January 22, 2012

Autistic Alterations

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Reviewed by: 
Joseph V. Madia, MD By:

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Autism spectrum disorders definition under review by the American Psychiatric Association

(dailyRx News) Some of those currently considered to be suffering from varying autism spectrum disorders (ASD) may be classified with new criteria in the next few months, according to new reports.

As the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is underway, the top minds in medicine recommend a more stringent analysis before classifying autism.

"Talk to a doctor if your child shows signs of autism."

“The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions for children who suffer from autism spectrum disorder,” states James Scully, M.D., Medical Director of the American Psychiatric Association (APA).

The alterations would change criteria from a simple “yes” or “no” to a rating scale of symptoms from mild to severe.

Moreover, the proposal compounds previously separated diagnoses such as Asperger’s, autistic disorder, childhood disintegrative disorder, and pervasive developmental disorder into the general category of autism spectrum disorders.

An expert panel at the APA reassessed guidelines while working on the DSM-V. Although decisions from their meeting are not yet final, the APA reports, “the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis.”

Current field tests do not anticipate a change in the number of individuals receiving care for ASD; however concerns are readily apparent. The Association for Psychological Science released a press release highlighting the work of Morton Gernsbacher, Ph.D., an expert on autism and professor at the University of Wisconsin-Madison.

Dr. Gernsbacher wrote a report in 2005 addressing the increases in the diagnosis of autism in recent years, providing “Three Reasons Not to Believe in an Autism Epidemic.”

Within the report, the doctor and her team explain that the uprise could be associated to a number of reasons including broadened diagnostic criteria, the inclusion of autism in special education categorization, and an overall increase in public awareness.

The doctor believes that all of those who need help should be granted access to a support network. She notes, “I hope that the new DSM-5 criteria don’t make that more difficult.”

dailyRx contributing expert Robert Pressman, Ph.D., Director of Research at the New England Center for Pediatric Psychology, shares similar concerns.  He explains," Whether or not the new structure of the diagnosis for autism expands or contracts the number of children who qualify is not as important as what diagnostic categories are developed to include children with significant symptoms that may fall out of the new autism diagnosis."  

Dr. Pressman reminds dailyRx readers that the DSM is merely a descriptive manual grouping symptoms into categories called disorders.  The sorting process involves a panel, primarily filled with practicing psychiatrists, that votes on its contents.  

"The significance of this manual is that the diagnosis, not necessarily the symptoms, become the basis of insurance and agency reimbursement," Pressman extrapolates. "The problem is most acutely felt in the area of pediatric diagnoses.

"Only about 10% of the material in the DSM is given over exclusively to children, leaving a small field within which the child practitioner may work. In the final analysis, the clinician is concerned about dysfunction—how symptoms may effect a person’s ability to integrate into society." 

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
January 20, 2012

Last Updated:
January 22, 2012