DSM-V and the Autism Diagnosis: Is The Change Hurting Children?

Fuss

Written by Dr. John Carosso
There has been lots of fuss about the DSM-V and the autism diagnosis; will it result in less children meeting diagnostic criteria and therefore less children getting the services they need? Is this concern legitimate? I’ve written about this in prior posts, but here I’ll provide further elaboration.

What’s the problem, and what is the diagnostic criteria?

Is the DSM-V Autism Spectrum Disorder (ASD) diagnosis the issue at hand, or is it another DSM-V diagnosis that might be a “problem”?

First let’s take a brief look at the ASD, the criteria includes:

1. “Deficits in social communication and social interaction” manifesting in, for example, poor back-and-forth communication, deficient eye contact, and absence in an interest in peers or inability to sustain the relationship/interaction.

2. “Restricted, repetitive patterns of behavior, interests, or activities, and/or hyper or hypo-sensitivities.

There are also specifiers for severity of the social and verbal deficit, and the extent of restricted interests. Finally, there are specifiers for “with or without intellectual impairment”, “with or without language impairment”, and “associated with a known medical or genetic condition or environmental factor”.

So, you can see that this criteria, with the specifiers, cover everything from what formerly was called ‘Autistic Disorder’ at the more severe end; ‘Asperger’s Disorder’ at the ‘high end’ and ‘Pervasive Developmental Disorder NOS’ for those in-between.

Is There Another Diagnosis?

Yes, there is another ‘competing’ diagnosis, and this is where there may be a potential “problem”. In that regard, the DSM-V has a new diagnosis referred to as “Social (Pragmatic) Communication Disorder (SCD), which entails “persistent difficulties in the social use of verbal and nonverbal communication manifesting in”, for example, difficulty “greeting others and sharing information”, using “overly formal language”, and “following rules for conversation” such as in turn-taking and rephrasing, and “difficulty understanding what is not explicitly stated.”

This diagnosis would cover those kiddos who may have autism-like verbal and social deficits and kiddo’s who ‘don’t quite get it’ socially, but who do not have any restricted or repetitive patterns of behavior or interests.

Which DSM-IV diagnosis will be most affected by the SCD diagnosis?

At least a portion of the kiddo’s who would have been diagnosed with Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) will now be diagnosed with Social Communication Disorder (SCD). Research published in January 2014 in the American Academy of Child and Adolescent Psychiatry found that about 8% of kids diagnosed within the autism spectrum under DSM-IV have subsequently been changed to SCD, which is a far-cry from the 20% predicted earlier by the Center for Disease Control (CDC). Most of the children whose diagnosis was changed had been diagnosed with PDDNOS, and were changed to SCD, which is understandable given that PDDNOS has such vague criteria. Those who had been diagnosed with Autistic Disorder or Asperger’s Disorder under DSM-IV were largely unaffected.

Nonverbal Learning Disability

Another “diagnosis” that may be impacted is “nonverbal learning disability” which essentially is the same as SCD. However, given that there has never been a formal DSM-IV “nonverbal learning disability” diagnosis, now these NVLD kiddo’s too have a better diagnostic fit with SCD.

Consequence of the DSM-V?

It’s likely this change in diagnosis to SCD, for the very few children who will be affected, will generally be positive. In that regard, having seen these kiddo’s first-hand, they clearly struggle with verbal and social skills, but are not “autistic”. Up to now, the diagnostic options have been few besides PDDNOS. These children can still obtain services consisting of individual and group speech/language, and outpatient social skill training, while avoiding the autism diagnosis that does not quite fit anyway.

Hope that helps to clarify the effect of DSM-V regarding the “Autism Spectrum Disorder” vs. PDDNOS, Autistic Disorder, Asperger’s, and Social Communication Disorder.

Feel free to follow-up with me, with any questions at jcarosso@cpcwcare.com.

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Dr. John Carosso

Dr. Carosso has more than 30 years of experience as a licensed Child Clinical Psychologist and Certified School Psychologist working in private, inpatient, outpatient, residential, school, and home settings. He is Clinical Director of Community Psychiatric Centers (cpcwecare.com), a licensed Behavioral Health Outpatient Clinic, and operates both the Autism Center of Pittsburgh (autismcenterofpittsburgh.com) and the Dyslexia Diagnostic and Treatment Center (dyslexiatreaters.com).