Comments on the DSM-5 Autism Spectrum criteriaPosted by in Uncategorized
People often ask about the new definition of Autism Spectrum Disorders (ASD) to be released with the DSM-5. They are concerned about restricting the diagnosis and about Asperger Syndrome and PDDNOS disappearing as diagnoses and if their child may no longer qualify for services.
I have been to several presentations on the new criteria, including some with some of the authors. I think the new system makes sense. It collapses the social deficits and communication deficits into one area, because they are so intertwined. They then add sensory processing problems to the Repetitive Behaviors area. Adding this makes all sorts of sense. While you can have sensory problems without having an ASD, nearly everyone with an ASD has sensory processing problems. So everyone will have the same diagnosis – Autism Spectrum Disorder. Then a severity level will be assigned ”support needed, significant support needed, and full support needed. This is not the same as “mild, moderate, severe”. It is to indicate the level of support needed by the person to live as independently as possible. Any child should automatically have at least “significant” support needed, because they are children! They need support for feeding, shelter, daily care, education, etc, just as any chid does. Then a qualifier will be added. Some may be “associated with epilepsy”, “associated with language regression at 24 months”, or “associated with Fragile X”. I suspect for those currently diagnosed with Asperger Syndrome, it may be “associated with the pattern of strengths and weaknesses associated with Asperger Syndrome”.
What about adults? By definition, it is a disorder if it interferes with some life domain – work, community, home. If it isn’t – it is not a disorder. If it does, then some level of support is needed. Nobody diagnosed with Asperger Syndrome should lose the diagnosis if they need support. If they don’t need support, do they have a disorder?
I predict the new criteria will still be variably applied, depending on the clinician making the diagnosis. People whose experience is more with severely affected people will still be reluctant to diagnosis higher functioning people, but those who are used to seeing the higher functioning people will continue to diagnose them. There will still be controversy, there will still be debate, and there will still be disagreement over how to apply the criteria. What should not change is people with ASD getting the services they need, regardless of severity or age.
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