The American Psychiatric Association’s Proposed Revision of the Diagnostic Criteria for Autism

As many of you may already know, the American Psychiatric Association (APA) has recently released their proposed revision of the diagnostic criteria for autism, which forgoing further revision, will appear in the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5) projected to be published in May 2013. The proposed criteria differs from the APA’s current diagnostic criteria for autism, as described in the DSM-IV, in several ways, the foremost being the inclusion of Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and Asperger’s Disorder under the all-encompassing category, autism spectrum disorder (ASD).

The APA’s decision to adopt the more comprehensive diagnostic criteria stems from the heated debate of whether Autistic Disorder, PDD-NOS, and Asperger’s Disorder are truly separate disorders with distinct diagnostic boundaries, or if they are ultimately the same spectrum disorder with symptoms falling along a broad range of severity. While this topic is still heavily debated, almost every data-based evaluation of the disorders have found that they are better described as falling along a spectrum rather than distinct categories.

Over the years, many have found the APA’s current diagnostic criteria for Autistic Disorder, PDD-NOS, and Asperger’s Disorder to be problematic. For starters, reported inconsistencies in clinical differentiation between these disorders, both over time and across settings, suggest that the disorders’ diagnostic boundaries are not so clear cut. Furthermore, since there are currently no apparent differences in cause (e.g., the disorders often coexist within families), and considering that treatment recommendations and treatment gain trajectories are virtually the same, these disorders do not appear to be distinct. Based upon these and other research findings, the APA has proposed the all-inclusive diagnostic category ASD, wherein symptoms reside along a spectrum of severity. You can read more about the APA’s proposed revision and their reasoning by clicking here.

While the APA’s broader diagnostic criteria for ASD are likely to provide a more research-based definition of autism, many are concerned about the possible fall out. Several concerns have recently been expressed, including:

  • Will those with more severe ASD diagnoses be sidelined? By broadening the definition of autism to include milder forms of ASD, the majority of those diagnosed with ASD will fall into the moderate to high functioning range. Thus, with milder cases of ASD becoming the “norm,” many are concerned that focus will be taken away from those with more severe cases of ASD who arguably need the greatest support. Indeed, this trend has been observed over recent years with many autism advocacy groups, which used to focus on those with severe disabilities, now almost exclusively focusing on the “mild” cases.
  • Will those with Asperger’s Disorder face greater stigma with an ASD diagnosis? Many are worried about the possible repercussions of applying a potentially more severe label to individuals currently diagnosed with Asperger’s Disorder. However, what may occur could be the opposite, rather than stigmatizing; the new criteria may in fact simply reduce the severity that the ASD diagnosis implies.
  • How will funding for services be allocated under the revised diagnostic criteria? Many are concerned that the amount of funding their child currently qualifies for may change under the revised definition of autism. This is a very big concern that requires real answers from law- makers. Depending on which state or country you reside in, your governing agencies have established what they will and will not fund based upon the specific diagnostic categories. If you have a child with an ASD diagnosis, now is the time to contact your governing agencies and advocate for your child.

While these are very real concerns, they do not take away from the scientific evidence that the disorder is best described as falling along a spectrum and that the APA’s revised diagnostic criteria likely offers a more accurate clinical definition of the disorder. As we move forward with the revised diagnostic criteria, we will surely run into obstacles; however, in the long run I believe we will have a much more clinically useful definition of autism. I am interested in hearing what you have to say on the matter. What are your thoughts on the APA’s revised diagnostic criteria?

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