2013-03-18

DSM 5


This editorial by Ozonoff is incredibly useful to understand what is happening to Autism Spectrum Disorder in the new DSM coming out in May. She succinctly reviews empirical evidence considered for the revision and briefly addresses concerns with the exclusion of Asperger's and the creation of a new category that might house those who present significant "social and communication difficulties who do not exhibit the repetitive behaviors of ASD."


Pervasive Developmental Disorders will not longer exist and some of the once considered PDDs are assumed to fit better in one category called Autism Spectrum Disorder (ASD). Two of them are no longer considered PDD or ASD. Rett is out because:


"(...) its molecular basis is known (the DSM focuses on disorders without a molecular or biological test, that must instead be defined behaviorally." (Ozonoff, 2013)

And Asperger Disorder is out because, in gross terms, it should never have been differentiated.


"To the extent that differences between subtypes have been found, they were quantitative (e.g., differing in degree of impairment, severity of symptoms, or level of cognitive function) rather than qualitative (Prior et al., 1998). "
"Multiple studies demonstrated that most children with an Asperger-like clinical presentation actually met DSM-IV criteria for Autistic Disorder (Gilchrist et al., 2001; Williams et al., 2008)."

"The strongest predictor of diagnosis was what site made it, rather than any characteristic of the child. This is a clear sign that the PDD subtypes were just not working."

Be sure to check the virtual issue and the 12 articles Ozonoff chose to discuss the history of the autism diagnosis. 


For those still worried about potential loss of services, here is what TACA emphasizes (below). We do for sure still have to be concerned with potential large numbers of individuals who may never get a diagnosis and go without appropriate supports. But the discussion is much more complex than just blaming the DSM.

Children receiving special education should not be impacted as Asperger’s, PDD-NOS, and childhood disintegrative disorder are not disability categories in IDEA 2004 and these children were already being served based on their individual needs under one of the other 13 categories in IDEA (such as Autism or Other Health Impairment). School districts should not be requiring a medical diagnosis or a re-diagnosis to determine eligibility or services.