The proposed changes to the diagnostic criteria for autism is a hot topic since the recent release from the American Psychiatric Association (APA). The community seems to be divided on their views of the new criteria. One group believes that the potential new diagnosis is going to overlook many children that would have been diagnosed by the current criteria and the other group believes that the new criteria allows for more specificity in the needs of the children.
There are several major changes to the newly proposed diagnostic criteria for autism spectrum disorder (ASD). There will no longer be multiple diagnoses that have come to be known as ASD. Autism, pervasive developmental disorder-not otherwise specified and Asperger’s disorder will not longer exist; the only diagnosis will be autism spectrum disorder. Next, the qualitative impairments in social interaction and communication have been combined and are no longer two separate sections. I believe the merging of the social and communication sections are appropriate. To effectively communicate with others, as well as for creating and maintaining relationships, the need for communication and social skills are inseparable. This criteria within the proposed guidelines is more specific to the difficulties that people with autism and related disorders have in comparison to the current diagnostic criteria. There has been an addition of the phrase “unusual sensory behaviors” within the stereotyped motor and verbal behaviors as part of the diagnostic criteria. The use of sensory activities for reinforcement with children and people on the autism spectrum has been highly successful within my practice. By adding this to the diagnostic criteria, it is my hope that it will open the door further for scientific research to be conducted on the efficacy of sensory input to people on the spectrum. The belief or disbelief in sensory issues of people with autism is debated within the professional community. Additional research within this area could further help define the diagnosis of autism spectrum disorders. An additional change is allowance for symptoms to be observed later in development, once the social demands exceed the limited capabilities of the individual, not specifically before three years of age. In my opinion, allowing for symptoms to be observed past the age of three years is an extremely important addition to the diagnostic criteria.
This would allow for children that do not have a delay in communication but may later exhibit social delays (including social language delays) and restricted repetitive patterns of behavior a better chance of meeting the criteria once the demands exceed their skill set. If this is to be added to the new diagnostic criteria it should allow for more children to receive diagnoses of ASD compared to the current criteria of having at least one deficit area in either social interaction, social communication or symbolic or imaginative play prior to the onset of three yeas old. The last major change is the need to level the severity of how ASD affects the individual. The levels that are being proposed are; “requiring very substantial support”, “requiring substantial support” or “requiring support.” The leveling of severity is of concern to me. On one hand, I feel that it will help identify the needs of the person on the spectrum more specifically, which will help with their services and treatment. However, on the other hand, I am concerned about how the services will be approved. Will a child that is a “level three, requiring very substantial support” receive the level of services that has been reported in research to provide the optimal outcome and the children that are diagnosed with “level one, requiring support” not be allowed the hours that are reported in research to provide them with the most optimal outcome? This area should be observed closely to ensure that children are still receiving the services that are proven through research to help them remediate the symptoms of autism spectrum disorder.
We will have to wait to see if the APA adopts these guidelines for publication in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, (DSM-5) in May 2013, to truly see if there is a change in the amount of people being diagnosed and to the level of service the children receive based off of the new diagnostic criteria.
Denise Rhine MSEd, BCBA
Senior Managing Supervisor
Center for Autism and Related Disorders
6 N. Main Street Suite 110
Fairport, NY 14450