Did the Alteration of Autism Spectrum Disorder Diagnosis (ASD) in the DSM-5 from DSM-IV-TR Influenced Researchers Results of the Mirror Neuron System activation in the Autistic Brain?

l will analyze the research projects  (investigated the MNS activation in the autistic brain), conducted before the DSM-5 was published, and compare it to the research projects conducted after the DSM-5 was published. Not finding a difference between the results, even after the diagnosis had changed, will contribute to an understanding of the reason behind the inconsistent  research results which is the absence of an accurate diagnosis of Autism Spectrum Disorder.

The purpose of this research is to investigate if the research results of the MNS activation in the autistic brain changed after the DSM-5 was published. That is as a consequence of the alteration in the diagnosis and so the sampling process of these research projects. I hypothesize that the results of the MNS activation in the autistic brain research projects changed after the DSM-5 was published. That is as the DSM-5 provided more accurate diagnosis criteria, and so led to accurate sampling processes.

 

Huerta, M., Bishop, S. L., Duncan, A., Hus, V., & Lord, C. (2012). Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. American Journal of Psychiatry, 169(10), 1056-1064.

The Specificity Range in the DSM-5 is 0.53 while the DSM IV specificity range from 0.24 in PDD-NOS to 0.53 in for autistic disorder. When using data from the clinical diagnosis  and parents reports the diagnosis specificity increased to 0.63. DSM-5 added symptom diagnosis such as the sensory interest and the aversions.  The new DSM-5 shifted from having multi-categorical diagnosis into single diagnosis of ASD.

PDD-NOS diagnosis based in the DSM-IV can still be held under the DSM-5. However, using the DSM-5 to diagnosis children with non-PDD diagnosis could lead to misclassification.

Harker, C. M., & Stone, W. L. (2014). Comparison of the Diagnostic Criteria for Autism Spectrum Disorder Across DSM-5, DSM-IV-TR, 2 and the Individuals with Disabilities Act (IDEA) 3 Definition of Autism.

In DSM- IV

1- Autism Disorder.

2- Asperger Disorder.

3- Pervasive Developmental Disorder- Not Otherwise Specified.

4- rett’s Disorder.

5- Childhood Disintegrative Disorder.

In DSM-5:

• Any child with 1,2,3 will be diagnosed as having ASD.
• IDEA specifies that the symptoms must adversely affect the child’s educational performance, while DSM-5 requires impairment in social, occupational, or other important areas of functioning.
• With or without intellectual disability.
• Note: The sensory interest that the DSM-5 added were that children with autism tend to focus on certain aspect of their environment (e.g) they may show interests in smelling or touching objects and display visual fascination in light or movement.

1. Posar, F. Resca, P. Visconti, Autism according to diagnostic and statistical manual of mental disorders 5(th) edition: the need for further improvements, J. Pediatr. Neurosci. 10 (2) (2015) 146–148

In a case report,  Annio Posar et al. (2015) described two cases of two 7 years old males. Based on DSM-5 both cases are diagnosed with ASD severity level 1.  On the other hand, based on DSM-IV-Text, case 1 is diagnosed with high Asperger’s disorder, while case 2 is diagnosed with extremely low Asperger disorder. This report argues that DSM-IV-Text has a more accurate diagnosis than DSM-5, suggesting that DSM-5 diagnosed ASD with a broader aspect that led to categorizing both cases in the same level of severity while they exhibit different symptoms. Despite the similarity between both cases in the tension they show when changes occur around them and their communication impairment, case 1 has no intellectual impairment but difficulty in perceiving spatial relationship between objects. Case 2, however, demonstrates an intellectual delay but no spatial perception difficulty (A. Posar, 2015). This indication conveys that current research projects may be basing their sampling process on an inaccurate diagnosis of ASD. This may have led to exaggerated or falsified results causing the inconsistency between research projects results.

Note:if the results after the analysis of the articles in this research indicated that there are no differences between the results based on the diagnosis after and before the DSM-5 than the suggestion from this this research will be that it may not be that the DSM-IV is more accurate but that a new more accurate diagnosis should be conducted taking into account the IQ level and the the objects special relationship perception.

 

Smith, I. C., Reichow, B. & Volkmar, F.R. J. (2015).The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review. Journal of Autism and Developmental Disorders. 45(8), 2541–2552.

A research group analyzed the DSM-5 diagnosis effect on samples from research projects conducted before the edition was published found that part of past research has sampling percentages that, based on DSM-5, are no more diagnosed with Autism Spectrum Disorder, or the level of severity targeted in the research. This paper was based on the idea that DSM-5 bases its diagnosis on social impairment, not repetitive behaviors, which may be the reason that past research subjects do not fall under ASD diagnosis. However, it was marked through this research that variations between the research projects conducted before DSM-5 are depicted through the participants’  IQ scores. Most diagnosis changes occur when the participants have an IQ that is greater than 70. (Isaac C et al 2015) Through this research analysis, it is notable that any research project conducted before the DSM-5, has a sample with High Functioning Autism, and its participants have an IQ greater than 70 may not be valid to measure the MNS activation in the autistic brain. That is because its subjects are no more diagnosed with ASD. On the other hand, any current research that is basing its experiment on research findings conducted before DSM-5 was published is building on inaccurate information. These information are formed by research projects conducted on subjects that are not diagnosed with ASD.

Note: This study also indicated that there were decrease in diagnosis of ASD in participants with IQ greater than 70. In other words, research projects that used subjects who have had diagnosis based on DSM-IV will have different diagnosis based on DSM-5. It also supported the view that diagnosis of PDD is maintained from DSM-IV to DSM-5. In other words, 75% of subjects participated on 52% of the research papers analysed in this study maintained there diagnosis under DSM-5.

The Citation:	The Year of the publication	What was it investigating?	The sampling details:	Results:
Before the DSM-5 was Published.
Fan, Y.-T., Decety, J., Yang, C.-Y., Liu, J.-L., & Cheng, Y. (2010). Unbroken mirror neurons in autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51, 981–988	2010	It investigating the mirror neuron activation during action observation of a hand or a moving dot, and the effect of that on the subjects imitation ability.   It is predicting that ASD participants when observing hand movement will show less mu suppression. If that was true but participants with ASD failed to imitate than MNS has nothing to do with imitation.	– 20 males in the control typically developed and 20 in the experimental group. – Age 11-26. – The experimental group had 7 autism, 8 Asperger’s disorder and 5 pervasive developmental disorder. – diagnosis are based on DSM-IV. – All participants had the Mean of an IQ score that is greater than 70. – The EEG was used in to measure the MNS activation.	– The mu suppression waves did not differ between TD and ASD individuals. – participants with ASD failed to imitate actions even though their mirror neurons showed the same activation as the TD groups. -different diagnosis of the ASD showed diffrent MNS activation. The more the impermint in activation is associated with a less mu suppression waves. *
Martineau, J., Andersson, F., Barthelemy, C., Cottier, J.P., Destrieux, C., 2010. Atypical activation of the mirror neuron system during perception of hand motion in autism. Brain Res. 1320, 168–175.	2010	Investigating MNS activation during hand movement and hand movement observation.	– 7 high functioning adults – all male Age between 19-31. – all participants had an IQ>70 – The diagnosis source was not clearly indicated but the DSM_IV was mentioned. – The MRI was used in this research.	– Execution Vs. Rest: activation was found in the left and motor area and and the right cerebellum. While the TD group activation in the left motor are only.   – Observation Vs. Rest: activation in more areas of the brain more than that of the TD groups.
Raymaekers R, Wiersema JR, Roeyers H. EEG study of the mirror neuron system in children with high functioning autism. Brain Res 1304: 113–121, 2009.	2009	It is investigating how the MNS is function in people diagnosed with autism.	– 20 children with high functioning Autism. 2 of them are girls. – 19 children typically developed. 5 of them are girls. – participants are between 8-13. – ^^all participants have an IQ level that is greater the 85 (vocabulary and, block design and picture arrangement. – Diagnosis were based on DSM-IV	1- the waves suppression are more during the performance than the observation of the action. 2- in either groups no mu wave suppression was found in either groups. 3- there was no relation between age and mu wave suppression. 4- significant correlation relation between mu waves suppression and intelligence. 5- no relation between severity level and mu wave suppression.
After the DSM-5 was Published.
Perkins, T. J., Bittar, R. G., McGillivray, J. A., Cox, I. I., & Stokes, M. A. (2015). Increased premotor cortex activation in high functioning autism during action observation. Journal of Clinical Neuroscience, 22(4), 664-669.	2015	– Tests the Mirror neuron Hypothesis using the fMRI on participants with high functioning autism or Asperger’s syndrome. – observed hand movements including grasping, waving, pointing.	– Participants are all male. – Age is 16-30 years. Participants were high functioning autism/ diagnosed with Asperger’s Syndrome. – Diagnosis were based on DSM-IV.	– Participants of both groups showed brain signals in the same areas. However, TD groups showed a an additional peak in the middle temporal. – Participants with AS showed greater activation in the small cluster bordering the gyrum. – TD participants showed activation in the right hemisphere while AS participants showed activation in the left hemisphere.
Schulte‐Rüther, M., Otte, E., Adigüzel, K., Firk, C., Herpertz‐Dahlmann, B., Koch, I., & Konrad, K. (2017). Intact mirror mechanisms for automatic facial emotions in children and adolescents with autism spectrum disorder. Autism research, 10(2), 298-310.	2017	– Investigates the involuntary automatic mimicry of facial emotional expression through the MNS activation. – Used the EEG.	– 18 typically developed and 18 participants diagnosed with ASD. – All participants are males. – The IQ Level is greater than 70. – age 15-18 – Diagnosis are based on DSM-IV, ICD-10, ADOS-G and ADI-R and SRS parent report. – Participants and parents self rated their empathy level.	– there are no impairment in emotional mimicry in ASD participants. – ASD imitation experiment have nothing to do with the MNS activation. – impermint in facial emotional mimicry in past research could be as a results of participants not paying attention, however, if participants paid attention they are able to imitate facial actions presented to them. – Younger participants tend to have more facial mimicry abilities than adults. – there was a significant relation between facial emotional mimicry and empathy in TD groups. But there were no facial emotional mimicry and empathy in ASD groups. (it was suggested that this may be related to an impairment in the MNS activation)
Fishman, I., Keown, C. L., Lincoln, A. J., Pineda, J. A., & Müller, R. A. (2014). Atypical cross talk between mentalizing and mirror neuron networks in autism spectrum disorder. JAMA psychiatry, 71(7), 751-760.	2014	Investigating if adolescent with ASD show greater connectivity between areas in the brain responsible for the theory of mind (the emotional processing of the other) and areas responsible MN (the physical processing of actions done by the other)	– 25 participants in each group. (Typically developed and ASD). – age 11-18. – Used DSM-IV criteria to diagnosis participants. – All participants had verbal, nonverbal and full scale IQ scores that are greater than 70. Used FcMRI.	– Participants with ASD showed more connectivity between ToM and MNS than the Typically developed participants. – Demonstrates that increased connectivity between the ToM and the MNS is associated with high severity of ASD and social impermint.

 

* it is shown through research that MNS activation depict the differences between the different types of ASD. IN this case, it is shown that the MNS activates differently in diffrent ASD type. From that we can infer that a lack of accurate diagnosis is leading to false results. Also, with the range of differences could be the reason that research projects are finding inconsistent results.

^^ In the DSM-5 it was indicated that one of the symptoms to be diagnosed with ASD is language impairment. However, if there is no impairment than the diagnosis should be based on other criteria and the individual situation most be associated with one of the levels of ASD.

Conclusions:

• Despite that it was reported that the DSM-5 is more accurate than the DSM-IV all research found, even after the DSM-5 was published, have samples that are diagnosed based on the DSM-IV.
• It was also reported that most variation between DSM-IV and DSM-5 are when individuals diagnosed have IQ level greater than 70. Meaning that usually participants who have IQ level greater than 70 and diagnosed with ASD based on DSM-IV, do not maintain their diagnosis under the DSM-5. However, all the research found have participants with IQ scores that is greater than 70. This may mean that participants with ASD in recorded research projects have different diagnosis than is indicated. Therefore, when measuring the MNS activation in these group, the resulting come to be inconsistent as the sample has heterogeneous symptoms.
• Not using the DSM-5 may be because it is more specific and will require time and effort to note in the samples.
• The hypothesis in this experiment was not proved, nor was it disproved because no research projects found has sample diagnosis based on the DSM-5. Therefore, it is unclear whether using the DSM-5 diagnosis will lead to accuracy and consistency in experiments measuring the MNS function in ASD.
• Research on the Mirror neuron system activation effect on the autistic mind where the sampling process are based on the DSM-5 is needed. This type of research may lead to a more consistent results, because all participants in the sample will have the same diagnosis.