Posts Tagged ‘ ASD ’

For Parents: Autism Spectrum Disorder In DSM-5

Wednesday, May 22nd, 2013

The DSM-5 has made major changes in the way that Autism Spectrum Disorder (ASD) is diagnosed. Here are 5 practical tips for parents based on these changes: 

1) Understand the implications of eliminating Asperger’s Disorder. For most children, this change should not have much impact in the diagnostic process. It will impact some children who are higher functioning and who would have, in the past, been diagnosed with Asperger’s Disorder. The DSM-5 includes severity criteria which were designed in part to incorporate these types of kids into the new diagnostic framework. That said, many in the field think that some kids may no longer receive a diagnosis if their symptoms are less severe. Some of the initial studies demonstrate that some kids who would have been diagnosed in the prior DSM will not receive a diagnosis using DSM-5. As a parent, be ready to have this discussion with a clinical provider – and be ready to ask questions like “If the old system was in place, would my child have been diagnosed as Asperger’s?” You may need to advocate more strongly than before for your child. Focus on the need for services that could make a difference for your child’s development and collaborate with your practitioners to make sure your child has every opportunity to benefit from intervention.

2) Understand the implications of eliminating other alternate diagnoses. DSM-5 does away with other diagnostic options like Pervasive Developmental Disorder Not Otherwise Specified. The impact may be felt for kids who have many symptoms of ASD but not necessarily the exact profile. There may be no alternative diagnosis despite the fact that they have many developmental issues that need attention. Make sure your practitioners seem savvy about DSM-V and know how to make sure a kid with this kind of mixed presentation doesn’t get lost in the transition to the new diagnostic framework. Have that discussion with them and be satisfied – or seek out another opinion.

3) Beware of the severity criteria and insurance. Many clinicians have told me that they are concerned that insurers may balk at covering services for some children who are rated to show less severe symptoms. We don’t know this yet. Make sure your clinician is on top of these issues and that the team is ready to take on battles if necessary. You want to have confidence in your providers because this is all new and it is not clear how it will all unfold.

4) Remain vigilant about the early signs of autism. Just because the way ASD is diagnosed has changed in DSM-5, that doesn’t mean the warning signs have changed. They remain the same and you should be aware of the 7 early signs of autism.

5) Remember that early intervention still matters. If you suspect that your child may have ASD, it is better to get started as early as possible with the evaluation process – and if necessary intervention. Intervention helps any child, no matter what the severity, and early intervention is, right now, the best we have to offer kids with ASD. The fact that we have switched to DSM-5 does not alter the importance of early intervention – though, again, you need to be aware that you might need to fight harder to get intervention. It’s a fight worth taking on.

Autism Awareness via

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Why Every Parent Should Be Aware Of Autism

Monday, April 29th, 2013

As Autism Awareness Month is coming to a close, it’s important to remind parents why they need to be aware of autism spectrum disorder (ASD). 

ASD is no longer a rare disorder. The estimated rate keeps rising. Parents need to be aware of the most telling signs in order to promote early recognition in their kids – and also provide a platform for understanding why a pediatrician may broach the subject.

Such early recognition is essential because early intervention can make a huge difference for a child with ASD. New interventions hold particular promise. While intervention at any time is beneficial, it’s clear that the earlier it starts, the more effective it may be.

Even if ASD hasn’t touched your life directly, it’s still important to know something about it. ASD has become, in a way, like cancer – it seems like we all know someone with cancer. You may have a friend who will have a child diagnosed with ASD in the next few years. Your kid may become friends with someone who has a sibling with ASD. Your kid may become friends with a child who has ASD.

Here are a few good links to follow to learn more about ASD:

Autism Speaks

National Institute of Mental Health

Child Mind Institute

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4 New Things We’ve Learned About Autism Spectrum Disorder In The Last 2 Years

Friday, April 19th, 2013

As part of Autism Awareness Month, I’ve been reflecting on some of the new things we have learned about Autism Spectrum Disorder (ASD) over the past few years. Four findings stand out for me: 

It’s Not Just DNA: The landmark twin study published in 2011 suggests that while genes are important, environmental factors that increase likelihood of ASD are a key etiological influence as well. This finding is a critical one as it is the first twin study to show such a strong environmental effect after controlling for the role of genetics. It gives new impetus to examining a range of environmental influences in addition to searching for genes that increase risk for ASD.

Recovery From ASD Is Possible: While it’s been a controversial topic in the scientific literature, a recent study provides solid evidence that some kids can “outgrow” ASD. What we still don’t know is why that is the case. But this paper does stand out as important documentation that the phenomena of recovery is real.

Psychosocial Interventions Can Change Brain Functioning: While complete recovery from ASD is still rare, the positive effects of early intervention are not. New research published in 2012 provides dramatic evidence that some interventions – such as the Early Start Denver Model – may not just improve behavior, but also “normalize” brain functioning in response to social stimuli. This is a dramatic result because it demonstrates there is ‘plasticity’ in the brain that can be shaped by intensive intervention. It shows that we should give more weight to supporting psychosocial interventions, in part because they can effect biological development.

ASD Is More Common Than Ever: A recent paper reported that 1 in 50 kids have ASD. While it is difficult to generate a premise statistical estimate of the frequency of ASD,  it is clear that each new attempt reports that the frequency is higher than previously reported. This trend may, of course, reverse with the publication of the new DSM 5 criteria for ASD. That said, the newest estimates bring attention to how common ASD is in the population – and how many kids need appropriate diagnosis and intervention.

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Do 1 in 50 Kids Have Autism Spectrum Disorder?

Wednesday, March 20th, 2013

The Centers for Disease Control (CDC) have released a report that suggests 1 in 50 kids suffer from autism spectrum disorder (ASD). This is indeed the number they found in their study of over 100,000 families. But that said, it’s difficult to draw firm conclusions on this finding. Here are a few key points to consider: 

1) One of the reasons that the rate of ASD has increased from the prior estimate of 1 in 88 kids is that, in this new study, data on older kids were collected. The prior estimate derived from sampling families who had an 8 year old child. The new research reached out to families with kids between 6-17 years of age. Thus one of the suggestions is that this newer estimate is higher because older kids with more mild symptoms were more likely to be represented in the sample. In this sense, the new data are more informative.

2) That said, it should be noted that the participation rate in the new study was quite low – only 23% of the families contacted participated in the survey. The authors suggest that this sample was not biased (based on statistical modeling used). However, it’s worth noting that prior estimates were based on sampling that resulted in participation rates closer to 50%. The issue – that isn’t resolved – is the extent to which families who have a child with ASD were more likely to participate – or put another way, families who don’t have kids with ASD may not have been motivated to participate. Bottom line, this participation rate is a concern.

3) The new study asked parents (or guardians) directly if they have been told (by a practitioner) that a child in the home (in the targeted age range) has ASD and also if the child currently has ASD. The authors suggest that this is an important strategy because not every child receives services and hence service-based estimates may be biased. But it’s also the case that only asking a parent/guardian these particular questions does not give a complete picture (for example, a child may have been misdiagnosed by a practitioner in either direction). So this sampling strategy is a mixed bag – there are both advantages and disadvantages to it. Of course, the gold standard would be to do a diagnostic assessment of all the kids – but something of this magnitude is typically not feasible for pragmatic reasons (it would be a huge scientific undertaking).

Taken together, we see that this study had strengths, weaknesses, and some mixed elements to it. Conducting a study of this magnitude is very difficult and as such the data should not be dismissed. But it’s tough to say if the new estimate is the “real” one or just another statistical estimate that is higher than previously thought.

We do, however, know three things for sure. First, whatever the true population estimate may be, ASD undoubtedly affects a profound number of youth. Second, it will be critical to evaluate how the new diagnostic criteria in the upcoming DSM 5 will impact these estimates – especially since there have been suggestions that at least 10% of kids currently diagnosed with ASD will no longer meet diagnostic criteria. And third, the key for any child who is diagnosed with ASD is to get intervention as early as possible, especially given some of the latest encouraging findings.

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Childhood Psychiatric Disorders: Will Genetic Engineering Ever Be A Solution?

Wednesday, February 27th, 2013

Following a stimulating Intelligence Squared debate, we’ve been discussing genetic engineering (think of it as directly changing DNA) here at – both in terms of using it to create a “Super Baby” and to prevent disease. As a follow-up, let’s consider the likelihood of genetic engineering being a factor in the future for a number of childhood psychiatric disorders – or more to the point, the challenges that lay ahead. 

Autism Spectrum Disorder (ASD)

There would be hope that genetic engineering would be feasible in the future, as ASD is believed to be highly genetic in origin. However, the genetic basis for ASD is not clear. In fact, there may be a range of genetic etiologies. For example, some cases may be due to a rare genetic mutation – but there could be a number of mutations that can lead to ASD (not just one identified disease gene) making the idea of genetic engineering more challenging. The majority of ASD cases may reflect a complex mix of genetic and environmental influences – and the latest statistical modeling suggests that the genetic contribution to ASD may not be as strong as previously thought (and that the role of the environment may be more pronounced). For those situations, the idea of using genetic engineering is even more murky, because there may be many genes involved and they probably interact with a variety of environmental factors. All of this is not to say that genetics won’t lead to possible biological therapeutics – rather it’s to point out that the lure of genetic engineering as a solution may not be the avenue that will be pursued.


The best evidence to date suggests that ADHD is due to a mix of genetic factors along with the influence of a number of environmental factors. As discussed above, this makes the pure application of genetic engineering difficult to imagine. There may a large number of genes involved, each of which may only have a small effect on the likelihood of developing ADHD – which, simply put, would make it very difficult to know what genes to target. Again, it’s tough to predict where genetic research will go, but while it may certainly lead to improved treatments over time for ADHD, it’s tough to see the role of genetic engineering.


You’re starting to see a pattern here. Like ADHD, depression is also thought to be influenced by many genes as well as the environment. As discussed above, this constellation of risk factors does not suggest that genetic engineering will be a factor any time soon.

Conduct Disorder (CD)

This is the same deal as the case for ADHD and depression – and it may be that the environment plays an even stronger role in the etiology of CD.


The idea of genetic engineering is provocative. But the reality may be far in the future for most childhood psychiatric disorders – and in many cases it may not be the way in which genetic research gets translated into prevention and intervention.

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