Criteria for a diagnosis of an Autism spectrum disorder
As a rule, autism starts in infancy or no later than the first years of life. First concerns usually come from parents who are alarmed if their child does not use language for the purpose of communication, despite being able to recognize words (Lord et al., 2000).
Although the deficits in communicating and the social reciprocity are not always evident in early years, they are usually the first criteria for the more careful examination and assessment. Also, they become more apparent as a child grows.
Therefore, the algorithms that are based on the correlation between the chronological age and operational language level were developed. Those algorithms include such criteria as verbal IQ, non-verbal IQ, patterns and levels of verbal and non-verbal communication, repetitive behaviours, etc. (Risi et al., 2006, p. 1096).
Due to heterogeneous nature of each case of the spectrum disorders, the diagnosis is made no earlier than when a child is two years old. At that point, the assessment based on the evidence of verbal and non-verbal intelligence and communication deficits can be draft together to the standard assessment scales, such as the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised (Lord et al., 2006).
Symptoms that might complicate a diagnosis
In case of autism spectrum disorders the presence of other childhood disorders in a patient often complicates the traditional diagnostic procedure. Autism spectrum disorders may or may not be accompanied by genetic syndromes. Also, they can coexist with non-spectrum diagnoses, which include language disorder, intellectual and learning disabilities (Risi et al., 2006).
The example of the complication of a diagnosis can be a child patient with the learning disability or some of the language disorders, causing failure in verbal intelligence tests that can be misinterpreted as an Autism spectrum disorder.
Neurocognitive Disorders: Delirium
Description of the delirium and depressive disorders as factor complicating a diagnosis
Acute organic brain syndrome or the acute confusional state, otherwise known as delirium is neurocognitive impairment is commonly linked to physical illnesses in elderly people.
There is a number of complications associated with the diagnosis of elderly patients, because of the changes in cognitive abilities and physical assets, frailty, dependence on medications, etc. In case of delirium some of those factors, for example, vision or hearing impairment can cause confusion in diagnosing delirium (Moraga & Rodriguez-Pascual, 2007).
One of the psychological disorders that tend to coexist with the delirium state is depressive disorders. The physical frailty and feeling of insecurity may result in the depressive disorders in elderly patients. However, depressive disorders might develop on the background of neurocognitive impairment, accompany it, or result in the delirium episode (Ely et al., 2004).
Factors and medications for elderly clients that complicate a diagnosis
The first factor in delirium diagnosis is global changes in cognition. The key factor is that it should not be misinterpreted as sensory impairment. Therefore, it presupposes reduced ability to sustain attention and disorganized speech (Tueth & Cheong, 1993).
The second factor is elimination or confirmation of the accompanied psychological disorders. It will also help to assess the severity of delirium since some of the symptoms can be caused by psychological comorbid factor. The third factor is precipitation caused by the hospital environment, malnutrition, or dependence on medication (Moraga & Rodriguez-Pascual, 2007).
The latter is important because the medication is the factor possible to control, even though it affects mood and cognitive abilities of patients. Therefore, over-medication in elderly patients can be confused with reduced neurocognitive functioning.
References
Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell Jr, F. E.,… & Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama, 291(14), 1753-1762.
Lord, C., Cook, E. H., Leventhal, B. L., & Amaral, D. G. (2000). Autism spectrum disorders. Neuron, 28(2), 355-363.
Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of general psychiatry,63(6), 694-701.
Moraga, A. V., & Rodriguez-Pascual, C. (2007). Accurate diagnosis of delirium in elderly patients. Current opinion in psychiatry, 20(3), 262-267.
Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P.,… & Pickles, A. (2006). Combining information from multiple sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(9), 1094-1103.
Tueth, M. J., & Cheong, J. A. (1993). Delirium: diagnosis and treatment in the older patient. Geriatrics, 48(3), 75-80.