TEACCH Autism Program Comments on the Proposed DSM-5 Diagnostic Criteria February 3, 2012
At TEACCH we have been getting many questions about the proposed diagnostic criteria for Autism Spectrum Disorder in the DSM-5. In short, the new diagnostic criteria will not change our TEACCH Autism Program services. We currently provide services to all individuals across the autism spectrum and across the lifespan and will continue to do so. The new criteria will change the labels that we use, but not the people that we serve or the services that we provide.
Currently, the DSM-IV defines five Pervasive Developmental Disorders (Autism, Asperger Syndrome, Childhood Disintegrative Disorder, Rett’s Disorder, and PDD-Not Otherwise Specified). While professionals are reliable at saying whether someone has a Pervasive Developmental Disorder or not, we are not reliable at determining which Pervasive Developmental Disorder someone has. Thus, two professionals might agree that a child has a Pervasive Developmental Disorder but one psychologist might say autism while another might say Asperger syndrome. This is confusing to families and often leads to many different evaluations in an attempt to find the right answer. Further some programs for adults, insurance companies, and schools have served individuals with one diagnosis but not another. The new diagnostic system acknowledges the fact that professionals can’t reliably differentiate between these different disorders. Additionally, the new system gets rid of the confusing “Pervasive Developmental Disorder” title. The new system will simply use the term Autism Spectrum Disorder to identify anyone who would have received one of these diagnoses in the past. This has the potential to lead to less confused parents and professionals. Indeed, professionals have been using the term autism spectrum disorder (ASD) for several years and the DSM is just now catching up to our current knowledge of the diagnosis.
There has been some concern that this new diagnostic system will result in individuals with a current diagnosis of Asperger syndrome not receiving a diagnosis in the future. However, the new diagnostic requirements are meant to include individuals across the entire autism spectrum – those with intellectual disability, those with average cognitive ability, and those who are above average. Instead of using separate diagnostic labels, everyone will be diagnosed with an autism spectrum disorder and then symptom severity will be specified. This shouldn't eliminate anyone who was previously diagnosed.
Also, the current DSM-IV diagnosis involves difficulties in social interaction, verbal and nonverbal communication, and the presence of repetitive behaviors and interests. It has been hard to separate symptoms into social vs. communication categories. For example is poor eye contact a social difficulty or a communication difficulty? So, the new system will have two categories - social communication difficulties and repetitive behaviors/interests. In addition to the repetitive behaviors that were included in the DSM-IV, the new criteria include unusual sensory interests and reactions. While DSM-IV requires 6 symptoms across three symptom areas (social, communication, repetitive behavior), DSM-5 will require 5 symptoms across 2 areas (social-communication; repetitive behaviors). We don’t anticipate that this will lead to a narrower definition – in fact, it is possible that those who were not previously diagnosed might now receive a diagnosis as fewer symptoms overall are required.
We think that the biggest controversy for the DSM-5 is the fact that many people have resonated with the term Asperger syndrome because it conveys the sense of high cognitive abilities, good language skills, and few symptoms. This term has helped a lot of people with less severe autism spectrum disorder to identify themselves and find others with similar experiences. While they will still qualify as having an autism spectrum diagnosis, the loss of a separate identification for the more verbal individuals on the autism spectrum is likely to be viewed as a loss of identity for some people with a current diagnosis of Asperger syndrome. We encourage individuals who currently have the diagnosis of Asperger syndrome to continue to engage in self-advocacy and understand that the term Autism Spectrum Disorder is not meant to change their self-identity.
We recognize that the proposed changes in the DSM diagnostic criteria have caused some anxiety and we want to assure you that the TEACCH Autism Program will continue to provide services for ALL individuals on the autism spectrum, their families, and their community support agencies.
Laura Grofer Klinger, Ph.D.
Director, TEACCH Autism Program
Associate Professor, Psychiatry
University of North Carolina – Chapel Hill