Changes in the Diagnosis of Autism Spectrum Disorders
By: Andrea Victor, PhD
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the criteria for diagnosing mental health disorders and is used throughout the medical community by therapists, physicians, and insurance providers. In May 2013, an updated version of the DSM will be released with changes in several diagnostic categories.
The new DSM‑5 makes significant changes to the diagnosis of Autism Spectrum Disorders (ASD). The current DSM-IV defines ASD across several categories, including Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS). However, the DSM‑5 proposes to combine these disorders into a single diagnosis of Autism Spectrum Disorder. This change was made due to the significant overlap and lack of differentiation among the previous subcategories.
The DSM-IV outlined three primary areas in the diagnostic criteria for Autism:
- Language deficits
- Social difficulties
- Repetitive behaviors and stereotyped interests
The upcoming DSM‑5 proposes to reduce these primary areas into two core areas of diagnosis for ASD:
- Communication and social interaction deficits, which include difficulties related to social reciprocity, nonverbal interaction, and maintaining social relationships
- Repetitive behaviors and stereotyped interests
The proposed changes in the DSM‑5 impact the diagnosis of ASD in several ways. First, social skills and communication have been combined due to the high level of overlap between the two domains. A deficit in communication typically has a significant impact on a child’s ability to initiate and engage in social interactions. Also, children with autism are no longer required to have a language deficit. The new criteria do not require language delays and abnormalities. Furthermore, children with ASD who have a language deficit will now be given an additional diagnosis to explain the language difficulties.
The DSM‑5 has also changed the criteria for communication disorders. Under the new proposed diagnostic criteria children can be diagnosed with three possible communication disorders: speech disorder, language disorder, and social communication disorder.
- Speech disorder is used when children have difficulty with articulation and pronunciation of speech sounds.
- Language disorder refers to children who have trouble understanding and/or formulating language.
- Social communication disorder is a new diagnosis that captures children with pragmatic language difficulties related to reciprocal conversation and repetitive, stereotyped use of language. These types of language deficits are often identified in children with ASD, but were not previously considered a separate diagnosis.
As these proposed changes to the diagnostic criteria evolve, it will be important for parents to ask questions and rely on their providers for additional information about the impact of these changes on their child. Each child will be uniquely impacted by these upcoming diagnostic changes; however, it is important to remember that these diagnostic changes should not impact the quality of care for your child. Although criteria and labels may change, your child’s treatment should still remain focused on their unique pattern of strengths and challenges.