Abstract
The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 deletes Asperger’s Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a “Social Communication Disorder” focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger’s Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger’s Disorder.
References
Charney, D. S., Barlow, D. H., Botteron, K., Cohen, J. D., Goldman, D., Gur, R. E., Lin, K., Lopez, J. F., Meador-Woodruff, J. H., Moldin, S. O., Nestler, E. J., Watson, S. J., & Zalcman, S. J. (2002). Neuroscience research agenda to guide development of a pathophysiologically based classification system. In D. J. Kupfer, M. B. First, & D. A. Regier (Eds.), A research agenda for DSM-5. Chapter Two. Available at: http://psychrights.org/research/Digest/CriticalThinkRxCites/CharneyInKupfer.pdf. Accessed February 6, 2013.
American Psychiatric Association (2012). DSM-5 development. DSM-5 overview: The future manual. Available at: http://www.dsm5.org/about/pages/dsmvoverview.aspx. Accessed February 6, 2013.
American Psychiatric Association (2013). From planning to publication: Developing the DSM-5. Timeline. Available at: http://www.dsm5.org/Documents/DSM%205%20development%20factsheet%201-16-13.pdf. Accessed February 6, 2006.
American Psychiatric Association (2012). News Release: American Psychiatric Association Board of Trustees Approves DSM-5. Diagnostic manual passes major milestone before May 2013 publication. Available at: http://www.psychiatry.org/advocacy-newsroom/news-releases/news-releases. Accessed February 6, 2013.
American Psychiatric Association (2012). DSM-5 development. DSM-5: The future of psychiatric diagnosis. Available at: http://www.dsm5.org/Pages/Default.aspx. Accessed February 6, 2013.
American Psychiatric Association (2012). DSM-5 development. Neurodevelopmental disorders. Available at: http://www.dsm5.org/meetus/pages/neurodevelopmental%20disorders.aspx. Accessed February 6, 2013.
Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215.
Wise, M. D., Little, A. A., Holliman, J. B., & Wang, C. J. (2010). Can State Early Intervention Programs meet the increased demand of children suspected of having autism spectrum disorders? Journal of Developmental and Behavioral Pediatrics, 31, 469–476.
Pine, D. (2009). Report of the DSM-5 Childhood and Adolescent Disorders Workgroup. Available at: http://www.dsm5.org/progressreports/pages/0904reportofthedsm-vchildhoodandadolescentdisordersworkgroup.aspx. Accessed September 27, 2012.
Stahmer, A. C., & Mandell, D. S. (2007). State infant/toddler program policies for eligibility and services provision for young children with autism. Administration and Policy in Mental Health, 3, 29–37.
Tsai, L. Y. (2003). Pervasive Developmental Disorders. Briefing paper. National Dissemination Center for Children with Disabilities. Available at: http://nichcy.org/wp-content/uploads/docs/fs20.pdf. Accessed October 11, 2012.
American Psychiatric Association (2011). DSM-5 development. A 05 autism spectrum disorder. Available at: http://www.dsm5.org/proposedrevisions/pages/proposedrevision.aspx?rid=94#. Accessed September 27, 2012. No longer available after December 1, 2012.
Nazeer, A., & Ghaziuddin, M. (2012). Autism spectrum disorders: Clinical features and diagnosis. Pediatric Clinics of North America, 59, 19–25.
Ozonoff, S. (2012). Editorial perspective: Autism Spectrum Disorder in DSM-5—An historical perspective and need for change. Journal of Child Psychology and Psychiatry, 53, 1092–1094.
Swedo, S. E. (2010). Autism spectrum disorders in DSM-5. What’s changing? What’s staying the same? Presented at: Department of Health & Human Services, Interagency Autism Coordinating Committee (IACC) Meeting. April 30, 2010, Washington, DC. Available at http://iacc.hhs.gov/events/2010/slides_susan_swedo_043010.pdf. Accessed February 6, 2013.
Lord, C. (2011). Where is the diagnosis of autism spectrum disorder (ASD) going? Webinar, March 18, 2011. Available at: http://www.aucd.org/docs/SIG%20Docs/autismsig/Dr.Lord_3_18_11_webinar.pdf. Accessed February 6, 2013.
Mahjouri, S., & Lord, C. E. (2012). What the DSM-5 portends for research, diagnosis, and treatment of autism spectrum disorders. Current Psychiatry Reports, 14, 739–747.
Szatmari, P. (2011). New recommendations on autism spectrum disorder. Shifting the focus from subtypes to dimensions carries potential costs and benefits. British Medical Association, 343, 167–168.
Starr, E., Szatmari, P., Bryson, S., & Zwaigenbaum, L. (2003). Stability and change among high-functioning children with Pervasive Developmental Disorders: A 2-year outcome study. Journal of Autism and Developmental Disorders, 33, 15–22.
Turgyin, N., Matson, J. L., Beighley, J., & Adams, H. (2013). The effect of DSM-5 criteria on the developmental quotient in toddlers diagnosed with autism spectrum disorder. Developmental Neurorehabilitation, 16, 31–43.
Taheri, A., & Perry, A. (2012). Exploring the proposed DSM-5 criteria in a clinical sample. Journal of Autism and Developmental Disorders, 42, 1810–1817.
Worley, J. A., & Matson, J. L. (2012). Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria. Research in Autism Spectrum Disorders, 6, 965–970.
Kaland, N. (2011). Brief report: Should Asperger syndrome be excluded from the forthcoming DSM-V? Research in Autism Spectrum Disorders, 5, 984–989.
Soke, G. N., Philofsky, A., Diguiseppi, C., Lezotte, D., Rogers, S., & Hepburn, S. (2011). Longitudinal changes in scores on the autism diagnostic interview-revised (ADI-R) in pre-school children with autism. Autism, 15, 545–562.
Klin, A., & Volkmar, F. R. (2003). Asperger syndrome: Diagnosis and external validity. Child & Adolescent Psychiatric Clinics of North America, 12, 1–13.
Lord, C., Petkova, E., Hus, V., et al. (2012). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry, 69, 306–313.
Rondeau, E., Klein, L. S., Masse, A., Bodeau, N., Cohen, D., & Guile, J. (2011). Is Pervasive Developmental Disorder not otherwise specified less stable than Autistic Disorder? A meta-analysis. Journal of Autism and Developmental Disorders, 41, 1267–1276.
Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. Journal of Child Psychology and Psychiatry, 50, 1235–1245.
British Psychological Society (2011). Response to the American Psychological Association: DSM-5 development. Available online at: http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf. Accessed June 14, 2012.
McPartland, J. C., Reichow, B., & Volkmar, F. R. (2012). Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 368–383.
American Psychiatric Association (2012). DSM-5 development. A 04 social communication disorder. Available at: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=489. Accessed August 14, 2012. No longer available after December 1, 2012.
Gibbs, V., Aldridge, F., Chandler, F., Witzlsperger, E., & Smith, K. (2012). Brief report: An exploratory study comparing diagnostic outcomes for autism spectrum disorders under DSM-IV-TR with the proposed DSM-5 revision. Journal of Autism and Developmental Disorders, 42, 1750–1756.
Willinger, U., Brunner, E., Diendorfer-Radnor, G., Sams Mag, J., Sirsch, U., & Eisenwort, B. (2003). Behaviour in children with developmental language disorders. Canadian Journal of Psychiatry, 48, 607–614.
Swedo, S. E. (2012). An update on the DSM-5 recommendations for autism spectrum disorder and other neurodevelopmental disorders. Presented at: July 2012 meeting of the IACC. Available at: http://iacc.hhs.gov/events/2012/slides_susan_swedo_071012.pdf. Accessed February 7, 2013.
Volkmar, F. R., Lord, C., Bailey, A., Schultz, R. T., & Klin, A. (2004). Autism and Pervasive Developmental Disorders. Journal of Child Psychology and Psychiatry, 45, 135–170.
Tsatsanis, K. D. (2003). Outcome research in Asperger’s syndrome and autism. Child & Adolescent Psychiatric Clinics of North America, 12, 47–63.
Paul, R. (2003). Promoting social communication in high functioning individuals with autism spectrum disorders. Child and Adolescent Clinics of North America, 12, 87–106.
Volkmar, F. R., State, M., & Klin, A. (2009). Autism and autism spectrum disorders: Diagnostic issues for the coming decade. Journal of Child Psychology and Psychiatry, 50, 108–115.
Cooper, J. L., & Vick, J. (2009). Promoting social-emotional wellbeing in early intervention services. A fifty state view. National Center for Children in Poverty, Columbia University Mailman School of Public Health. Available online at: http://www.nccp.org/publications/pdf/text_885.pdf. Accessed August 9, 2012.
Shackelford, J. (2006). State and jurisdictional eligibility definitions for infants and toddlers with disabilities under IDEA. National Early Childhood TA Center (NECTAC). Available online at: http://www.nectac.org/~pdfs/pubs/nnotes21.pdf. Accessed August 14, 2012.
Vorgraft, Y., Farbstein, I., Spiegel, R., & Apter, A. (2007). Retrospective evaluation of an intensive method of treatment for children with Pervasive Developmental Disorder. Autism, 11, 413–424.
Paul, R. (2003). Promoting social communication in high functioning individuals with autistic spectrum disorders. Child & Adolescent Psychiatric Clinics of North America, 12, 86–106.
Strain, P. S., Schwartz, I. S., & Barton, E. (2011). Providing interventions for young children with autism spectrum disorders: what we still need to accomplish. Journal of Early Intervention, 33, 321–332.
U.S. Education Department. Data accountability center. IDEA Part C Data. (August 13, 2012). Table C-2-1. Number of infants and toddlers ages birth through 2 served under IDEA, Part C, by Early Intervention and State: Fall 2011. Available at: http://www.ideadata.org/TABLES35TH/C2-1.pdf. Accessed February 8, 2013.
Greenspan, S. I., Brazelton, T. B., Cordero, J., et al. (2008). Guidelines for early identification, screening, and clinical management of children with autism spectrum disorders. Pediatrics, 121, 828–830.
Stahmer, A. C., & Ingersoll, B. (2004). Inclusive programming for toddlers with autism spectrum disorders: Outcomes from the children’s toddler school. Journal of Positive Behavior Interventions, 6, 67–82.
Bouder, J. N., Speilman, S., & Mandell, D. S. (2009). Brief report: Quantifying the impact of autism coverage on private insurance premiums. Journal of Autism and Developmental Disorders, 39, 953–957.
Fulda, K. G., Johnson, K. L., Hahn, K., & Lykens, K. (2012). Do unmet needs differ geographically for children with special health care needs? Maternal & Child Health Journal, E-published ahead of print. doi: 10.1007/s10995-12-1029-4.
Parish, S. L., Shattuck, P. T., & Rose, R. A. (2009). Financial burden of raising CSHCN: Association with state policy choices. Pediatrics, 124, S435–S442.
Happe, F. (2011). Editorial: Criteria, categories, and continua: Autism and related disorders in DSM-5. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 540–542.
Reynolds, A. M., & Malow, B. A. (2011). Sleep and autism spectrum disorders. Pediatric Clinics of North America, 58, 685–698.
Bonuck, K., & Grant, R. (2012). Sleep problems and early developmental delay: Implications for early intervention programs. Intellectual and Developmental Disabilities, 50, 41–52.
Hume, K., Bellini, S., & Pratt, C. (2005). The usage and perceived outcomes of early intervention and early childhood programs for young children with autism spectrum disorder. Topics in Early Childhood Special Education, 25(4), 195–207.
Dvortcsak, A., & Ingersoll, B. (2006). Including parent training in the early childhood special education curriculum for children with autism spectrum disorders. Topics in Early Childhood Special Education, 26(3), 179–187.
Choutka, C. M., Doloughty, P. T., & Zirkel, P. A. (2004). The “Discrete Trials” of Applied Behavior Analysis for Children with Autism: Outcome-Related Factors in the Case Law. Journal of Special Education, 38, 95–103.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grant, R., Nozyce, M. Proposed Changes to the American Psychiatric Association Diagnostic Criteria for Autism Spectrum Disorder: Implications for Young Children and Their Families. Matern Child Health J 17, 586–592 (2013). https://doi.org/10.1007/s10995-013-1250-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-013-1250-9