What is the DSM-5?
The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM) to guide healthcare professionals diagnosing mental health conditions. The manual’s fifth edition – DSM-5 – took effect in May 2013.
Why was the new edition needed?
The American Psychiatric Association periodically updates the DSM to reflect new understanding of mental health conditions and the best ways to identify them.
The goals for updating the criteria for diagnosing autism included:
- More accurate diagnosis
- Identification of symptoms that may warrant treatment or support services
- Assessment of severity level
How does the DSM-5 change the way autism is diagnosed?
Six major changes included:
1. Four previously separate categories of autism consolidated into one umbrella diagnosis of “autism spectrum disorder.”
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 hyper- or hypo-reactivity to stimuli (lights, sounds, tastes, touch, etc.) or unusual 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.
What are the new criteria for diagnosing autism?
The DSM-5 criteria for autism fall under two categories:
In addition, clinicians are asked to rate the severity of these problems, based on the level of daily support they require.
How will these DSM-5 changes affect people already diagnosed with Asperger syndrome, PDD-NOS or other previous autism categories?
The DSM-5 states, “Individuals with a well-established DSM-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 if I or my child want to keep the diagnosis of Asperger syndrome?
Many people strongly identify with their diagnosis of Asperger syndrome. Healthcare providers can still indicate a diagnosis of Asperger syndrome (or another previously used autism category) in a patient’s medical record, alongside the current DSM-5 coding for “autism spectrum disorder.” Colleges and school districts may vary in their policies for educational records.
What is the new diagnosis of social communication disorder? Who will it affect?
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 may now receive a diagnosis of social communication disorder. However, this should apply only to newly diagnosed people. It should not be applied retroactively to someone already diagnosed with PDD-NOS under the DSM-IV criteria.
Is social communication disorder on the autism spectrum?
No. Social communication disorder is considered a communication disorder. People who have the symptoms of social communication disorder in addition to restricted, repetitive behaviors may receive a diagnosis of autism instead.
Will insurance companies cover treatments for social communication disorder? Will schools provide special education services?
Because this is a new diagnosis, it is unclear what challenges people will have in accessing insurance coverage and special education services. If you or your child is diagnosed with social communication disorder and have difficulty obtaining coverage or services, email our advocacy team.
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