![]() ![]() With regard to the diagnosis of pervasive developmental disorders (PDDs) (the categorical title used for the “autism spectrum disorders” in DSM-IV), DSM-5 has introduced several major changes, which include (1) converging the diagnostic groups previously subsumed under the category of PDDs into a single diagnosis of ASD (2) merging the social and communication impairment symptom domains required for the diagnosis of autism into a single domain, thus reducing the symptom domains involved in diagnosis from 3 to 2 (3) expanding the “restricted, repetitive behaviors” symptom domain to include abnormalities in sensory processing and (4) relaxing the age at onset criterion.įor autism and related conditions, the most significant and controversial revision in DSM-5 is the merging of 4 disorders that were distinct under DSM-IV criteria into a single diagnostic category. Furthermore, the applicability of items and concepts taken out of context and without formal training in the assessment processes from which the items are derived may create some significant issues. This approach, while both cost efficient and research focused, comes at the potential price of some loss of “ecological validity.” In other words, in real-world settings, clinicians do not have the time to take weeks of training on a panoply of research instruments. The use of such instruments for research is well known, and often, as in autism, these have been explicitly “keyed” to categorical diagnostic criteria. A second shift in the DSM-5 has been the focus on the use of relevant dimensional and other assessment instruments. Historically, DSM has been used for both research and clinical purposes this differs from the current ICD-10 approach, which has separate manuals for research and clinical work. This decision, understandable particularly from the point of view of more specific and research-based criteria sets, also poses some practical challenges for DSM-5. One is the elimination of “subthreshold” categories, such as pervasive developmental disorder not otherwise specified (PDD-NOS), throughout the manual. "Future research is needed, as concerns remain for impaired individuals, who, because of the change in diagnostic criteria for ASD, may no longer qualify for treatment but still demonstrate a need for services.Before discussing the specific changes, it is important to note 2 overarching conceptual shifts in DSM-5. "Our findings provide further insight regarding how the DSM-5 is being used nationally and internationally to diagnose, or failing to diagnose, those with ASD," Kulage said in a statement. Compared with earlier reviews, the findings suggested smaller decreases in ASD diagnoses. Overall, 28.8 percent (P = 0.06) of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for social communication disorder. The researchers found that use of DSM-5 criteria indicates reductions in the diagnosis of ASD (20.8 percent P < 0.001), DSM-IV-TR autistic disorder (10.1 percent P < 0.001), and Asperger syndrome (23.3 percent P = 0.001) a nonsignificant decrease was seen in pervasive developmental disorder-not otherwise specified (46.1 percent P = 0.52). ![]() Kulage, M.P.H., from the Columbia University School of Nursing in New York City, and colleagues examined changes in the frequency of ASD diagnoses since the DSM-5 publication in a five-year follow-up systematic review and meta-analysis. ![]()
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