There has been a great deal of talk recently in the media and between parents
and professionals about possible upcoming changes in the way autism spectrum
disorders (ASDs) are classified. the fear expressed by parents concerns whether
their child will no longer meet criteria for the diagnosis and consequently be
unable to receive necessary services. Much of this talk has arisen over the
public comments concerning the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) that is due out by summer 2013.
The upcoming changes are based on new knowledge and understanding about ASDs. As all parents of a child with an ASD know there have been major advances in areas
of brain research, genetics and the general understanding of child development
and child behavior. The aim is to use this information to make the field of ASD more understandable and to make the core concepts that identify a child as having an ASD clearer.
Numerous clinicians, professionals and advocates have been involved in this process and at the present time field studies are being conducted to test the proposed new diagnostic criteria. The concern is being raised that a more stringent diagnostic set of standards could alter the composition of children diagnosed with an autism spectrum. The aim is to have a set of criteria that does not exclude a child who has an ASD but does not include children who do not have an ASD.
The greatest fear of any parent is that their child will not meet service eligibility criteria and necessary and successful services will stop. An additional concern about the financial cost of care and services presently covered by medical assistance through the medical loophole program due the diagnosis of autism accentuates this fear and concern.
Although there have been some reports of children with high functioning autism spectrums who would be excluded from the “new diagnosis” information is still limited. Most of the children who failed to meet the proposed criteria failed because they did not meet the social communication criterion or the restricted or repetitive behavior criterion. Children in the previous categories of Asperger’s disorder and PDD (NOS) were at greatest risk for not meeting the proposed DSM-5 criteria. An extensive review is now underway to determine the statistical and real life service eligibility implications of
the proposed criteria changes.
As a parent you must not rush to judgement. The existing criteria are behind the times. They are inexact and lack a dimensional understanding of the autism spectrum diagnosis. Change is needed. The new criteria must not, however, exclude high functioning children and adults who do not have the behaviors that are typically seen in those children with ASDs who have a low IQ. These behaviors include: stereotyped or repetitive speech, motor movements or repetitive use of objects (sterotypies); excessive
adherence to routines, ritualized patterns of verbal or non-verbal behavior or excessive resistance to change; highly restricted, fixated interests; and increased or decreased reactivity to sensory input or unusual interest in sensory aspects of the environment.
Those writing the new criteria understand the importance of autistic type social-communication impairments. It is these impairments that lead to the greatest social, emotional and educational problems encountered by individuals with ASDs as they age. The effects of these deficits on relationship building and the ability to find successful satisfying long term employment cannot be overstated. Due to the importance of these core deficits parents should be encouraged that their child who has deficits in these
areas and not other associated areas would still be able to maintain the diagnosis of ASD.
As with all matters, patience is the key. Those working on this endeavor are committed to providing your child the best care possible. The public outcry has been heard. The criteria have not been finalized. New studies and reports will be presented as they become available. Please stay tuned.