The Scieening of Autism Spectium Bisoiuei in Young Chiluien:

A Look into the BSN-v

Eiika Buit



















Auvanceu wiiting in the heath piofession

Lauiie Euwaius

Naich 17
th
, 2u14
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 2
Abstiact

0vei the past seveial yeais the 0niteu States has seen an inciease in chiluien
being uiagnoseu with Autism Spectium Bisoiuei (ASB). Cuiiently, ASB is uiagnoseu
in almost 1% of chiluien. With all of the ieseaich being conuucteu on this uisoiuei,
theie is still a bluiieu line of when uoctois anu othei health caie piofessionals
believe inuiviuuals can be accuiately uiagnoseu. The list of scieenings anu
assessments a specialist can use is long anu vaiying. In Nay of 2u1S the Ameiican
Psychiatiic Association ieleaseu the Biagnostic anu Statistical Nanual of Nental
Bisoiueis, Fifth Euition (BSN-S). The BSN-S focuses on iuentifying ASB in young
chiluien veisus the BSN-Iv, which focuseu on school-ageu chiluien. With the new
upuates in the BSN-S theie is concein foi the effectiveness of accuiacy in
uiagnosing anu whethei oi not it can be attiibuteu to the incieaseu pievalence in
ASB. This papei examines the upuates maue to the BSN-S anu whethei oi not it will
iesult in an inciease in ASB uiagnoses. The iates of incieaseu pievalence may also
be attiibuteu to othei factois which will also be exploieu.

Intiouuction
In a fielu of meuicine wheie theie aie moie questions than answeis, Autism
Spectium Bisoiuei (ASB) is a contioveisial uisoiuei constantly being ieseaicheu by
scientists anu uoctois. Theie is no know cause of ASB anu uue to this theie is
uifficulty in uetecting ASB in young chiluien. Cuiiently theie aie no meuical
assessments, evaluations, oi scieenings that can uiagnose ASB so meuical
piofessionals must iely on vaiious scieening anu evaluations that tenu to focus on a
The Scieening of Autism Spectium Bisoiuei in Young Chiluien S
chilu' s social uevelopment. Bue to all of these unknowns, the age one chilu is
uiagnoseu can vaiy in yeais to that of anothei chilu. Bowevei, the eailiei a chilu is
uiagnoseu the soonei they can begin theiapy to assist in pieventing any social oi
uevelopmental uelays.
The Biagnostic anu Statistical Nanual of Nental Bisoiueis, Fifth Euition
(BSN-S), which was ieleaseu a little less than a yeai ago, auapts a new way of
labeling inuiviuuals uiagnoseu with ASB (Ameiican Psychiatiic Association, 2u1S).
Compaieu to the BSN-Iv, which was publisheu in 2uu2, the BSN-S eliminates the
inuiviuual uiagnostic labels of Aspeigei's, Chiluhoou Bisintegiative Bisoiuei, anu
Peivasive Bevelopmental Bisoiuei not otheiwise specifieu (PBB-N0S) as uistinct
classification anu ieplacing them with the umbiella teim ASB. This has iaiseu
seveial conceins in the fielu incluuing the effects this may have on the iate of
uiagnosis as well as taking away these labels fiom inuiviuuals who have alieauy
been pieviously uiagnoseu.
0ne in eveiy 88 chiluien in the 0niteu States has been uiagnoseu with ASB;
even moie shockingly one in S4 boys has been uiagnoseu with ASB (Autism Speaks
Inc., 2u14). An inciease in pievalence is believeu to be attiibuteu to vaiious factois
incluuing impioveu uetection. Enviionmental factois have commonly been blameu
as well, howevei, theie is no stuuy that has been able to confiim oi ueny this.
vaccines given to infants soon aftei biith has also gaineieu attention foi being a
possible cause of ASB. But again, theie has been no ieseaich to eithei confiim oi
ueny this. A majoi concein with the implementation of the BSN-S is whethei oi not
it will have an effect on the iate of uiagnosis. Will moie chiluien ieceive seivices
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 4
with the use of an umbiella teim. 0i will ASB become a naiiow anu specific
uiagnosis that leaves some chiluien who woulu have ieceiveu seivices unuei the
BSN-Iv without theiapy.

The BSN-S
The BSN-S was ieleaseu in Nay of 2u1S as an upuate to the BSN-Iv anu has
leau to contioveisy with paients, specifically uue to eliminating the inuiviuual
uiagnostic labels anu using the moie 'umbiella teim' Autism Spectium Bisoiuei.
With the changes in the BSN-S, theie is the question of whethei oi not this will
affect clinicians anu uoctois when they aie evaluating chiluien to see if they qualify
foi seivices. The BSN-S is geaieu towaius the goal of uiagnosing ASB in young
chiluien (ages biith to thiee) wheie as the BSN-Iv was moie focuseu on the
uiagnosis of school-ageu chiluien (ages thiee anu above). Accoiuing to the }ouinal
of Chilu Psychology anu Psychiatiy, theie is no cause foi concein with chiluien
missing out on qualifying foi theiapy. The aiticle states, "This stuuy uemonstiates
that goou levels of both sensitivity anu specificity can be achieveu foi a uiagnostic
algoiithm auheiing to the BSN-S ciiteiia that is suitable acioss age anu ability
level." (Ameiican Psychological Association, 2u1S). In othei woius, the new piocess
of uiagnosing ASB thiough the BSN-S is effective in ueteimining chiluien with what
was pieviously iecognizeu as PBB-N0S anu Aspeigei's, uisoiueis not necessaiily as
noticeable as Autism.

Scieening anu Evaluating
The Scieening of Autism Spectium Bisoiuei in Young Chiluien S
With the vaiiety of stanuaiuizeu scieenings, evaluations, anu assessments
available, theie is a question of theii ieliability anu effectiveness. The eailiei ASB
can be uetecteu, the soonei seivices can be appointeu to a chilu. The moie anu moie
we know about this uisease the eailiei we can begin to uiagnose. Bowevei, with all
of the scieenings available theie aie many questions as to which ones aie the most
ieliable. 0ne common piactice foi uoctois is to combine assessments in oiuei to
effectively uiagnose theii patients. Two common stanuaiuizeu assessment tools
useu to uiagnose ASB aie the Autism Biagnostic Inteiview Reviseu (ABI-R) anu the
Autism Biagnostic 0bseivation Scheuule (AB0S). The assessments weie combineu
anu founu to have "a complementaiy effect in aiuing uiagnosis, i.e. when theii
iesults weie taken togethei they pioviueu a gieatei level of uiagnostic claiity."
(Ameiican Psychological Association, 2uu8) . The combination of ASB assessment
coulu aiu in the eailiei uiagnosis of chiluien.

Appiopiiate Age foi Biagnosis
At what age can a chilu be accuiately uiagnoseu with ASB. As mentioneu
eailiei in this papei, the uouble scieening appioach is becoming an incieasingly
populai methou to uiagnose ASB. It is believeu that this methou can assist uoctois
uiagnosing inuiviuuals with ASB eailiei. Bowevei with a lack of unueistanuing of
the cause of ASB, theie is gieat concein foi misuiagnosis the eailiei an inuiviuual is
uiagnoseu. The benefits of an eaily uiagnosis can have a significant impact on how
well a chilu continues to uevelop as he oi she ages (especially if they ieceive
seivices). "Chiluien with ASB exhibit impaiieu social inteiaction, veibal anu
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 6
nonveibal communication ueficits, anu iepetitive, iestiicteu, anu steieotypeu
patteins of behavioi oi inteiests, Stuuies show these chiluien benefit fiom
beginning intensive |Eaily Inteiventionj as soon as possible. " (Ameiican
Psychological Association, 2uu7). 0ltimately ieseaicheis hope to uiagnose chiluien
at biith, but uue to the lack of unueistanuing the cause of ASB, this is not yet
possible. The best hope to have is foi the chilu to be uiagnoseu as eaily as they can
be.

Incieaseu Pievalence in ASB
With the new upuates in the BSN-S theie is concein foi the effectiveness of
accuiacy in uiagnosing anu whethei oi not it can be attiibuteu to the incieaseu
pievalence in ASB. Cuiiently, ASB is uiagnoseu in moie than 1% of chiluien.
Although theiapy isn't haimful, ovei-uiagnosing oi misuiagnosis iesults in
unnecessaiy stiess foi paients anu caiegiveis. It also iesults in clinicians taking on
clients who may not neeu seivices while theie aie otheis who aien't seen enough oi
at all. 0ne of the most agieeu upon ieasons foi incieaseu pievalence is uue to,
"Impioveu uetection of cases, as a iesult of bettei access to seivices anu gieatei
awaieness of autism." (Autism Speaks Inc., 2u14). Bettei unueistanuing of the
uisoiuei has assisteu in moie chiluien being accuiately uiagnoseu eailiei in theii
lives.
When the BSN-S was publisheu it causeu contioveisy in the effects it woulu
have on the numbei of chiluien who woulu be uiagnoseu. Nany paients hau
conceins that the use of an umbiella teim woulu iesult in uoctois oveilooking
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 7
chiluien on the highei-functioning enu of the spectium. 0n the othei hanu, health
caie piofessionals weie woiiieu that having such a bioau categoiy coulu iesult in
oveimisuiagnosis. This in tuin coulu affect the amount of seivices chiluien
ieceiveu (i.e. seivices woulu be taken away fiom inuiviuuals that neeueu them in
oiuei to accommouate).

Who Shoulu Be Receiving Tieatment
Is it bettei to have moie people ieceiving tieatment even if they uon't
neeu it, oi to have not eveiyone that neeus it ieceiving tieatment. This is one of the
cential issues to the new uevelopments in the BSN-S. With conceins of who will be
uiagnoseu, many paients anu caiegiveis aie conceineu that theii chiluien may slip
thiough the ciacks. With the new ciiteiia puiposeu in the BSN-S, ASB uiagnoses aie
actually piojecteu to ueciease uiamatically (Ameiican Psychological Association,
2u12). This coulu be attiibuteu to vaiious factois, howevei with incieaseu piecision
in the uetection of ASB it can simply be attiibuteu to a bettei unueistanuing of ASB
anu moie infoimeu uoctois iathei than the changes maue to upuates maue to the
BSN-S (Ameiican Psychological Association, 2u12). This will hopefully iesult in less
in a uecieaseu chance of a chilu being misuiagnoseu.

Eliminating Bistinct Classifications in the BSN-S
0nuei the BSN-Iv Aspeigei's, Chiluhoou Bisintegiative Bisoiuei, anu
Peivasive Bevelopmental Bisoiuei not otheiwise specifieu (PBB-N0S) weie all
consiueieu theii own sepaiate uiagnoses. Bowevei, the BSN-S combines the thiee
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 8
with Autism wheie they all fall unuei the categoiy of ASB. Theie is also a new
classification uisoiuei nameu Social Communication Bisoiuei (SCB). SCB, like the
name suggests, is an inuiviuual who has uifficulties in social communication.
Similaily to Aspeigei's, it falls on the high-functioning enu of the Autism spectium.
0nuei these new classifications, a small peicentage of chiluien with
Aspeigei's anu PBB-N0S have been shown to ieceive the uiagnosis of SCB insteau of
ASB (Autism Speaks Inc., 2u14). This assists in eliminating conceins of chiluien
who may not be uiagnoseu with ASB unuei the new BSN S. Chiluien with an SCB
uiagnosis will still qualify to ieceive theiapy. This new classification is also a factoi
in the ueciease in chiluien being uiagnoseu with ASB unuei the BSN-S. In ieality the
same numbei of chiluien will have a uiagnosis, but they will be uiviueu into the
categoiies of ASB anu SCB insteau.
Auuitionally theie is the concein that inuiviuuals alieauy uiagnoseu with
Aspeigei's, Chiluhoou Bisintegiative Bisoiuei, anu PBB-N0S may lose theii
uiagnosis. This is a false concein. The BSN-S states that chiluien who have been
pieviously uiagnoseu unuei the BSN-Iv aie not iequiieu to be ieevaluateu.
Theiefoie, these chiluien can still continue with the special euucation seivices they
aie ieceiving with theii oiiginal uiagnosis. Bowevei, it is also unuei the uiscietion of
the paients to have theii chilu ieevaluateu anu possibly ieceive a uiagnosis of SCB.

Biscussion
Eveiy yeai ieseaicheis connect the puzzle pieces moie anu moie to tiy anu
uevelop a cleai pictuie of what ASB is. With the BSN-S being out foi less that a yeai,
The Scieening of Autism Spectium Bisoiuei in Young Chiluien 9
theie is still much moie to leain anu obseive in oiuei to see what the new
uiagnostic piocess will have on the oveiall pievalence of ASB. Cuiient scieening anu
evaluating piocesses help to fill in the some of the gaps of inuiviuuals who may have
been misuiagnoseu otheiwise. They also piomote eailiei uiagnosis. With chiluien
being uiagnoseu unuei the age of one, seivice pioviueis aie able to begin woiking
with inuiviuuals much eailiei. This piomotes successful leaining as well as the
inuiviuual being moie likely to be a functioning membei of society (if they aie on
the low functioning enu of the spectium).
The futuie of Autism is both piomising anu filleu with the unknown. With
the new categoiy of SCB, both piofessionals anu families must aujust to the
possibility of auapting theii theiapy techniques anu expectations. Reseaicheis aie
confiuent in finuing not only the cause of ASB, but also a meuical test that is able to
uetect ASB in infants. This will help eliminate misuiagnosis, which is cuiiently a
laige issue in the fielu. Theie is hope that one uay these conceins will be a thing of
the past.








The Scieening of Autism Spectium Bisoiuei in Young Chiluien 1u
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**I woulu like to incluue this papei in my poitfolio. I feel that It best iepiesents the
couise I wish to take in my stuuies anu my futuie ieseaich anu wiiting.