DSM-5 and a New Take on Autism Spectrum Disorders

DSM-5 and a New Take on Autism Spectrum Disorders

                The American Psychiatric Association (APA) adopted the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in May 2013.  The DSM is the tool that is used to develop consistent diagnoses of disorders and conditions by mental health clinicians.  One area of significant change in the fifth edition of the DSM is to Autism or Autism Spectrum Disorders (ASD).  In the previous edition of the DSM, there were four separate disorders: Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder- not otherwise specified.

As many of the disorders overlapped or had unclear differentiations from one another, there was concern about how consistently the diagnoses were being applied across different practitioners.  A team of doctors recommended to the APA the use of a single umbrella category, Autism Spectrum Disorder to be a better reflection of current knowledge about Autism.  Rather than having a separate diagnostic category, people who meet criteria for ASD will be described as having symptoms that fall along a continuum of ASD.  Further distinctions will be made based on severity levels as some individuals will have very mild symptoms, whereas others will have severe symptoms.  This continuum will allow clinicians to account for the differences in symptoms and behaviors from person to person.  Rett’s Syndrome was eliminated from the DSM-5.

The diagnosis of Autism is based upon impairments in social communication and interaction and by restricted, repetitive and stereotyped patterns of behavior.  The DSM-5 identified new criteria for Autism Spectrum Disorder and all four must be met in order to make a diagnosis of ASD.

  1. Persistent deficits in social communication and social interactions across contexts, not accounted for by general developmental delays and manifested by all 3 of the following:
    1. Deficits in social-emotional reciprocity (lack of back and forth interaction)
    2. Deficits in non-communicative behaviors used for social interaction (facial expressions or gestures)
    3. Deficits in developing and maintaining  relationships appropriate to developmental level (difficulty making friends)
  2. 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

2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal

behavior, or excessive resistance to change

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of

environment (such as adverse reactions to sound or textures, seeming to be

insensitive to pain, or fascination with lights or spinning objects)

 

  1.  Symptoms must be present in early childhood (but may not manifest fully until social demands exceed limited capacities)
  2.  Symptoms together limit and impair everyday functioning (American Psychiatric Association, 2013).

The changes listed above will significantly alter clinical practice.  Clinicians should be mindful of and educated around these changes to the DSM-5 to ensure they are making accurate diagnoses.  This is ever so important as determining an accurate diagnosis is the first step for a practitioner in defining a treatment plan for a patient.

Sharon Kirkland, LMSW

http://lcswsupervisors.com/members/sharon-kirkland

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