The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years work by hundreds of international experts in all aspects of mental health.
It was updated in 2018 and changes made to criteria will affect Autism and some associated or co-morbid (but separate) Mental Health conditions.
Coding updates to the ICD-10 will take effect on October 1st, 2018. The ICD-10 is the International Statistical Classification of Diseases and Related Health Problems and lists all diseases known to mankind.
The effects on a current diagnosis of Autistic Disorder, Asperger’s, CDD, or PDD-NOS after these changes are explained below.
How do the new DSM-V changes affect the way Autism is diagnosed?
Six major changes include:
1. Four previously separate categories of Autism consolidated into one umbrella diagnosis of “Autism Spectrum Disorder. (ASD)”
The previous categories were:
- Autistic disorder
- Asperger syndrome
- Childhood disintegrative disorder
- Pervasive developmental disorder-not otherwise specified (PDD-NOS)
2. Consolidation of three previous categories of Autism symptoms
- Social impairment
- Language/communication impairment and
- Repetitive/restricted behaviors
into two categories of symptoms
- Persistent deficits in social communication/interaction and
- Restricted, repetitive patterns of behavior
3. The addition of sensory issues as a symptom under the restricted/repetitive behavior category. This includes over or under reactivity to stimuli (lights, sounds, tastes, touch, smells etc.) or unusually intense or fixated interests in stimuli (staring at lights, spinning objects, etc.)
4. A severity assessment scale (levels 1-3) based on level of support needed for daily function.
5. Additional assessment for:
- Any known genetic causes of Autism (e.g. Fragile X Syndrome, Rett Syndrome)
- Language level
- Intellectual disability and
- The presence of Autism-associated medical conditions (e.g. seizures, anxiety, gastrointestinal disorders, disrupted sleep)
6. Creation of a new diagnosis of Social Communication Disorder, for disabilities in social communication without repetitive, restricted behaviors.
How will these DSM-V changes affect people already diagnosed with Asperger syndrome, PDD-NOS or other previous Autism categories?
The DSM-5 (V) states that “Individuals with a well-established DSM-4 (IV) diagnoses of Autistic disorder, Asperger’s disorder or Pervasive Developmental Disorder Not Otherwise Specified should be given the diagnosis of Autism Spectrum Disorder.”
What is the new diagnosis of Social Communication Disorder? Is it still classified under the Spectrum?
This new diagnosis applies to people who have persistent problems with the social use of language, but don’t have restricted interests or repetitive behaviors.
Some people who would have previously received a diagnosis of PDD-NOS that was included on the Spectrum may now receive a diagnosis of SCD. However, this will apply only to newly diagnosed people and will not be applied retroactively to someone already diagnosed with PDD-NOS under the DSM-4 (IV) criteria.
SCD will not be classed under the Spectrum. It is considered a communication disorder. People who have the symptoms of SCD in addition to restricted, repetitive behaviours may instead still receive a diagnosis of Autism.