If you know what DSM means, then you’re a lot more informed than I was when I first stepped into the world of autism. The debate about the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) may be a little more than you can digest right now, but the change will affect diagnosis after May 2013, when the DSM-V will be published. These changes will likely affect both services and decisions regarding your child in the next few years.
Quick primer on the DSM
- It is the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. The fifth edition will be published in May 2013, after a 14-year revision.
- It is used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders.
- It establishes the criteria for an autism diagnosis. A diagnosis is necessary to receive social services, medical services, and insurance payments. Education services also consider the DSM.
The DSM-IV currently identifies a set of Pervasive Developmental Disorders that are considered “autism spectrum disorders.” These include Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).
The proposed changes to the DSM will collect all of these disorders into one umbrella term called “Autism Spectrum Disorder” (ASD). Distinctions will be made according to severity levels, based on the amount of support needed due to challenges with social communication and restricted interests and repetitive behaviors.
This change signals how ASD represents a continuum from mild to severe, rather than being a set of distinct disorders. It is hoped that clinicians will more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of assigning labels that are inconsistently applied.
Currently, Autistic Disorder includes impairments in Communication, Social Interaction, and Restricted Interests and Repetitive Behaviors. The Communication and Social Interaction domains will be combined into one called “Social/Communication Deficits.” This change will hopefully make diagnoses more clear and distinct when applied across the autism spectrum.
Much of the controversy revolves around the elimination of the labels of Asperger’s Disorder and PDD-NOS. If your child currently has a label of Asperger’s Disorder (Syndrome) or PDD-NOS, expect to hear different language when discussing their diagnosis. Because there are changes in the strictness of some criteria, clinicians may reconsider diagnoses. Studies support these changes. A recent analysis of the DSM-IV and DSM-V by Catherine Lord showed that 91% retained the ASD diagnosis, while 9% lacked sufficient social impairment for a diagnosis under the DSM-V.
The changes in the DSM reflect research, analysis, and expert opinion. The people involved in the revision process hope that the changes are more accurate and reliable, ensuring consistency. What happens due to these changes remains to be seen. The implications will unfold over the months ahead and will have a ripple effect on social service eligibility, education services and insurance. As always you can support your child best by understanding how their diagnosis leads to services they need to build a successful future.