by Becky L. Spivey, M.Ed.
If you have a child with autism in your home or classroom, you have
likely heard of the DSM — Diagnostic and Statistical Manual, published
by the American Psychiatric Association. The DSM is the primary manual
used by clinicians to provide a formal diagnosis of autism and related
disorders. This manual outlines specific criteria that must be met to
receive a diagnosis of autism and provides standard guidelines for
clinicians to use for the diagnosis of other psychological disorders and
conditions. As of 2013, there have been some very important changes in
the new Diagnostic and Statistical Manual – Fifth Edition* (DSM-V) for
the diagnosis of autism spectrum disorder (ASD).
One of the most significant changes is that
the separate diagnostic labels of Autistic Disorder,
Asperger’s Disorder, and PDD-NOS (pervasive developmental disorder - not otherwise specified)
have been replaced by ONE umbrella term – “Autism Spectrum Disorder.” The revised diagnosis
represents a new, more accurate, medical and scientific way of diagnosing individuals with
autism-related disorders. Further distinctions for ASD will now be made according to severity
levels, based on the amount of support needed due to one’s challenges. The DSM-V revision
website says the reasons for using the umbrella term of “Autism Spectrum Disorder” are:
- The old way isn’t precise enough because different clinicians diagnose the same person with different disorders, and some change their diagnosis of the same symptoms from year to year.
- Autism encompasses by a common set of behaviors and should be characterized by a single name according to severity. The Neurodevelopmental Work Group at the National Institute of Mental Health believes a single umbrella disorder will improve the diagnosis of ASD without limiting the sensitivity of the criteria, or substantially changing the number of children being diagnosed.
The removal of the formal diagnoses of Asperger’s Disorder and PDD-NOS is a MAJOR change.
People currently holding these diagnoses will likely receive a different diagnosis when reevaluated.
Using the old DSM-IV, patients could have a diagnosis of four separate disorders:
autistic disorder, Asperger’s disorder, childhood disintegrative disorder, or the catch-all diagnosis
of PDD-NOS. Researchers found that these separate diagnoses were not consistently applied
across different clinics and treatment centers. Anyone diagnosed with one of the four pervasive
developmental disorders (PDD) from DSM-V should still meet the criteria for ASD with a more
accurate DSM diagnosis.
New revisions to other specific criteria needed for a diagnosis of Autism Spectrum Disorder
are more thorough and strict compared to the old criteria.
For example, the individual must now present more symptoms to meet criteria within the area of fixated interests and repetitive
behaviors. Previously, the domains for Autistic Disorder included impairments in Communication
and Social Interaction, and Restricted Interests and Repetitive Behaviors. In the DSM-V, the
Communication and Social Interaction domains are now combined into one, titled “Social/
Communication Deficits.” Additionally, the requirement of a delay in language development is
no longer necessary for a diagnosis.
These revisions (based on research, analysis, and expert opinion) have been made in hopes that
the diagnosis of autism spectrum disorders will be more specific, reliable, and valid. Despite
these positive hopes, there are legitimate concerns regarding how these changes might impact
people on the spectrum. One of the biggest concerns is that some who are higher functioning
will no longer meet the more strict diagnostic criteria and will therefore have difficulties
accessing relevant services. There are many questions as to what will happen to people currently
diagnosed with Asperger’s Disorder or PDD-NOS. Furthermore, there is uncertainty regarding
how state and educational services and insurance companies will adopt these changes.
Also, under the new DSM-V criteria, individuals with ASD must show symptoms from early
childhood, even if the symptoms are not recognized until later. This criteria change encourages
earlier diagnosis of ASD but allows people to receive the diagnosis even if their symptoms may
not be fully recognized until social demands exceed their capacity. It is an important change from
DSM-IV criteria, which supported identifying school-aged children with autism-related disorders,
but was not as useful in diagnosing younger children.
These changes are sure to have an impact on families and people currently diagnosed with an
autism spectrum disorder. It remains to be seen how diagnosticians and clinicians will use the
new criteria in evaluating children and the impact it will have on the availability of services.
Therefore, it is important to remain informed and up to date. To follow and learn more about
the proposed changes, see the DSM-V
revision website http://www.dsm5.org/Pages/Default.aspx.
*DSM-5 is the manual used by clinicians and researchers to diagnose and classify mental
disorders. The American Psychiatric Association (APA) published DSM-V in 2013, culminating a
14-year revision process.