Tuesday, April 2, 2013

Autism Awareness: Changes in DSM-V

Today is designated as Autism Awareness Day (and April as Autism Awareness Month). The goal is to increase both visibility and understanding of the "Autism Spectrum Disorders," which have also been referred to as "Pervasive Developmental Disorders" (PDD) - disorders involving severe and lasting impairment in several areas of development, most notably social skills and communication, sensory integration, and rigid/repetitive behaviors, interests and activities.

To date, this spectrum has included separate diagnoses: Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Syndrome, and PDD Not Otherwise Specified. However, this is about to change. When the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-V) takes effect next month, there will be a significant change in these diagnoses. Rett's Disorder will continue to be a separate disorder, and no longer considered part of the autism spectrum (which makes sense due to its unique symptoms, including deceleration of head growth between 5-48 months of age, and loss of purposeful hand movements, replaced by repetitive, "stereotyped" hand movement [hand washing or wringing motions]). All of the other diagnoses currently classified as PDD will be be compined into a new diagnosis: Autism Spectrum Disorder (ASD).

The current (DSM-IV) criteria for Autism focus on three categories of symptoms: communication, social skills, and repetitive/stereotyped behaviors, interests, and activities. The new criteria for ASD will include only two categories: social communication, and repetitive/stereotyped behaviors (etc.). The latter category will also reportedly include recognition of issues with sensory integration/stimulation. Language delays will be removed as a criterion, since there can be many reasons for such delays, and delays are not seen universally in those with PDD/ASD. A new diagnosis is also being added for those without repetitive/stereotyped behaviors: Social Communciation Disorder.

While the DSM-IV criteria have been associated with inconsistent diagnoses from clinician to clinician (i.e., low reliability), preliminary results reportedly show good reliability. A retrospective application of the new criteria to individuals with current PDD diagnoses also shows that most continue to meet the revised criteria for ASD. Most of those who no longer meet criteria for ASD do meet the criteria for Social Communication Disorder.

These latter findings address the biggest concern within the Autism community: would those who have a current PDD diagnosis no longer meet criteria and therefore become ineligible for services they currently receive. Those with current diagnoses have also been reassured that they will automatically be able to maintain an ASD diagnosis; the revised criteria will be applied primarily to newly diagnosis individuals with ASD.

Nevertheless, advocacy groups are cautious about the changes, waiting to see results from prospective studies. There is uncertainty about how the criteria will work with very young children and/or adults. There are also some reservations from those who identify with the Asperger's community (or possibly other PDDs) about relinquishing that separate identity. Overall, while the changes seem to be scientifically sound, their actual human impact remains to be seen.

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