For the first time in more than a decade, a new version of the Diagnostic and Statistical Manual of Mental Disorders will be unveiled this weekend and with it comes major change to the way autism is diagnosed.
The American Psychiatric Association is releasing the fifth edition of the DSM at its annual meeting beginning Saturday in San Francisco. The new version marks the first major update since 1994 of the so-called psychiatric bible which is relied on by everyone from mental health professionals to researchers and insurers to determine what symptoms merit a diagnosis.
Among the most controversial changes to the manual is its updated definition of autism. The psychiatric association decided to eliminate the diagnosis of Asperger’s syndrome and instead fold it as well as childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified into the broader category of “autism spectrum disorder,” with clinicians indicating a level of severity.
Changes were also made to the way autism will be diagnosed, which led to concern that some with the developmental disorder could lose the label entirely and, with it, needed services.
In an effort to quell such worries, the new DSM includes a note specifying that “individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder,” according to an advance copy of the autism entry provided to Disability Scoop.
Nonetheless, even as the new edition is going to press, pushback continues. A new book from Allen Frances, a psychiatrist who led the task force responsible for the previous version of the manual, is critical of the DSM-5.
And, just weeks ago, Thomas Insel, director of the National Institute of Mental Health wrote of the DSM that “patients with mental disorders deserve better.” Insel said that his agency would be moving away from the manual’s classification system and looking to more scientifically verifiable standards for research going forward.
Subsequently, Insel appeared to soften his tone, issuing a joint statement with the American Psychiatric Association indicating that the DSM in addition to the World Health Organization’s International Classification of Diseases offer “the best information currently available for clinical diagnosis of mental disorders.”
Those behind the DSM revision say that it is research-based and the product of a transparent process. There were three open-comment periods while the manual was under development, which drew more than 13,000 responses, officials from the psychiatric association said.
“The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care,” said David J. Kupfer, chair of the DSM-5 Task Force.
Beyond the autism updates, the new manual will include a far less controversial change to its listing for “mental retardation,” replacing the term with the more commonly accepted “intellectual disability.” Additionally, plans called for the diagnosis to be adjusted to put less emphasis on IQ score and allow more consideration for clinical assessment.