Although AS was introduced as a discrete diagnostic category in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4, 1994), almost 20 years later, its diagnostic label was removed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), and it was encompassed in a more general category of autism spectrum disorders (ASD). Since then, AS has always been a topic of significant interest and debate. This is the seventh part of our series Matters of the Mind.Asperger syndrome (AS) was first described by Hans Asperger in 1944, as the behavioral characterization of individuals who have difficulties in communication and social interaction. For now at least, autism diagnosis remains an art rather than a science. In a revealing commentary, the DSM-5 neurodevelopmental disorders work group wrote of the need to evaluate DSM-5 against “the true gold standard of expert clinical diagnoses”. More than anything, the DSM-5 debate highlights the subjective and somewhat arbitrary nature of autism diagnosis and definitions.
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Diagnosis is a means to an end and the proposed changes still allow a lot of flexibility in interpretation. As a number of practising clinicians have told me, their main objective is to address the person’s needs. A welcome change from previous editions is that DSM-5 will be regularly updated, so we can look forward to bug-fixes in DSM-5.1.Īnd despite all the fuss, it’s possible that nothing much will change. However, the true consequences may not become apparent until after the manual comes into force.
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Official “(]()” of the DSM-5 are currently underway. DSM 5.xĬlearly, the issues surrounding autism and the DSM-5 are far from settled. Thirty-four of the children received a DSM-IV diagnosis of PDD-NOS, but only half of these met criteria for Autism Spectrum Disorder in the DSM-5. Rather than recoding old data, they used DSM-IV and DSM-5 criteria to assess 132 children referred to their diagnostic team. Perhaps the clearest evidence to date comes from a relatively small study, conducted by Vicki Gibbs and colleagues at Autism Spectrum Australia. The same recoding process also gave the majority of non-autistic children an autism spectrum disorder diagnosis. The Cornell group recoded information from two “gold standard” diagnostic tools and, in contrast to the Yale study, found that 96% of children originally diagnosed with Asperger’s or PDD-NOS would meet DSM-5 criteria for autism spectrum disorder.īut again there are concerns. More recently, a paper published by Marisela Huerta and colleagues at Cornell University reached very different conclusions. However, the Yale study’s recoding is problematic because the items in the new DSM-5 criteria don’t neatly map onto the questions that were asked during development of the DSM-IV.Ī/Prof James McPartland discusses autism prevalence, what’s known about causes and changes to the DSM. By recoding data collected during the development of the DSM-IV, they determined that many kids diagnosed with Asperger’s or PDD-NOS would not meet the new DSM-5 criteria. These fears appeared to be confirmed by a study published earlier this year by James McPartland and colleagues at Yale University. They might qualify for a new diagnosis, social communication disorder, but there are currently no guarantees that assistance will be available for people with this diagnosis. Under the DSM-5, they would probably miss out. Under the DSM-IV, they qualify for a diagnosis of PDD-NOS. In a 2011 (, Will Mandy and colleagues at University College London identified a subgroup of children who experience serious social and communication difficulties but don’t show repetitive or restricted behaviours.
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But there are genuine concerns that some people, particularly those with Asperger’s or PDD-NOS, may miss out on a diagnosis - and access to the support they need. Most researchers agree the changes make sense, at least in theory.
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The DSM-5 brings two major simplifications: the three diagnoses will be rolled into a single diagnosis, autism spectrum disorder and social and communication difficulties will be merged into a single category. Three different clincians can give three different autism-related diagnoses to the same child.