As many of you know, the American Psychiatric Association is in the process of revamping the DSM - the diagnostic manual that names and describes the symptoms of mental, neurological and developmental disorders for practitioners in the United States and, to some degree, in other nations. The present criteria for Autism Spectrum Disorders are in for some huge changes if the proposed criteria are approved. Some of these changes include the removal of the categories Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) and Asperger Syndrome. The new criteria for Autism Spectrum Disorder are quite different, too: many people who were once included in that group will no longer fit the criteria.
Meanwhile, a whole slew of new and related disorders and categories are listed, including, among others:
- A 00 Intellectual Developmental Disorder
- A 01 Intellectual or Global Developmental Delay Not Elsewhere Classified
- A 02 Language Impairment
- A 03 Late Language Emergence
- A 04 Specific Language Impairment
- A 05 Social Communication Disorder
- A 06 Speech Sound Disorder
- A 07 Childhood Onset Fluency Disorder
- A 08 Voice Disorder
You'll want to explore the entire proposed DSM-V, but for now you may be interested in the criteria for Autism Spectrum Disorder, below. As you'll see, the emphasis is on perseverative and repetitive behaviors - and there is some very odd language that seems to suggest that a person with "general developmental delays" may not also be eligible for an autism diagnosis. From what I can tell, my son - who has significant language and social communication issues but few perseverative or repetitive behaviors, and presently has a PDD-NOS - will no longer fit into the autism category. He may, instead, wind up with a Social Communication Disorder diagnosis.
If you're like me, you're teeming with questions. Will my child (or I) need to be rediagnosed? If so, what will a different diagnosis mean to me or to the services, treatments and educational program I now have in place? If I have Asperger syndrome, will I now be "autistic?" Or will I fit into a completely different category? If my child has anxiety in addition to autism spectrum symptoms, will he be dually diagnosed? I have requested an interview with a representative of the committee, and hope to find out much more about the new criteria and what they will mean to us. This is just the first of many blogs and articles I'll be writing on this topic!
Proposed New Criteria for Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.