Tag Archives: dsm-5

A Visual Representation of the Autism Spectrum

The story of autism spectrum disorder has always been told largely through statistics. Professionals speak of the costs to families of autistic children, the earliest age for diagnoses, and the percentage of children who develop the disorder. Many people have heard the term autism but don’t really know what it means because the statistics can’t fully convey what it means to be autistic.

Autism spectrum disorder is difficult to explain and grasp because it’s a very wide spectrum. According to psychologist Kathleen Platzman, “We need an educational model wide enough to take in the whole spectrum. That means it’s going to have to be a fairly broad model.”

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) proposes three levels of severity for autism spectrum disorder, which is meant to describe its impact on everyday functioning. Individuals who require “very substantial support” are rated level 3; those who require “substantial support” are rated level 2; and those who require “support” are rated level 1. While these ratings provide important information, they don’t do a lot to help visualize the complexities of the disorder.

Michael McWatters is a designer and UX Architect at TED, the organization responsible for TED Talks and various other initiatives. He’s also the father of a boy with autism spectrum disorder. When his son was diagnosed, McWatters wanted to know where he fell on the spectrum, but quickly became frustrated by the lack of an accurate visual representation of the disorder. He had envisioned the spectrum as a straight line that looks something like this:

Autism image

Was his son’s condition mild, severe, or somewhere in between? It seemed overly simplistic. But then McWatters had a revelation—the spectrum isn’t a single line or flat continuum at all! So he decided to create his own diagram, basing his visualization on the three generally accepted axes for the disorder: social, communication, and behavioral.

autism-disorder1 (1)

In his visualization, the greater the impairment on any of the three axes, the further the point moves away from the center. This visualization of the symptoms acknowledges the dimensionality of the disorder in a way a simple spectrum line cannot.

We had the opportunity to speak with McWatters. He indicated that this is just the beginning of his efforts and that he views this as an experimental project. He is currently working with two leading autism researchers to revise his visualization to align more closely with DSM-5 and hopes to find a way to demonstrate both the strengths and deficits associated with autism.

For Michael McWatters, autism spectrum disorder can’t be reduced to statistics and percentages—it’s deeply personal. “People have responded very positively to this visualization,” he says, “and I think it’s because it not only provides a more accurate view of autism, it demonstrates just how unique each person on the spectrum is.”

You can learn more about Michael and his son on his Web site, ASDDad. We’re looking forward to his new discoveries and the graphic representation that he will create as a result.

What do you think? PAR wants to hear from you, so leave your comments below.

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The Importance of Properly Diagnosing Early Onset Bipolar Disorder

Although early onset bipolar disorder (EOBD) was first described in 150 AD, the diagnosis remains surrounded in controversy because no such diagnosis exists. A person either meets the criteria for bipolar disorder set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or not. The problem is that, as with DSM-IV, the criteria describe bipolar disorder as it exists in adults. The child phenotype differs markedly from adult onset bipolar disorder. Children with this disorder exhibit a more chronic form of irritability, more rapid mood swings, intense emotional outbursts, and impulsive aggression.

An additional complication when making the diagnosis in children is that most of the symptoms associated with EOBD also exist in ADHD, OCD, and ASD. Moreover, children with EOBD also have high rates of comorbid conditions.

Though it was hoped that DSM-5 would resolve the main concerns, the following issues remain unaddressed:

  1. Technically, EOBD diagnosis still does not exist.
  2. Teens and children must meet adult criteria to be diagnosed as bipolar.
  3. Many children who would have received a diagnosis of bipolar disorder prior to the publication of DSM-5 will now receive a diagnosis of disruptive mood dysregulation disorder (DMDD).

Despite the hope for some consensus, experts in the field have yet to reach agreement on (a) what symptoms constitute the core features of EOBD, (b) how to differentiate bipolar disorder from other childhood disorders, and (c) how best to manage children who have the disorder.

When Drs. Richard M. Marshall and Berney J. Wilkinson began seeing children who exhibited severe symptoms of bipolar disorder, they used omnibus rating scales as part of their initial diagnostic assessment. To their surprise, many of the scales completed by parents and teachers had ratings in the normal range even though the children had symptoms of bipolar disorder. An item analysis revealed that existing rating scales did not contain a sufficient number of items associated with the disorder. To address these shortcomings, Marshall and Wilkinson developed the Pediatric Behavior Rating Scale (PBRS), a standardized, norm-referenced parent and teacher rating scale for use with children ages 3 to 18 years.

Rather than providing specific diagnoses, the PBRS enables clinicians to identify the core features of EOBD, thereby serving as the critical first step in differential diagnosis and intervention planning. The PBRS provides clinical researchers with another tool to assist in (a) defining this disorder, (b) differentiating EOBD from related disorders, and (c) evaluating the efficacy of interventions aimed at alleviating its symptoms.

Approximately 20% of our nation’s 50 million K–12 students meet diagnostic criteria for a mental disorder, and 10% experience significant functional impairments at home, at school, and with peers. Nevertheless, children exhibiting such symptoms are often punished for willful disobedience rather than receiving effective treatment. In fact, 80% of children with mental illness remain undiagnosed and untreated, resulting in increased risk for suicide, school failure, and criminal behavior. Accurate differential diagnoses of EOBD and related disorders is the key to effective interventions.

Unless otherwise cited, source material is attributed to:
Marshall, M. M., & Wilkinson, B. J. (2008). Pediatric Behavior Rating Scale. Lutz, FL: PAR.

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