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Psychiatrists Approve New DSM, Asperger’s Dropped

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Major changes to the diagnostic criteria for autism and other conditions are on track to take effect after the nation’s psychiatrists gave final approval to a new version of the Diagnostic and Statistical Manual of Mental Disorders this weekend.

The American Psychiatric Association’s board of trustees gave a green light Saturday to the DSM’s fifth version, paving the way for the manual’s publication in May 2013 after more than a decade of consideration.

Full details on the final changes approved by the organization are not expected to be available until the completed DSM is made public.

However, officials did confirm that one of the most controversial proposals calling for autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified to be folded under the label “autism spectrum disorder” did get approved. The organization said the change will “help more accurately and consistently diagnose children with autism.”

Talk of the autism change has sparked concern that some currently diagnosed with the disorder may no longer qualify under the new criteria, but experts on the psychiatric association panel responsible for recommending the updates insist that this will not be the case.

In addition to changes to the autism diagnosis, the proposed DSM also included recommendations that the term “mental retardation” be replaced with “intellectual developmental disorder.” What’s more, psychiatrists responsible for assessing the diagnosis suggested that the new DSM put less emphasis on IQ score, which led to some criticism, though it’s unclear if that change was approved for the final manual.

The DSM is used by everyone from mental health professionals to researchers and insurers to determine what symptoms are worthy of an official diagnosis. The current edition was released in 1994, with minor updates added in 2000.

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Comments (9 Responses)

  1. Clare says:

    I have to say, I hope they stop using the term, mental retardation. I have never liked the term, Retardation is a word I do not like. It feels so negative, and I think it gives a negative self-concept to those who are diagnosed with it. They should not feel diminshed because of the medical term used to describe the challenge in their lives. They are human beings and should be treated with dignity and that term does not give them that,

  2. A.Harris says:

    Do people really not get it yet? The terms retard and retardation aren’t inherently offensive, they just have become that way because they describe a condition that still carries a stigma with it. You can argue all day that having an intellectual disability SHOULDN’T be stigmatizing, but human nature is what it is!
    Look at all the medical terms that have been used over the years to describe various levels of intellectual disability…they’ve all become “offensive”: Imbecile, Moron, Idiot and now Retard.
    Twenty years from now people will argue that “Intellectual Disability” is negative and degrading and everyone will have to come up with a new term to use for the exact same condition. Think about it…when they established the terminology “Mentally Retarded” they probably though they were being very objective and sensitive…after all it just means that mental function is slowed down or inhibited in some way…that’s all. Until you get past the pattern of people devaluing and marginalizing those with disabilities your just going to have to keep renaming it…it’s not the term that offends, it’s the attitude.

  3. Jon K. Evans says:

    I simply refer to persons FORMERLY REFERRED TO AS MENTALLY RETARDED, as simply HARD CORE DISABLED. That can run the gamut from those suffering from intellectual deficits to Christopher Reeve’s unfortunate injury-that led to his death!

  4. Donnah Nickerson-Reti, MD says:

    I have several comments to make regarding the DSM approval. Let me tell you where I am coming from when I comment on this. I am a neurodevelopmental psychiatrist. I am also a woman who has Asperger’s Syndrome. I am the parent of a child with Asperger’s and am married to a man on the autism spectrum. At least 70% of my private practice has been devoted to caring for people with Asperger’s and autism. I, and many of my colleagues do not agree that these hotly debated diagnostic entities (particulalrly Asperger’s) should be lumped into the overarching category of Autism. This is not a matter of one entity being more or less severe/mild than the other. It has to do with the actual nature of the disorders. They are different.
    The group who write the DSM had the opportunity to listen to leaders in the field of autism and Asperger’s Syndrome. It does not appear they were interested in real world experience or rigorous examination. In the reports I’ve read,their field trials are seriously flawed. Some of the psychiatrists who were initially on the panel actually left due to disagreements with the lack of scientific and clinical thoughtfulness. People like myself wrote to them directly offering our insights, but they were not interested in hearing from highly trained people in their own field who actually have these disorders. The sections on Autism and Asperger’s are not the only sections that reflect politics rather than clinical and scientific honesty in the final decisions regarding diagnostic definitions. It is a real shame that publishing deadlines and ignorance were the guiding principals behind what will appear in the final edition of the fifth version of this manual.

    The panels that worked on the most egregiously screwed up sections of the new manual should get out more into the clinical world. I am outraged that they could make claims that the new changes will not adversely affect patients, especially students trying to obtain special education services. I have spent a goodly amount of time at school meetings with my patients and their parents. I can assure you, there are huge numbers of cash-strapped school districts, my own probably tops the list, salivating over this good news. Despite the fact that no formal diagnosis is actually required for a child to receive sp. ed. services, most schools do go down that path. As a result of the changes they are making to the DSM, there will be huge numbers of children who will now be denied the special education services they need, and I daresay many will have their services taken away. Adult patients who met criteria (not “qualify” as stated in this article – we’re not talking about getting a loan or applying to college here! the word qualify implies some sort of merit basis) for Asperger’s will not meet the criteria of the new autism definition, and their job protections under the ADA and Section 504 will indeed be affected, as will be the families who are dependent on them.

    I also want to add that of the approx. 45,000 psychiatrists in the USA, the APA only represents approx. 36,000 of them and I don’t believe the board of directors and work groups who wrote the new manual actually checked with many psychiatrists practicing who see real world patients. They will say that they did field trials which confirmed their decision, but the trials were too small and seriously flawed.

    Lastly, remember this: the DSM (any version of it) is not a book you need to pay attention to. The new manual will only help people more “accurately and consistently diagnose children with autism” as they themselves have now defined it, not in any clinically truthful or accurate sense. I would urge everyone to use an alternative source such as the ICD for coding purposes, or just refuse to participate in the whole charade by not using codes at all. Give them respect when they have done work worthy of it.

  5. Donnah Nickerson-Reti, MD says:

    Thank you A. Harris for making the point you did. Psychiatry, Psychology, and societies keep changing the terminology as you say. Each new euphemism for the same objective criteria merely adds another word that can be perverted for the sake of devaluing other people. I think that our government actually contributes to the problem of stigmatizing mental illness. Re-naming patients as “consumers” suggests that mental illnesses and mental health patients don’t deserve the status of ‘patient’ in the same way that someone with cardiac disease would be; rather that the illness should be kept under wraps. Stigma will never disappear with that kind of attitude. Thanks again A. Harris for talking aout this.

  6. vmgillen says:

    @Dr. Nickerson-Reti,

    Surely you recognize that the DSM is THE tool for insurance codes, so in the real world of Pt Tx no one can ignore it. All your other comments are on the money.

  7. JCP says:

    A.Harris: Why don’t you get it yet? It doesn’t matter what the intention was when the term was established. “It’s not the term that offends.” Really?? It certainly DOES offend! It has become emotionally charged over time, it hurts people, and for that reason we need to stop using it. It’s that simple. It’s called empathy and respect for others!

  8. Whitney says:

    People look at Ken and Barbie dolls at the idea humans. I know few people in Texas who believe the government has the best interest people with disabilities at heart. I agree with the some of posts but realize this it not only affects special education but also disability services such as Social Security. Dr. Nicholson-Reti there is far more implications that are wide reaching.

  9. Donnah Nickerson-Reti, MD says:

    responding to vmgillin: The DSM is only ONE of the coding options. In my private practice, I have always refused to participate in the insurance panels (in order to maintain a privacy firewall for my patients), but I will fill in forms that my patients can submit if they wish. There are other coding books, such as the ICD-10, that are used by medical people for such purposes. The ICD coding is not a servant of the DSM work groups; so, while not perfect either, it is indeed an acceptable alternative.

    responding to JCP: A descriptive word is no more than just that. Any word can be perverted and co-opted by people with malicious intent. Just because people have done so with the descriptive diagnostic term “mental retardation” doesn’t mean that we should stop using the term for its intended descriptive purpose. For medical purposes no one uses that term with anything other than the clinical meaning and purpose intended. The offensive nasty people who demean others with words use spin-off terms such as ‘tard’, ‘retard’, and the like. They also use words like ‘spaz’ which got its start from the medical term spastic. Should we encourage the neurologist to wipe that word from use as well even though it has a perfectly appropriate descriptive use in medical communication? Should we rename schizophrenia just because the word ‘schizo’ has come into use as a derogatory. Any word can e taken and used by people who are so inclined, to demean others. Think about the innocuous word ‘tool’, a perfectly useful and descriptive term. It is used by adolescents all across the country to belittle and demean peers who they dislike. In short, replacing the descriptive term ‘mental retardation’ with an even less accurate term like “intellectual developmental disorder” isn’t going to change the underlying problem of hate. Pretending that it could will only allow the underlying problem to stay hidden and grow.

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