Members of the committee tasked with updating the diagnostic criteria for autism appear to be digging in as critics worry that proposed changes will strip many of their diagnosis.
In a commentary released this week, members of the American Psychiatric Association panel charged with revising the autism definition appearing in the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, defended the changes they’re proposing.
Specifically the work group has recommended that several labels including Asperger’s syndrome and pervasive developmental disorder, not otherwise specified be folded into an umbrella diagnosis of “autism spectrum disorder.”
However, many in the autism community became alarmed about the changes in January when a group of Yale University researchers reported that an analysis they conducted found that a significant number of people currently diagnosed with autism could be left out under the new criteria.
In response, thousands signed an online petition asking the American Psychiatric Association to reconsider, as parents and advocates worried that the diagnostic changes could leave many without needed services.
Nonetheless, the committee continues to defend its proposal and in a commentary appearing in the April issue of the Journal of the American Academy of Child & Adolescent Psychiatry the group criticized the methods used in the analysis released early this year. Specifically, the committee faults the research for relying on data collected in the early 1990s and said that the findings “justify neither alarming headlines nor dramatic conclusions.”
Any change to the autism definition in the DSM could have huge implications. The book is relied on by everyone from mental health professionals to researchers and insurers.
The American Psychiatric Association, which publishes the DSM, says that preliminary results from field tests it conducted of the proposed changes are finding the criteria to be “both sensitive and specific.”
The organization has agreed, however, to open up an additional public comment period on the issue this spring.
“We remain open to any concerns the academic and advocacy communities might have, but we strongly support the decisions that these leading researchers and clinicians have made,” said David Kupfer, chair of the DSM-5 Task Force, in a statement this week. “The proposed ASD criteria are backed by the scientific evidence.”
The fifth edition of the DSM is expected to be published in May 2013.
The APA’s decision, while disappointing, is not surprising. I knew that they would not be swayed. It is quite unfortunate for those of the Asperger’s community, however, to be losing this diagnosis. Not just for insurance purposes, which is quite significant in an of itself, but for identification purposes, for education purposes, for treatment purposes. The APA says they are basing their decision on scientific research — nonsense! They have been inundated with evidence from Asperger’s experts which say otherwise (that the Asperger’s diagnosis should remain). Did they listen? Obviously not. Because it was not THEIR idea. Or perhaps because it was not financially sound to do so…
Michelle,
What I can see happening is that the DSM-5 is rolled out and in 4 years, the CDC will get around to looking at kids born in 2002 and 2004. The numbers then will dramatically drop and the cover up will be the criteria has changed. But the real reason is that our vaccination policy was altered after 2001. Just a thought.
From what I have been reading, clinicians do not have to use the new DSM to make their diagnoses. They can chose to diagnose just as they always have. This book is not the be-all/end-all when it comes to diagnosing. The book is published as a cash cow for the APA. Maybe instead of trying to convince them to change their minds, we advocate for people not to buy this book.
As a school psychologist I can say the change is welcomed, and will be better reflective of the single Autism special educational eligibility (which still included Asperger’s and PDD-NOS). Research has strongly indicated that symptoms of Autism can vary in a wide “spectrum”. The terms Autism Spectrum Disorder or individuals being on the “spectrum” appears to be a common practice. The problem is that the word spectrum does not appear in the DSM-IV-TR, the proposed definition changes for DSM-V formally recognize that Autism is a spectrum diagnosis and eliminates the need for additional confusing terms/diagnoses.
The changes also help stop the problem of attempting to separate social and communication symptoms from one another when identifying individuals. If you compare the previous criteria to the new, there are relatively few changes in the new criteria, most old items have been combined due to redundancy or re-categorization, and sensory issues have finally been formally recognized in the criteria.
As for any coverups related to vaccines, take a look at the research. Studies from Denmark which regularly collects information from all of its citizens saw no difference in Autism occurrence in children who received the MMR and those who did not. Japan broke the MMR into three vaccines due to concern the triple shot MMR was too much for some children’s immune systems to handle. However, when they reassessed the number of Autism cases after the change they found no decrease. The vaccine argument is a sad state of affairs as it creates a significant public health risk for preventable diseases.
Yea! I for one am glad they are standing their ground.
This is outrageous! The public and professional community have spoken and been disregarded. Please note that this committee was named without persons with ASD many of whom, by the way, are therapeutic providers themselves.
PS. I agree by the way that it is an improvement in many ways. That said, disregard for Theory of Mind issues, executive function issues will result in them being misdiagnosed again. At this incidence rate, anyone presenting with mental health issues should be screened at least. What our community should have done was provide specific, meaningful feedback (particularly where the severity level page is noted–the GAF is find thank you) instead of attacking the document in it’s entirety.