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January 5, 2012

DSM-V and Autism: Don't Fret

Written by Dr. Carosso

The Diagnostic and Statistical Manual is the primary manual psychologists use to diagnose. The upcoming Fifth Edition will have some significant revisions to how autism is diagnosed, and I’m hearing concerns from parents that this could effect insurance reimbursement and services.

Well, there are some significant changes; gone are the current diagnoses such as Autistic Disorder, PDDNOS, and Asperger’s. Instead, the more global term “Autism Spectrum Disorder” is used, but the specific diagnostic criteria, and qualifiers, seem to be quite explicit and appear to cover the necessary bases. Severity criteria is also forthcoming to help differentiate between the former diagnoses. Some might say the upcoming diagnostic criterion is more user-friendly and specific. Of course, between now and release in May 2013, some things could change, but have a look for yourself:

Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.

I'll keep you informed of any other changes but, in the meantime, I hope this helps to squelch some fears. We’ll look at this further as the release date nears.
Please feel free to comment or ask any questions.
God bless.

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