1 December 2012
Dear friends and colleagues,
Today, the American Psychiatric Association voted to accept the revised fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The manual – used by clinicians nationwide to diagnose mental health conditions – will be published in spring 2013.
The revision introduces two fundamental changes in the diagnosis of autism spectrum disorder. First it collapses previously distinct autism subtypes – including autistic disorder and Asperger syndrome – into one unifying diagnosis of autism spectrum disorder (ASD).
Second, the current three symptom domains of social impairment, communication deficits and repetitive/restricted behaviors will become two – social communication impairment and repetitive/restricted behaviors.
These changes have a strong scientific rationale. However, they are more than an academic exercise. They will impact how ASD is diagnosed, can affect access to services and will influence how the prevalence of ASD is measured. Thus, over the past year, we’ve had good reason to closely monitor and provide feedback to the DSM-5 committee that oversees the proposed DSM revisions. Throughout the year, we’ve communicated directly with the revision committee – conveying our concerns – indeed, our insistence – that the DSM-5 not result in the denial of autism-related services to any who need them. (See Autism Speaks’ letter to the DSM-5 committee here.)
We’ve closely monitored the results of early studies evaluating the new diagnostic criteria. These studies included the recently published first field trial. It suggests that the revisions increase the reliability of diagnosis, while capturing the vast majority of those who would have been diagnosed under the DSM-IV. Of the small number of individuals excluded, most received the new diagnosis of “social communication disorder.” (See comments on the field trial and all our DSM-5 updates here.)
Today, after careful consideration, we are acknowledging the APA’s approval of the DSM-5 with cautious optimism. Going forward, it will be crucial to study how the new criteria function in real world community settings. For example, the field trial was conducted with school age children, primarily of Caucasian background and evaluated by specialists in academic centers. As such, we need more information about how the new criteria will affect children from more diverse ethnic backgrounds in community settings. To this end, in collaboration with the Centers of Disease Control and Prevention, Autism Speaks is funding a study comparing the DSM-IV and DSM-5 criteria in a large ethnically diverse community-based sample of children in South Carolina. This is in addition to another community study comparing the two sets of criteria with children in South Korea. We also need to conduct research that examines how the criteria affect diagnosis of ASD in both younger children and adults.
We are reassured that the DSM-5 committee has stated that all individuals who currently have a diagnosis on the autism spectrum, including those with Asperger syndrome, will be able to retain an ASD diagnosis. This means that no one with a current diagnosis on the autism spectrum should “lose” their diagnosis because of the changes in diagnostic criteria. Also, the committee has stressed that the new DSM-5 criteria represent a “living document,” in which changes can and likely will be made as new studies are conducted. As always, we will remain in close communication as this new information becomes available. Please let us hear from you. (Contact information here.)
Geraldine Dawson, Ph.D.
Chief Science Officer, Autism Speaks