Monday, December 3, 2012

American Psychiatric Association Approves DSM-5 ASD Category


The American Psychiatric Association’s recommendation to delete (remove) Asperger’s disorder as a separate diagnostic category from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was approved on December 1st by the by the Association's Board of Trustees.  Specifically, DSM-5 will include a new category of “autism spectrum disorder,” which subsumes the current diagnoses of autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). This new category reflects DSM-V Work Group members’ conclusion that “a single spectrum disorder” better describes our current understanding of the neurodevelopmental disorders. 

The objective of the new ASD criteria is that every individual who has significant “impairment” in social-communication and restricted and repetitive behavior or interests (RRBI) meet the diagnostic criteria for autism spectrum disorder. Language impairment/delay will no longer be a necessary criterion for diagnosis of ASD. Therefore anyone who demonstrates severe and sustained impairments in social skills and restricted, repetitive patterns of behavior, interests, or activities in the presence of generally age-appropriate language acquisition and cognitive functioning, who might previously have been given a diagnosis of Asperger’s disorder, would now meet the criteria for the new category of ASD. The criteria also feature dimensions of severity that include current levels of language and intellectual functioning. Additionally, symptom examples are expected to be provided for all ages and language levels, so that ASD will not be overlooked in persons of average or superior IQ who are experiencing “clinical” levels of difficulty. Full details of all the revisions will be available in May 2013 when the American Psychiatric Association's new diagnostic manual is published. 

Critics of the new category of ASD expressed concern that individuals would lose their current diagnoses and no longer be eligible for special services. But the revision will not affect their education services, experts say. The term "autism spectrum disorder (ASD)," is used by many experts and practitioners in the field. The new category will include the complete autism spectrum, from mild to the more severe forms of the disorder. Catherine Lord, an autism expert at Weill Cornell Medical College in New York and member of psychiatric group's autism task force, commented that anyone who met criteria for Asperger's Disorder (syndrome) in the current manual (DSM-IV-TR) would be included in the new diagnosis. Lord also comments that although there has been much controversy about whether there should be separate diagnoses, "Most of the research has suggested that Asperger syndrome really isn't different from other autism spectrum disorders." "The take-home message is that there really should be just a general category of autism spectrum disorder, and then clinicians should be able to describe a child's severity on these separate dimensions." Another reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said. Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she commented that it will be critical to monitor so that children don't lose services. While including Asperger’s Disorder under the new category of “autism spectrum disorder” may well require a period of transition and adjustment, the proposed “dimensional” approach to diagnosis will likely result in more effective identification, treatment, and research for individuals on the spectrum.

A more detailed summary and discussion of the proposed revisions to DSM disorders and criteria are available at <http://www.dsm5.org> 

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: Author.

American Psychiatric Association (2011). DSM-5 development. A 09 Autism Spectrum Disorder.
Lord, C. et al. (2011). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry. doi:10.1001/archgenpsychiatry.2011.148
Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for Asperger syndrome and autism in schools. London: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

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