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Final Input Sought On DSM Autism Changes


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The panel responsible for crafting new diagnostic criteria for autism, intellectual disability and other disorders is seeking public comment for a third and final time.

The American Psychiatric Association said Wednesday that it will accept public comments now through June 15 on proposed changes for the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders. The first revision in more than a decade to what’s considered the bible of mental health disorders, the new edition of the manual is expected to be published in May 2013.

Among the most controversial proposals is a dramatic change to the definition of autism. Those behind the DSM are looking to fold autistic disorder, Asperger’s syndrome, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified under one umbrella diagnosis of “autism spectrum disorders,” with diagnosticians indicating a level of severity associated with an individual’s condition.

In order to qualify under the new criteria, individuals would have to exhibit specific types of deficits in socialization as well as behavior.

The change has many in the autism community worried after a study released earlier this year found that a significant number of people currently diagnosed with autism may be stripped of the label under the new definition, potentially leaving them without needed services.

Nonetheless, the DSM panel tasked with revising the autism diagnosis is standing firm on their proposal. In a commentary published in the April issue of the Journal of the American Academy of Child & Adolescent Psychiatry the group said that preliminary results from field tests on the proposed changes found the criteria to be “sensitive and specific.”

In addition to the autism changes, the DSM committee has also proposed replacing the term “mental retardation” with “intellectual developmental disorder,” reflecting a shift that many government entities and education institutions have already undertaken in recent years. What’s more, the criteria for the condition would also be altered to focus more heavily on mental abilities and adaptive functioning skills rather than IQ alone.

Other conditions slated to be changed in the forthcoming DSM include those related to communication, socialization, motor skills and behavior.

Two previous DSM comment periods in 2010 and 2011 have already netted nearly 10,800 responses, which led to some alterations to the proposals, officials with the American Psychiatric Association said.

“The comments we have received over the past two years have helped sharpen our focus, not only on the strongest research and clinical evidence to support DSM-5 criteria but on the real-world implications of these changes,” said John Oldham, president of the organization.

Once the current public comment period comes to a close, those behind the DSM revision will incorporate any additional feedback in their final recommendations which are expected to go before the psychiatric organization’s board in December, officials said.

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Comments (8 Responses)

  1. Adele Lessly says:

    I would like to see a broader spectrum when a child has a disability. I have 2 children where there motor skills are fine, but language is very hard for them on all levels. They do not fall into any catagory for additional help.
    I would also like to have mental retardation taken out and replaced with intellectual developmental disorder.

    Adele Lessly

  2. Gina says:

    The levels of autism are pretty vague. The level of support my son needs varies based on the environment and situation. It he is familiar with the surroundings and there are clear expectations, he doesn’t need a lot of support. In unfamiliar or unstructured environments he needs a lot more support. A lot depends on if his sensory system is regulated or not.

  3. Parnelle Bordes says:

    Does this mean that my son has to be revaluated? What should a parent do to make sure that her child still gets the service that he or she needs? My son should not have services taken away because the old diagnosed changed there needs to be consideration for that person.

  4. VMGillen says:

    Get rid of the “ASD” Dx completely, until an etiology is worked out. People need to have specific symptoms addressed (as Gina points out). If the APA, and insurers, need a diagnostic code, let them remeber this is for their paperwork, and make the DSM appropriate for processing payment, not determining eligibility for services. The biggest problem, IMO, is the DSM shapes the entire dialogue on autism, often warping it beyond recognition. As a reult, we’ve seen ASD turn into the Dx du jour, with many new providors claiming to provide services (and reaping big$$$s as a result) in actuality serving very limited segments of the population.

  5. Kelli Inabnet says:

    I believe it is necessary that these disorders become more clearly defined. As a mother of child with “classic” autism, exhibiting nearly every symptom in the book, it is frustrating to watch my child regress due to a lack of services from the increase number of children “on the spectrum”. Working 6 years in the child/adolescent psychiatric environment opened my eyes to just how many children are misdiagnosed and given a label. Not every child, but some. While I don’t want to see ANY child fall through the cracks, I would like to see some lines drawn between children who can perform academically and will function as adults (with whatever sensory issue they may have) and my child who will never live on his own or understand the world. Not trying to step on anyone who is trying to get what they can for their child, I would do the same. BUT… there IS a difference.

  6. Dianne MacKay says:

    I am not surprised that the medical community is caving in to governmental pressure, The government should be held accountable for allowing our children to have expressions of autism which are increasing for reasons they,the food industry and pharmaceutical companies conveniatly ignore. Rather than deal with the fact that autism is increasing ,it is easier to pretend increasing rates of autism is not really a problem but rather the victims are the problem.These changes would actually hurt those individuals that probably would have the best chances for becoming self sufficient.I was ignorant of autism and like the rest of the public was only on the fringe of understanding this mental disfunction. My son was a late diagnosis for mild autism -I inially did not believe the diagnosis. Something was wrong but I did not know what.But when I read up it was a real OMG moment as it all made sense. I wish had been better educated so he could have had some early intervention and not suffered as he did. Despite being in the health care field, i was uneducated about autism and totally overlooked this. Intervention Does not even have to governmental at all times,in many cases the public could just be better informed and educated to assist their children. I am not imagining my son’s problems or his cousins with moderate and severe autism. This was never in our family before. Please wake up and pretend that it is your child with autism and then you will really read what experts ,without conflicts of interest ,are really claiming. I really fear what is happening to our children and pray that those with opinions will be fully educated and open to a situation that will not go away b/c the legal definition will be changed. The doctors that are pretending there is no problem will all be held morally responsible .

  7. Sarah says:

    Is there a diagnostic category for environmental poisoning? Maybe there should be in the case of autism. Maybe that is actually what we’re dealing with all along given that 1 in 54 boys are now dxed and there’s been a 78% increase since 2002. Neurological damage from a neurotoxin. Most of the cases have to be environmentally triggered. Also, maybe all suspected cases should include a recommendation for medical testing for physical issues associated with autism like inflammation in the GI and brain so they cna be treated.

  8. Mike the Psych says:

    Sarah there is no definitive clear environmental trigger or poison for Autism unfortunately. Lead poisoning and other teratogens can lead to a variety of disabilities, Autism Spectrum Disorders, Intellectual disabilities, sensory losses in hearing or vision, or developmental delays… the list goes on.

    Any mental health diagnosis is made after a through physical exam as well, to rule out any health or medical causation.

    The diagnostic criteria are changing very little in terms of symptom criteria, in fact it is mainly combining previous DSM-IV criteria and adding components like sensory dysfunctions.

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