The notion that the autism epidemic will be eliminated as a result of the proposed changes in the DSM seems like a pretty big leap. The changes in the DSM will consolidate the categories of autism, PDD-NOS and Asperger’s disorder (AS) and refine the diagnostic process. There are many reasons why these changes are necessary. The first is that there is so much vagueness and inconsistency in the way children are currently being diagnosed. You can have one child be seen by three different professionals and get three different diagnoses: autism; PDD-NOS, and Asperger’s disorder. In addition to issues of treatment and services, it is very difficult to effectively conduct research in this population, due to the challenges of accurately classifying children. One might ask, does the child who is non-verbal, with significant cognitive delays, high rates of stereotypy and other challenging behaviors have the same underlying deficits as the child who is able to speak in complete sentences, has an IQ of 120 and mild range of challenging behaviors. Yet, today, with the system available, both of these children would receive the same diagnosis: Autism. In the new system, they too would get the same diagnosis, but it would be accompanied with a better description of the child’s abilities and challenges.
So, back to the question of whether the changes will greatly reduce the numbers of individuals being diagnosed. The implication, of course, is that many of the individuals currently being diagnosed as having Asperger’s syndrome (AS) will no longer qualify under the new system. I see two possible outcomes. The first is that those individuals who have AS will continue to get diagnosed; only it will be a diagnosis of autism. If, after all, they do demonstrate deficits in the three areas of social, communication and behavior, there should be no problem. The second is that those few individuals who fall on the fringe and possibly fail to meet the criteria, will more than likely receive a different diagnosis; such as Anxiety Disorder, OCD, or ADHD.
It has not been my personal experience that the increase in autism has all been accounted for by those individuals who fall on the cusp of the diagnosis. Therefore, even if some individuals no longer meet the standards for the diagnosis, I do not believe the numbers will change dramatically. Remember, in 1987, the incidence was 1/2500. Today, it is 1/110. So, even if the numbers change to 1/1000 (which I would find unlikely); it is still double what we saw 30 years ago. We will need to carefully monitor the impact of the new system to insure that it is not closing out those individuals who need the support and expertise of individuals who work with people with autism spectrum disorders.
Joanne Gerenser, Ph.D., CCC-SLP.
In response to “New autism definition may exclude many, study suggests,” by Benedict Carey for The New York Times.