Monday, February 25, 2013

Article # 324. DSM 5 and its implication to Autism Spectrum Disorders (ASD)



DSM 5 and its implication to Autism Spectrum Disorders (ASD)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), also known as the ‘bible of psychiatric diagnosis’ has been approved last month. Although the actual publication will not be until May of this year, the revisions seems to be final.
Along with this new revision is a major overhaul of the diagnostic criteria and a new conceptualization of Autism Spectrum Disorders (ASD). The proposed changes have been based on a large body of research and have been discussed by qualified professionals. They are aimed to improve the diagnosis for ASD and to aid professionals to give specific interventions to specific needs of each individual.
Here are the changes:
1. A blanket term of Autism Spectrum Disorders will be used. Asperger’s Syndrome and Pervasive Developmental Disorders Not Otherwise Specified (PDD-NOS) will be removed- The DSM-5 panel decided to remove the sub-categories of ASD since there is no sound evidence to suggest that there really is a need for them. For instance, people with Asperger’s Syndrome and High Functioning Autism are not substantially different from one another, i.e. their symptoms overlap a lot. Additionally, PDD-NOS is not very clear and diagnosis varies from one professional to another- you can be diagnosed with PDD-NOS with mild symptoms or only one or two symptoms.
It is important to note that people who are currently diagnosed as having Asperger’s Syndrome  and PDD-NOSwill be given a new diagnosis after re-evaluation. I personally believe that this change will have a significant effect on people with AS and PDD-NOS since a large number of them identify greatly with their diagnosis (although some welcome the change).
2. No longer a TRIAD of IMPAIRMENTS: Most of the literature in Autism describe it as having three main symptoms: Communication impairments, Limited Imagination and Repetitive Behaviours, and Impairments in Social Interactions. In the DSM-V however, it is reduced into two. Firstly,  Social and Communication Domain- which combines social interaction aspects and verbal/ non-verbal communication aspects. Secondly, Restricted and Repetitive Interests and Behaviours, which includes  ’Stereotyped and Repetitive Speech’ and ‘Hyper- or Hypo-Sensitivity to Sensory Aspects of the Environment’. It is important to note that deficits in each of these areas must be ‘impairing’ before one can be diagnosed with Autism.
3. Symptoms may not fully manifest until demands exceed capacity: Although the DSM-V requires most symptoms to be present in early childhood (before age 3), it also acknowledges that children may not have other symptoms because of their environments, or any other reason.
4. Clinicians should include Specifiers: Along with an ASD diagnosis, clinicians will be asked to include a description of each children in order to monitor the onset and (if applicable) the progression of each determinants. Specifiers include Intellectual Ability, Language Competence, Motor Co-ordination, difficulties in Literacy/Numeracy, and other disorders.