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Poruchy autistického spektra dle DSM-5: Přehled klinických kritérií a diagnostických nástrojů

 

Diagnostic and Statistical Manual of Mental Disorders / DSM-5

Fifth Edition (DSM-5) is a widely used diagnostic tool for Autism Spectrum Disorder (ASD) assessment. The DSM-5 provides clinical criteria for the diagnosis of ASD, which is characterized by impairments in social communication and restricted, repetitive patterns of behavior, interests, or activities.

The DSM-5's clinical criteria for the diagnosis of ASD include the following essential features:

  • Persistent deficits in social communication and social interaction across multiple contexts.
  • Restricted, repetitive patterns of behavior, interests, or activities.
  • Symptoms must be present in the early developmental period.
  • Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning.

The DSM-5's classification system for ASD includes several subtypes, that are categorized based on the level of support needed, providing a more detailed and nuanced approach to characterizing the different presentations of ASD.

The subtypes of ASD according to the DSM-5 are as follows:

  • Autism Spectrum Disorder Level 1: Requiring Support (F84.0)
  • Autism Spectrum Disorder Level 2: Requiring Substantial Support (F84.1)
  • Autism Spectrum Disorder Level 3: Requiring Very Substantial Support (F84.2)

These subtypes reflect the range of support needed for individuals with ASD, from those who require minimal support to those who require very substantial support. 

In addition to the clinical criteria, the DSM-5 recommends the use of specific assessment tools and metrics for the evaluation of Autism Spectrum Disorder (ASD). These tools are designed to collect information that helps clinicians make informed decisions about whether an individual meets the criteria for ASD.

The assessment tools recommended by the DSM-5 include:

  • Autism Diagnostic Observation Schedule (ADOS): A semi-structured observational assessment tool used to assist in the diagnosis of ASD. The ADOS is designed to assess communication, social interaction, and play or imaginative use of materials for individuals suspected of having ASD.
  • Autism Diagnostic Interview - Revised (ADI-R): A comprehensive, semi-structured interview for diagnosing autism and distinguishing it from other developmental disorders. It is conducted with the parents or caregivers of the individual being evaluated.
  • Childhood Autism Rating Scale (CARS): A behavioral rating scale used to diagnose autism in children. The CARS is designed to assess the severity of autism symptoms and is based on observations of the child's behavior.

These assessment tools are designed to be administered by trained professionals who specialize in the assessment and diagnosis of ASD. The DSM-5 also recommends that the assessment process may involve gathering information from parents, caregivers, and other individuals who are familiar with the child, as well as conducting direct behavioral observations and clinical interview.

It is important to note that while these assessment tools are important for the evaluation of ASD, they are not enough for an official autism diagnosis. The assessment process for ASD is comprehensive and may involve the input of multiple professionals with expertise in the field. Regular assessments are important for guiding treatment choices throughout the entire lifetime.

DSM-IV and DSM-5

In comparison to the previous version, DSM-IV, the DSM-5's classification of ASD differs substantially. The DSM-5 provides detailed guidelines for distinguishing between autism with and without intellectual disability, whereas the DSM-IV did not provide such guidelines. The DSM-5 also includes some different features compared to the DSM-IV, providing a more comprehensive and nuanced approach to the diagnosis and classification of ASD.

In conclusion, the DSM-5 provides clinical criteria for the diagnosis of ASD, which is characterized by impairments in social communication and restricted, repetitive patterns of behavior, interests, or activities. The DSM-5's approach to ASD classification is more comprehensive and inclusive, taking into account the individual's language and intellectual abilities. The subtypes of ASD are categorized based on the level of support needed, providing a more detailed and nuanced approach to characterizing the different presentations of ASD.

DSM-5 and ICD-11

The DSM-5 and ICD-11 offer distinct approaches to the classification and diagnosis of Autism Spectrum Disorder (ASD). The DSM-5 provides clinical criteria and subtypes based on the level of support needed, while the ICD-11's classification system includes subtypes categorized by an individual's language and intellectual abilities. The DSM-5's assessment tools, such as ADOS, ADI-R, and CARS, focus on behavioral observations and social communication. In contrast, the ICD-11 recommends tools like DISCO, ADI-R, and ADOS, which consider a broader range of information, including social and communication abilities, behavior, and interests.

The ICD-11's approach is more comprehensive, inclusive, and tailored, allowing for a more accurate diagnosis and support for individuals with ASD across different age groups and levels of severity.