Autism Diagnosis Rules Likely to Change

Autism individual differences should be better categorized under proposed rules

/ Author:  / Reviewed by: Robert Carlson, M.D

Next year, the American Psychiatric Association will likely revise how autism is defined.  Years of research about the complex nature of the disorder is leading to new diagnostic rules.

Proposed changes include the creation of a new category called autism spectrum disorder, eliminating Asperger Syndrome as a subtype, and placing the patient's degree of impaired functionality on a spectrum of severity.

Autism and related conditions involve abnormal development of the nervous system, mind, and behavior.  Serious problems functioning as an adult can result from problems that begin during childhood.

Children with this designation often show impaired development, such as restricted social interaction and communication, repetitive behavior, an unusual interest in or lack of interest in sensory experiences.

Parents may notice their child is slow at learning language and/or making friends, compared to their child's peers. Such a child may not notice what other children notice, or they may shy away from making eye contact.

Some may engage in stereotyped behavior such as making the same sound over and over, while another might pay unusual attention to particular objects. Nonetheless, high-functioning patients with the disorder may also display unusual talents and abilities.

Much discussion has centered on exactly who should be considered autistic, based on which diagnostic rules doctors should use. Dialogue among clinicians, scientists, and patient advocates has focused on the proposed reworked definitions to be published by the American Psychiatric Association's Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders in mid-2013.

Currently, the 4th edition of the DSM categorizes autism, Asperger's disorder, childhood disintegrative disorder, and "pervasive developmental disorder not otherwise specified" as separate conditions.

If the proposed changes are indeed ratified and published, the larger category of "autistic spectrum disorder" will be used to categorize individual experience and behavior, ranging from mild to severe impaired functionality.

According to Dr. James Scully, Medical Director of the American Psychiatric Association (APA), the proposed criteria will lead to more accurate diagnoses, and will help physicians and therapists design better treatment interventions to cope with the challenges posed by autism spectrum disorder.

The individual differences among patients with autism and related developmental disorders has made diagnosis and treatment challenging, and the hope is that the proposed changes will support more diagnostic flexibility.

Patients with these disorders and their families should benefit from the reworked criterion being proposed for the DSM-V, as treatment plans can be tailored more finely to the individual profile. For instance, those who on the high functioning part of the scale who may very well not need the same medications as others.

Scientists, doctors and concerned citizens alike have voiced opinions about the proposed changes. This feedback and perspectives from researchers and the public has been studied and debated by recognized experts in the field of developmental and communication disorders.

Patients with developmental disorders with diverse symptoms and levels of functionality need the categories to be neither too broad nor too restrictive, which requires a balancing act for the American Psychiatric Association’s DSM task force. Families can anticipate pediatricians and psychiatrists will soon have better diagnostic tools at their disposal.

The history of medicine is often one of the redefinition and recategorization of disorders. In the 14 years since the DSM-IV was published, new data from genetics, brain imaging, pharmaceutical interventions, and population studies has added to medical knowledge of how psychological development can go awry.

Patients currently coping with these disorders, as well as the families, caregivers, and medical professionals supporting them, should have new reason to expect more accurate diagnoses and, perhaps, better treatments, in the near future.

Reviewed by: 
Review Date: 
April 23, 2012