Psychiatric cliff avoided

In this morning’s SFARI website, Emily Singer nicely summarized the approval of DSM-5: “After several years of debate, the American Psychological Association has approved the new version of the Diagnostic and Statistical Manual of Mental Disorders, the guidelines used to diagnose psychiatric disorders. Changes to the diagnostic criteria for autism have been among the most controversial of the new guidelines, called the DSM-5. The two biggest changes streamline the guidelines, reducing the number of classes of symptoms as well as the number of disorders that fall under the autism heading.

In the DSM-5, the traditional subclasses of autism, which include the milder Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS), are restructured as a single disorder called autism spectrum disorder. This change has triggered concerns that some people diagnosed under the existing guidelines, the DSM-IV, will lose their access to therapy and other services. Studies of the potential impact have shown conflicting results, and scientists on both sides of the issue say the answer won’t become clear until results of the field trials — tests of the DSM-5 in a real-world setting — are in. (Preliminary results, reported at an autism conference in May, suggest that most people won’t be left behind.)

The second major change, which has been less controversial, is bringing together social deficits and language problems into the single category of social communication problems. (The other major category of symptoms, restricted and repetitive behavior, remains intact.) That change is based on research showing that language and communication difficulties in people with autism are often limited to the social domain.

The changes are all based on an extensive review of the scientific literature on autism. But a survey of health and education professionals published in November suggests that people working in the clinical arena may have some trouble accepting the changes.  As I noted in a blog on the study, approximately half of the participants said they are opposed to the changes, 22 percent said they support the proposed changes, and 28 percent said they are uncertain.”

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