There has been a plethora coverage regarding the "DSM-5" and its new definition of autism. DSM stands for "Diagnostic and Statistical Manual of Mental Disorders", produced by the American Psychiatric Association (APA). This manual is one of the tools used by clinicians when diagnosing Autism Spectrum Disorder. The current DSM ("DSM-IV") was published in 1994, and is being revised, with a publication date of May 2013.
The main points regarding the proposed criteria for the Autism Spectrum Disorder diagnosis in the DSM-5 include:
- In the proposed DSM-5, there will be a single diagnosis (Autism Spectrum Disorder) with no subcategories. The rationale behind this is the current DSM-IV subcategories (e.g. Autism, Asperger’s, PDD-NOS) are really versions of the same underlying condition, but they vary in terms of severity, language level, or intelligence (www.dsm5.org). An individuals severity will be described according to how much support he/she needs to function in everyday life.
- Diagnosis requires difficulties in two areas - in order to receive a diagnosis of Autism Spectrum Disorder in the new DSM-5, an individual has to have difficulties in the following two areas of development (paraphrased fromwww.dsm5.org):
- social communication and social interaction – This includes problems with back-and-forth conversation, starting interactions, sharing interests or emotions, nonverbal communication ( gestures and eye contact) and developing relationships
- repetitive/restricted behavior and interests – This includes repetitive speech or movements, rituals, resistance to change, fixated interests, or unusual sensory interests or sensitivities (sensory difficulties were not included in the DSM-4)
Under the DSM-5, all children will receive the same diagnosis (Autism Spectrum Disorder). According to The Hanen Centre “This should simplify things a little for parents who grapple with the somewhat confusing differences between the current PDD categories. A single diagnosis will hopefully eliminate much of this confusion, and enhance an understanding that the children are more similar than they are different.”
The Hanen Center goes on to explain how “some families are concerned that their child who is "high-functioning" or has Asperger Syndrome will no longer meet the criteria for a diagnosis since these terms will no longer be used in the DSM-5.” However, the APA explains that:
"anyone who shows the Asperger type pattern of good language and IQ but significantly impaired social-communication and repetitive/restricted behavior and interests, who might previously have been given the Asperger disorder diagnosis, should now meet criteria for ASD" (www.dsm5.org)
With the release of DSM-5 in May 2013, we will change the way we describe autism-related disabilities to the singular “Autism Spectrum Disorder.” Children will no longer be diagnosed as having “autism,” “PDD-NOS” or “Asperger Syndrome” as all of these different classifications will depart. However, individuals with ASD will be referred to as having one of three severity levels (see chart at end).
Children whose level of severity falls outside the of these three levels but who exhibit significant social communication challenges will then possibly be diagnosed as having “Social Communication Disorder.” (See criteria for this diagnosis at the end of this post). It highlights those with social communication/social pragmatic challenges who do not exhibit the more “restricted, repetitive patterns of behavior, interests, or activities” which has been one of the diagnostic hallmarks of ASD.
- A new diagnosis of "Social Communication Disorder" – has been added to the DSM-5. If an individual has difficulties with "social communication and social interaction" but not with "repetitive/restricted behaviour and interests", he/she may qualify for a "Social Communication Disorder" diagnosis.
One important note is that when a student is qualified for services under an eligibility category, these services are not determined by the eligibility category itself but instead by the individual needs documented in the IEP written for that student. Services should be driven by individual need as determined by the IEP team.
Severity Levels for ASD
Severity Level for ASD
Restricted Interests & repetitive behaviors
‘Requiring very substantial support’
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.
Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.
‘Requiring substantial support’
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.
Rituals and repetitive behaviors and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.
Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.
Rituals and repetitive behaviors cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.
Social Communication Disorder
- Social Communication Disorder (SCD) is an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.
- The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination.
- Rule out Autism Spectrum Disorder (ASD). Autism Spectrum Disorder by definition encompasses pragmatic communication problems, but also includes restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed.
- Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).
American Psychiatric Association, DSM 5 Development:http://www.dsm5.org