on permanency of autism

 10 may 2022 

i assessed this 2-year-old female service user (SU) in 2019 due to delayed speech (age 3-4 years old started to talk) without a standardized intelligence test but with a vineland social maturity scale & the childhood autism scale & SDM-5 screening tool with the diagnostic impressions of F84.0 autism spectrum disorder (ASD) with intellectual & language impairments, T/C F70 mild intellectual developmental disorder & F90.2 ADHD, combined presentation.

today, 2 years & 9 months after, at age 5 years & 8 months, we assessed her again with the help of our practicum students. i had wanted the stanford-binet to be given, but since it's not easy, I did not insist. instead, I asked that the raven's (abstract reasoning) be given since it has norms starting at age 5.3 & she got an estimated IQ of 112 (high average) & with an estimated mental age of 6 years & 4 months. 

I was in a dilemma as to whether to still give the diagnostic impression of  ASD since the full range of required symptoms are no longer present. to the credit of the parents (the SU is an ONLY CHILD!) , they completed the 12-session package with our visiting SPED interventionist & elsewhere. so, the DEVELOPMENTAL PROGRESS was phenomenal (this is the principle of EARLY INTERVENTION), plus the fact that her level of dysfunctionality is not severe (most probably mild only -- I validated this by asking the parents for comparison with diagnosed cousins with ASD as well).

since, I could not let the parents wait for additional hours (needing time to research further), i ended up limiting my diagnostic impression to T/C (To Consider) F80.0 speech sound disorder because that was the outstanding area needing remediation in the social maturity scale.

then,  I read this from DSM-5-TR (2022) on ASD, p.62 (in reference to criterion C. "symptoms must be present in the early developmental period...." which reads "Diagnostic criteria may be met when restricted, repetitive patterns of behavior, interests, or activities were CLEARLY PRESENT during childhood or at some time in the past, EVEN IF SYMPTOMS ARE NO LONGER PRESENT." (this is a verbatim repetition of DSM-5, 2013, p. 54).

moreover, DSM-5-TR adds this interesting admission of limitation: "However, the symptoms of ASD occur as DIMENSION WITHOUT UNIVERSALLY ACCEPTED CUTOFF SCORES for what would constitute a disorder. Thus, the diagnosis remains a CLINICAL one, taking all available information into account, & is NOT SOLELY dictated by the score on a particular questionnaire or observation measure" (p. 62).