Autism: A NZ Perspective
The criterion for the diagnosis of the autism was changed in 2013, following changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These changes brought many new challenges to individuals and their families, particularly with the removal of the Aspergers’ Syndrome and the introduction of a new diagnosis.
Individuals with a previous diagnosis of Autistic Disorder, Asperger’s Disorder, or Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) under the DSM-4 would likely be given the diagnosis of Autism Spectrum Disorder. However, individuals and their families may wish to retain the names of their previous diagnosis, as these can often become linked to their sense of identity and community (i.e. access to support groups that bear the old names).
The process for the identification and diagnosis can be stressful and challenging. Early identification of issues is often noted by parents and family doctors, but the children’s difficulties become more evident as they become exposed to community settings outside the home (such as early childhood centres).
Diagnosis of individuals for Autism Spectrum Disorder since the advent of the DSM-5 scrutinizes two particular functional areas:
* persistent difficulties with social communication and social interaction, and
* restricted and repetitive patterns of behaviour
Past and present evidence of difficulties may be considered as part of this diagnosis.
The DSM-5 also included a new diagnosis — the Social (Pragmatic) Communication Disorder (SCD). This diagnosis applies to individuals who have difficulties with social language, but do not have restricted interests or repetitive behaviour typical of autism.
Although SCD is a relatively new diagnosis, there is still ongoing research to investigate specific strategies for affected individuals. However, many of the social strategies and programs that are used for the Autism Spectrum Disorder should still be useful for those who meet the criteria for SCD.
In the past, diagnosis for autism had often come from single clinicians in clinical settings, but data from these settings can be insufficient to perform a thorough differential diagnosis. The multidisciplinary team (MDT) approach is preferred, which can be made up from the following disciplines –
* Child and adolescent Psychiatrists,
* Clinical or educational Psychologists,
* Speech-Language Therapists,
* Behaviour Specialists,
* Occupational Therapists.
An MDT approach would allow for a robust diagnosis that would include discipline-specific assessment tools and observation of the child in the home, educational settings and other community settings. The team would also be able to refer for further tests (such as hearing tests) when required. The MDT approach allows for accurate planning of future services and supports. It also allows the child to be assessed in a specific “snapshot in time”, and hence eliminate repetition and redundancies from the assessment process.
As autism is a spectrum disorder, the amount and type of support should be determined on a case-by-case basis, according to each child’s functional abilities. Individuals and families should be provided with enough support to be as independent as possible while minimising distress in all settings.
Autism is often accompanied by unseen difficulties such as sensory processing difficulties (for example, auditory and taste sensitivity), so professional input is helpful to reduce trial-by-error in the affected individual’s daily living.
Although ASD is a developmental disorder, its impact lasts throughout the entire lifetime. Clinical support for some individuals can often be weighed towards childhood and educational services, but support for affected adults should be available as well.
Access to information
Access to MDT services and support services can vary from country-to-country and region-to-region. Rural areas can often be at a disadvantage for the families and for the health clinicians to work with them. Although resources and research evidence can be found on the internet, the information can often be spread out, repetitive and/or difficult for families to collate and understand. Some information can be anecdotal and may not apply universally to everyone. Families can therefore experience an overload of information, which can often be outdated or inapplicable to their situations.
The NZ Autism Spectrum Disorder Guideline
The New Zealand Autism Spectrum Disorder Guideline was created and published in 2008 following an inquiry by the NZ government into autism related services in 1998. The guide was comprehensively researched and included input from health professionals, non-government agencies and families.
The guideline is a living document, which means that it is continuously updated, with the second edition being available since 2016. It is the world’s first guideline to acknowledge the whole life-long impact of autism, from early intervention and diagnosis through to community living for adults.
Despite the depth of its research, the guideline is user-friendly for affected individuals and their families. There is a clear guide as to the potential usefulness of different strategies and therapies i.e:
A — The recommendation is supported by GOOD evidence (where there are a number of studies that are valid, applicable and clinically relevant).
B — The recommendation is supported by FAIR evidence (based on studies that are mostly valid, but there are some concerns about the volume, consistency, applicability and/or clinical relevance of the evidence that may cause some uncertainty, but are not likely to be overturned by other evidence).
C — The recommendation is supported by EXPERT OPINION only (from external opinion, published or unpublished, e.g, consensus guidelines).
The guideline covers a wide a range of topics and critically evaluates assessment tools and options for therapy across the entire lifespan. The New Zealand Autism Spectrum Disorder Guideline can be downloaded from the NZ Ministry of Health website for free:
There are also additional supplementary papers and/or handouts that can be navigated to via this page:
It is important to remember that the guideline in not meant to replace health professional input.
Thank you for reading. I hope that this brief article, together with its links, have been useful to improve your understanding of autism.