DSM5 in Distress

The DSM's impact on mental health practice and research

Will the DSM-5 Reduce Rates of Autism?

The DSM-5 radical redefinition of autism will dramatically reduce the number of people who will qualify for the diagnosis. Read More

purpose of DSM changes

The argument made in this article seems to presuppose a desire on the part of the APA to maintain similar levels of diagnosis in combination with clearer, less "fungible" criteria. In fact, though I can't believe that this is the case.

My strong impression is that the changes in criteria reflect a negative response to the high number of children found to have enough symptoms to warrant an Aspergers or PDD-NOS diagnosis. "Too many" children have evidently fallen into categories that were expected to describe only a small number of youngsters whose symptoms left them challenged but without an official diagnostic category.

If I am correct, then the actual DESIRE behind the changes is to solidify the autism spectrum diagnosis by developing clearer, less elastic boundaries. This would, of course, lessen the number of people with the diagnosis.

Meanwhile, we still have a very large cohort of people with social, communication, and speech issues who, for example, don't have perseverative behaviors or significant sensory challenges. Their issues are very real, but are not the same as those which will be defined under the ASD name.

Presumably (though not definitely!) those kids would lose the ASD diagnosis in order to gain a more appropriate diagnosis -- such as social communication disorder, social anxiety, or some combination of other diagnoses. Or not.

In my opinion, while there is now a social "understanding" of autism that has been helpful (or hurtful depending upon your point of view), there is nothing sacred about the term. In fact, from our point of view as parents, it can be very confusing. Our son, with a PDD-NOS diagnosis, has very few of the "usual" ASD symptoms -- and thus is often taught and/or accommodated incorrectly.

Yes, he has speech delays (not included in the new criteria) but no, he has no sensory challenges (which ARE included in the new criteria). Yes, he has difficulty understanding nonverbal communication, but no - he does not perseverate on a single area of interest. He doesn't need the extraordinarily structured, sensorily careful settings provided to people with what will soon be "real" ASD -- but he sure as heck DOES need a small, interactive, multimodal learning situation.

In other words, our son doesn't need the level of restriction provided to kids with "autism," and could thrive as an apprentice in a largely hands-on field. I'm guessing he's not alone: many of the kids in autism settings are receiving either too much or the wrong type of education and vocational training! Staying with the ASD diagnosis wouldn't do him or anyone else in his circumstances any favors.

Lisa Jo Rudy

DSM changes and ASD, PDD, spectrum disorders

Lets face it, first off the actual statistics were grossly miscalculated and now it is 1 in 88 that have some form of Autism, be it verbal, non verbal, pdd-nos (a typical), aspergers, etc. The changes in the DSMV will only further the lack of services for the children who have these conditions.

As Lisa Jo Rudy aptly mentioned, the educational venue which provides services to these kids, is already at a clear disadvantage as it does not do so on a case to case basis, and some of the basis of which those services may be provided depending on the actual diagnose (should it even be correct)are surely lacking for these kids who do not necessarily fit into the "new criteria".

The whole thing revolving around autism and its umbrella of manifestations, for any degree of its form upon each individual cannot be simplified to fit into a facetious diagnostic manual. That is precisely the very loophole that is being promoted.

It is sad to know that children and families will negatively be impacted upon by the DSMV changes relating to autism. Remember parents, you are your child's best advocate, primary caregiver, and provider...find the doctors that will adequately assess, test, and diagnose the primary condition and don't be fooled by the co-morbid conditions which usually are the secondary conditions that often get treated.

Opposed to providing the right supports needed for these kids to thrive in an evasively labeled stigmatic society, is the equivalent to recognizing the primary condition at early stages of functioning. Unfortunately, the outcome of the lack of doing so can ultimately change the course of any child's lifetime.

Intellectually Disabled will also lose their label.

The present cost of giving ABA to ID children is about $80,000 a year. I am sure insurance companies, mandated in many states to give ABA to autistic children as a sole scientifically indicated medical therapy, are going to be relieved these children are "no longer autistic" but intellectually disabled.

I'm glad to see my son lose his "Aspergers" label,too, as he was in a behavioral classroom that never took into account he was dyslexic. Not until he was home schooled did he receive curriculum adapted to this.

Dr. Frances, in giving a talk with a mother whose son was labelled bi-polar who was insistent he be heavily medicated, you said something like (I'm paraphrasing):"I'm NOT saying that these kids aren't difficult to raise, that they don't have difficulties managing behaviors...I AM saying they don't deserve to be labelled as mentally ill."

I've never forgotten. A pill does not cure our children of their humanity. People used to complain about Dr. Spock. He couldn't hold a candle to the "experts" manipulating weak willed parents today who have all the ideas and none of the common sense.

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Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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