DSM-5 and Its Impact on Autism Spectrum Disorder

DSM-5 small

This article was contributed by Dr. Aleck Myers, the Clinical Director at the Autism Society of North Carolina.

The American Psychiatric Association released its long-awaited DSM-5 on May 22, 2013. There has been considerable discussion over the new definition of Autism Spectrum Disorder (ASD) and how it might affect diagnosis and services for people and their families. The Autism Society of North Carolina offered a side-by-side summary comparison of the previous (DSM-IV) definition with the new DSM-5 definition in its summer 2013 edition of the Spectrum.The following is a brief summary of the DSM-5 criteria, requirements and level of severity for ASD:

Diagnosis now requires meeting criteria across four categories:

A. Persistent deficits in social communication and social interaction across contexts, meeting all of the following:

  • Social-emotional reciprocity (e.g., conversation, joint attention)
  • Nonverbal communicative behaviors (e.g., eye contact, body language, facial expressions, gestures)
  • Developing and maintaining relationships (e.g., imaginative play, making friends)

B.  Restricted, repetitive patterns of behavior, interests, and activities meeting at least two of the following:

  • Stereotyped/repetitive speech, motor movements, or use of objects
  • Excessive adherence to routines/rituals or excessive resistance to change
  • Highly restricted fixated interests, abnormal in intensity or focus
  • Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment

C.  Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D.  Symptoms together limit and impair everyday functioning

Also, three levels of severity:

  • Requiring support (Mild)
  • Requiring substantial support (Moderate)
  • Requiring very substantial support (High)

Perhaps in response to concerns raised to an earlier draft of the DSM-5 diagnostic criteria, there is an additional notation in the criteria, specifying that “individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the new diagnosis of autism spectrum disorder.”

A new diagnostic category (not under ASD) was also added to the DSM-5: Social Communication Disorder.

How does this affect those with ASD?

The big questions in all of our minds were “So, how does this affect services for people with ASD? Will people be underdiagnosed? Will services be lost? Will it be more functional and aid diagnosis, or will it have a detrimental effect?

The data seem to be coming in gradually on this. So far, verbal reports – I’ve been pestering clinicians whenever I run into them! – and early data are promising. A study reported by Tamara Dawkins, Allison T. Meyer, and Mary E. Van Bourgondien with Division TEACCH at the University of North Carolina suggested that the majority of people (children and adults) with Pervasive Developmental Disorder (PDD) are not likely to be affected by the changes in DSM-5.

Perhaps as importantly, I have yet to hear any horror stories about people losing services. More information must be gathered before we all relax though. In particular, it will be interesting to learn what is happening to people who in the past would have received an Asperger’s Syndrome diagnosis. Will they continue to find services? It was a wise move to “grandfather in” those people who carried that diagnosis under the DSM-IV, but what is happening to other people now with the same characteristics? We need to keep a close watch. I’m optimistic, but cautious.

Aleck Myers, Ph.D., LP, HSP, can be reached at amyers@autismsociety-nc.org.

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