Experts evaluate DSM-5

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(This article is an introduction to a special report on the DSM-5 that appeared 30 May 2013 on SFARI.org. You can view the special report here. For the report, I conceived the idea, commissioned and edited the articles, and worked with the web producer on the images and presentation.)

It’s been nearly 14 years in the making, with heated debate for at least 2, but finally it’s here: The American Psychiatric Association published the DSM-5, the newest revision of the Diagnostic and Statistical Manual of Mental Disorders, on 18 May.

For this special report, we asked several experts to review the DSM-5 criteria for autism — and their reactions are surprisingly positive overall.

Walter Kaufmann, a member of the DSM-5’s Neurodevelopmental Disorders Work Group, notes that the term ‘intellectual disability’ replaces the previous ‘mental retardation,’ a change that is long overdue. The DSM-5 places a greater emphasis on daily life skills over the intelligence quotient in determining intellectual disability.

The new version of the manual also acknowledges for the first time that females with autism may have features that differ from those of males with the disorder, notes William Mandy, a lecturer in clinical psychology at University College London in the U.K.

One of the big changes in the DSM-5 is the decision to have a single diagnosis of autism spectrum disorder, folding in the milder Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS). Many people raised concerns that this move would deny people with less severe symptoms a diagnosis of autism and, as a result, access to services even when they need them.

Simon Baron-Cohen, director of the Autism Research Centre at Cambridge University in the U.K., was among those most critical about this change. He now points out that the DSM-5 has made allowances for this fear, and says there is, in fact, much to recommend in the new criteria.

Evidence so far also suggests that people now diagnosed with Asperger syndrome or PDD-NOS won’t lose services, says Ari Ne’eman, president of the Autistic Self Advocacy Network. Ne’eman says the new unified diagnosis may instead make it easier for them to get the help they need.

As Ne’eman points out, however, the DSM-5 still has flaws. One big area of concern is the creation of a new diagnosis called social communication disorder.

Helen Tager-Flusberg, director of Research on Autism and Developmental Disorders at Boston University, says there is little evidence that this new category is either reliable or valid, and it should never have been created.

There may be multiple revisions of the DSM-5 to address this and many other concerns, but in the meantime, diagnostic tests may need to be updated to align with the new criteria, says Amy Esler, assistant professor of pediatrics at the University of Minnesota.

What do you think? Join the community discussion here to weigh in on the criteria and pose any questions you may have.

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