By Martin J. Lubetsky, MD
Many parents and professionals are debating the American Psychiatric Association (APA) approved DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) revised diagnosis of autism. DSM-5 is expected to be available for purchase by the time of the APA Annual Meeting in May 2013.
Autism Spectrum Disorder (ASD), the revised diagnostic category, is a developmental neurobiological disorder, characterized by severe and pervasive impairments in reciprocal social interaction skills and communication skills (verbal and nonverbal), and by restricted, repetitive, and stereotyped behavior, interests, and activities. The current DSM-IV-TR describes Pervasive Developmental Disorder (PDD) as the diagnostic umbrella, with five subtypes. With the upcoming changes in DSM-5, the separate diagnostic classifications under PDD will be subsumed under one category Autism Spectrum Disorder (ASD). This puts autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder under ASD. The new ASD diagnostic category will include specifiers for severity and verbal abilities, and also include associated features such as known genetic disorders, epilepsy, and intellectual disability.
The new ASD diagnostic category will also combine the current three domains (social, communication, and behaviors) into two domains (social and communication deficits, and fixated interests and repetitive behaviors), based upon the belief that deficits in communication and social behaviors are inseparable. Much debate has been triggered by these APA approved changes. One concern raised is whether the new ASD label will exclude individuals currently diagnosed with autism or PDD. A second issue highlighted is the fear of loss of school placement and funding if the new ASD label excludes a child previously diagnosed with autism or PDD. A third objection voiced is the loss of identity of individuals diagnosed with Asperger’s Disorder into the broader ASD category. Researchers have defended the new categorization as an improvement in evidence-based criteria which will not negatively impact individuals with ASD.
Time will tell if the new ASD diagnostic category is an improvement in the field of autism, and if researchers show the benefit rather than detriment.
Martin J. Lubetsky, MD is Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, and the Chief of Child and Adolescent Psychiatry Services and Center for Autism and Developmental Disorders at Western Psychiatric Institute and Clinic of UPMC, and Chief of Behavioral Health at Children’s Hospital of Pittsburgh of UPMC. Dr. Lubetsky is a past recipient of the Grandin Award from the Advisory Board On Autism and Related Disorders (ABOARD). He is co-editor and co-author of Autism Spectrum Disorder.