In May 2013 significant changes were made to Autism Spectrum Disorder and related diagnoses. This blog will provide an overview on why these changes were made, and what the changes are. Stay tuned for part 2 of this blog, which will talk about possible impacts this may have on individuals.
What is the DSM-5 and why were revisions made to how Autism is diagnosed?
DSM-5 stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. This edition was recently updated and has been in active use since May 2013. As with many manuals, periodically it is necessary to update it, and the criteria for the diagnosis of Autism and related disorders was specifically targeted for revision due to concerns about the consistency, validity, and appropriateness of certain categories and criteria in the DSM-4. Current statistics indicate that 1 in 88 children are diagnosed with Autism, which has represented a significant increase in numbers. There have been concerns in the field as to whether this increase was fully due to a true increase in prevalence or whether the diagnostic criteria were being applied correctly and consistently.
How is the DSM-5 Autism Spectrum Disorder different from DSM-4 and why were the changes needed?
There are some significant changes in the Autism diagnosis from the DSM-4 to the DSM-5. Under the DSM-4, there were pervasive developmental disorders identified which included Autism, Asperger Disorder, Rett Syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). Asperger, Rett, and Childhood Disintegrative Disorder were all brand-new diagnoses in the DSM-4, and PDD-NOS had been significantly redefined for that edition. PDD-NOS has probably been the most debated of these categories, and in studies, there has tended to be the least reliability in this category when looking at diagnosis. There is quite a bit of overlap between that and Autism, which is part of why it has now been replaced by the Autism Spectrum Disorder label now. Rett Syndrome is a genetic or medical condition that at certain points may have characteristics of Autism, so now individuals can still be diagnosed with Rett Syndrome medically, and may also have a diagnosis of Autism Spectrum Disorder if they meet that criteria. Childhood Disintegrative Disorder also has some qualities and characteristics that fall under Autism Spectrum Disorder, but other physical symptoms are distinctly different, so it is not possible to have both diagnoses. With Asperger Syndrome there were actually very few differences between that and Autism in the DSM-4, and there have been studies showing that there was evidence of diagnosis bias; males from affluent backgrounds were much more likely to receive this diagnosis, whereas people from other demographics were more likely to receive a diagnosis of PDD-NOS. So, the idea was in making changes to give further clarification and specificity to the diagnosis of Autism.
Here is a site that details these criteria with specific illustrative examples. Looking at that criteria, it involves deficits in social-communication skills, as well as having restricted, repetitive patterns of behavior and interests. These symptoms must be present in early childhood and must limit and impair the individual’s ability to function in their everyday activities. One very controversial change in the DSM-5 is the addition of a new disorder completely separate from autism, which is labeled as Social Communication Disorder. This involves persistent difficulties in the use of verbal and nonverbal communication and these deficits having a negative impact on the individual’s social, communication, and academic competency and achievement. There is some overlap with this and Autism Spectrum Disorder, but unless repetitive, restricted behaviors are noted, an individual would not fall under the Autism Spectrum Disorder diagnosis, whereas before they may have fallen under one of the pervasive developmental disability diagnoses.
Stay tuned for part 2 of this blog, which will discuss the clinical implications of these changes, and how they can affect an individual and their access to treatment.