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A Focus On: Autism, Redefined
Untitled, © 2002 by Andrew Stamm. Taken from Autism Spectrum Disorders. Publisher: Oxford University Press. 10.1093/med/9780195371826.001.0001 © Oxford University Press 2011.
The American Psychiatric Association (APA) publishes the Diagnostic and Statistical Manual of Mental Disorders (known as DSM), which is the “standard classification of mental disorders used by mental health professionals in the United States.” Changes to the 5th edition of the manual, known as DSM-5 have very recently been published. Among the most controversial of the changes to the DSM-5 are those regarding the definition of autism (currently falling under the diagnostic category of Pervasive Developmental Disorders - PDD), which will soon be referred to as Autism Spectrum Disorder (ASD).
Autism is a developmental neurobiological disorder, characterized by severe and pervasive impairments in social interaction and communication skills (verbal and nonverbal), and by restricted, repetitive patterns of behavior, interests, or activities.
Under DSM-5, the separate diagnostic subcategories under PDD in DSM-IV will now be subsumed under one category - Autism Spectrum Disorder (ASD). This puts autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder all under ASD. The new ASD diagnostic category includes specifiers for severity and verbal abilities, and will also include associated features such as known genetic disorders, epilepsy and intellectual disability. Severity levels are based on the amount of support needed by an individual with ASD; e.g., an ASD patient could be considered “level 1,” “level 2,” or “level 3.”
The new ASD diagnostic category combines the current three domains of autism symptoms (social impairment, communication impairment, and repetitive/restricted behaviors) into two domains (social interaction and communication deficits, and restricted interests/repetitive behaviors).
Many parents and professionals are questioning the new DSM-5 revised diagnosis of autism. One concern raised is whether individuals currently diagnosed with Asperger’s disorder and PDD-NOS may not meet the new criteria. The DSM-5 committee has stated that individuals who currently have a diagnosis on the autism spectrum will retain their ASD diagnosis. A second concern raised is whether there would be risk of change in school placement or funding for treatment, if a child with autism does not meet the new criteria. A third concern is whether there would be a loss of “identity” for individuals diagnosed with Asperger’s disorder who will fit into the broader ASD category.
The DSM-5 committee has defended the new categorization as an improvement in accuracy and reliability of diagnosis of ASD. The APA notes that the new version is more precise, and that autism is defined by a common set of behaviors, therefore should be classified based on severity. Furthermore, the new criteria are considered to be more thorough.
Martin J. Lubetsky, M.D, Professor of Psychiatry, University of Pittsburgh School of Medicine, USA
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