No More Asperger's Syndrome: Changes to DSM Diagnoses
In May of 2013 the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be coming out with many surprises for the wide spectrum of people who suffer from mental disorders and related conditions. Depending upon your particular point of view, these changes to the manual may be considered commonsensical or else downright puzzling.
The proposed draft revisions to the DSM disorders and criteria may be found on the American Psychiatric Association DSM-5 Development web site.
There you may not only view the proposed changes but you can also add your comments until April 20, 2010.
Since ADHD has so many co-morbid and sometimes overlapping conditions, it is wise to understand the potential changes in store for the way these conditions and disorders may now be diagnosed. To see a list of some of these related conditions please read my article, "ADHD and Multiple Diagnoses" or Eileen Bailey's "Co-Existing Conditions" for more information.
Here are some of the suggested changes for related, co-morbid, or co-existing conditions of ADHD in the DSM-5:
- The huge change in the classification of autism spectrum disorders is the elimination of both Asperger's Syndrome as well as Pervasive Developmental Disorder Not Otherwise Specified as diagnostic labels. Both will be subsumed under the broad category of Autism Spectrum Disorder.
- "Learning Disabilities" will be added as a new diagnostic label. The DSM-IV formerly used the term "Learning Disorder (formerly Academic Skills Disorders)" to describe what we call commonly call Learning Disabilities.
- For those children who do not meet the criteria for adults for Bipolar Disorder a new category, called "temper dysregulation disorder with dysphoria," will be created in order to accommodate children who are aggressive and irritable.
- There are some mental health advocacy groups who wish to include other mental conditions to the diagnostic manual including Sensory Processing Disorder and Seasonal Affective Disorder.
- The big change in diagnostic labels for substance related disorders will be replacing the words "abuse" and "dependence" with "use disorder." For example, "Alcohol Dependence" has been changed to "Alcohol-Use Disorder."
These are but some of the many potential revisions to the Diagnostic and Statistical Manual of Mental Disorders. There will also reportedly be a change in philosophy as to how co-existing conditions and disorders may be labeled and treated.
In a November 2009 New York Times article entitled, "A Powerful Identity, A Vanishing Diagnosis" author Claudia Wallis discusses how conditions such as autism spectrum disorders will be defined by the severity of symptoms. In addition, related issues, conditions, and challenges may be specified. Wallis explains:
"... a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism. Thus, they might go untreated, or the treatment would not be covered by insurance.
The new edition, by contrast, will list not only the core issues that characterize a given diagnosis but also an array of other health problems that commonly accompany the disorder. For autism, this would most likely include anxiety, attention disorders, gastrointestinal problems, seizures, and sensory differences like extreme sensitivity to noise."
This may be good news to some individuals such as my son who not only has autism but extreme symptoms of ADHD, and all those related conditions listed above. The question in my mind is will the new diagnostic criteria for some of these disorders and conditions provoke change for the better or worse as far as things such as insurance coverage for treatment? Will these revisions clarify some diagnostic criteria so we are neither over diagnosing nor under diagnosing individuals? Will the changes in wording promote better acceptance of these disorders in the general community?
Time will be the measure of the success for these potential changes.
What are your thoughts on the proposed revisions to the DSM? Do you feel they will hurt or help? Express yourself here. We want to hear what you have to say!
Wallis C (2009) A Powerful Identity, a Vanishing Diagnosis. New York Times, November 2, 2009