Signposting for diagnosis of Autism Spectrum Disorder using the Diagnostic Interview for Social and Communication Disorders (DISCO)

Recent research has investigated the capability of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) descriptions to identify individuals who should receive a diagnosis of Autism Spectrum Disorder (ASD) using standardised diagnostic instruments. Building on previous research investigating behaviours essential for the diagnosis of DSM-5 ASD, the current study investigated the sensitivity and specificity of a set of 14 items derived from the Diagnostic Interview for Social and Communication Disorders (DISCO Signposting set) that have potential for signposting the diagnosis of autism according to both the new DSM-5 criteria for ASD and ICD-10 criteria for Childhood Autism. An algorithm threshold for the Signposting set was calculated in Sample 1 (n = 67), tested in an independent validation sample (Sample 2; n = 78), and applied across age and ability sub-groups in Sample 3 (n = 190). The algorithm had excellent predictive validity according to best estimate clinical diagnosis (Samples 1 and 2) and excellent agreement with established algorithms for both DSM-5 and ICD-10 (all samples). The signposting set has potential to inform our understanding of the profile of ASD in relation to other neurodevelopmental disorders and to form the basis of a Signposting Interview for use in clinical practice

DSM-5 Autism Spectrum Disorder:in search of essential behaviours for diagnosis

The objective of this study was to identify a set of 'essential' behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Highly discriminating, 'essential' behaviours were identified from the published DSM-5 algorithm developed for the Diagnostic Interview for Social and Communication Disorders (DISCO). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. An adjusted essential item set (54 items; Study 2) had good sensitivity when applied to individuals with higher ability and performance was comparable to the published full DISCO DSM-5 algorithm. Investigation at the item level revealed that the most highly discriminating items predominantly measured social-communication behaviours. This work represents a first attempt to derive a reduced set of behaviours for DSM-5 directly from an existing standardised ASD developmental history interview and has implications for the use of DSM-5 criteria for clinical and research practice

Diagnosing autism spectrum disorder:who will get a DSM-5 diagnosis?

Background Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the 'sub domain' level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels. Methods A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190). Results Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level. Conclusions This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level

Autism:Implications for Inclusive Education with respect to Software Engineering

Contains fulltext : 219448.pdf (preprint version ) (Open Access)CSERC '1

Re-storying autism: a body becoming disability studies in education approach

This paper presents and analyzes six short first-person films produced through a collaborative multimedia storytelling workshop series focused on experiences of autism, education and inclusion. The aim of the project is to co-create new understandings of autism beyond functionalist and biomedical ones that reify autism as a problem of disordered brains and underpin special education. We fashion a body becoming disability studies in education approach to proliferate stories of autism outside received cultural scripts – autism as biomedical disorder, brain-based difference, otherworldliness, lost or stolen child and more. Our approach keeps the meaning of autism moving, always emerging, resisting, fading away and becoming again in relation to context, time, space, material oppressions, cultural scripts, intersecting differences, surprising bodies and interpretative engagement. We argue that the films we present and analyse not only significantly change and critique traditional special education approaches based on assumptions of the normative human as non-autistic, they also enact ‘autism’ as a becoming process and relation with implications for inclusive educators. By this we mean that the stories shift what autism might be and become, and open space for a proliferation of representations and practices of difference in and beyond educational contexts that support flourishing for all

'Objects in transition: the puppet and the autistic child'

Abstract Although claims for the efficacy of puppetry in therapeutic contexts lack extensive academic research, some published evidence does exist. A phenomenological and embodied approach is used here beginning with the writer’s own experience as a mother to theorize on the puppet’s role as a surrogate communicator and facilitator with children who lack communication skills. Instead of foregrounding language difficulties (as is often the case in writings on autism), this article focuses on the physical reality of a puppet. The writer explores notions of embodiment where neurological patterns are established through physical interaction with the world, and suggests ways in which this patterning may be interrupted or disturbed, and how puppets, as safe and to some extent controllable physical objects, may act therapeutically to re-establish some of these patterns. It is further suggested that puppets may work in similar ways to Winnicott’s ‘transitional objects’ in babyhood, operating in a ‘transitional space’. Winnicott claims that in a psychologically healthy adult, the comfort of infantile transitional objects and phenomena is transferred to religion, art and creativity – activities that provide a bridge between the inner world that we totally control and the external world, which we do not. Such activities are linked to a creative ‘space’ of mind and are psychologically necessary. Puppets operate in this space. Overall, stress is laid on the importance of the material reality of the puppet and its ‘objectness’ to help explain its particular efficacy