Last month the American Psychiatry Association (APA) published the most recently revised edition of the Diagnostic and Statistical Manual of Mental Health Disorders which has been commonly referred to as the ‘bible of mental health disorders’. This latest edition revised and revamped its 18 year predecessor including changing the way the ranges of Autism were categorized and diagnosed. This included omitting Asperger’s and PDD-NOS as individual categories and placing them under the broader concept of Autism Spectrum Disorder. This new category groups autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder.
While there are numerous benefits to this change, there are still some major concerns that need to be evaluated. The psychiatric association say they are leaving nothing as the final word on the DSM diagnostic criteria nor are they setting the diagnoses in stone.
It is estimated that 60% of the people who previously qualified as having autism as categorized by the DSM-IV will be eligible based on the current revised version. For people who have struggled to get funding and acknowledgement, this may not be positive. However, the new criteria should make it easier to get diagnosed. Doctors will now consider the patient’s history instead of just looking at current behavior so someone who ‘gets better’ can still be eligible for mental health services.
The concerns began at the announcement of the changes that were to be made to the DSM-5, and they have continued even after the edition was published last month. Individuals remain concerned that they will lose their original diagnoses, and that since autism is a disorder that is often thought to mean profound disability, the public’s perception of autism may be affected. But the APA has structured the new diagnoses in such a way that it will not just pack all the cases together. Instead, it includes new qualifiers and severity levels that are designed to capture the wide range of symptoms.
The qualifiers include intellect disability, language ability and regression while the severity levels range from 1 to 3. For the moment it is unclear how this may affect the autistic community since in an evaluation it is now possible to be diagnosed with varying qualifiers at varying severity levels. It will ideally however, allow clinicians to identify opportunities for intervention.
This change can broaden the scope of people considered under the general diagnosis of ASD. For instance, individuals with Asperger’s or with PDD-NOS who were previously excluded from certain goods and services, will now be included. But in cases where diagnoses are covered but are not tied to the DSM risk confusion may fade from use. This however raises another concern. Will it be too broad a scope? With the severity level being based on the current physician’s opinion rather than on predefined presets, what assurance is there that these diagnoses will be fair and accurate ?