Differential Diagnosis Of Autism Research Articles

Differential diagnosis of autism, attachment disorders, complex post‐traumatic stress disorder and emotionally unstable personality disorder: A Delphi study

Differential diagnosis of autism, attachment disorders, complex post‐traumatic stress disorder and emotionally unstable personality disorder: A Delphi study

Positive and differential diagnosis of autism in verbal women of typical intelligence: A Delphi study.

Diagnostic criteria for autism are relatively vague, and may lead to over and underdiagnosis when applied without clinical expertise. Indeed, autism is best reliably identified by experienced clinicians who take into account qualitative aspects of the condition. When assessing for autism in women, little guidance exists to support clinicians deciding whether to attribute adaptive difficulties to autism, a psychiatric condition, or both. The purpose of this study was therefore to propose guidelines for clinicians assessing for autism in women. To do this, we aimed to describe the clinical expertise involved in making positive and differential diagnoses of autism in adult women of typical intelligence. We interviewed 20 experienced clinicians from seven countries. We then elaborated Delphi statements summarizing participant views on the topic, which our participants rated. We obtained a final list of 37 suggested clinical guidelines to improve specificity and sensitivity of autism diagnosis in women. Participants had developed individual assessment strategies, although much overlap existed across participants. Participants provided insight to differentiate autism from post-traumatic stress disorder and Borderline Personality Disorder, and underlined the importance of being able to make differential diagnoses particularly in cases where non-autistic people had strongly self-identified with the spectrum.Lay abstractThe diagnostic criteria for autism are relatively vague and can lead to both under- and over-diagnosis if applied as a checklist. The highest level of agreement that a person is autistic occurs when experienced clinicians are able to make use of their clinical judgment. However, it is not always clear what this judgment consists of. Given that particular issues exist when assessing for autism in adult women, we wanted to explore how expert clinicians address difficult diagnostic situations in this population. We interviewed 20 experienced psychologists and psychiatrists from seven countries and discussed how they conducted autism assessments in adult women. We then came up with a list of 35 statements that described participant views. Our participants completed an online survey where they rated their agreement with these statements and provided feedback on how the statements were worded and organized. We obtained a final list of 37 suggested clinical guidelines. Participants agreed that diagnostic tools and questionnaires had to be coupled with judgment and expertise. Participants felt that trauma and Borderline Personality Disorder could be difficult to differentiate from autism, and agreed on some ways to address this issue. Participants agreed that self-identification to the autism spectrum was frequent, and that it was important to provide alternative support when they did not ultimately diagnose autism.

DIFFERENTIAL DIAGNOSIS OF THE AUTISTIC SPECTRUM DISORDER AND ASPERGER SYNDROME

The aim of the paper was to described substantial symptoms making possible a clinical differential diagnosis of autism and Asperger syndrome. Those differences do not me rely reflect the intensification of negative features but that Autism and Asperger syndrome are separate syndromes, which, however, share a common spectrum of symptoms. Making a differential diagnosis is essential due to different therapeutic and educational needs of children suffering from those syndromes. The most evident differences are language and communication, manipulative behaviours, social relations as well as manual skills. The first important difference is language, which has been neglected so far since the research concentrated on communication and its disorders. While language is of a high diagnostic value that allows early identification of symptoms specific for Asperger syndrome. The second difference is a very high level of manipulative behaviours in Asperger syndrome which leads to disorders in social functioning of such individuals. Therefore, dealing with manipulation is a significant therapeutic task. At the same time, manipulative behaviours occurring in Asperger syndrome should be distinguished from resistence manifested by autistic children. Moreover, children with Asperger show a need of social relations despite considerable lowering of social competencies, and failures to communicate provoke the intensification of deviant behaviours. Finally, children with autism and Asperger syndrome vary in the level of manual skills. Though initial picture may be very similar, the potential of people with Asperger syndrome for gaining proper graphomotor skills is considerably higher due to the lack of deep disorders in motor planning.

Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential Diagnoses.

• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child’s overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Differential Diagnosis of Autism and other Developmental Disabilities in International Adoption Cases: The Implications of Language Abilities

An accurate differential diagnosis of children adopted from foreign language situations that include challenging conditions (e.g., neglect) often rests upon accurate measurement of cognitive abilities in the context of low English proficiency, specifically, and may also include generally poor linguistic skills in the native language. In addition, because the goal of any adoption program is ultimately to generate effective intervention supports when needed and measurable progress in function as the child assimilates into his/her new home, it is essential that these programs be designed within the context of valid measurement. Given the particular confluence of low language ability and entrée into a culture that may have differing social interactive norms than the previous culture, one can imagine that identifying disabilities generally, but social-interactive based disabilities such as autism spectrum disorders specifically, could be problematic. Thus, assessment and treatment in these children is difficult and fraught with potential pitfalls. Moreover, recent advances in the measurement of cognitive abilities have out-paced changes in diagnostic classification and treatment methods, and it appears that applications to international adoption cases have lagged even further. This suggests that diagnosis should not be guided solely by available subtests on an intelligence battery or on clinical ascertainment instruments, because these could be confounded by language ability and cultural background. The purpose of this paper is to review measurement of cognitive abilities and diagnosis in international adoption situations and discuss methods for ensuring that diagnosis and treatment include consideration of potential pitfalls. In addition, potential confounds on clinical instruments are discussed.

Wechsler IQ profiles in diagnosis of high-functioning autism.

A Wechsler Intelligence Scale profile characterized by VIQ < PIQ with lowest subtest score on Comprehension and highest on Block Design has been associated with autism. Recently, this profile has been applied to assess the accuracy of diagnosis in research samples and for differentiating autism from similar disorders in high-functioning individuals. Universality of this profile, however, has not been sufficiently demonstrated. We therefore examined WISC-R and WAIS-R profile characteristics in 81 rigorously diagnosed high-functioning (VIQ and FSIQ > 70) children (n = 45) and adults (n = 36) with autism. Analysis of the profiles in these groups did not reveal the presumed typical VIQ < PIQ pattern. The typical subtest pattern was found, but the magnitude of profile variability was small. We concluded that individuals with autism can demonstrate a wide range of ability levels and patterns on the Wechsler scales, without a single characteristic prototype. Use of IQ score profiles in the diagnosis and differential diagnosis of autism in high-functioning individuals is not considered valid.

Autism and autistic-like disorders: the hypothalamic-pituita-ry-adrenal system as a model for research.

In this article an overview is given of the differential diagnosis of autism and autistic-like disorders. The diagnosis of the so-called 'Multiple Complex Developmental Disorders' (MCDD) as a distinct entity is discussed in relation to autism and schizophrenia. Biological research and the relevance of results until recently are discussed. Finally, the importance of the hypothalamic-pituitary-adrenal system (HPA system) as a model for research is proposed. Research on the flexibility of this system may contribute in understanding the ways of stress processing in disorders like autism, MCDD and schizophrenia.

Autism

International school psychologists play an important professional role in providing early diagnostic, consultative and treatment-planning services for autistic children and their families. Recent advances in our understanding of this complex disorder necessitates updating professionals in the etiology and treatment of autism. The article describes components of making a differential diagnosis of autism from developmental language/speech disorders, mental retardation and schizophrenia. Etiological theories based on recent neurobiological data are outlined and the psychometric properties of cognitive ability and behavioral rating instruments frequently used with this population are delineated. Specific innovative educational and pharmacological treatment approaches are reviewed.

Autism: Etiology, differential diagnosis, and behavioral assessment update

Significant advances in neurophysiological and psychopharmacological research necessitates updating professionals in the etiology, differential diagnosis, and general assessment considerations of autism. A review of the DSM-III-R diagnostic criteria is followed by an extensive description of etiological theories based on recent advances in neurobiological research. The article describes components of making a differential diagnosis of autism from mental retardation, schizophrenia, and developmental language/speech disorders and delineates the psychometric properties of cognitive ability and behavioral rating instruments frequently used with this population. Pharmacological treatment and behavioral intervention issues are reviewed.

A study of the use of nonverbal systems in the differential diagnosis of autistic, mentally retarded and fragile X individuals

The problems that autistic individuals show in the areas of interpersonal relationships and language have been long recognized and are well documented. Nonverbal behaviors and their implications for overall affective and cognitive development have received far less scrutiny. The purposes of this paper are to investigate the significance of movement behaviors in the differential diagnosis of autism, to present a newly developed assessment tool and observational procedure for gathering data in nonverbal areas of concern and to illustrate appropriate statistical measures which can be used to determine whether there are specific nonverbal behaviors which distinguish autistic individuals from other groups of severely disabled persons. The results show that studies of nonverbal behaviors are important in that autistic persons show a variety of anomalies, but that one must be very selective in using nonverbal behaviors for differential diagnoses since individuals with other developmental disorders also exhibit deviations in a variety of movement areas. The number of problems and the degree to which they are exhibited suggest that dance/movement therapy is an appropriate intervention for several developmentally disabled populations.

Play Assessment in the Differential Diagnosis of Autism and Other Causes of Severe Language Disorder

The autistic child's problems with language may be an impairment in symbolic functioning that affects all forms of communication, including representational thought and the ability to play creatively. The hypothesis that autistic children specifically do not project symbolic meaning onto toys (which is not associated with other conditions causing severe language disorder) was tested in a group of 15 severely language-impaired children. Data were obtained from a parent interview/questionnaire and analysis of a video-taped play session. The findings suggest that language-disordered children who meet DSM III criteria for autism most consistently show absence of symbolic play, and those who do have symbolic play fall into a wide range of diagnostic categories excluding autism. The report presents valuable observational and interpretational clinical factors, useful in the assessment and differential diagnosis of a language-impaired child.