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Significant Changes to the Way Certain Mental Disorders are Diagnosed in DSM-V

January 3rd, 2013

The New Year brings significant changes to the way certain mental disorders are diagnosed, in the    Diagnostic and Statistical Manual of Mental Disorders –V (“DSM-V”).   In December,  the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual.   The final version of the DSM-V will be available in May 2013.

One of the most controversial changes for the DSM-V is creating a single “autism spectrum disorder” category, with stricter requirements than the DSM-IV.   After considerable study and controversy, the American Psychiatric Association voted to approve a new, streamlined definition of autism, that technically eliminates the diagnosis of Asperger’s Syndrome or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).    The Work Group has proposed that autism, Asperger‘s disorder, PDD-NOS and childhood disintegrative disorder be consolidated within  the category of Autism Spectrum Disorder.  But the new definition notes that psychiatrists should  with take into account a person’s diagnostic history. Thus, the new definition would include anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before.   According to Commentary by the America Psychiatric Association, “The change signals how symptoms of these disorders represent  a continuum from mild to severe, rather than being distinct disorders. The new category is expected to help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of providing general  labels that tend not to be consistently applied across different clinics and centers.”

Specifically, the new definition requires:

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.    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.    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.

Pediatric bipolar disorder also posed a challenge to the Work Group.   Psychiatrists are more frequently giving the diagnosis of Bipolar disorder, characterized by episodes of depression and mania, even  to children as young as 2 — along with powerful psychiatric drugs and tranquilizers.  To stop this trend, the committee created an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

The DSM-V new mental disorders include:

  • Hoarding; (previously considered a symptom of obsessive-compulsive behavior)
  • “Premenstrual dysphoric disorder,”
  • “Binge-eating disorder “

The changes above should not have a significant impact on school classification of students and will not result in fewer students being classified.   The 13 areas of disability under the Individuals with Disabilities Education Improvement Act remain constant and depend on the discussion and consensus of the Committee on Special Education, not on a medical diagnosis.  For autism, the changes proposed by DSM-5 are designed to better identify autism spectrum disorders and distinguish them from other conditions.   In some ways, the criteria for DSM-5 are actually broader.   For example, while DSM-IV criteria require evidence of difficulties related to autism prior to age 3, the DSM-5 definition only requires a child to show examples of unusual behavior in early childhood, whether or not they occur before age 3.

For more information, visit www.specialneedsnewyork.com.

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Are You the Brother or Sister (Sibling) of an Individual with a Developmental Disability

December 18th, 2012

  • Are you an adult (over 18)?
  • Are you the brother or sister (sibling) of an individual with a developmental disability? *
  • Does your sibling live in New York State (including New York City)?

If you answered “yes” to these questions, then we want to hear from you! Please complete our New York State Siblings Needs Survey. We are trying to better understand the needs of siblings in New York State. The findings from this survey will help us plan the next steps to support adult siblings of persons with developmental disabilities.  We will also give you a list of sibling web resources at the end of the survey. The survey will take about 10-15 minutes.

To complete the survey, click on this link:

https://cornell.qualtrics.com/SE/?SID=SV_byDnruQStwJLQeE

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Funding Helps Inclusion Education For Special Needs Students

October 11th, 2012

As part of the overhaul process of special education in New York City public schools, one of the goals is increased student inclusion, both in individual schools and system-wide. Though inclusive classroom placement for students with disabilities has been the national education policy for some ten years, in New York City public schools, of the approximately 165,000 students with disabilities, some 40 percent of them currently spend all or most of their school day in separate classes from students without disabilities.

According to numerous studies, children with disabilities who are educated with their peers without disabilities in inclusive classrooms show a variety of academic gains, including mastery of  IEP goals, improved standardized test performance, increased motivation, and better on-task behaviors. [1]  In contrast, students with disabilities who are educated in separate classes show a graduation rate of 5 percent, which is far below the citywide overall graduation rate of 65 percent.

Now, as part of the overhaul process, New York City schools will begin incorporating students into inclusive classrooms for grades kindergarten, sixth and ninth. Administrators, including principals, teachers and aids, have been training to work with all levels of learners, their families, and individualized education plans (I.E.P.s), and teachers with special needs students in their classrooms. [2]

Prior to 2012, rather than have every school able to accommodate every student,  New York City students with special needs would often be transferred from their neighborhood school, or even their district school, to attend a school with special needs services in place. These reform plans are one part of a push to comply with the Education for All Handicapped Children Act of 1975 for all 1,700 New York public schools. And while advocates and parents have been working for a broader acceptance of students with special needs in the public school system, some have voiced concern that mainstream educators do not have the necessary resources and training to meet students’ needs effectively, and that some special needs students will be placed in inclusive classrooms when they would be better served working with education specialists. [3]

This past May, The Panel for Education Policy voted to alter New York city’s financing formula to help restructure the city’s special education program by allotting money to the students rather than to special education classes. [4]

For more information, visit our website at www.specialneedsnewyork.com.

  1. http://www.wrightslaw.com/info/lre.incls.rsrch.whitbread.htm
  2. http://schoolbook.org/2012/05/24/city-panel-approves-special-education-inclusion-plan
  3. http://www.nytimes.com/schoolbook/2012/08/09/special-ed-reform-brings-city-more-in-line-with-national-trend/
  4. http://eservices.nysed.gov/sepubrep/
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Proposed Changes for Autism Spectrum Disorders in the Diagnostic and Statistical Manual (DSM) can have a Profound Impact

September 20th, 2012

Our guest blog this week is written by Lisa B. Rudley, Vice President of Private Client Services for Clark Dodge Asset Management. Lisa is responsible for Client Advisory Services and Business Development and brings over 15 years of financial investment services expertise.

By Lisa Rudley

A coalition of groups within the autism community is extremely concerned about potential impacts of the proposed criteria for Autism Spectrum Disorders (ASD) in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) – 5th Edition. The new criteria are supposed to be finalized by December 2012 for May 2013 publication. The ramifications of a new autism definition are far reaching and could be devastating. Among other changes, the new autism criteria will eliminate Asperger Syndrome and PDD-NOS, although children with these conditions could still be diagnosed with autism if they meet the DSM-5 criteria. A child who does not present with restricted or repetitive behaviors would not meet the criteria for autism. Everything from epidemiology to services could be affected for individuals with autism. Those dealing with autism need more answers and support, not more hurdles.

Since February 2012, five studies have been published indicating the proposed DSM-5 ASD criteria will significantly reduce the number of people diagnosed with ASD compared to the current DSM-IVTR criteria:

McPartland and Volkmar – 39.4% decrease
Worley and Matson – 32.2% decrease
Matson et al. – 47.8% decrease
Gibbs et al. – 23.4% decrease
Taheri and Perry – 37% decrease

In addition, Field Trials which identified 83 children with ASD, were reported by Dr. Swedo, chair of the APA’s Workgroup on Neurodevelopmental Disorders (NDD). These trials indicated that the decrease in the number of identified ASD cases using the proposed criteria would be in the single digits, but this would be counter-balanced by the inclusion of some cases that had been missed by the DSM-IVTR. The NDD Workgroup is concerned primarily with the new criteria accurately diagnosing new cases of ASD as they present in the community and does not think that the decreases in the published studies are accurate. Currently, there is no data on adult patients using the new criteria.

Online Survey to Collect Data on New ASD Cases Using the Proposed Criteria

SafeMinds and the Holland Center want to collect and analyze much more data on the proposed criteria through an online survey to assess its impact on autism diagnosis in the community.

This survey can be used by any clinician who speaks English anywhere in the world. The data will be made available to the NDD Workgroup directly. Cases are needed urgently given the tight time frame for publication of the proposed criteria!

Please spread this information and link to any clinician who diagnoses people with autism:

www.dsm5asdsurvey.org

New York State Legislation to Protect People with Autism

Last legislative session, Assemblyman Thomas Abinanti from the 92nd District (D-Greenburgh) sponsored legislation, A9983 that will define “autism” under New York State law as the currently used criteria set out in the Diagnostic and Statistical Manual (DSM-IVTR), a definition that has been in use since 1994. Assemblyman Abinanti along with many of his assembly and senate colleagues believe that the proposed changes would significantly impact people with the diagnosis of autism today and in the future.  Also, the cost to the New York State to re-diagnose people with autism would be extremely costly when these precious resources could be used help people with autism.  The bill was very close to going to the floor of both houses for a vote and Assemblyman Abinanti is expected to reintroduce in the upcoming session starting in January, 2013.

(Some of this information was reprinted with permission from SafeMinds and the Holland Center)


Lisa B. Rudley is Vice President of Private Client Services for Clark Dodge Asset Management www.clarkdodgewealth.com.   Lisa is responsible for Client Advisory Services and Business Development and brings over 15 years of financial investment services expertise.  She earned her BA from Richard Stockton College of NJ in 1988 and received an MBA in finance with a designation in international business from Fordham University in 1995. Lisa lives in Briarcliff Manor, NY with her husband and three children. As a parent of a child diagnosed with an autism spectrum disorder, Lisa has a comprehensive understanding of the “Special Needs” community. Currently, Lisa serves on the boards of the Elizabeth Birt Center for Autism Law and Advocacy (EBCALA) www.ebcala.org and Autism Action Network (AAN) www.autismactionnetwork.org.  She is the President of the Ossining Special Education Parents Teachers Organization (SEPTO) and is the co-founder of the NAA NY Metro Westchester www.naanyc.org sub-chapter support group servicing over 600 families in the Westchester area.
Contact:  Lisa Rudley: lisarudley@yahoo.com


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Services for People with Special Needs: Educated Canines Assisting with Disabilities (ECAD)

August 30th, 2012

This week, we interviewed a service organization that assists people with disabilities and special needs, Educated Canines Assisting with Disabilities (ECAD).  Since 1997, ECAD has been training and placing assistance dogs to help people with disabilities to gain independence and mobility. We spoke with ECAD advocate, Lee O’Brien-Rothman, and Communications and Public Relations Manager, Patricia Robert to find out more about the services they offer to people with special needs.

I am a retired disabled Police Officer who has spent 14 years serving my community. Brady came into my life after it was turned upside down by and on duty incident and subsequent PTSD. Being trapped in the wet blanket that is PTSD I became depressed and cut off from the entire outside world. Through Educated Canines Assisting with Disabilities, ECAD, I was chosen by a smart but goofy and kind golden retriever that immediately brought a smile to my face and a spark back in my life. ”

– Lee O’Brien-Rothman and Brady graduated from ECAD in May 2011. Since then, the two have become tireless advocates for ECAD and for Assistance Dogs. Brady O’Brien-Rothman has a Facebook page with thousands and thousands of friends.

How can people find out about ECAD:

People can visit our website, WWW.ECAD1.ORG or contact www.assistancedogsinternational.org, a coalition of non-for-profit organizations that train and place assistance dogs.

Do people have to qualify for a dog? If so, how?

People who apply for an ECAD educated Service Dog are always interviewed by our co-founder and Director of all programs, Lu-Picard. After they have filled out and submitted the completed application form, they can visit the main training facility, located in Dobbs Ferry. ECAD Service Dogs are educated to assist people with a wide range of disabilities, including adults, teens, even children as young as two, who have autism. It isn’t so much “qualifying” as it is following through with the determination to learn how to train/be responsible for a Service Dog by participating in the two-week team training sessions that are held several times each year. ECAD does not educate dogs for vision or hearing alerts.

How to apply for an ECAD Service Dog:

Information about applications can be found on ECAD’s website, or by calling the main office at 914-693-0600 ext.1958 and asking for the client liaison person.

What breeds of dogs are used as ECAD Service Dogs?

ECAD primarily trains golden retrievers, and Labradors, and a Lab-Great-Dane mix, all for their good temperament and intelligence. All ECAD Service Dogs are educated to respond to 80+ commands, including the retrieval of dropped objects, the pulling of wheelchairs, turning light switches on and off, loading and unloading the wash, reminding their person to take medication, alerting people with sleep disorders when they don’t respond to an alarm, and many other things. In addition to helping with physical problems, our service dogs are also trained assist people with emotional or psychological problems that stem from Post Traumatic Stress Syndrome (PTSD) and Traumatic Brain Injury (TBI) – problems that are being experienced by many veterans in recent years.

Tell us a bit more about ECAD’s Programs.

ECAD’s mission is to enable people with disabilities to gain greater independence and mobility through the use of specially educated dogs. Our programs include:

  • Project HEAL: a program that honors and empowers veterans and service members by addressing both visible and invisible disabilities. It entails a transition program that focuses specifically to re-adapt to a civilian culture by bridging the gap through a modified Service Dog Training program.
  • Canine Magic Service Dogs: a program in which ECAD Service Dogs are trained to assist children with Autism through emotional bonding, socialization, cognitive development and safety.
  • Open Doors: Service Dogs can be found working in public and private homes, hospitals, courthouses and nursing homes to help people with both physical and emotional disabilities.
  • ECADemy: a vocational curriculum administered at alternative schools specializing in helping children and teens with emotional, behavioral and social problems. All of these Service Dogs are trained by these students.

Can People Volunteer?

ECAD is a non-for-profit organization – volunteers are ALWAYS welcome at ECAD. There are many opportunities including:

–       Assisting in the main office

–       Grant writing

–       Becoming a home handler

–       Transporting ECAD Service Dogs to in-home trainings (on weekends only)

For more information on volunteering at ECAD, contact Tara at 914-693-0600 ext.1950.


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New Center for Autism Research to Open in Westchester County

June 15th, 2012

A new treatment and research facility for autism is under construction in White Plains, New York.  The Center for Autism and the Developing Brain will be part of New York-Presbyterian Hospital.  The center broke ground on April 4 and will open in 2013.

The new facility will provide a wide range of clinical services to people living with autism spectrum disorders (ASD) and other developmental disorders.  The center is a collaboration between the hospital, Weill Cornell Medical College, and Columbia University, along with the New York Center for Autism.  It will be located at New York-Presbyterian’s 214-acre White Plains campus.

Until the center opens, the hospital provides limited clinical services at a temporary location on the hospital grounds and offers ASD assessments through participation in their research studies.  When the permanent center opens, insurance will be accepted, including Medicaid in some situations.

According to the Centers for Disease Control (CDC), the prevalence of autism is continuing to increase.  The CDC found that, in the communities they studied, the prevalence of autism had increased from one in 88, from one in 110.  Autism continues to be more prevalent in boys than in girls, with one in 54 boys and one in 252 girls in the research group being diagnosed with ASD.  It remains unknown whether the increase is due to more careful diagnoses or another factor.

For assistance with questions regarding your child’s special needs visit our website at https://www.specialneedsnewyork.com/

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What Should I Know About Autism Awareness Month?

April 9th, 2012

April is Autism Awareness Month, a time to raise public consciousness about autism and autism spectrum disorders.  You should be aware of what is happening this month to raise awareness, and new facts that have just been reported about autism diagnoses.

One of the most prominent signs you may see – or wear yourself – indicating the significance of this month is the Puzzle Ribbon, produced by the nonprofit Autism Society.  This ribbon featuring multi-colored puzzle pieces is an internationally-recognized symbol of autism awareness.  Wear it with pride and thank others when you see them wearing it.

If you noticed an iconic building in your city illuminated in blue on Monday evening and wondered why, it was in honor of World Autism Awareness Day, sanctioned by the United Nations and initiated by the nonprofit organization Autism Speaks.  From the Empire State Building to Brazil’s Christ the Redeemer Statue, from Tokyo Tower to Graceland in Memphis, a blue light of awareness shown on close to 3,000 structures in more than 600 cities throughout the world.

A recent report by the Centers for Disease Control reveals a sharp increase in the rate of autism diagnoses. In the United States today, one in every 88 children is diagnosed with autism or an autism-related disorder.  While the diagnosis rate has been rising for years, the recent numbers represent a large increase: since 2006, there has been a 23% increase, and since 2002, a 78% increase.  One difficult question is whether this increase in diagnoses actually represents an increase in autism.  Public health officials say that the increase may be partly accounted for by more successful efforts to diagnose autism in younger and minority children.

What autism events and facts do I need to be aware of:

  • The Puzzle Ribbon is a recognized symbol of autism awareness that benefits the Autism Society
  • April 2 was World Autism Awareness Day, initiated by Autism Speaks and marked with their Light It Up Blue campaign
  • Autism diagnoses have risen sharply: now one in every 88 children in the U.S. is diagnosed with autism or an autism-related disorder

For assistance with questions regarding your childs special needs visit our website athttps://www.specialneedsnewyork.com/.

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Autistic Children Who Wander Have New Code and Medical Resources They Can Access

September 6th, 2011

The Centers for Disease Control (CDC) has approved a new medical diagnosis code for wandering. Individuals with autism, intellectual disabilities, and related conditions are more prone to wandering, which exposes them to potentially harmful and life-threatening dangers. The new code is listed as V40.31 – wandering in diseases classified elsewhere.

“It is our hope that the recognition of wandering as a medical diagnosis will bring opportunities for the development of resources including training for schools and caregivers, emergency search personnel protocols, financial assistance for safety equipment and support and education for families,” said Lori McIlwain, the board chair of the National Autism Association.

Health care professionals can start to use the new code in October in medical records. The CDC wants to gain better data with the new code to understand the prevalence of this behavior. Autism Spectrum Disorders (ASD) are noted for affecting an individual’s social, behavioral, and communication skills. ASDs begin in childhood and can last throughout a person’s lifetime. Individuals who are prone to wandering need extra care to monitor them. Behavioral intervention early on is needed to help the individual lessen these behaviors and make progress.

The National Autism Association conducted an online poll and 92 percent of parents said that their autistic child had a tendency to wander. Exposure to the outdoor elements, drowning, and other factors put the individual at risk for an injury or death. Speaking with your health care provider about your child’s behavior and what resources there are can help turn the situation around. It is also advised to speak with a qualified special needs attorney to learn about and access much-needed resources for your child.

Littman Krooks LLP counsels families with special needs planning. Our New York City, White Plains or Fishkill Special Needs attorneys can assist with Medicaid planning, special needs trusts, comprehensive estate planning, and special education advocacy matters. In addition, our New York Special Needs Trust attorneys can assist clients with long-term care and asset preservation and protection planning for loved ones with disabilities that need around-the-clock care.

To learn more about New York special needs planning, visit www.specialneedsnewyork.com, or http://www.littmankrooks.com/special-needs-planning.

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New York Ranks In The Top 10 Places To Live For People With Autism

July 18th, 2011

New York City’s educational resources and access to medical care have earned it a position in the top 10 places to live in the United States for people with autism, according to the world’s largest autism science and advocacy organization.

The organization, Autism Speaks, conducted an online survey of 800 parents of children with autism to study the quality of services provided in metropolitan areas throughout the country. New Yorkers said that they were satisfied with their child’s educational services, access to clinical and medical care, adaptable employer policies, nearness to outside services, and the recreational opportunities available to their child.

However, 75 percentage of respondents from areas such as Texas, Virginia, Tennessee, Ohio, Florida, Michigan and California reported that they were satisfied with the resourced and opportunities available to their children.

The survey was designed to encourage conversation in the autism community, the organization said, and that while New York was ranked highly for those with autism, it is a struggle for parents to get services that benefit their children in other areas of the country. Autism Speaks said that it hopes the survey will “inform policy makers and leaders in local communities about the tremendous need for increased services and inspire action.”

In New York City, the law firm of Littman Krooks LLP firmly believes that children with autism deserve access to the health care they need and opportunities to help them succeed. Our New York special needs attorneys have decades of experience in courtrooms and settlements to uphold your child’s rights. To learn more, visit https://www.specialneedsnewyork.com/ or call 914-684-2100.
https://www.specialneedsnewyork.com/

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