DSM-IV vs DSM-5…

DSM-IV vs DSM-5 and Autism Spectrum Disorders – how it will impact NBC clients & IBC staff

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.


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