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Will New Diagnostic Criteria End the “Autism Epidemic”?

Will New Diagnostic Criteria End the “Autism Epidemic”?
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A proposed new definition of autism is sure to spark an outcry among parents, professionals and many currently diagnosed with Asperger’s Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). An expert panel appointed by the American Psychiatric Association is currently reviewing the new definition, which is to appear in May of 2013 in the fifth edition of the†Diagnostic and Statistical Manual of Mental Disorders, the standard reference for mental disorders in the US.†DSM criteria are used in making decisions about research studies, insurance coverage and treatment decisions, so these changes could have a very real impact on people’s lives.

Changes in Diagnostic Criteria and the “Autism Epidemic”

Diagnoses of autism, once considered an extremely rare condition, as well as of related conditions including PDD-NOS and Asperger’s Syndrome, started to increase significantly in the 1980s. Autism is now said to occur in 1 to 100 individuals according to figures from the Center for Disease Control and Prevention; a recent study of school children in South Korea found an even higher rate of 1 in 38 children meeting diagnostic criteria for autism. On seeing such high rates in a condition once estimated to occur in 1 in 10,000 children, some have declared an “autism epidemic.” Some have speculated that various environmental causes were the reason while others have pointed to the expanded diagnostic criteria.

The †diagnostic criteria for autism were significantly broadened in the 1987 DSM-R; a child now had to display 8 out of 16 criteria in the areas of social and communicative impairment and in repetitive behaviors. The DSM-IV (1994) and DSM-IVR (2000) specified that a person had to present with six out of twelve criteria in such areas.

New Proposed Criteria Could Exclude Many Now Diagnosed With Autism, PDD-NOS, Asperger’s

The new proposed criteria in the DSM-V introduce a new diagnosis, autism spectrum disorder, that will encompass a number of current diagnoses, Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The†proposed definition can be seen as making the criteria for diagnosis more precise, as they require that†an individual present with†three deficits in social interaction and communication specifically and at least two repetitive behaviors, to receive an autism spectrum disorder diagnosis.

The first study about the proposed †DSM-V criteria have indeed been found to be likely to exclude many who are now diagnosed with autism or related conditions. The “vagueness” of the DSM-IV criteria have, it is thought, led to too many being dignosed with autism. The†New York Times summarizes the study:

In the new analysis, Dr. [Fred R. Volkmar, the director of the Child Study Center at Yale University School of Medicine], along with Brian Reichow and James McPartland, both at Yale, used data from a large 1993 study that served as the basis for the current criteria. They focused on 372 children and adults who were among the highest-functioning and found that over all, only 45 percent of them would qualify for the proposed autism spectrum diagnosis now under review. The focus on a high-functioning group may have slightly exaggerated that percentage, the authors acknowledge.

The likelihood of being left out under the new definition depended on the original diagnosis: About a quarter of those identified with classic autism in 1993 would not be so identified under the proposed criteria; about three quarters of those with Aspergerís would not qualify; and 85 percent of those with P.D.D.-N.O.S. would not.

The researchers are undertaking a broader analysis that will include 1,000 cases.

All of this may seem overly academic. But the DSM is not called a “Bible” for nothing.

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Photo by Richard Masoner via Wikimedia Commons

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43 comments

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11:20AM PST on Jan 18, 2014

My 14 year old son has Autism.

12:09AM PDT on Oct 13, 2012

"DSM4 gave autism purchase by introducing a milder form that is close to the extremely populous boundary of normality. Then autism took flight on the wings of definitional diffusion, internet contagion, financial incentive, and naïve interpretation of epidemiological results.
The autism “epidemic” is set to spread further starting in May 2013, when the next revision of the diagnostic manual (DSM 5) will be published. The DSM 5 definition of an “autistic spectrum” will cast an even wider net, capturing many people now considered to be normal or to have another disorder" Dr. Allen Frances, former chairman of the current DSM4, Professor Emeritus of Psychiatry
(regarding DSM5) "And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.’ Simon Wessely, Institute of Psychiatry, King's College, London
“Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM4 [and ICD-10] are terms arrived at through peer consensus.” Tana Dineen, Psychologist

10:27AM PDT on Mar 16, 2012

i will stand up and fight and b a voice for those who cant b their own.... thank you soooo much Leslie G. for sharing my petition i have psychiatrist who have sign and know and understand what these changes will not cover Def need more ppl to step up and sign my petiton again ty ty soooo much Leslie G. for sharing its very much appriciated by me, my family (2 of my 4 children are autistic)

3:22PM PST on Feb 26, 2012

Thank you for the interesting article. To Linda C. I just signed and shared your petition and was sad to see there were not many signatures on it. Any one with concern please sign Linda C.'s
petition at http://www.the petitionsite.com/1/Autism-and-other-medical-disorders-dsm/
Thanks!

6:48AM PST on Feb 25, 2012

I feel very fortunate that neither of my daughters is autistic, but I've met mothers of autisic kids and they have spent a lot of time, effort and money trying to help and understand their kids. For good or ill these new standards just seem like another issue many parents will have to deal with.

8:28AM PST on Feb 24, 2012

I'll bet $$ is behind it.

8:14AM PST on Feb 24, 2012

I agree unfortunately there is always an underlying agenda, I'd hazard a guess it has to do with money. In schools it always has to do with money. The standardized testing for instance is a big money maker for a select few!!! It will be hard to get rid of. Politically it's going to bevery enticing to go with a diagnosis that will significantly reduce what it costs to fund special ed. in schools.

8:12PM PST on Feb 17, 2012

"Gaming the system"? As if there were a plethora of fantastic services already available that these 'greedy' parents were seeking to exploit! The mental health services in this country are absolutely abysmal, and once that child ages out and turns the magic age of 21, be prepared for next to nothing. Just who specifically is behind all these altruistic diagnostic changes, I have to wonder... could it be a way of cleverly disguising cutting services to this needy group. As to whether children with Autism/PDD actually exist, you don't need to be a psychiatrist or need any scale to measure. Just walk into any classroom and observe. It is eye-opening.

1:10PM PST on Feb 7, 2012

these changes will effect appx 1.5 million ppl please go to my link http://www.thepetitionsite.com/1/Autism-and-other-medical-disorders-dsm/
and sign the petition the move signatures i get the better voice i will have please help stop those changes i have 2 children that it will affect all help and support is appriecitated please also pass it along to other you know lets make more ppl aware of the situation

4:24AM PST on Jan 27, 2012

Does this mean that people who were diagnosed with Asperger's now have to be re-evaluated to see if they still meet the criteria.

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Kristina Chew Kristina Chew teaches ancient Greek, Latin and Classics at Saint Peter's University in New Jersey.... more
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