The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, called the DSM-V, includes some significant changes to diagnostic criteria for autism, grouping several previously separate disorders under one umbrella. If you or your child are on the autism spectrum or you're in the process of being diagnosed, it's important to understand these changes in the DSM-V, the reasons for the new definition, and how the changes may affect you.
New Diagnostic Criteria for Autism Spectrum Disorder
When a doctor or psychologist diagnoses someone with autism, he or she compares the individual's behavior with the criteria laid out in the DSM. If the behavior fits the description listed in the text, then the individual may be diagnosed with an autism spectrum disorder.
The new revision of the DSM included a different definition of ASD. To be diagnosed with ASD, and individual must have displayed symptoms starting in early childhood, and those symptoms must impair the individual's ability to function in day-to-day life.
Social and Communication Deficits
In order to receive a diagnosis of Autism Spectrum Disorder, a person must have all three of the following deficits:
- Problems reciprocating social or emotional interaction - This can include difficulty establishing or maintaining back-and-forth conversations and interactions, inability to initiate an interaction, and problems with shared attention or sharing of emotions and interests with others.
- Severe problems maintaining relationships - This can involve a complete lack of interest in other people, difficulties playing pretend and engaging in age-appropriate social activities, and problems adjusting to different social expectations.
- Non-verbal communication problems - This can include abnormal eye contact, posture, facial expressions, tone of voice, and gestures, as well as an inability to understand these non-verbal signals from other people.
Repetitive and Restrictive Behaviors
In addition, the individual must display at least two of these behaviors:
- Extreme attachment to routines and patterns and resistance to changes in routines
- Repetitive speech or movements
- Intense and restrictive interests
- Difficulty integrating sensory information or strong seeking or avoiding behavior of sensory stimuli
DSM-V Changes for Autism Spectrum Disorders
The latest revision of the DSM will be released in May of 2013, but many practitioners are already working off of the proposed revisions. There are some significant changes to the definition of autism.
One, Rather Than Five Disorders
Previously, there were five autism spectrum disorders, each of which had a unique diagnosis: Autistic Disorder or classic autism, Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS), Rett's Syndrome, Childhood Disintegrative Disorder
In the latest revision of the DSM, these disorders will not exist as separate diagnoses on the autism spectrum. Instead, with the exception of Rett's Syndrome, they will be subsumed into the diagnosis of "Autism Spectrum Disorder." Rett's Syndrome will become its own entity and will no longer be part of the autism spectrum.
According to The American Psychological Association, the standards for diagnosing autism spectrum disorders have changed for several reasons:
- While it's possible to clearly distinguish the difference between people with ASDs and those with neurotypical functioning, it's more difficult to diagnose the sub-disorders validly and consistently.
- Since all people with autism spectrum disorders display some of the typical behaviors, it's better to refine the diagnosis by severity than to have a completely separate label.
- A single diagnosis of ASD better reflects the current research about the presentation and pathology of autism.
Changes to Core Diagnostic Criteria
The previous version of the DSM had three core criteria for diagnosis:
- Language challenges
- Social deficits
- Stereotyped or repetitive behaviors
The new DSM will have only two core areas: communication and social deficits and fixed or repetitive behaviors
The DSM-V Development Team explains that it is difficult to separate communication deficits and social deficits, since these two areas overlap significantly. Communication is often used for social purposes, and communication deficits can dramatically affect social performance.
Language Delays Not Part of Diagnosis
Previously, a language delay was a significant factor in diagnosis classic autism. In addition, individuals with Asperger's Disorder could not have a language delay in order to receive that diagnosis.
The new version of the DSM will not include language delay as a criterion for diagnosis. Because language delays could occur for many reasons and weren't consistent across the autism spectrum, the DSM-V Development Team felt that they should not be required for diagnosis.
How These Changes May Affect You
According to Autism Speaks, there are a few ways these revisions could affect you:
- The American Psychiatric Association has not yet stated that those who already have an ASD diagnosis will be able to keep this diagnosis. This means that some individuals may need to be reassessed to see if they meet the new criteria.
- Those with Asperger's Syndrome, which will no longer be a diagnosis, may wish to continue using this label to describe themselves. The Asperger's community is well-established, and changing the name may be inconvenient and bothersome. It is unclear whether this label will continue to be used informally.
- The strict requirements for the core symptoms of ASD may result in fewer people being diagnosed. This may especially affect the diagnosis of young children, who may not yet display all the signs of autism.
If you have concerns about whether you or your child may lose your diagnosis, contact your healthcare provider for more information. Only your doctor knows the specific symptoms that affect you or your child.
Truly a Spectrum
Although the definition of autism is changing, the core characteristics of the disorder remain the same. Since people with all levels of autism display many of the same characteristics but vary in the degree to which they display them, the new DSM-V criteria may better reflect that autism is a spectrum, rather than a group of separate disorders.