I just spent the week on the road, speaking for PESI on autism. I was in Idaho Falls, ID, Salt Lake City, UT, Cheyenne, WY, and Denver, CO. I was so pumped by the people I met and the passion they had for helping individuals in the autism spectrum. I managed to always get my full presentation done on time, but we had some great exchanges during that time too.
There is so much that we are learning about individuals in the autism spectrum. The DSM-V, which will be out in 2013, is hoping that there can be clarification to allow more services, instead of fragmented services. That is still to be seen, especially for the higher functioning who may not quite make it under the new criteria. But the DSM is also adding a new category or diagnosis – Social Communication Disorder – which is hoped to pick up those who are dropped by the DSM for autism but are recognized for their significant struggles with social and communicative language. Of course it will be about who is willing to take up with services cause for this new population.
For those that haven’t seen the proposed DSM-V criteria, there are 4 sections, and the individual has to meet criteria in all for sections right now, although they are looking at the possibility of needing only 3 out of 4. The areas are 1) Persistent deficits in social communication and social interaction across contexts, 2) Restricted, repetitive patterns of behavior, interests, or activities (which can include sensory) 3) must be present in early childhood although not necessarily fully manifest until social demands outstrip limited capacities, and 4) symptoms together limit and impair everyday functioning. I am fairly certain that the 4th criteria will have to be met, but how impairment is defined is gray at present, since that might be somewhat subjective based on the diagnostician.
We need to look at the redefined areas in order to determine interventions and accommodations in order to maximize assistance to this population. I was hearing during my week on the road that there are still diagnosticians who want to wait until 4 0r 5 before they apply the diagnosis. I am hearing of some states who are encouraging educational diagnoses in order to get services started due to problems in the healthcare field in finding and diagnosing these children in a timely manner. I know that is a problem here in Iowa too. I had a parent tell me within the last year that a child psychiatrist told them that getting a diagnosis of autism spectrum was just trying to find an excuse for their child’s bad behavior. While the Des Moines area is embracing the education diagnosis to get services started, I know that this is not statewide.
As a country, we need to increase the understanding of the autism spectrum disorders so that Child Find can occur early at the healthcare level, not wait until children begin school. I am not against an educational diagnosis, I simply feel that we are putting these children behind the eight ball forcing them to wait before they can get the help they need. The educational system, also is not set up for the level of intervention needed, if we wait till they start kindergarten. The school’s main mission is to academically educate our society’s children. Unless the system is changed for this population, they will quickly fall into anxiety, confusion and frustration, trying to juggle academic learning, with the social and language demands of a regular classroom. There need to be changes at the school level to accommodate these children but the bigger demand is on early identification and services so that they are more prepared for the academic learning that is the main purpose of our classroom. We also have to look at the older individuals and how to develop a system of service for them to become productive members of our society.
Let’s look toward 2013 to say how we use the revised criteria to identify early, provide necessary services, and systems of change to allow this population to be fully integrated into their communities. Our passion will allow everyone to function at their optimal levels.