Autism Spectrum Disorder Diagnosis (ASD)

0:00 this talk is an overview of the diagnosis of autism spectrum disorder also known as autism or ASD in this talk I'll review the ASD diagnosis in the dsm5 with pneumonics and visuals the two major symptom clusters in ASD are social impairment and restricted Behavior there are three social impairment symptoms reciprocity refers to difficulties processing and responding to complex social cues for example the patient may have difficulties in knowing knowing when and how to join a conversation or knowing what and what not to say rhetoric refers to absent reduced or atypical use of non-verbal communication for example the patient may have reduced or unusual eye contact gestures facial expressions body

0:47 orientation or speech intonation relationships refers to absent reduced or atypical social interest for example the patient may have difficulty making and maintaining friendships May outwardly reject others or be overly passive or disruptive in approaching others there are four restricted Behavior symptoms restricted refers to highly restricted or fixated interests for example this may be someone who is highly preoccupied with a specific interest such as airplanes or trains to the extent that it interferes with learning other topics or is clearly excessive repetitive refers to repetitive motor actions use of objects speech or other repetitive behaviors this often involves behaviors referred to as stemming which refers to behaviors

1:32 used to self-stimulate for example this may include hand flapping finger flicking Spinning Coins lining up toys or repeating words rigid refers to excessive adherence to routines or resistance to change for example this may involve insistence on strict adherence to rules in a board game or distress at apparently small changes such as taking a different route to school or work reactive refers to extreme responses to sensory stimuli either extremely hyperreactive or extremely hypoactive for example this may involve extreme distress when exposed to specific sounds or textures excessive smelling or touching of objects fascination with lights or spinning objects or even apparent indifference to pain or temperature you can see that

2:19 I've chosen RW for each of these symptoms to hopefully make them easier to remember to meet criteria for the diagnosis of ASD a patient must have all three of the social symptoms and at least two of the restricted symptoms associated with functional impairment to remember this you can visualize the a in autism where the three points in the Triangle at the top represent the social symptoms and the two points on the legs at the bottom represent the restricted symptoms these are the major details to remember about the ASD diagnosis but there are two last things to keep in mind first is that symptom onset must be during early development the second is that you should be careful to distinguish ASD from from intellectual disability which depending on the severity of the intellectual disability can be very

3:05 similar to ASD I'd like to conclude by discussing disease severity there are three formal severity levels based on the patient's required level of external support let's go over examples of symptoms you might see in each of these severity categories in the lowest severity level requiring support the social symptoms you may see are that the patient may have difficulty initiating social interactions or have odd responses to social situations the patient may speak in full sentences but use odd atypical gestures or body language in their non-verbal communication the restricted symptoms you may see are restricted or repetitive behaviors only in a few contexts and they may be subtle you may see mild difficulty in switching activities or switching Focus between tasks in the

3:51 substantial support severity level the social symptoms are of course a bit more severe there may be only limited initiation of social interactions and reduced social responses non-verbal communication may be very odd and the patient may only speak in simple sentences at this severity level their restricted and repetitive behaviors may be seen in multiple contexts and obvious even to Casual observers and there may be notable distress when having to switch between activities finally in the very substantial support severity level the social symptoms may involve rarely if ever initiating interactions and having minimal or no social responses the patient may have few intelligible words and completely absent use of non-verbal communication they may only

4:36 approach caregivers in order to have basic needs met such as feeding or toileting the restricted and repetitive behaviors are likely present in all contexts and severely impairing and there is likely severe distress and resistance when switching between activities that's the end of this talk I hope the simplification makes it easy to remember ASD thank you