It’s DSM 5 day

18 May

Yes, the day has arrived that the DSM 5 (the Diagnostic and Statistical manual) is released by the American Psychiatric Association. The DSM codifies the traits which make up, among many other things, an autism diagnosis. There was a great deal of controversy of the past few years about the way the DSM would handle autism. A major change was to move away from the “spectrum” of autism disorders (ASD) to a single autism diagnosis with a severity scale. Since eligibility for services is often tied to an autism diagnosis–such as insurance, special education and state disability services–many groups were concerned that the new DSM would leave specific groups out. One can find discussions of how those with Asperger syndrome will not be included in the new autism, how those with intellectual disability will not be included and how those with PDD-NOS will not be included.

Yesterday, Molecular Autism included three papers on the DSM 5.

The first introduces the other two: DSM-5: the debate continues by Fred R Volkmar and Brian Reichow.

Here is the abstract (full text free online):

We are fortunate to have invited commentaries from the laboratories of Dr Cathy Lord and Dr Fred Volkmar offering their perspectives on the new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for the autism spectrum. Both Lord and Volkmar are world-leaders in autism and in the autism phenotype and both have been very involved in the DSM: Volkmar was the primary author of the DSM-IV Autism and Pervasive Developmental Disorders section, and Lord has been equally active in the Neurodevelopmental Disorders Workgroup of DSM-5. As such, there are none more qualified to comment on what has been potentially gained or lost in the transition from the fourth edition to the fifth edition of this bible of psychiatric classification and diagnosis.

The first contributed paper is Autism in DSM-5: progress and challenges

Here is the abstract (and full text is available free online):

BACKGROUND:
Since Kanner’s first description of autism there have been a number of changes in approaches to diagnosis with certain key continuities . Since the Fourth edition of the Diagnostic and Statistical Manual (DSM-IV) appeared in 1994 there has been an explosion in research publications. The advent of changes in DSM-5 presents some important moves forward as well as some potential challenges.

METHODS:
The various relevant studies are summarized.

RESULTS:
If research diagnostic instruments are available, many (but not all) cases with a DSM-IV diagnosis of autism continue to have this diagnosis. The overall efficiency of this system falls if only one source of information is available and, particularly, if the criteria are used outside the research context. The impact is probably greatest among the most cognitively able cases and those with less classic autism presentations.

CONCLUSIONS:
Significant discontinuities in diagnostic practice raise significant problems for both research and clinical services. For DSM-5, the impact of these changes remains unclear.

The second contributed paper is DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes by Rebecca Grzadzinski, Marisela Huerta and Catherine Lord.

The abstract is below and the full text is online.

The heterogeneity in the clinical presentations of individuals with autism spectrum disorders (ASDs) poses a significant challenge for sample characterization and limits the interpretability and replicability of research studies. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for ASD, with its dimensional approach, may be a useful framework to increase the homogeneity of research samples. In this review, we summarize the revisions to the diagnostic criteria for ASD, briefly highlight the literature supporting these changes, and illustrate how DSM-5 can improve sample characterization and provide opportunities for researchers to identify possible subtypes within ASD.

The DSM 5 is big news, and relatively big business. As discussed on the American Public Media program Marketplace, the DSM has a major effect on how insurance companies reimburse for various treatments–if you don’t have the diagnosis, you may not get reimbursed for the treatment. Also, the DSM 5 itself makes the APA a significant amount of money, raising questions about whether the DSM was pushed forward too soon (hence the title of the Marketplace spot: How much is the DSM-5 worth?)


By Matt Carey

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6 Responses to “It’s DSM 5 day”

  1. farmwifetwo May 18, 2013 at 21:01 #

    I no longer have to worry about the “kick the non-verbal off the spectrum because they are ID” problem tossed around the internet. As of Wed the non-verbal testing came back age 15. Not bad for a non-verbal autistic 11yr old. Therefore with the verbal scores etc his IQ is now 77 which is borderline. 3yrs ago it was in the 60′s so I expect it will continue to climb like it has with his bro.

    This is not necessarily a good thing since ODSP etc is heavy on being ID but…..

    It is very, very amazing since the ABA people told me when he was 4 (we removed them 12 mths later) that if I did not do what they said it could not be done!!!! :)

    I plan to get the eldest redone before too longer… I expect he will be kicked off officially. A year ago on the IV he was still ASD but the Psychiatrist told me he wouldn’t under the 5. It’s time, he goes.

  2. Candice May 20, 2013 at 15:55 #

    I’m not able to get the full-text to work for “DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes” by Rebecca Grzadzinski, Marisela Huerta and Catherine Lord.

  3. Ken May 21, 2013 at 15:51 #

    I looked for a DSM5 Day Hallmark card, but couldn’t find one. So I wrote my own poem:

    I hope your day is special as
    We disappear the spectrum
    The evidence for an epidemic
    Exists solely in your rectum.

  4. Katie Mia May 28, 2013 at 09:47 #

    I meant to stop by earlier and thank you for providing this information, as I used the links in discussion elsewhere. I am wondering if anyone has “pirated” the actual final criteria now that it is has been officially released.

    I have been able to find no source other than a Psychology Today article that seemed to contradict some of the things that Sue Swedo had earlier commented on in an APA website video per her description of the alterations that were made in the final revision.

    Allen Frances, the previous chair of the DSMIV committee, in the Psychology Today article, presented a quote from what seems to be the final revision, which appeared to have backed away from the explicit requirement of 3 of 3 criterion elements in Social Communication impairments.

    He also presented text that seemed to indicate that a previous “well established” diagnosis under DSMIV criteria was advised as an automatic assessment of the New DSM5 ASD diagnosis.

    http://www.psychologytoday.com/blog/saving-normal/201305/two-fatal-technical-flaws-in-the-dsm-5-definition-autism

    Earlier in the year in Sue Swedo’s statement in the APA web page video she suggested that only RRBI’s could be met by history alone, per previous assessment.

    http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-changes-to-autism-spectrum-disorder

    Allen Frances does not appear too happy with the final revision as he describes these changes as two “fatal flaws”.

    That is quite a bit more of a “condemnation” as opposed to all the hype that was raised around Tom Insel’s statement about the direction of research toward brain disorder rather than mental disorder as a “condemnation” of the DSM5 criteria, where he later clarified his statement was not at all intended that way as he considers the criteria a continued necessary tool for diagnosis, in the next decade.

    Of course, while Allen Frances once had great influence, he has nowhere near the influence of Tom Insel, at this point in time. However, Frances is obviously still a very credible source of information.

  5. Depression Symptoms February 1, 2014 at 23:47 #

    Great article on depression! Thanks Matt you can also find other supporting depression information at http://depression-symptoms.org

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