Understanding the DSM-5
What is the DSM?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard reference for the classification of mental disorders. The DSM lists the symptoms of ASD and states how many of these symptoms must be present to confirm a diagnosis of ASD.
What are the changes?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), introduces significant changes to current diagnostic definitions of autism and related conditions:
- Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorders will be replaced by one central diagnosis of 'Autism Spectrum Disorder' (ASD)
- there will be an assessment of symptom severity on a 3-point scale ranging from 'requiring support' to 'requiring very substantial support'
- 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 be replaced by 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'.
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. More recent studies suggest that this figure could actually be between 5 and 10%.
Our 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.
Please note: People diagnosed under the old system, DSM IV, will retain their diagnosis. There is no need to be reassessed or have the previous diagnosis validated.