News and Notes from The Johnson Center
DSM-V – What do the changes mean?
JCCHD | Tue, April 10, 2012 | [Assessment Corner][News]If you have a child with autism you have likely heard of the DSM-IV. The DSM-IV stands for the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV). It is published by the American Psychiatric Association and it’s the primary manual used by clinicians to provide a formal diagnosis of autism and related disorders. The manual outlines the specific criteria that must be met to receive a diagnosis, as well as the corresponding label and numerical code that is sometimes used by insurance companies to identify the diagnosis. The main purpose is to provide standard guidelines for clinicians to use for the diagnosis of different psychological disorders and conditions.
The DSM-IV currently identifies a set of Pervasive Developmental Disorders that are considered “autism spectrum disorders” (ASDs). These include Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-IV has been under revision for several years and a new edition, the DSM-V, will be released in 2013. Significant changes to the criteria and categories of ASDs are planned for the new edition. As a parent it is important that you be well informed, so we will review the proposed changes and their possible implications.
One of the most significant changes is that the separate diagnostic labels of Autistic Disorder, Asperger’s Disorder, and PDD-NOS will be replaced by one umbrella term “Autism Spectrum Disorder.” Further distinctions will be made according to severity levels. The severity levels are based on the amount of support needed, due to challenges with social communication and restricted interests and repetitive behaviors. For example, a person might be diagnosed with Autism Spectrum Disorder, Level 1, Level 2, or Level 3. The DSM-V revision website says the reasons for using the umbrella term of “Autism Spectrum Disorder” are 1) the old way isn’t precise enough—different clinicians diagnose the same person with different disorders, and some change their diagnosis of the same symptoms differently from year to year, and 2) autism is defined by a common set of behaviors and it should be characterized by a single name according to severity.
The removal of the formal diagnoses of Asperger’s Disorder and PDD-NOS is a major change. People who currently hold these diagnoses will likely receive a different diagnosis when re-evaluated. This has the potential to be confusing for parents of children with these diagnoses as well as children and adults who identify strongly with their diagnosis.
Revisions to the specific criteria needed for a diagnosis of Autism Spectrum Disorder have also been made. The new criteria are more thorough and strict compared to the old criteria. For example, more symptoms are needed to meet criteria within the area of fixated interests and repetitive behaviors. Other changes to the criteria include a reorganization. Currently, the domains for Autistic Disorder include impairments in Communication, Social Interaction, and Restricted Interests and Repetitive Behaviors. In the new edition, the Communication and Social Interaction domains will be combined into one, titled “Social/Communication Deficits.” Additionally, the requirement of a delay in language development is no longer necessary for a diagnosis.
These proposed changes are based on research, analysis, and expert opinion. The revisions have been made with the hope that the diagnosis of autism spectrum disorders will be more specific, reliable, and valid. Despite these positive hopes, legitimate concerns have been raised regarding how these changes might impact people on the spectrum. One of the biggest concerns is that some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services. Questions have been raised about what will happen to people currently diagnosed with Asperger’s Disorder or PDD-NOS. Furthermore, there is uncertainty regarding how state and educational services and insurance companies will adopt these changes.
It is clear these changes will have an impact on families and people currently diagnosed with an autism spectrum disorder. It remains to be seen how diagnosticians and clinicians will use the new criteria in evaluating children and the impact it will have on the availability of services. Therefore, it is important to remain informed and up to date. To follow and learn more about the proposed changes, see the DSM-V revision website: http://www.dsm5.org.
