Autism panel raises concerns about recent DSM changes

DSM Changes
DSM Changes

A federal autism panel has raised concerns that recent changes to an influential psychiatric manual, which simplified the definition of autism, could result in a reduction in necessary services.In December 2012, the American Psychiatric Association voted to merge Autistic Disorder, Asperger Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder into one disability, called Autism Spectrum Disorder.

The change was published in the fifth edition of the the Diagnostic and Statistical Manual of Mental Disorders, released in May 2013.

In a recent policy statement, the Interagency Autism Coordinating Committee, a federal advisory committee, warned medical professionals and policy makers that they should exercise caution before reclassifying people with less severe symptoms as no longer qualifying for medical and other daily living services.

“In particular, clinicians should pay special attention to individuals with obvious (Austism Spectrum Disorder) symptoms who narrowly missed criteria for ASD based on DSM-5, to ensure that they are not inadvertently denied needed ASD-specific services,” the report stated. “Services should be based on need rather than diagnosis; it would not be appropriate for a child to be denied ASD-specific services because he or she does not meet full DSM-5 criteria if a qualified clinician or educator determines that the child could benefit from those services.”

The IACC is specifically concerned about the implications for parents seeking early intervention service for their children, especially because many ASD symptoms do not fully manifest until children reach three years old.

The new edition of the DSM is the first since the 4th edition was released in 1994. The addition of Asperger’s Syndrome that year has proved controversial, as it is often credited as a factor in the large increase in people diagnosed with autism spectrum disorders in recent years.

“Although the diagnostic criteria are intended primarily for use by clinicians and researchers in their diagnostic assessments, the IACC is aware that it is important to also remember that these the criteria also have a direct impact on people who have the disorders and their families, and their ability to assess symptoms and obtain services that can help them optimize their health, well-being and quality of life,” the report stated. “Any revision of the diagnostic criteria must be made with great care so as to not have the unintended consequence of reducing critical services aimed at improving the ability of persons with autism.”