In a previous post, I explained that Asperger's syndrome (AS) may be combined under an umbrella diagnosis of autism spectrum disorder in the new version of the Diagnostic and Statistical Manual, due out in 2013. According to the proponents of the proposed changes, one of the major differences between autism and AS is the lack of language delay in persons with AS. Many of the other symptoms, including social difficulties, are seen in both AS and autism. Proponents believe it will be easier for those diagnosed with AS to receive services through medical organizations and schools if diagnosed with autism instead of AS. But a recent study suggests that many people now diagnosed with AS would be excluded from the proposed definition of autism spectrum disorders.
The proposed changes are expected to narrow the definition of autism spectrum disorders, making it harder for people to meet the diagnostic criteria, thus sharply reducing the rising number of people being diagnosed with autism. The new definition states that someone needs to have deficits in three areas of social interaction and communication and at least two repetitive behaviors.
Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and his colleagues conducted a study and found that 65 percent of child and adults with high functioning forms of autism would no longer meet the criteria based on the proposed changes. But other experts believe that the changes can help children who are not currently receiving services become eligible, for example, some states provide services to those with autism but not those with AS. Under a blanket diagnosis, all those diagnosed under the new criteria would be eligible for services.
The proposed changes do include the addition of "Social Communication Disorder" which is, according to the American Psychiatric Association, "an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability....." Diagnosis of Social Communication Disoder would be based on "functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination."
The proposed changes are still being discussed, although according to an article in the New York Times, revisions are about 90 percent complete and will be finalized by December 2012. The new definition of autism is meant to clarify the diagnostic criteria and to use only one name, rather than having separate diagnoses for autism, Asperger's syndrome and pervasive developmental disorder (PDD) but it remains to be seen whether the change will create more confusion.
"Autism Spectrum Disorder," Proposed Revisions, American Psychiatric Association