Significant changes were made to the Autism Spectrum Disorder (ASD) diagnosis in May of 2013. This blog post will provide an overview on the changes made from the DSM-IV criteria to the new DSM-V criteria.
What is the DSM?
In the United States, the DSM (Diagnostic and Statistical Manual of Mental Disorders) serves as the manual for psychiatric diagnosis. Treatment recommendations, as well as payment by health care providers, are determined by the DSM classifications.
Revisions to the autism criteria in the DSM-IV were made on May 18th, 2013. All changes under the DSM-V criteria became effective on January 1st, 2014.
Comparing the changes from DSM-IV to DSM-V:
The old DSM-IV categorized individuals with autism into 3 subtypes: Autistic Disorder, Pervasive Developmental Disorder Not Otherwise specified (PDD-NOS), and Asperger’s Disorder.
The new DSM-V combined the different subtypes of autism into 1 diagnosis of Autism Spectrum Disorder (ASD). In addition, a new diagnosis, Social Communication Disorder (SCD), was created for those individuals who have social and communication difficulties but do not present any repetitive behaviors or restrictive interests that are typical of the autism diagnosis. This new diagnosis caused a lot of controversy between professionals and families since individuals diagnosed with SCD would have fallen under the PDD diagnoses in the DSM-IV.
Controversies due to the new DSM-V criteria:
Presently, the Center for Disease Control and Prevention (CDC) reports that 1 in 88 children (1 in 54 boys and 1 in 252 girls) receive an autism diagnosis. When this prevalence was announced in 2013, professionals and families of children diagnosed with autism were concerned as to whether the increase was due to an actual increase in prevalence or due to an actual broadening of the diagnosis criteria and awareness of the spectrum.
Autism Speaks conducted a research comparing autism prevalence using the DSM-IV criteria as well as the DSM-V criteria for Autism Spectrum Disorders (ASD). They also re-evaluated those children diagnosed with ASD with the newly created diagnosis of Social Communication Disorder (SCD). Results of this study found that the estimated autism prevalence would decrease given that some children would receive the new diagnosis of SCD. Specifically, 83% of children who received an ASD diagnosis under the DSM-IV would still receive the same diagnosis under DSM-V, but the remaining 14% would be diagnosed with SCD.
Changes with the new SCD diagnosis:
Looking at the changes in criteria, Yale child psychiatrist and epidemiologist Young-Shin Kim and her colleagues found the following:
*Of children previously diagnosed with PDD-NOS, 71% would now be diagnosed with ASD, 22% with SCD and 7% with another non-autism disorder.
* Of those previously diagnosed with Asperger disorder, 91% would now be diagnosed with ASD, 6% with SCD and 3% with another non-autism disorder.
* Of those previously diagnosed with autistic disorder, 99% would now be diagnosed with ASD and 1% with SCD.
And although the study concluded that the DSM-V would lower the autism prevalence by approximately 10%, these results have to be evaluated with caution given that they applied the new criteria to old medical records of children identified as having autism back in 2008, but they didn’t assess for the new diagnosis, SCD. In addition, these results sparked widespread concern among autism advocates because there are no present treatment guidelines for SCD, with some parents claiming that they had lost autism services due to the change in diagnosis from ASD to SCD.
As Dr. Kim suggests, “Until proven otherwise, the treatments for ASD and SCD should remain the same or similar. It’s important for children moving to a SCD diagnosis (and to their families) that they continue receiving the interventions they would have received with an autism diagnosis under the earlier DSM-IV criteria. Our research team also wants to thank Autism Speaks and its donors for supporting this important work,” she adds.