It’s been nearly 14 years in the making, with heated debate for at least 2, but finally it’s here: The American Psychiatric Association published the DSM-5, the newest revision of the Diagnostic and Statistical Manual of Mental Disorders, on 18 May.
For this special report, we asked several experts to review the DSM-5 criteria for autism — and their reactions are surprisingly positive overall.
Walter Kaufmann, a member of the DSM-5’s Neurodevelopmental Disorders Work Group, notes that the term ‘intellectual disability’ replaces the previous ‘mental retardation,’ a change that is long overdue. The DSM-5 places a greater emphasis on daily life skills over the intelligence quotient in determining intellectual disability.
The new version of the manual also acknowledges for the first time that females with autism may have features that differ from those of males with the disorder, notes William Mandy, a lecturer in clinical psychology at University College London in the U.K.
One of the big changes in the DSM-5 is the decision to have a single diagnosis of autism spectrum disorder, folding in the milder Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS). Many people raised concerns that this move would deny people with less severe symptoms a diagnosis of autism and, as a result, access to services even when they need them.
Simon Baron-Cohen, director of the Autism Research Centre at Cambridge University in the U.K., was among those most critical about this change. He now points out that the DSM-5 has made allowances for this fear, and says there is, in fact, much to recommend in the new criteria.
Evidence so far also suggests that people now diagnosed with Asperger syndrome or PDD-NOS won’t lose services, says Ari Ne’eman, president of the Autistic Self Advocacy Network. Ne’eman says the new unified diagnosis may instead make it easier for them to get the help they need.
As Ne’eman points out, however, the DSM-5 still has flaws. One big area of concern is the creation of a new diagnosis called social communication disorder.
Helen Tager-Flusberg, director of Research on Autism and Developmental Disorders at Boston University, says there is little evidence that this new category is either reliable or valid, and it should never have been created.
There may be multiple revisions of the DSM-5 to address this and many other concerns, but in the meantime, diagnostic tests may need to be updated to align with the new criteria, says Amy Esler, assistant professor of pediatrics at the University of Minnesota.
What do you think? Join the community discussion here to weigh in on the criteria and pose any questions you may have.
There are several reasons why social communication disorder should not have been included in the DSM-5, says Helen Tager-Flusberg.
The newest edition of the Diagnostic and Statistical Manual of Mental Disorders relies on intellectual function in daily life, both for diagnosing intellectual disability and for determining its level of severity, says Walter Kaufmann.
There is little to fear in the definition of autism in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, and a lot to recommend it, says Simon Baron-Cohen.
The newest edition of the Diagnostic and Statistical Manual of Mental Disorders overtly acknowledges that females with autism may have features that differ from those of males with the disorder, says William Mandy.
As clinicians adopt the new criteria for autism, the many tests now used to diagnose the disorder may need to be modified, says Amy Esler.
The newest edition of the Diagnostic and Statistical Manual of Mental Disorders is an imperfect document, but it is far from the calamity that many have accused it of being, says Ari Ne’eman.
The National Institute of Mental Health is moving away from research proposals that hew closely to clinical diagnoses such as autism spectrum disorder. The announcement has struck many autism researchers as an attack on the already-controversial new diagnostic criteria for the disorder.
Listen to our virtual roundtable on the DSM-5 criteria for autism, featuring Thomas Insel, Catherine Lord and Helen Tager-Flusberg.