TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 205 • Must show persistent symptoms from early childhood across multiple contexts; • Display difficulties processing and responding to complex social cues; • Suffer from anxiety because of purposefully calculating what is socially intuitive for other adults; • Express difficulty in coordinating nonverbal communication with speech; • Struggle to comprehend what behavior is considered appropriate in one situation but not another; and • Learn to suppress repetitive behavior in public. Following assessment procedures outlined in the DSM-5 to use “standardized behavioral diagnostic instruments with good psychometric properties, including caregiver interview, questionnaires and clinician observation measures” (APA, 2013, p. 55) and by Jones (2010), clinical assessment of Walter included the following: • Biopsychosocial clinical interview of Walter with his mother as an additional informant • Level 1 Cross-Cutting Symptom Measure (see APA, 2013, pp. 733–744 or www.psychiatry.org/dsm5 ) • The Clinician-Rated Severity of Autism Spectrum and Social Communication Disorders (see APA, 2013, p. 52 or www.psychiatry.org/dsm5 ) • Historical evaluations (prior psychological testing results) • Collateral reports from the referring vocational rehabilitation counselor • Simon Baron-Cohen’s Autism Spectrum Quotient (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001; Ketelaars et al., 2008) Adhering to DSM-5 dimensional rather than DSM-IV-TR multiaxial classification (Jones 2012), Walter was diagnosed using this format: 299.00 Autism spectrum disorder; requiring substantial support for social communication and social interaction (level 2 moderate); requiring support for restricted repetitive behaviors, interests and activities (level 1 mild); without accompanying intellectual impairment; without accompanying language impairment; without catatonia. Notice the diagnostic precision offered by the DSM-5 in comparison with Walter’s non-descriptive diagnosis using the DSM-IV-TR formulation: Asperger’s Disorder (APA, 2000). In contrast, the severity ratings for autism spectrum disorder are listed independently for social communication and restricted repetitive behaviors, rather than providing a global rating for both psychopathological domains (per the DSM-5 they are listed from most severe to least severe). For Walter, his moderate severity rating of requiring substantial support for social communication means: “Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others” (APA, 2013, p. 52). His mild severity rating of requiring support for restricted repetitive behaviors (RRBs) means: “Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence” (APA, 2013, p. 52). The diagnostic formulation offered to counselors in the DSM-5 provides a richer contextual description of the client to support more personalized treatment planning. This attention to dimensional ratings and individualized treatment strategies is also captured in the newly conceptualized schizophrenia spectrum disorders. Schizophrenia Spectrum and Other Psychotic Disorders The New Landscape Counseling clients presenting with psychotic and schizophrenia spectrum disorders is challenging and diagnostically complex. To assist with these difficulties, the DSM-5 presents a new conceptualization to