By the way, here is a link to a very balanced and thoroughly professional summary of the DSM-IV vs DSM-5 controversy.

http://autismjabberwocky.blogspot.com/2012/01/new-york-times-dsm-5-autism-coverage.html

Based on my own experience, any child who has an Autism spectrum diagnosis via DSM-IV now will be able to retain an “Autism Spectrum Disorder” via DSM-5 unless their symptoms do not significantly impair their day-to-day functioning.  Anyone receiving BHRS (mistakenly called “wraparound” services in PA) is supposed to have “more than mild” impairment of functioning (that translates to a GAF of 60 or lower), so the probability of a very small number, if any, of current recipients of BHRS losing their Autism spectrum classification via DSM-5 is extremely low.

The greatest concern I have is that DSM-5 lumps together what is now Axis I, II and III into a single class of disability.  That means that the requirement of a “mental illness” diagnosis (Axis I) to justify receiving BHRS will have to be adjusted to accommodate DSM-5.  In all likelihood, the DSM-IV standard will be retained by state Medicaid agencies because using DSM-5 would make it possible to conflate intellectual disability (now diagnosed on Axis II) with mental illness (as Autism spectrum disorders are now classified) and to then “justify” someone’s classification as “intellectually or globally developmentally delayed” rather than on the Autism spectrum.  DSM-5 classifies Autism spectrum disorders as “neurodevelopmental disorder” and the result of that classification might be the elimination of a rationale to fund its treatment via BHRS because it is no longer a “mental illness.”  Then again, with the collapsing of Axis I, II and III, DSM-5 could be “the best thing that ever happened” to children with disabilities because the artificial distinction between children with intellectual disabilities and those without them can be set aside — if they have mental illness symptoms, they can be diagnosed with them whether or not they also have an intellectual disability, and the existence of the latter does not eliminate the existence of the former.

One important thing to note about DSM-5 and intellectual disability is that a child can’t be called “intellectually disabled” if they cannot take a standardized IQ test.  This means that every child who can currently be classified as “intellectually disabled” via DSM-IV code 319 (because their social functioning is significantly impaired, they’re under 18, and they can’t take a standardized IQ test) can still be classified as intellectually disabled via DSM-5.  Since DSM-doesn’t consider intellectual disability in a separate category anymore — it’s all lumped in with the “mental illnesses” (Axis I) and “other medical conditions” (Axis III) so that means that all three categories of disability have to be given equal weight.  I honestly do not see grave consequences of DSM-5′s definition of “Autism spectrum disorder” for children who have significantly disabling symptoms and who currently receive or are entitled to BHRS in Pennsylvania because of the severity of those symptoms.  Children with only mildly disabling symptoms will be the most at-risk of not being eligible for the new Autism spectrum disorder diagnosis.  You should compare the DSM-IV definition with the DSM-5 definition here:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

If you use the actual DSM-IV diagnostic criteria from the source cited here as a “checklist” for a child with a current Autism spectrum diagnosis, and then apply that same “checklist” to the DSM-5 diagnostic criteria, you will see for yourself how similar the two sets of criteria are (and perhaps get some reassurance that a particular child you know is not likely to be reclassified if and when DSM-5 is adopted).

Your feedback is invited, as always.

Steve

A recent alarm has been sounded regarding the proposed changes in the diagnostic criteria for Autism and I want to help clarify what is happening.  I do not believe that there is reason to be concerned about this for our clients, but in the wider world of children who have been receiving services to treat conditions that are not significantly impairing their day-to-day functioning, there may be some cause for concern. 

I’m attaching the official definitions of Autism from the DSM-IV-TR (the current standard for diagnosing autism) and the DSM-5 proposed definition.  You will see that the two definitions are extremely similar, but it does seem that some of the higher-functioning children with Asperger’s disorder (“whose symptoms together do not limit or impair everyday functioning”) will no longer be classified as having an Autism spectrum disorder.  This may be alarming to some parents; some authorities are suggesting that the new definition of “Autism” (which replaces the separate definitions of Asperger’s, Retts, Childhood Disintegrative Disorder, etc) will reduce the diagnosis of Autism spectrum disorders by as much as 32%.  I don’t think so, but we don’t work with children who are superficially impaired, so I don’t know how many (of the total children currently diagnosed with Autism spectrum disorders) are actually only superficially impaired – but I suspect it’s not nearly 32% of the total. 

In the fields of psychiatry and psychology, for every expert there is an equal and opposite expert.  If and when the proposed definition of Autism is adopted by the American Psychiatric Association (there is a terrific battle being waged against this by Asperger’s advocacy groups and others so this may not happen for some time yet), licensed physicians and mental health professionals will be able to render diagnoses on the basis of their clinical understanding of the child (as they should) and be able to use the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA) to assist them in that process.  I am confident that a competent mental health professional will be able to render a diagnosis of Autism in the case of any child whose condition seriously limits his/her functioning based on either DSM-IV-TR or DSM-5.  Since all of the children we serve (those who receive Behavioral Health Rehabilitation Services, sometimes mistakenly called “wraparound” services in Pennsylvania) must be seriously impaired in their everyday functioning ability (have a Global Assessment of Functioning (GAF) below 60), and this has been the standard since 1992, the change to DSM-5 should have no significant impact on the diagnosis or delivery of BHRS to any of our clients. 

Please pass this on to parents and teachers of our clients if you feel they are concerned about whether or not the DSM-5 proposed changes in the definition of Autism will adversely affect their child’s treatment or education program.  If you have questions, please don’t hesitate to reply to this e-mail.  Best wishes always.

Steve

Hope to hear from you about this!

Steve