It’s time to welcome yet another DSM! The Diagnostic and Statistical Manual of Mental Disorders has recently published the fifth edition of its standardized criteria for the classification of mental disorders. The DSM-V and all of its changes have been in
effect since May 2013, so today I will review the new criteria for autism.
PDD to ASD
Previously referred to as PDD (Pervasive developmental
disorders), the name of the disorder is now ASD or Autism spectrum
disorders.
5 disorders to 1
disorder
In the previous DSM, the five disorders that fell under PDD
were Autistic Disorder, Asperger’s Syndrome, PDD-NOS, Rett Syndrome and Child
Disintegrative Disorder. Now, Autistic
Disorder (autism), Asperger’s Syndrome, and PDD-NOS all fall under ASD and are
no longer separate diagnoses. CDD has
been taken out and Rett Syndrome is now a specifier (more detail later).
3 autism dimensions
to 2 autism dimensions
The DSM-IV-TR required individuals to express difficulty in
the three dimensions of social skills, communication, and restricted and
repetitive behaviors. The DSM-V combines
social interaction and social communication into one dimension and maintains
restricted and repetitive behaviors as one dimension for a total of two
dimensions.
ASD criteria
For the first dimension (social communication and social
interaction), the individual must exhibit all three symptoms, but these
symptoms can range from mild to severe. The former DSM required that an individual
exhibit at least six symptoms across three dimensions.
For the second dimension (restricted and repetitive patterns
of behavior), the individual must exhibit at least two of the four symptoms,
again ranging from mild to severe.
Important to note: One of the symptoms under this dimension highlights
increased or decreased reactivity to sensory input or unusual interests in
sensory aspects of the environment.
There was no mention of sensory input before and most professionals who
work with individuals with autism can attest that this is an important factor
to consider.
Symptom onset
The DSM-IV-TR required that symptom onset occur prior to the
age of three. The DSM-V does not specify
age of onset, only indicating that symptoms present in the early developmental
period. However, these symptoms might
not occur until social demands are placed on the individual and those demands
exceed the individual’s capacity.
Specifiers and
modifiers
Previously, Rett Syndrome was included under PDD. Now, if a child meets ASD criteria, that
child will receive an ASD diagnosis with etiology (the cause) as the
specifier. So, ASD with Rett Syndrome or
ASD with Fragile X syndrome (both genetic disorders). This change allows individuals with other
genetic disorders to receive the ASD diagnosis and receive services whereas
before, individuals with only genetic disorders would not be considered for the
diagnosis.
Other important factors contributing to the individual's difficulties can be labeled with the ASD diagnosis
as modifiers. For example, an individual
who experiences seizures in addition to meeting the ASD criteria will receive a
diagnosis of ASD with seizures. ASD with
intellectual disabilities is another option.
The DSM-V also allows diagnosticians to specify the
perceived age of onset and pattern of onset, which gives more information as to
the individual’s early history. ASD with
onset before 20 months with loss of words specifies the time of perceived onset
as well as a description of the behavior pattern.
Level of severity
The DSM-V allows for the differentiation of severity levels
for ASD along the two dimensions of social interaction and social communication
and restricted and repetitive patterns of behavior. Level 1 denotes that the individual requires
support, level 2 that the individual requires substantial support, and level 3
that the individual requires very substantial support.
New rule out disorder
If an individual experiences marked deficits in social
communication, but does not otherwise meet the criteria for ASD, this
individual should be evaluated for Social Communication Disorder. Social Communication Disorder is a new
disorder and is a rule out disorder for ASD.
In order to be diagnosed with social communication disorder, the
individual cannot also meet criteria for ASD.
Dual diagnoses
Individuals can now be diagnosed with both ASD and
ADHD. ASD was considered the more
pervasive disorder prior to the DSM-V.
It is important to remember that ASD is now a true spectrum,
as individuals can exhibit behaviors that range from mild to severe across the
two dimensions. The DSM-V has moved
autism criteria from categorical to dimensional. Each child diagnosed with ASD will present
differently and it is important to consider each child’s strengths and
weaknesses. It will be interesting to
see how the DSM-V ASD criteria is received in the community and hopefully,
individuals will be properly diagnosed and receive the services they need.
I found much of this information from The Center for Autism and
Related Disorders’ segment on the DSM-V and the Autism Speaks webpage on DSM-V
criteria. Check them out for more
information!
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