The alarm generated by the change from DSM-IV to DSM-5, scheduled for May 2013, is concerning to me as a licensed psychologist with thirty years of experience working with children on the autism spectrum. Moreover, as a respected and staunch advocate for children with disabilities of all kinds, I object to what appears to be the creation and nurturance of an unnecessary state of fear among parents of children with autism spectrum disorders by some popular, though misinformed, advocates.
Similarly zealous people lobbied furiously for state laws that would force private insurance companies to cover the treatment of autism to the delight of the state Medicaid agencies that seem to be the only substantive beneficiary of these lobbying efforts and laws. This push has resulted in little more than the elimination of Medicaid funding for children. In my professional opinion, the fact that this terrible disservice to parents of children with autism was perpetrated by “advocates” who were either ignorant of or hostile toward Medicaid funding that had existed, as a Civil Right, prior to their efforts is a dreadful irony. Parents literally gave up their entitlement to treatment funding under the EPSDT mandate of Medicaid in exchange for the opportunity to beg private insurance companies for funding. Worst of all, these same “advocacy” organizations continue to believe that it is “philosophically inappropriate” to expect Medicaid to fund autism treatment. Even after they’ve won battles in twenty-nine states to get private insurance to cover autism treatment, they still don’t think it’s important to help autistic children from impoverished families get the treatment funding they’re entitles to under Medicaid; an unconscionable thought.
Undoubtedly, some clinicians have and always will use diagnostic tools for nefarious purposes. Especially though who work for organizations that exist for the sole purpose of reducing or eliminating funding for treatment like Managed Care organizations, for example. On the other hand, responsible and ethical clinicians will continue to use tools for the benefit of their clients and patients. DSM=IV is being misused now and, without question, DSM-5 will be misused in the future.
The good news is that DSM-5 is actually less likely to be abused than DSM-IV in many ways. I believe that DSM-5 is a tool that will not result in the wholesale devastation of the population of children with autism spectrum disorders that is being projected by others with background in law, nursing and other fields while exceedingly well-qualified mental health treatment professionals in the field of autism treatment are trying to quell these misplaced fears. I am one of them.
I presenting information in support of this position during the program regarding DSM-IV vs DSM-5 issues at AutismOne in Chicago in May as part of a panel discussion with several people who were expressing alarm over the impending DSM-5 implementation. We presented our opinions in a congenial panel that offered opposing views of the probable impact of DSM-5. AutismOne offered a free download for the presentation, which documents the strong consistency between DSM-IV and DSM-5, including the improvements that DSM-5 actually makes.
It is available here.
In my professional opinion, it is not appropriate to present just the portion of a set of facts that causes people discomfort and fear. Instead, one should present the entire set of facts and let people judge for themselves whether or not a reason for fear exists after considering the opinions of other responsible, reliable and conscientious professionals. Especially professionals with a proven track record of advocacy for children and more than thirty years of clinical experience using tools like DSM-IV to benefit children, like myself.