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DSM-5 and proposed changes to the diagnosis of autism.

IMPLICATIONS OF DSM-5 The American Psychiatric Association’s stated goals for the changes to its diagnostic criteria for autism spectrum disorder (ASD) in DSM-5 are to “accurately and completely identify” individuals with autism by production of reliable and valid diagnostic criteria1 in order to offer a clearer, simpler, more reliable diagnostic scheme and recognize the “essential shared features of the autism spectrum.”2 This means that, for the clinician, it should be easier to diagnose ASD than trying to distinguish between high-functioning autism (HFA) and Asperger’s disorder. In addition, the vague diagnosis of pervasive developmental disorder not otherwise specified (PDD-NOS) has been replaced, in part, by social communication disorder (SCD) (see Table 1, page 162). Questions have already been raised about the appearance of a new diagnosis, SCD, that describes children with difficulties in the pragmatics of verbal and nonverbal communication, leading to impaired social function. This disorder excludes an autism diagnosis, and thus rules out the presence of restrictive, repetitive behaviors (RRBs);3 however, SCD seems to resemble mild autism or PDD-NOS.4,5 Questions remain about how the criteria for SCD will be implemented, and whether children who meet criteria for SCD will meet eligibility for medical and educational services.6 Overall, the changes should result in more reliable and valid diagnoses, with estimates of individual severity and associated conditions. It will remain important for clinicians to take a thoughtful and complete history and combine information from multiple sources with clinical observation to diagnose children with ASD with improved specificity. For clinicians and families, the singular question is whether the new criteria will change access to treatment and/or educational services. Studies have noted that individuals with a diagnosis of Asperger’s disorder or PDD-NOS, those with higher IQ, and female patients may be at most risk.4 This could impact whether children with an established DSM-IV diagnosis of Asperger’s disorder or PDD-NOS would need DSM-5 and Proposed Changes to the Diagnosis of Autism