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DSM- IV vs. DSM- 5: What has Changed?

Posted by National Autism Network , in Legislation and Healthcare, Autism Treatments, Autism Awareness 28 May 2013 · 41,105 views

DSM 5 DSM V
DSM- IV vs. DSM- 5: What has Changed? On May 22, the DSM-5, the latest version of the Diagnostic and Statistical Manual of Mental Disorders, was released by the American Psychiatric Association (APA). The latest edition of the United States’ mental health “bible” has had the medical world abuzz in the time since the APA announced that they would be making dramatic changes to the classification of many mental disabilities. Perhaps the most dramatic, and highly controversial, change to the DSM is the reclassification of the criteria that determines an autism diagnosis. The following are the five major changes to autism diagnosis criteria generated by the publication of the DSM-5:

1. In 1994, the DSM-IV first implemented variations of an autism diagnoses including autistic disorder, Asperger’s disorder, Rett disorder, childhood disintegrative disorder, and PDD-NOS. 1 The recent edition of the manual has narrowed the scope of autism and made it so that these formerly separate variations of autism now fall under the umbrella term autism spectrum disorder (ASD), the severity of which will be determined by a sliding scale based on an individual’s symptoms.2-3 Many fear that the elimination of these subcategories will result in the loss of diagnosis for those who have varying conditions and could lead to a potential loss of insurance benefits.4 The APA has summarized insurance implications of the DSM-5 which can be found here.  Autism Speaks, the leading science and autism advocacy organization, states in their report concerning the changes of DSM-5 that “no one should be reevaluated or ‘lose’ their diagnosis because of administrative reasons of the DSM-5.”3

2. Changes to the diagnostic criteria of autism are also a major feature of the DSM-5. Previously there were three core criteria for autism diagnosis5:
· Language challenges
· Social deficits
· Stereotyped or repetitive behaviors

The most recent addition of the DSM will condense these criteria so that only communication and social deficits and fixed or repetitive behaviors are the core areas for diagnosis.5 Previously, an individual must have met 6 of 12 deficits in social interaction, communication, and repetitive behaviors for an autism diagnosis.2 However, under the DSM-5, an individual must only “exhibit three deficits in social communication and at least two symptoms in the category of restricted range of activities/repetitive behaviors. Within the second category, a new symptom will be included: hyper- or hypo- reactivity to sensory input or unusual interests in sensory aspects of the environment.”3 Additionally, the number of criteria that must be met has gone “from 12 to 7 which reduces the number of possible combinations of symptoms to receive an ASD diagnosis.”2 Also, the requirement for a language delay is no longer necessary for a diagnosis.3 In October 2012, the American Journal of Psychiatry conducted a comprehensive assessment of the DSM-5 criteria based on previously collected data and found that the “DSM-5 criteria identified 91 percent of children with clinical DSM-IV PDD diagnoses, suggesting that most children with DSM-IV PDD diagnoses will retain their diagnosis of ASD using the new criteria.”6 SafeMinds has compiled a list of independent research studies that attempt to compare the DSM-IV with the latest version of the diagnostic manual.

3. According to Autism Speaks, another major change identified in the DSM-5 is “symptoms can currently be present, or reported in past history.”3 Furthermore, “the DSM-5 proposes a more inclusive age-of-onset criterion, recognizing that although symptoms should [be] present in early childhood, they may not fully manifest until social demands exceed the capacity of the individual to cope with them. The major rationale behind these changes is to improve reliability.”7

4. In addition to a level of diagnosis (e.g. Level 1, Level 2, etc.), individuals will be evaluated and described in terms of any known genetic cause, level of language and intellectual disability, and presence of medical conditions such as seizures, anxiety, depression, and/or GI tract problems.3

5. The final major change comes in the form of a new category known as Social Communication Disorder. According to the APA, Social Communication Disorder is “characterized by a persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. Symptoms include difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation.”8 John Elder Robison, author of Look Me in the Eye, which details his life living with Asperger’s, describes the new disorder as sort of “autism lite,” suggesting that “the person has some features of autism but not enough to meet the diagnostic standard under the new definition.”9 Children who formally received a diagnosis of PDD-NOS may now be eligible for an SCD diagnosis. Due to the recent addition of this disorder to the DSM, it remains to be seen whether or not children who are diagnosed with this new condition will be reimbursed for treatment under insurance mandates.3

It has been nearly 20 years since the release of the DSM-IV by the APA and we can only wait and see what the effects of the changes to the DSM-5 regarding diagnosis, services, and insurance coverage related to ASD will be.  Autism Speaks is currently conducting a domestic and an international study  to compare the DSM-IV and the DSM-5 criteria in ethnically diverse samples.3 Individuals, families, clinicians, and educators can each take a survey  to report their various experiences with the DSM-5 criteria.

We would love to hear your experiences with the new DSM-5.  Please report your experiences with receiving diagnosis, services, and insurance coverage under the DSM-5 on our Forum here.

*UPDATE*
Research indicates that only 35 percent of children diagnosed with ASD before age 3 based on the DSM-IV criteria retained the diagnosis using the DSM-5 criteria. The children whose diagnosis was retained using the DSM-5 criteria showed greater signs of social impairment and scored an IQ less than 70 at a ratio of nearly 3 to 1. Read about the recent research here.

The Simons Foundation Autism Research Initiative (SFARI) recently launched its Special Report: DSM-5, which is a series of articles written by various experts and focuses on the many implications the DSM-5 will have on individuals with ASD.


References
1.    “Diagnostic Classifications.” Autism Society of America. Accessed May 24, 2013.
2.    Weisman, Katie. “Impact of the DSM-5 Criteria for ASD – Community Update – May 2013.” SafeMinds. May 16, 2013. Accessed May 24, 2013. http://www.safeminds...ate-may-2013-2/.
3.    “Answers to Frequently Asked Questions about DSM-5.” Autism Speaks, Inc. Accessed May 24, 2013. http://www.autismspeaks.org/dsm-5/faq.
4.    “The Book of Suffering.” Economist.com (blog), May 21, 2013. Accessed May 24, 2013. http://www.economist...lemma-diagnosis.
5.    Wilson-Miller, Kate. “Criteria for Autism in the DSM-V.” I Love to Know Autism. Accessed May 24, 2013. http://autism.loveto...ia-autism-dsm-v.
6.    “Autism Spectrum Disorder.” American Psychiatric Publishing. 2013. Accessed May 24, 2013. http://www.dsm5.org/... Fact Sheet.pdf.
7.    Lai M-C, Lombardo MV, Chakrabarti B, Baron-Cohen S (2013) Subgrouping the Autism “Spectrum": Reflections on DSM-5. PLoS Biol 11(4): e1001544. doi:10.1371/journal.pbio.1001544. http://www.plosbiolo...al.pbio.1001544.
8.    “Social (Pragmatic) Communication Disorder.” American Psychiatric Publishing. 2013. Accessed May 24, 2013. http://www.psych.org...-Fact-Sheet.pdf.
9.    Robison, John Elder. “Social Communication Disorder—is it “Autism Lite?”” My Life with Asperger’s (blog), January 17, 2013. Accessed May 24, 2013. http://www.psycholog...-it-autism-lite.





Bradys Nana
Aug 07 2013 10:18 PM
I Can Only Hope That Our Government Will Take.Steps To Prepare For AnD that Support The ProgThat We Need To Help Our 1 In 10 Children Born Today With Some Spectrum Placement.  Think Ahead And Be Prepared For The Future Needs For This Children/And Their Families.

Jane Brooks
Jan 24 2014 06:45 PM
well the category 5 will give doubts of a dual diagnosis of asd-ds a excuse.