24. Why a Spectrum
• That is why Autism is referred to as a
Spectrum Disorder, on one end of the
Spectrum Disorder a child may have “Some”
symptoms, while at the other end of the
Spectrum a child may have “Multiple” For
Example, A Child who display few symptoms
may be characterized as Mildly Autistic.

25. Brief History of Autism
• In 1943, Leo Kanner identified Autism: Kanner
labeled the disorder “Autistic Disturbance Of
Affective Contact.”
• Kanner said Autistic children had “Reverse
Patterns” typically observed in nuero-typical
infants. For Example, Infants are normally
interested in Social, as opposed to Nonsocial
Environments.
• 1980 Autism first described in USA within with
the publication of DSMIII
(Tanguay, Robertson, Derrick, 1980)

26. Impact of DSM-5/Changes/Future
• UNSURE/UNCLEAR/DEBATABLE in
regards to Autism, but it doesn’t really clear
things up for me.
• Further, the Trials have not been kind to the
Criteria for this Diagnosis across past/present
DSM’s.
• Obviously we need more studies more data
and I hope that data comes from ASD People.