Redefining Autism: A Health Central Explainer

APage Editor April 26, 2012
  • autism dsm changes infographic

    (click to enlarge)


    As the media and mental health researchers grapple with the rapidly increasing rate of autism diagnoses, more theories have been advanced linking that increase with environmental factors.  As of yet, however, there has been no scientifically plausible support for these suggestions.  On the other hand, studies have been published that indicate autism rates have risen at least in part due to non-causative factors such as increased awareness of the condition, broadened diagnostic criteria, and sociological factors.  In response, the Diagnostic and Statistical Manual of Mental Disorders, which is used to determine the course of treatment--not to mention insurance coverage and available services for mental illnesses—has re-evaluated the definition of autism.  The re-evaluation has resulted in changes to the DSM-4 that will first go into effect with the DSM-5 that will be released next year. 

     

    The new diagnostic criteria reduced the number of qualifying symptoms from 6 out of 12 in three groups (those being social interaction, communication, and repetitive & restricted behaviors and interests), to 3 out of 7 symptoms from two groups (social communication and social interaction).

     

    In addition to these changes, Asperger’s and Pervasive Development Disorder Not Otherwise Specified (PDDNOS) will no longer be included under the classification of Autism Spectrum Disorder (ASD).   Recent clinical experience and research has also discovered that heightened or dulled sensitivity to sensory experiences is a key feature of autism that will be included for the first time in the DSM-5.

     

    What’s the problem?

     

    While the psychiatric community is generally pleased with these adjustments, there is wide spread concern about what this will mean for those currently diagnosed with autism, Asperger’s and PDDNOS, since insurance coverage and access to treatments are dependent on their diagnosis.  The DSM is faced with determining how much of the criteria a patient must meet to warrant an autism diagnosis.  If the bar is set too high, those autistic people with mild symptoms are excluded; set too low it may support an autism diagnosis for people who don’t have it.  For a closer look at the changes please visit the DSM-5 page

     

    A new study released in this month’s Journal of the American Academy of Child & Adolescent Psychiatry, conducted by Yale Child Study Center evaluated the potential impact of the proposed changes.

     

    How did they do the study?

     

    The study analyzed the symptoms of 933 participants and evaluated them for autism with the DSM-4; 657 participants showed a clinical diagnosis of ASD, and 276 weren’t diagnosed with ASD.  Participants where then evaluated using field trial symptom checklists that included individual checklist items (nonverbal communication), group checklist items as established by an individual DSM-5 symptom (nonverbal and verbal communication), DSM-5 symptom criterion (social-communicative impairment), and overall diagnostic criteria. 

  •  

    What did they find?

     

    The study concluded that the proposed DSM-5 diagnostics criteria could significantly alter the composition of the autism spectrum.  When applying the DSM-5 criteria, 60 percent of ASD cases met the revised diagnostics.  Overall specificity was high with 94 percent of participants accurately excluded from the spectrum.  About 25 percent of those diagnosed with autism and 75 percent of those with Asperger’s Syndrome or PDDNOS would not meet the new diagnostic criteria.  The study also found that higher-functioning individuals might be less likely to meet the diagnosis than individuals with more significant cognitive disabilities.    

     

    So what’s the significance?

     

    The new, more exclusive DSM-5 diagnostics pose serious ramifications regarding treatment eligibility and medical assistance.  The impact of the new criteria still needs to be examined in a clinical and research setting, but the immediate needs of those on the spectrum may not be met as result of a narrowed diagnosis. 

     

    Those who have already been diagnosed on the autism spectrum will not suddenly lose their diagnosis or covered services, but future diagnosis will be very different.   While the new criteria makes ASD diagnosis more accurate, there still needs to be some sort of recognition and assistance for those on the high-functioning end of the spectrum that will likely be excluded from the DSM-5 definition. 

     

    Citations:


    American Psychiatric Association. (2011, January 26). American psychiatric association dsm-5 development. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

     

    Sensitivity and Specificity of Proposed DSM-5 Diagnositc Criteria for Autism Spectrum Disorder. (2012, March 16). Journal of American Academy of Child & Adolescent Psychiatry. Retrieved from

    http://www.jaacap.com/article/S0890-8567(12)00042-1/abstract