There has been concern that the new DSM-5 category ofautism spectrum disorder (ASD), which subsumes the previous DSM-IV diagnoses of autistic disorder (autism), Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), will impact the prevalence of autism and affect eligibility for services. Funded in part by Autism Speaks, a new study in theJournal of the American Academy of Child and Adolescent Psychiatry reports that the estimated prevalence of autism under the new DSM-5 criteria would decrease only to the extent that some children would receive the new diagnosis of social (pragmatic) communication disorder (SCD). The new diagnosis of SCD was created along with revised criteria for autism in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Briefly, SCD describes individuals who have social and communication difficulties without the repetitive behaviors or restrictive interests typical of autism.
The new findings were based on detailed, in-person ASD evaluations performed during an earlier Autism Speaks study by the same investigators. In this new study, the researchers used DSM-5 criteria to re-assess the symptoms of 292 children diagnosed with autism during their earlier study. The findings suggest that a majority of individuals with a prior DSM-IV diagnosis meet DSM-5 diagnostic criteria for ASD and SCD. Overall, the researchers found that 83 percent of children who received a diagnosis of autism under the DSM-IV would still receive the diagnosis under DSM-5. The remaining 14 percent would switch to a diagnosis of SCD.
Examining the previous DSM-IV subtypes (autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specified [PDD-NOS]), Yale University child psychiatrist and epidemiologist Young-Shin Kim and her colleagues found the following:
- Of children previously diagnosed with PDD-NOS, 71 percent would now be diagnosed with ASD, 22 percent with SCD and 7 percent with another non-autism disorder.
- Of those previously diagnosed with Asperger disorder, 91 percent would now be diagnosed with ASD, 6 percent with SCD and 3 percent with another non-autism disorder.
- Of those previously diagnosed with autistic disorder, 99 percent would now be diagnosed with ASD and 1 percent with SCD.
Until proven otherwise, the treatments for ASD and SCD should remain the same or similar,” says Dr. Kim. “It’s important for children moving to a SCD diagnosis – and to their families – that they continue receiving the interventions they would have received with an autism diagnosis under the earlier DSM-IV criteria.” It is also important to note that, according to the DSM-5, individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or PDD-NOS should be given a diagnosis of ASD. Those who have marked deficits in social communication, but whose symptoms do not currently meet the criteria for ASD, should be evaluated for social (pragmatic) communication disorder.
Kim YS, Fombonne E, Koh Y-J, Kim S-J, Cheon K-A, Leventhal B, A Comparison of DSM-IV PDD and DSM-5 ASD Prevalence in an Epidemiologic Sample, Journal of the American Academy of Child & Adolescent Psychiatry (2014), doi: 10.1016/j.jaac.2013.12.021.
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a new Volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.
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