Autism Spectrum Disorder: Overdiagnosis & Stretchability Where Does the Spectrum End Learning Intentions History of ASD DSM-IV Pervasive Developmental Disorders Diagnostic in addition to Statistical Manual of Mental Disorders of the American Psychiatric Association, 4th edition (1994) ICD-10 Pervasive Developmental Disorders F84 International Classification of Diseases of the World Health Organisation, 10th revision (1990)

Autism Spectrum Disorder: Overdiagnosis & Stretchability Where Does the Spectrum End Learning Intentions History of ASD DSM-IV Pervasive Developmental Disorders Diagnostic in addition to Statistical Manual of Mental Disorders of the American Psychiatric Association, 4th edition (1994) ICD-10 Pervasive Developmental Disorders F84 International Classification of Diseases of the World Health Organisation, 10th revision (1990) www.phwiki.com

Autism Spectrum Disorder: Overdiagnosis & Stretchability Where Does the Spectrum End Learning Intentions History of ASD DSM-IV Pervasive Developmental Disorders Diagnostic in addition to Statistical Manual of Mental Disorders of the American Psychiatric Association, 4th edition (1994) ICD-10 Pervasive Developmental Disorders F84 International Classification of Diseases of the World Health Organisation, 10th revision (1990)

McIntosh, Teresa, Co-Publisher has reference to this Academic Journal, PHwiki organized this Journal Autism Spectrum Disorder: Overdiagnosis & Stretchability Where Does the Spectrum End Brisbane Metro Interagency Forum 12 July 2016 Dr Peter Parry Child & Adolescent Psychiatrist Snr Lecturer, University of Queensl in addition to Learning Intentions Underst in addition to criteria as long as ASD diagnosis in addition to changes over time. Consider what factors could be driving an increase in ASD diagnoses Appreciate the complexities of childhood communication, emotional in addition to behavioural problems in terms of co-morbidities, equifinal symptom endpoints in addition to the biopsychosocial model. Consider fair methods of allocating precious education, health in addition to welfare resources. History of ASD Holy Fools – Brother Juniper (C12th Franciscan), Dostoevsky’s “The Idiot” 1943 US child psychiatrist Leo Kanner describes case series: 11 children obsessive insistence as long as sameness, solitary play = “Infantile Autism” 1944 German scientist Hans Asperger describes boys with milder version Intelligent, obsessive interests, problems socially 1950s/60s Uni of Chicago Bruno Bettelheim = “refrigerator mother theory” DSM Changes: DSM-I (1952) Childhood Schizophrenia (no ASD) DSM-II (1968) Childhood Schizophrenia includes “autistic, atypical, withdrawn” DSM-III (1980) “Infantile Autism” as distinct category = severe cases from infancy DSM-III-R (1987) “Autism Disorder” = loosening of criteria increase diagnoses (Volkmar et al. Am J Psychiatry 1988; 145:1404-8) 1988 “Rain Man” with Dustin Hoffman based on Kim Peek

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DSM-IV Pervasive Developmental Disorders Diagnostic in addition to Statistical Manual of Mental Disorders of the American Psychiatric Association, 4th edition (1994) 299.00 Autistic Disorder 299.80 Pervasive Developmental Disorder, NOS 299.80 Asperger’s Disorder 299.80 Rett’s Disorder 299.10 Childhood Disintegrative Disorder DSM-5 changes: Rett’s Disorder removed Other 4 = ASD Addition of unusual sensory behaviours Deficits social communication in addition to social interaction combined More criteria descriptions ICD-10 Pervasive Developmental Disorders F84 International Classification of Diseases of the World Health Organisation, 10th revision (1990) Descriptions rather than criteria Very similar to DSM-IV: F84.0 Autistic Disorder F84.2 Rett’s Syndrome F84.3 Other Childhood Disintegrative Disorders F84.5 Asperger’s Syndrome F84.8 Other Pervasive Developmental Disorders F84.9 Pervasive Developmental Disorders, Unspecified DSM-5 Criteria as long as ASD 299.00 Diagnostic in addition to Statistical Manual of Mental Disorders of the American Psychiatric Association, 5th edition (2013) Persistent deficits in social communication: Social-emotional reciprocity Non-verbal communication Underst in addition to ing in addition to maintaining relationships Restricted, repetitive patterns of behaviour: Stereotyped movements Inflexible routines Fixated interests Hyper- in addition to hypo- sensitivities Symptoms present since early development Significant impairment Not solely due to intellectual disability Specify severity: 1 “requiring support”, 2 “substantial support”, 3 “very substantial support”

DSM-5 Other Neurodevelopmental Disorders Intellectual Disabilities: Mild, Moderate, Severe Intellectual Disability Global Developmental Delay Communication Disorders: Language Disorder Speech Sound Disorder Stuttering Social Communication Disorder ADHD Specific Learning Disorder (reading, writing, maths) Developmental Coordination Disorder Tic Disorders Other Neurodevelopmental Disorders DAMP & DBD & Anxiety Comorbidities Disorder of Attention, Motor Control & Perception Gillberg (Norwegian paediatrician) Disruptive Behaviour Disorders (DBDs) Oppositional Defiant Disorder Conduct Disorder Separation Anxiety Disorder Obsessive Compulsive Disorder Trauma in addition to Stressor related Reactive Attachment Disorder Disinhibited Social Engagement Disorder PTSD in addition to other stress reactions Rising Rates of ASD For 4 decades following Kanner 1943: Prevalence 2 to 4 per 10,000 children Post DSM-III-R rates rose dramatically

Rising Rates of ASD Wing & Potter 2002 Rising Rates of ASD Wing & Potter 2002 Rising Rates of ASD Fombonne2009 A best estimate of ASD = 60 to 70/10,000 (0.6 to 0.7%, or 1 child in 150)

Rising Rates of ASD in USA CDC website 2016 8 y.o. Boys 1:42; Girls 1 in 189 by 2010 Latest Rising Rate of ASD in USA CDC National Health Statistics Report, November 2015 Prevalence of autism (ages 3 to 17) increased 80 percent from 2011-2013 to 2014. From 1 in 80 (1.25%) to 1 in 45 children (2.24%). 1 in 30 boys! Related to alteration in CDC questionnaire. Higher income white American families CDC USA rates of ASD since 1997

Explaining the Increase in the Prevalence of Autism Spectrum Disorders: The proportion attributable to changes in reporting practices. Hansen et al JAMA Paediatrics 2015 Danish data: children born 1980 – 1991. “Changes in reporting practices can account as long as most (60%) of the increase in the observed prevalence of ASDs in children born from 1980 through 1991 in Denmark.” Causes of Rising Rates Better detection true cases Various brain changes/deficits but no clear consistency Environmental factors interacting with genetics Harrington & Bora in press: Evidence ASD starts in-utero Older mothers in addition to fathers Folic Acid/Iron def in utero Survival prem babies, twins, triplets etc Toxins, autoimmune dysfunction Not vaccines – according to 100s studies in addition to meta-analyses but are couple dozen contrary studies re: thimerosal (Hg) in addition to /or Aluminium adjuvant WHO 2006. Statement on Thiomersal: “The Global Advisory Committee on Vaccine Safety concludes that there is no evidence of toxicity in infants, children or adults exposed to thiomersal (containing ethyl mercury) in vaccines.” Thimerosal/thiomersal removed from vaccines in Australia in 2000. Loosened diagnostic boundaries Secondary gain social drivers Diagnostic upcoding Education funding, welfare payments, Medicare Diagnosis du jour Medicalisation of systemic attachment & social problems

Diagnostic Substitution Science Daily July 2015 “False Epidemics” of DSM Disorders “Psychiatric Diagnosis Gone Wild: The ‘Epidemic’ Of Childhood Bipolar Disorder” Emeritus Prof Allen Frances – in Psychiatric Times 2010 As Chair of the DSM-IV Task Force I bear partial responsibility as long as two other false “epidemics”-of attention-deficit in addition to autistic disorders. “Thought leading” researchers encouraged child psychiatrists to ignore the st in addition to ard bipolar criteria Then enter the pharmaceutical industry – not very good at discovering new drugs, but extremely adept at finding new markets as long as existing ones. Federal Funding as long as Autistic Children 2007 Tim Fischer MP 1984-2001, National Party leader 1990-2001 Deputy PM, Australia 1996-1999 Later Ambassador to the Vatican Son with autism – reason retired from parliament PM John Howard 2007: “motivation as long as the (new funding as long as autistic children) package” from the Fischer family

Diagnostic Upcoding as long as ASD Be as long as e age 7: Centrelink welfare parent/carer payments. Special Medicare rebates as long as psychologists, speech pathologists, OTs. Be as long as e age 13: Special Medicare rebates as long as child psychiatrists, paediatricians Funding as long as educational assistance to schools. Diagnostic Upcoding Batstra & Frances. Diagnostic inflation: causes in addition to a suggested cure. J Nerv Mental Dis 2012 Frances & Batstra. Why so many epidemics of childhood mental disorder J Dev Behav Paediatr 2013 Skellern, Schluter & McDowell. From complexity to category: responding to diagnostic uncertainties of autistic spectrum disorder. J Paediatr Child Health 2005 Diagnostic upcoding in Qld high among children with learning disorders. Up to 1 in 50 Qld school children. Thivierge. Precision in addition to unfairness of the PDD-autism diagnosis NADD Bulletin (Canada) 2008

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Leon Eisenberg Chair APA Section of Child Psychiatry (amongst innumerable posts in addition to honours) Brainless Psychiatry v Mindless Psychiatry Biopsychosocial Model George Engel Biopsychosocial Case Formulation Nurcombe B. Diagnosis in addition to treatment planning in child in addition to adolescent mental health problems. In Rey JM (ed), IACAPAP e-Textbook of Child in addition to Adolescent Mental Health. Geneva: International Association as long as Child in addition to Adolescent Psychiatry in addition to Allied Professions 2014.

DSM Introduction “generally atheoretical stance” (with respect to aetiology) is designed as long as research, caution needed clinically in addition to not appropriate as long as as long as ensic/insurance purposes introduction to DSM-III. “not to be used in a cookbook fashion” introduction to DSM-IV. Spitzer’s mea culpa “Relentless in its logic, Horwitz in addition to Wakefield’s book as long as ces one to confront basic issues that cut to the heart of psychiatry. It has as long as ced me to rethink my own position The very success of the DSM in addition to its descriptive criteria has allowed psychiatry to ignore basic conceptual issues especially the question of how to distinguish disorder from normal suffering.” “DSM diagnostic criteria ignored any reference to the context in which they developed.” Robert Spitzer ( as long as mer chair DSM-III) Foreword to book: “The Loss of Sadness: How psychiatry turned normal sorrow into depressive disorder” DSM-5 struggling with reliability (poor kappa field trials) let alone validity – but ASD not too bad http://www.madinamerica.com/2013/03/the-dsm-5-field-trials-inter-rater-reliability-ratings-take-a-nose-dive/

Learning Intentions Underst in addition to criteria as long as ASD diagnosis in addition to changes over time. Consider what factors could be driving an increase in ASD diagnoses Appreciate the complexities of childhood communication, emotional in addition to behavioural problems in terms of co-morbidities, equifinal symptom endpoints in addition to the biopsychosocial model. Consider fair methods of allocating precious education, health in addition to welfare resources.

McIntosh, Teresa Co-Publisher

McIntosh, Teresa is from United States and they belong to Boating World and they are from  Irvine, United States got related to this Particular Journal. and McIntosh, Teresa deal with the subjects like Boating

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