How Does Relaxing the Algorithm for Autism Affect DSM-V Prevalence Rates?

28 Jun

There has been much discussion of the impact the DSM 5 will have on who will be diagnosed with autism. Another paper exploring this came out yesterday: How Does Relaxing the Algorithm for Autism Affect DSM-V Prevalence Rates?. The abstract is below:

Although it is still unclear what causes autism spectrum disorders (ASDs), over time researchers and clinicians have become more precise with detecting and diagnosing ASD. Many diagnoses, however, are based on the criteria established within the Diagnostic and Statistical Manual of Mental Disorders (DSM); thus, any change in these diagnostic criteria can have a great effect upon children with ASD and their families. It is predicted that the prevalence of ASD diagnoses will dramatically decrease with the adoption of the proposed DSM-5 criteria in 2013. The aim of this current study was to inspect the changes in prevalence first using a diagnostic criteria set which was modified slightly from the DSM-5 criteria (Modified-1 criteria) and again using a set of criteria which was relaxed even a bit more (Modified-2 criteria). Modified-1 resulted in 33.77 % fewer toddlers being diagnosed with ASD compared to the DSM-IV, while Modified-2 resulted in only a 17.98 % decrease in ASD diagnoses. Children diagnosed with the DSM-5 criteria exhibited the greatest levels of autism symptomatology, but the Mod-1, Mod-2, and DSM-IV groups still demonstrated significant impairments. Implications of these findings are discussed.

Without the full paper it is difficult to compare the modified criteria. Also, from the abstract alone we can’t tell much about the methodology of the application of the DSM 5 and the two modified criteria. Keeping those very large caveats in mind, this study points to a lower rate of autism diagnoses for toddlers under the DSM 5, even with modifications. The study does not appear to address the question of the effect of the DSM 5 on diagnosing adults.

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8 Responses to “How Does Relaxing the Algorithm for Autism Affect DSM-V Prevalence Rates?”

  1. seventhvoice June 28, 2012 at 08:05 #

    I still, and perhaps mistakenly, feel that the broadening out of the ASD diagnostic criteria will in fact result in fewer children being diagnosed with ASD in a way that meaningfully allows them access to support services and alike. Whilst more children may come under the heading of having aspects of mild ASD, (mild as in not qualifying for support). I think it is merely an illusion that a better diagnostic system will lead to fairer levels of support for families of children with ASD. I hope I am wrong. As for adults, it’s hard enough to be accurately diagnosed as adult as it is. I don’t think the new criteria will in any way help with that issue.

  2. futuredave5 June 28, 2012 at 12:21 #

    Autism is a disease diagnosed only by its symptoms. By restricting the definition, one of the most obvious results will be that the children with the best coping mechanisms will be denied service. I don’t see how this could possibly be a good thing.

    Children who are “almost typical” might be able to function independently with just a small amount of assistance. Denying that assistance (by moving the entrance requirements) just increases the chances that more kids will receive their primary care through the state prison system.

    Similarly, if a child makes great progress between 2 and 4, in our school system at least, they will be “mainstreamed.” This process saves the school system a lot of money, but puts ASD kids in classes for which they are almost (but not quite) completely unprepared.

    My goal is to eventually mainstream my son, but at the moment, if he were to be placed in a typical classroom, he would disrupt the education of every other child in the class. Imagine if the school system were required to suggest mainstreaming.

    Imagine if the school system were required to say: “Your son isn’t autistic, he is just a year behind in language.” (Oh good. That explains everything. Let’s mainstream him and see if a single underpaid teacher in a large classroom can catch him up. Even though two years of intensive therapy did not.)

    Just because the parents spent a few thousand dollars on therapy to get a child is able to tie their own shoes does not mean the child is cured.

    The American Psychiatric Association should reconsider this. First, we are getting closer to chemical and physical tests for autism that will render the DSM definition obsolete.

    But second, and most importantly, their primary goal should be to do no harm. I think they are running the risk of doing serious harm to thousands of children.

    • Roger Kulp June 30, 2012 at 02:11 #

      futuredave5,

      Just because the parents spent a few thousand dollars on therapy to get a child is able to tie their own shoes does not mean the child is cured.

      I could not agree more.But to get off topic,this is something that a parent,usually a mother,used to spend years with on an autistic child,like my mother did with me.I was twelve years old when I tied my shoes for the first time.But since both parents usually have to work nowadays,they have to hire expensive therapists.

      As far as chemical and physical tests,we are there already for a few forms of autism.Some like autism caused by defects in folate metabolism,which I have,are fairly new,and we can test for genes,proteins,and metabolic markers.

      There is another form of autism that involves genes related to Parkinson’s,and the synthesis of glutathione,often in families where there is a history of Parkinson’s or Alzheimer’s.Just to name two very different types.

      It really is remarkable that we have been able to come as far as we have in the face of the antivaccine movement,Genetic research must continue.It will not lead to abortions of autistic fetuses as some claim..

      You mention a point that I have wondered about these last few years.If we can point to an inherited process or syndrome that can present as autism,do we still want to call it autism?Will autism even exist as a diagnosis,when the DSM-VI or VII comes out?Will it just be recognized as a feature of any number of diseases and syndromes,many of which are yet unnamed or undiscovered?

      These are the sort of discussions we ought to be having.

  3. greenwichspecialneedssupport June 28, 2012 at 13:20 #

    Reblogged this on Greenwich Special Needs Support Group and commented:
    I think they are trying to keep people from getting labeled so they don’t have to provide services

    • VMGillen June 28, 2012 at 18:12 #

      Trust me, the APA is not looking to change labels so they don’t have to provide services. Those services provide billable hours – part of why, IMO, the APA (Formerly expert in analytical/cognitive, now suddenly all twitterpated about “behavioural” approaches – notice a trend based on billable Dx?) should not be formulating the DSM.

      One thing I’m wondering: what happens to long-term, comparative cohort studies? Has the APA figured out how to match apples with oranges?

  4. Yo-Yo July 1, 2012 at 13:18 #

    “Autism is a disease diagnosed only by its symptoms.”

    Speak for yourself. I am not diseased. Autism is a farce, diagnosed only by symptoms. LIke with ADHD or childhood bipolar syndrome, the reality has been heavily obscured.

    • futuredave5 July 2, 2012 at 09:13 #

      Sorry, it was not a great choice of words. I said “disease” so I could make the point that medical science does not know the cause, only the symptoms.

      Even the new tests like the EEG studies are really not looking at the cause. They are detecting different electrical patterns in the brain, for example, but no one knows exactly why the patterns are different.

      The way we treat autism is similarly restricted. My son has learned to use quite a few words at ABA therapy, but still, that is just a fancy way of treating the symptoms.

      The DSM gives different labels to different kids based on different sets of symptoms. But what if all those symptoms were caused by the same condition?

      Let’s say, for example, that one type of autism is related to an inability to process certain proteins. In some kids, this form of autism leads to speech delays, while in other kids it leads to repetitive behaviors. The DSM would classify these as two separate conditions, even though the root cause is similar.

      It just seems very unscientific to me.

      • Roger Kulp July 2, 2012 at 15:47 #

        No Dave,don’t apologize.I refuse to buy into that crap about autism is just a “difference” that somehow makes your life better.We can’t let the majority with mild forms of autism define what autism is for everybody on the spectrum.Families with severely disabled autistics need to confront these people where ever and when ever possible.

        For some people autism is a disease.The trouble is finding the right cause.This can be very complicated,without a road map.The biggest clues are learning what your family medical history is,and then investigate related causes of autism.Because autism is not this monolithic thing,any more than it’s an “identity”,or “vaccine damage” for that matter.Autism is merely a presenting feature of many different diseases,syndromes,and disorders.

        I had something explained to me recently,and it made a great deal of sense.The reason there are so very few autistics out there like me,autistcs over the age of say,forty,who are severely disabled,or have a lot of complex medical,and congenital brain related problems,is that most of them are probably dead.Dead,maybe in their twenties or thirties,from seizures,acute infection,or complications from same.I would also add undiagnosed metabolic crisis.As someone who came very,very close to death five times in my life from such things,usually meningitis or pneumonia,this seems very logical.This may be one reason the antivaxers can talk all they can about an “autism epidemic”,and have so few 50 year old with autism,not Asperger’s,or PDD stand up and tell them they’re wrong.Yes I know it’s all going to be the same now,but you get my point.

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