Whereas DSM-IV included three sets of symptoms for autism, in the draft version of DSM-5, social and communication problems have been melded to form “social/communication deficits” and “fixated interests and repetitive behaviors.” The criteria for both sets must be met for the diagnosis of ASD to be made.Īlthough DSM-5 uses the term “spectrum” to characterize the disorder, one might ask: a spectrum of what? The most immediate suggestion is that the autistic spectrum captures variations on social communication problems. In fact, ASD encompasses a number of syndromes that were individually classified in DSM-IV Asperger's disorder and pervasive developmental disorder not otherwise specified are gone. The name of the broader category in which autism is situated is no longer pervasive developmental disorder it is autism spectrum disorder (ASD).
While many things about autism, such as key diagnostic features, remain similar in DSM-5, other aspects of the diagnosis involve major changes in DSM-5. It is good that DSM-5 allows for this, but the popularity of this practice reflects the still limited understanding we have of pathophysiology in autism and other syndromes defined on purely behavioral grounds. If, however, the symptoms are sufficient to meet criteria for other disorders, then the patient should be diagnosed as having two or more disorders.
The presence of these other symptoms should be noted, and, if necessary, the patient should be treated. It is understood in both DSM-IV and DSM-5 that children who meet the criteria for autism often have symptoms of other disorders (anxiety disorders, affective disorders, attention deficit hyperactivity disorder, specific language disorders, and intellectual disability in particular). Rejecting a categorical understanding of autism (with its all-or-nothing approach to diagnosis) and replacing it with a dimensional model is a considerable improvement over DSM-IV. This study appeared in the Maonline edition of the Journal of Autism and Developmental Disorders.DSM-5 has been conceived as both conservative and progressive it attempts to keep important diagnostic traditions intact while it introduces clinically important paradigmatic shifts. “Future research is needed, as concerns remain for impaired individuals who, because of the change in diagnostic criteria for ASD, may no longer qualify for treatment but still demonstrate a need for services." “Our findings provide further insight regarding how the DSM-5 is being used nationally and internationally to diagnose, or fail to diagnose, those with ASD,” they wrote. It is the failure to diagnose ASD that, in some cases, may impede the timely and intensive treatment associated with improvement, they observed. Citing national data, the authors noted that nearly 30 percent of children in the United States with ASD are not receiving behavioral or medication treatment. It could also indicate that fewer individuals are failing to receive an ASD diagnosis than what previous studies anticipated,” they wrote. “This may be because clinicians now have a greater comfort level with interpreting DSM-5 criteria. To assess changes in the frequency of ASD diagnoses following publication of the DMS-5, Kulage, Smaldone, and colleagues conducted a systematic review and metanalysis of 33 studies conducted in the five years since the updated diagnostic criteria were published. They found that the more-restrictive criteria of the DSM-5 decreased the incidence of ASD diagnoses, although the decrease was lower than earlier estimates. “With more than one-fifth of individuals with notable social communication and interaction difficulties, coupled with disruptive, restrictive, repetitive behaviors who will no longer qualify for an ASD diagnosis, clinicians, researchers, and public health officials need to recognize that there are individuals lacking a diagnosis who remain in need of services,” the authors wrote. This article originally appeared in the Fall 2019 issue of Columbia Nursing Magazine.Īpproximately one in five individuals who would have received a diagnosis of autism spectrum disorder (ASD) using the previous Diagnostic and Statistical Manual of Mental Disorders criteria (in the fourth edition of the manual) does not meet the more-restrictive diagnostic criteria of the current DSM-5, an analysis from Columbia Nursing suggests.Īs a result, individuals who have autism-like conditions and remain impaired but lack an official ASD diagnosis may not qualify for necessary services, wrote lead authors Kristine Kulage, MPH, director of research and scholarly development, and Arlene Smaldone, PhD, assistant dean of scholarship and research.