If a child has an intellectual disability their school should have IQ testing no less than two years old on record. If they don’t testing should be requested. If the child is under the age of seven and nonverbal there are several tests that could be given. In my opinion, the most appropriate in the Universal Nonverbal Intelligence Test (UNIT). It may be possible for the Institute for Behavior Change to do this evaluation. Visit our website to access our referral form. If we can help we will.
Based on my experience, any child who has an Autism spectrum diagnosis via DSM-IV will now 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 Pennsylvania) is supposed to have “more than mild” impairment of functioning 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. “More than mild” impairment of functioning translates to a GAF of 60 or lower.
My greatest concern is that DSM-5 lumps Axis I, II and III together into a single class of disability. That means 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. Using DSM-5 would make it possible to conflate intellectual disability (now diagnosed as Axis-II) with mental illness, as Autism spectrum disorders are now classified, 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,” 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”. However, 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 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 eighteen and 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 II), meaning that all three categories of disability have to be given equal weight. I do not see grave consequences of DAM-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 can compare the DSM-IV and DSM-5 definitions here.
If you use the actual DSM_IV diagnostic criteria from the course cited above as a “checklist” for achild with a current Autism spectrum diagnosis, and then apply that same “checklist” to the DSM-5 diagnostic criteria, you will see how similar the two criteria are. You may even get some reassurance that a particular child you know is not likely to be reclassified if and when DSM-5 is adopted.
Below is a link to a balanced professional summary of the DSM-IV vs DSM-5 controversy:
Download IBC referral paperwork here.
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