DSM Changes

Understanding the DSM-5

What are the changes?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to be published in 2013, will introduce significant changes to current diagnostic definitions of autism and related conditions. In particular, the different subtypes defined by the DSM-IV (Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorders) will no longer be used. All of these will be subsumed under one central diagnosis: 'Autism Spectrum Disorder' (ASD). In addition, there will be an assessment of symptom severity (on a 3-point scale ranging from 'requiring support' to 'requiring very substantial support').

The other significant change will be that the current set of diagnostic criteria (impaired social reciprocity, impaired language/communication, and restricted and repetitive pattern of interests/activities) will be replaced by just two: 'social/communication deficits' and 'fixated interests and repetitive behaviours'. Unusual sensitivity to sensory stimuli, not part of the old system, will now be included under 'fixated interests and repetitive behaviours'.

Language impairment/delay will no longer be a relevant feature for the diagnosis of ASD. Instead, there will be a new diagnostic label, 'Social Communication Disorder (SCD)', which includes criteria such as 'impairment of pragmatics' and impairment in the 'social uses of verbal and nonverbal communication'. This means that some children, who would currently receive a diagnosis of ASD may under DSM-5 receive a diagnosis of SCD.

For this and other reasons, the proposed changes to the DSM have caused controversy and widespread concern, with some researchers reporting that up to 45% of children with an ASD would not be captured using the new criteria. For example, Volkmar argued that the proposed changes would probably exclude many people who would currently be diagnosed with high-functioning autism. However, more recent studies lead to the conclusion that this figure could actually be between 5 and 10%.

OTARC's response to the changes

OTARC has published a position paper in which we argue that the changes to the DSM are generally positive as they result from advances in our understanding of ASD. For example the elimination of the different subtypes reflects the result of studies conducted by OTARC researchers and many other researchers indicating that the different subtypes are more similar than different. The elimination of the subtypes is also likely to simplify the diagnostic process.

However, we do share the concern about clinical implications of the changes: With the narrowing of the diagnostic criteria for ASD, a few children may no longer be diagnosed with an ASD and may therefore not be eligible for services. Furthermore, children categorised under the new label of Social Communication Disorder, for which no treatment guidelines or service eligibility policies are provided, may also miss out on services.

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If you would like information on this page made available in an alternative format, please contact Dr Elfriede Ihsen at e.ihsen@latrobe.edu.au.