One of my concerns in reading the new diagnostic criteria is that people with Mental Retardation (also called Cognitive Delays) seem to be pushed out of the autism spectrum and into very different diagnostic categories. It's a little unclear as to how such people might be recategorized - or what such recategorization might mean.
For example, the wording preceding criteria for the autism spectrum disorder describes: "Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays." There are two new categories, Intellectual Developmental Disorder and Intellectual or Global Developmental Delay Not Elsewhere Classified.
To find out more about the APA's plans, I emailed with Dr. Bryan King of the Neurodevelopmental Disorders workgroup.
My Question for Dr. King
There seems to be a desire to remove people with "Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays" from the ASD category. Does this mean that a child with Mental Retardation (also called Intellectual Delays) no longer qualify for an Autism Spectrum diagnosis? Would that person wind up dually diagnosed with Intellectual Development Disorder and social communication disorder rather than with an ASD diagnosis?His Response
There is no explicit desire to move anyone in to or out of specific diagnostic groups, however, by creating more specificity we believe that people may be given diagnoses that better capture their individual conditions. The qualifier above about general developmental delays ensures that the social communication deficits are more specific, and also potentially allows for earlier diagnosis if appropriate.
Just as typically developing infants and toddlers are able to engage in very rich social communication and interaction across contexts, appropriate to their developmental level, so too most individuals with intellectual delays or disabilities are also able to communicate. On the other hand, significant deficits in social communication in toddlers may suggest the presence of autism. What the criterion above is meant to ensure is that clinicians take into account what is typical in terms of social communication abilities at a given age or developmental level, and not assume, for example, that a lack of social perception in a teenager with intellectual disability not automatically suggest the presence of autism. As is currently the case, some individuals with Down Syndrome may also meet criteria for autism; but most will not.
