Proposed DSM-V for Autism Spectrum Disorder

The chart below compares the current criteria for autism, according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, published in 1994 by the American Psychiatric Association) to the proposed changes in the DSM-V, expected to be published May 2013.  The proposed changes appear, at first glance, to expand those that qualify to all persons on the spectrum, thus including those with Asperger's Syndrome and PDD-NOS (Pervasive Developmental Disorder, Not Otherwise Specified).  However, on second glance, the criteria for ASD proposed in DSM-V appears more restrictive.  It is unclear whether the new criteria would be more inclusive or exclusive.  While arguably expanding the umbrella to those along the spectrum, some speculate that the DSM-V criteria is more restrictive.  What do you think?    

Current, DSM-IV	Proposed for DSM-V
Autistic Disorder	Autism Spectrum Disorder
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):	Must meet criteria A, B, C, and D:
(1)  qualitative impairment in social interaction, as manifested by at least two of the following: (a)  marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b)  failure to develop peer relationships appropriate to developmental level (c)  a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2)  qualitative impairments in communication as manifested by at least one of the following: (a)  delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b)  in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c)  stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3)  restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (a)  encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b)  apparently inflexible adherence to specific, nonfunctional routines or rituals (c)  stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements) (d) persistent preoccupation with parts of objects	A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:                 1.     Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2.     Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3.     Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and  in making friends  to an apparent absence of interest in people
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.	B.    Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1.    Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases).  2.    Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3.     Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4.     Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.	C.    Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
	D.    Symptoms together limit and impair everyday functioning.

School District Predetermined Placement for Student with Autism

Kirsch-Goodwin & Kirsch successfully represented a special education student with autism at a due process hearing and secured private placement due to the school district’s predetermination of the student’s placement, and that the placement was not appropriate to meet the student’s unique educational needs.  In Deer Valley Unified Sch. Dist., 111 LRP 71612 (SEA AZ 2011), an Administrative Law Judge found that an Arizona school district predetermined the placement of a student with autism and that the proposed school did not address the student's unique needs.  Because the district denied the student a free and appropriate public education (“FAPE”), both procedurally and substantively, it was directed to reimburse the student's parent for private school tuition and to continue paying tuition for the student's attendance at the private school. 

Implications of this decision:  School districts and charter schools in Arizona should ensure that the IEP team makes initial placement decisions, and not the administration.  Parents must be included in the IEP team decisions.  Parents are members of the IEP team.  The administration of a school district or charger school may not make initial placement decisions that are merely reviewed by the IEP team.  A school district or charter school that has its administration make placement decisions denies parents their due process rights and contravenes the Individual with Disabilities Act (“IDEA”) amounts to predetermination.  Here, the school district denied FAPE to a student with autism when it issued prior written notices (“PWN”) proposing a special school and convened an IEP team to reconsider the placement only after the student's parent rejected it.

Summary:  An Arizona school district denied FAPE to a student with autism when it predetermined an inappropriate placement for him.  After the student was comprehensively evaluated, the district convened a team meeting to develop an IEP for his upcoming school year.  The student's parent presented information from two special schools she wanted the district to consider as potential placement options.

The district subsequently issued two PWNs informing the parent that it was placing the student at a third special school that had not been discussed at prior meetings.  Because this school was populated by peers who functioned on a lower level than her child, the parent rejected the placement as inappropriate and not the LRE.  The district convened another meeting for team members to review the proposed placement.  The team maintained the district's proposed placement as determined by its administration.
The parent filed for due process alleging a denial of FAPE.  The ALJ explained that providing FAPE is a two-fold process inclusive of procedural and substantive obligations.  To comply with procedural obligations, a district must permit parents to participate in making educational decisions concerning their child and must also provide PWN when proposing any changes to the child's IEP.
The ALJ noted that the district did not include the parent in making the initial placement decision. Instead, it issued a PWN imposing a placement for the student that would take effect unless the parent objected.   The parent objected.  The district convened to reconsider the proposed placement. The ALJ stated, "One wonders what Respondent School District would think if, at the beginning of a hearing, the Administrative Law Judge announced that he has reviewed the exhibits and made a decision for the parent, but will keep an open mind and reconsider his decision upon presentation of further evidence at the hearing."

The ALJ also explained that a district has a substantive obligation to provide a student with an IEP that is reasonably calculated to provide the student with an educational benefit and a placement that facilitates the achievement of goals.  The student's IEP contained goals for communication and social development that required him to have interaction with peers at or above his functioning level.  But because the district's proposed placement was populated by students with lower communication skills than those of the student, the IEP goals could not be accomplished through the proposed placement. Therefore, the district engaged in both procedural and substantive violations of the IDEA.

Bullying and Teen Suicides

 USA Today Columnist Bruce Kluger visits Staten Island, New York to look at the bullying and suicide 'epidemic' happening today.

http://www.usatoday.com/news/opinion/forum/story/2012-01-24/bullying-teen-school-suicides-cyberbullying/52777832/1

New Definition of Autism May Exclude Many

Today's New York Times looks at new definitions of autism that may change the way people are  diagnosed and provided with benefits.http://www.nytimes.com/2012/01/20/health/research/new-autism-definition-would-exclude-many-study-suggests.html