Regarding IQ testing

Regarding IQ testing:  The school should have records of IQ testing, not less than 2 years old if a child has an intellectual disability.  If they don’t, they should be asked to do the testing.  If the child is under the age of 7 and nonverbal, there are several tests that could be given.  The most appropriate in my opinion is the UNIT (Universal Nonverbal Intelligence Test).  It may be possible for the Institute for Behavior Change to do this evaluation; go to www.ibc-pa.org to get the referral form.  Download it, fill it out and mail or fax it in.  If we can help, we will.

By the way, here is a link to a very balanced and thoroughly professional summary of the DSM-IV vs DSM-5 controversy.

http://autismjabberwocky.blogspot.com/2012/01/new-york-times-dsm-5-autism-coverage.html

Based on my own experience, any child who has an Autism spectrum diagnosis via DSM-IV now will be able to retain an “Autism Spectrum Disorder” via DSM-5 unless their symptoms do not significantly impair their day-to-day functioning.  Anyone receiving BHRS (mistakenly called “wraparound” services in PA) is supposed to have “more than mild” impairment of functioning (that translates to a GAF of 60 or lower), so the probability of a very small number, if any, of current recipients of BHRS losing their Autism spectrum classification via DSM-5 is extremely low.

The greatest concern I have is that DSM-5 lumps together what is now Axis I, II and III into a single class of disability.  That means that the requirement of a “mental illness” diagnosis (Axis I) to justify receiving BHRS will have to be adjusted to accommodate DSM-5.  In all likelihood, the DSM-IV standard will be retained by state Medicaid agencies because using DSM-5 would make it possible to conflate intellectual disability (now diagnosed on Axis II) with mental illness (as Autism spectrum disorders are now classified) and to then “justify” someone’s classification as “intellectually or globally developmentally delayed” rather than on the Autism spectrum.  DSM-5 classifies Autism spectrum disorders as “neurodevelopmental disorder” and the result of that classification might be the elimination of a rationale to fund its treatment via BHRS because it is no longer a “mental illness.”  Then again, with the collapsing of Axis I, II and III, DSM-5 could be “the best thing that ever happened” to children with disabilities because the artificial distinction between children with intellectual disabilities and those without them can be set aside — if they have mental illness symptoms, they can be diagnosed with them whether or not they also have an intellectual disability, and the existence of the latter does not eliminate the existence of the former.

One important thing to note about DSM-5 and intellectual disability is that a child can’t be called “intellectually disabled” if they cannot take a standardized IQ test.  This means that every child who can currently be classified as “intellectually disabled” via DSM-IV code 319 (because their social functioning is significantly impaired, they’re under 18, and they can’t take a standardized IQ test) can still be classified as intellectually disabled via DSM-5.  Since DSM-doesn’t consider intellectual disability in a separate category anymore — it’s all lumped in with the “mental illnesses” (Axis I) and “other medical conditions” (Axis III) so that means that all three categories of disability have to be given equal weight.  I honestly do not see grave consequences of DSM-5’s definition of “Autism spectrum disorder” for children who have significantly disabling symptoms and who currently receive or are entitled to BHRS in Pennsylvania because of the severity of those symptoms.  Children with only mildly disabling symptoms will be the most at-risk of not being eligible for the new Autism spectrum disorder diagnosis.  You should compare the DSM-IV definition with the DSM-5 definition here:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

If you use the actual DSM-IV diagnostic criteria from the source cited here as a “checklist” for a child with a current Autism spectrum diagnosis, and then apply that same “checklist” to the DSM-5 diagnostic criteria, you will see for yourself how similar the two sets of criteria are (and perhaps get some reassurance that a particular child you know is not likely to be reclassified if and when DSM-5 is adopted).

Your feedback is invited, as always.

Steve

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