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Psychological Definitions of Autism

Part 1

Psychological definitions of autism

 

Chawarska, Klin, & Volkmar, 2003, p. 23

American Psychological Association (2013)

Definition

Autism is a neurodevelopmental disorder characterised by deficits in social and communication and by the presence of restricted and repetitive behaviours and/ interests (Chawarska, Klin, & Volkmar, 2003, p. 23). This disorder is known to have characteristics of abnormalities in social interaction, language development and as used in social communication and imaginative play before age of 3. All these must be noted for one to be noted as having autism.

The American Psychological Association (2013) defined Autism as ‘persistent deficits in social communication and social interaction among multiple contexts, as manifested by several characteristics currently or by history’. These features include deficits in nonverbal communicative behaviours used for social interaction, deficits in developing, maintaining and understanding relationships and deficits in social-emotional reciprocity.

 

 

 

Characteristics

For the definition to qualify to represent autism, it has to key references to behaviour and these include that the abnormality is linked to:

-social and communication behaviour of people.

-problems in language development

 

 

-social and communication problems are noted but these have to be persistent over time

-failure to form meaningful relationships

-autist people do not have ability to understand, interpret or show nonverbal cues.

-difficulties in focus or attention

They can be unable to respond to social interactions

Change of definitions with time

Definition of autism is borrowed from APA and much is borrowed from the body in what constitutes proper definition of autism. They state three domains of abnormality of which at least two must be present and period must be at least two years. This is similar to what was stated by APA although this does not give historical development of the definition. What is given is latest adoption where all users are expected to refer to.

APA is one of the most distinguished organisations in the field of mental disorders and as such, it has had to change how it defines autism, mainly to avoid and reduce inconsistencies over the same. According to Autism Speaks Canada, (Autism Speaks Canada, 2017),APA’s Neurodevelopmental Disorders Work Group all stakeholders in the field to find one working definition and improve process of diagnosis of the disorder. To date, the only three point criteria, as defined above must hold and it includes interaction of social and communication patterns that are consistence and these repetitions have to be at least two.

The effect of this was to reduce previous categories such as Asperger syndrome, PDD-NOS, use of two instead of three domain symptoms (social/ communication impairment and restricted interests). Unlike previous cases where symptoms used were current only, the present definition uses historical cases as well.

Development of new definitions also followed discoveries of the disorder where all people are described as either fragile X syndrome of Rett syndrome. Lastly, the new definition includes Social Communication Disorder (SCD). This separates people diagnosed with social communication problems but do not show signs of repetitive behaviour.

Culture specificity

There is consideration of family and genetic issues in definition and origin of the disorder. There is inclusion on how autism is viewed among many societies. Different perceptions influenced their definitions but these variances were due to lack of education and therefore little understanding of the disorder. Understanding local values is however useful in diagnosis. There is no evidence that autism is specific to certain cultures. It is the perception that shapes diagnose process. Vaidya (2016, p. 33) noted that autism is a universal condition across all cultures, with variations across, only expression and course varies.  

APA note that there are no differences in occurrence of the disorder but it is influenced by different perceptions in these cultures.

Point of abnormal behaviour

One’s behaviour is noted after two years after which if persistent, one is considered autistic.

APA considers a standard of at least two years during which at least two diagnostic features are noted.

Singularity of autism definition

The authors use a number of definitions and choose one to work on, including APA. This makes it easier for readers to assess the definition to work on.

It is possible to reach at a single definition and this is because APA gathers a number of professionals from different specialities, countries and cultures.

 

Evaluation of both definitions

The explanation is similar to the American Psychological Association in that they both explain autism in terms of the inability to develop communicative and social skills. Both definitions go further to insist these inabilities have to be persistent and their effects will be seen in the inability to form meaningful social relationships this means that they are not occurrences of a limited period, but observed over some time. APA’s definition is clearer due to the inclusion of nonverbal cues that are not fully developed.

Both definitions have a major limitation in that they do not tell how often or widespread is the occurrence of this disorder. They however make it easier to identify people who have such a problem as they include the salient points of social interactions and communication. 

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

It has been used for more than 10 years mainly by professionals, and international experts in the aspect of health. They produced criteria that are used as references for the classification of mental disorders. They are to be used for all cases including, inpatient, outpatient, nursing, hospital, and private practice among others cases. They are used for diagnosis, treatment, and research (American Psychiatric Association, 2013). The classification provides features for various illnesses on what should be used for the above purposes. Also included are prevalence, development and course, diagnostic markers, medication and functional consensus, and differential diagnosis among others. In some cases, there is the inclusion of culture-related and gender-related diagnostic issues.

International Classification of Diseases

The standard is used for all Member States and has been translated into more than 43 languages in 117 countries where the main content is reporting data on mortality and health status. It is the standard tool for classification used for diagnostics, epidemiology, and other clinical purposes. Being a standard, it is used by various stakeholders such as researchers, health information technology workers, insurers, classification of diseases, organisation of records among others. Disease patterns are also recorded and this enables the allocation of resources (WHO, 2016).

2. DSM diagnostic for:

Schizophrenia

It falls under schizophrenia spectrum and it includes a number of disorders that include delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behaviour (including catatonia), and negative symptoms). Being among other psychotic disorders, they have major features of delusions and hallucinations. Delusions may include the belief one is being persecuted overrating one’s abilities, and the belief of harm to one’s body among others. Hallucinations are ‘perception like experiences that occur without an external stimulus’.

Others are disorganised thinking and speech, grossly disorganised or abnormal motor behaviour, sometimes including catatonia). Negative symptoms, impaired cognition, depression, and mania symptoms have also been associated with the disorder under the DSM 5th Edition. Schizophrenia can take six months and there is one month of phase with active symptoms.

Depression

According to the International Classification of Diseases, depression is characterised by several features as indicated below but it has to be noted that depression is itself a symptom of various disorders, including schizophrenia. DSM hardly defines it on its own. The international classification of diseases notes that there are mild and moderate and extreme cases of depression.

In mild depression, there is a loss of interest and enjoyment, and one is increased fatigue, as the main ones. It may last for two weeks.

Moderate cases of depression have features of one having difficulties in continuing with work and other social activities. One will be noticed to be disturbed but will still participate in socialising and other activities.

In severe depression, one is distressed and agitated, there is a loss of self-esteem. One also feels useless, guilty and on the extreme, one may feel the temptation of suicide. One, therefore, is likely to stop all social and domestic responsibilities or do them on a very limited scale.

Obsessive Compulsive Disorder

This is characterised by repetitive thoughts, obsession of some kind, leading to compulsive acts. There are certain thoughts, and images that enter one’s mind in a form of stereotypes. They are four main features: they are recognised as one’s thoughts, there is at least one thought that is continually repressed, the impulse to act on the thought is often not pleasurable and the thoughts and images of impulses are not also not pleasant as they are repetitive.

3. a.

Both systems tend to provide a standard way of diagnosing illnesses and therefore make it easy to communicate among various practitioners. However, ICD-10 with three- and four-digit codes has been noted as presenting challenges that make coding difficult. (Wockenfuss, Frese, Herrmann, Claussnitzer, & Sandholzer, 2009) It may be reliable but it is difficult in some cases such as morbidity data. Besides, there have been complaints about the use of the same criteria to assess a person for depression and anxiety (Miller, 2016). This may be due to difficulties in creating a single manual for all people to use for all mental problems.

3 b.

Due to the challenges named above, they present challenges in validity in some cases although in all cases, they have been noted to be valid. An update to ICD-11 and DSM-5 has made it easier to increase utility and validity in diagnosis. They have also been noted to have increased compatibility globally among many practitioners (Regier, Kuhl, & Kupfer, 2013).

3c.

Both systems are user-friendly though ICD-10 has challenges in using 3 and 4-digit codes. However, DSM-5 is large and some users may find it a little bit intimidating. The latest editions made it their goal to be user-friendly (Black & Grant, 2014).

4

The statistical deviation from the average where ‘statistically rare behaviour is defined as ‘abnormal” by Hill (2010, p. 197).

 

Source: Hill (2010), pg. 197

4. Statistical data on:

a. Average age of diagnosis

According to CDC (CDC, 2016), diagnosis of autism occurs at the age of 2 but most at the age of 4. At 8 years, there was a prevalence rate of 14.6% per 1000 years. CDC noted that there are no differences in median age between the sexes. The general median age is 4 years.

b. Gender distribution

The ratio of males to females in the prevalence of autism has been constant between 4:1 and 5:1, according to CDC data. This ratio is the same for the last 4.5 years. It was found that 1 in 42 boys had ASD compared to girls, 1 in 189.

Source: CDC (2016)

c. Variation in ethnic groups

As indicated above, Hispanic White Children were 30% more likely to have the disorder compared to non-Hispanic black children but they were 50% more likely compared to Hispanic children.

d. Susceptibility in certain populations

Black populations were 48% more likely to have the disorder compared to Hispanics, 38%, and 25% non-Hispanic (AAP News, 2014).

References

A Level Psychology Through Diagrams. (2010). Oxford: Oxford University Press.

AAP News. (2016, January 22). Autism prevalence now 1 in 68, varies by sex, race/ethnic group.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington: American Psychiatric Pub.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), Fifth Edition. New York: American Psychiatric Association.

Autism Speaks Canada. (2017, January 21). Answers to Frequently Asked Questions about DSM-5.

Black, D. W., & Grant, J. E. (2014). DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical .. Washington, D.C.: APA.

CDC. (2016, January 22). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012.

Chawarska, K., Klin, A., & Volkmar, F. R. (Eds.). (2003). Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment. New York: Guilford Press.

Miller, S. (2016, January 21). The DSM 5: Mental Health’s "Disappointingly Sorry Manual" (Fifth Edition).

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92–98.

Vaidya, S. (2016). Autism and the Family in Urban India: Looking Back, Looking Forward. New York: Springer.

WHO. (2016, January 22). History of ICD. Retrieved from Classifications:

Wockenfuss, R., Frese, T., Herrmann, K., Claussnitzer, M., & Sandholzer, H. (2009). Three- and four-digit ICD-10 is not a reliable classification system in primary care. Scand J Prim Health Care, 27(3), 131–136.

 

 

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