The American Psychiatric Association’s draft proposed diagnostic criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) will include new categories for learning disorders and a single diagnostic category, “autism spectrum disorders” that will incorporate the current diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified).
The DSM is the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes. The APA today announced many of the proposed diagnostic criteria, which will be available for public comment until April 20. The proposed criteria will be reviewed and refined over the next two years. During this time, the APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real-world clinical settings.
The DSM-5 Neurodevelopmental Work Group members have also recommended that the diagnostic term “mental retardation” be changed to “intellectual disability,” bringing the DSM criteria into alignment with terminology used by other disciplines and the Department of Education. In addition, the Work Group is recommending that there be only one diagnosis for intellectual disabilities, with severity defined not only by IQ, but also by impairments in adaptive functioning.
“In suggesting these revisions, the work group has considered the many advances in the field of autism and neurodevelopmental disorders, as well as the concerns of advocacy groups, family members and the medical groups who treat those living with autistic disorders,” said David Kupfer, M.D., chair of the DSM-5 Task Force.
The proposed revisions to the neurodevelopmental disorders in DSM-5 also include a new overarching category of learning disabilities, containing two subcategories: dyslexia (related to reading) and dyscalculia (related to mathematics). Edwin Cook, M.D., a member of the DSM-5 Neurodevelopmental Disorders Work Group, emphasized that the diagnostic criteria were related to a person’s age, intelligence and opportunity to acquire skills, and that individually administered, culturally appropriate and valid measures should be used to evaluate the learning disabilities. “It’s important that we differentiate between the presence of a learning disability and the expected variations in individual abilities,” Dr. Cook said.
The recommended DSM-5 draft criteria for autism spectrum disorders include a new assessment of symptom severity related to the individual’s degree of impairment. The draft criteria also specify deficits in two categories: 1) social interaction and communication (e.g., maintaining eye-to-eye gaze, ability to sustain a conversation and peer-relations) and 2) the presence of repetitive behaviors and fixated interests and behaviors. Additionally, in recognition of the neurodevelopmental nature of the disorder, the criteria require that symptoms begin in early childhood. Clinicians must take into account an individual’s age, stage of development, intellectual abilities and language level in making a diagnosis.
“The recommendation of a new category of autism spectrum disorders reflects recognition by the work group that the symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders,” said Dr. Cook. In addition to specifying a range of severity of ASD, the criteria will include description of the individual’s overall development, course (e.g. regression), and language. “We expect that the proposed changes will improve the sensitivity and specificity of the criteria for autism spectrum disorders, so that clinicians may be able to more accurately diagnose these disorders.”
Material adapted from the American Psychiatric Association by CFisher.
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