Abstract: The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM- 5 deletes Asperger’s Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a “Social Communication Disorder” focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger’s Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger’s Disorder. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Subjects: *American Psychological Association; *Diagnostic and Statistical Manual; *Pervasive Developmental Disorders; Diagnosis

PsycINFO
Classification: Developmental Disorders & Autism (3250)

Title: The role of prenatal, obstetric and neonatal factors in the development of autism.

Authors: Dodds, Linda, Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada, l.dodds@dal.ca
Fell, Deshayne B., Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
Shea, Sarah, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
Armson, B. Anthony, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
Allen, Alexander C., Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada

Memorial Hospital
Memorial Hospital is a privately owned 600-bed facility. The hospital provides a broad range of health care services, including complete laboratory and X-ray facilities, an emergency room, an intensive care unit, a cardiac care unit, and a psychiatric ward. Most of these services are provided by several other hospitals in the metropolitan area. Memorial has purposely avoided getting involved in any specialized fields of medicine or obtaining very specialized diagnostic equipment because it was felt that such services would not be cost-effective. The General Hospital, located only a few miles from Memorial, is affiliated with the local School of Medicine and offers up-to-date services in those specialized areas. Instead of trying to compete with General Hospital to provide special services, Memorial Hospital has concentrated on offering high-quality general health care at an affordable price. Compared with the much larger General Hospital, Memorial stresses close personal attention to each patient from a nursing staff that cares about its work. In fact, the hospital has begun to place ads in newspapers and on television, stressing its patient-oriented care.

However, the hospital’s administrator, Janice Fry, is concerned about whether the hospital can really deliver on its promises, and worries that failure to provide the level of health care patients expect could drive patients away. Janice met recently with the hospital’s managerial personnel to discuss her concerns. The meeting raised some questions about how the hospital’s quality of health care could be assured. Jessica Tu, director of nursing, raised the question, “How do we measure the quality of health care? Do we give patients a questionnaire when they leave, asking if they were happy here? That does not seem to answer the question because we could make a patient happy, but give them lousy health care.” Several other questions were asked concerning the hospital’s efforts to keep costs down. Some people were concerned that an emphasis on costs would be detrimental to quality. They argued that when a person’s life is at stake, costs should not be of concern.
After the meeting, Janice began thinking about these questions. She remembered reading recently that some companies were using total quality management (TQM) to improve their quality. She liked the idea—if it could be used in a hospital.
Discuss some ways that a hospital might measure quality.
What are the potential costs of quality for Memorial Hospital? How could the value of a human life be included?
Are there any ideas or techniques from TQM that Janice could use to help Memorial focus on providing quality health care?
What measures could Memorial use to assess the quality of health care it is providing?