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Jerry Webster

Autism and the DSM V

By January 21, 2012

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The New York Times published a front page article "New Definition of Autism Will Exclude Many, Study Suggests" Thursday (January 19, 2012,) ABC News picked it up and it's been splashed all across the media.  Ironic, since I addressed the proposed changes in February of 2010, and our former Autism Guide, Lisa Jo Rudy, wrote an article about the changes last July.

The DSM V is the yet (2013) to be published Diagnostic and Statistical Manual, the handbook for diagnosing psychiatric and psychological illness or disorders.  The latest iteration was the DSM IV TR (Diagnostic and Statistical Manual Four, Text Revision) published in 2000.  Considered the "Bible" of diagnosis, a DSM diagnosis is required for medical reimbursement for services provided by insurance companies.  The DSM IV is also used to identify children for the purpose of identifying their disabilities in their Evaluation Report, and to provide services through and Individual Education Plan (IEP.)

I have reported here, as has the national media, new prevalence levels for Autism, which have risen to as much as one in 80, or one in 110, depending on the organization collecting the data.  In a presentation, reported by the New York Times, experts proposed that the new definition will narrow the number of children who have diagnoses of Autism.

Currently, there are separate categories for Autism, Aspergers Syndrome, and PDD-NOS (Pervasive Developmental Disability, Not Otherwise Specified.)  The new Diagnostic and Statistical Manual will put all three into the "Autism Spectrum Disorders" category.  There is currently no consensus as to the outcome in terms of the number of diagnoses.  I know that PDD-NOS was being dropped as a category, but is still sometimes used because students with spectrum disorders may have such irregular clusters of abilities and disabilities, that some children with ASD's don't classically fit into Autism but they have deficits which cause significant social and academic difficulties.

Certainly, the woman in the article who was concerned that her daughter might lose her diagnosis was not informed that significant social and academic difficulties would probably remain part of the differentiated diagnosis.   There is no question that some higher functioning students may drop out of this category:  will there be a place in other behavioral disorders for those who are most challenged?

The other wrinkle is that Autism has in some ways become the "Disability du Jour."  I remember a time 30 years ago when dyslexia was the answer to all academic difficulties; not immaturity, cognitive disabilities, or attention deficit disorder.  In the same way, children with significant behavioral problems were lumped, at an early age, as autistic or the emerging category, bipolar disorder.   Having spent part of my summer in an early intervention program, I have to wonder whether some children with learned maladaptive behaviors are being diagnosed with autism.

Comments

January 22, 2012 at 1:57 am
(1) Sandy says:

It all depends on what aspect one looks at with the change in the DSM. Since this is Special Education topic, it only makes sense to address that. There is a difference between an educational label of which public schools use, and a medical diagnosis. In some states, it doesn’t matter if the child had a PDD-NOS diagnosis, the school termed the IEP Developmental Delay until the age of 9. Some states simple term it a speech IEP. The only states of which the new version of the DSM will effect is those who have regional centers, and even before the new DSM, those states had issues to begin with.
Public schools don’t use the same criteria as medical does, because schools are not medical. If a child doesn’t fit under the ASD criteria for a IEP, they can always place them under OHI. Those who are higher functioning with out academic delays have always had a more difficult time having an IEP and not a 504.
Above anything else with the new DSM, every person with a diagnosis would require a medical evaluation to determine where they best fit. Since all children do progress, often they would land in a different category. Every child now with a diagnosis would have to be re-evaluated/ diagnosed. The autism rates simply wont decrease once the DSM is released. Every single state would have to alter their criteria for an educational label.

April 14, 2012 at 11:31 pm
(2) circulation sanguine says:

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