DSM-5 Revisions “Redefine” Autism

The Diagnostic & Statistical Manual of Mental Disorders (DSM-5) recently underwent its first major revision in the past 20 years. The DSM (or “the psychiatrist’s Bible”) is used to diagnose mental and behavioral conditions in infants, children and adults. The DSM-5 has made significant changes to a number of mental disorders and classifications, including the “re-classification” of Autism Spectrum Disorder, as well as the addition of several new disorders. These changes have been met with both praise and criticism, and will impact children, parents and medical professionals. While Massachusetts Advocates for Children acknowledges that these changes will not impact students’ IEPs or eligibility for specialized services, the revisions to the DSM-5 will have a major impact on children and adults with disabilities, most notably those diagnosed with Autism Spectrum Disorder.

Under/Over Diagnoses

While DSM-5’s new categorizations should not affect student’s IEPs and related services, experts worry that changes in the “required” characteristics of diagnoses such as Autism Spectrum Disorder may cause an underdiagnosis of students who display symptoms. Also, the addition of new disorders such as Disruptive Mood Disorder (for children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times per week for more than a year) may cause an influx or overdiagnosis of children who are believed to have DMD. Special education and the DSM-5 are no stranger to issues of misdiagnosis; we are in a culture where an inattentive and/or hyperactive child is almost automatically viewed as having ADHD (Attention Deficit Hyperactivity Disorder.) While it is too soon to tell, this influx of new and redefined disabilities may increase the commonality of misdiagnoses within special education — a phenomenon that impacts evaluation, placement and IEP eligibility.

DSM-5’s Changes to Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disability that affects one’s verbal and nonverbal communication and social interaction. These symptoms typically present themselves before age 3 and have an adverse effect on the child’s educational performance. Identifying characteristics of ASD include repetitive activities and stereotyped movements, resistance to change in environment and routine and unusual responses to sensory stimuli.

The DSM-5 now has one broad autism diagnosis of Autism Spectrum Disorder. Previous to this year’s changes, the DSM-5 listed autism diagnoses under separate categories of Asperger’s Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder and Rett’s Disorder. Under DSM-5’s revisions, individuals previously diagnosed within one of the aforementioned disorders are now labeled under the umbrella term of Autism Spectrum Disorder. The DSM-5 explains that this re-classification reflects a consensus that the separate disorders “are actually a single condition with different levels of severity.”

Combining these four previously separate disorders into a single condition has raised major concerns among parents, teachers and disability advocates. The Autism Research Institute discusses these changes, stating “... legitimate concerns have been raised regarding how these changes might impact people on the spectrum...some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services. Questions have been raised about what will happen to people currently diagnosed with Asperger’s Disorder or PDD-NOS. Furthermore, there is uncertainty regarding how state and educational services and insurance companies will adopt these changes.”

Autism Speaks created a resource guide for parents of and those with ASD, identifying problematic issues such as how these changes will impact treatment, support services and insurance coverage. The nonprofit organization reassures that all individuals currently diagnosed on the Autism spectrum will remain on the spectrum, will not “lose” their diagnosis and should have no need to be reevaluated by doctors or school systems. DSM-5 changes will also have no effect on insurance coverage or eligibility.

Additional Disorders and Conditions Affected by DSM-5

Autism Spectrum Disorder is not the only disorder to undergo changes. The DSM-5 sought changes to the terminology and determining characteristics for a number of existing disorders. A new diagnosis of Social (Pragmatic) Communication Disorder was added for individuals with “persistent difficulties” in social uses of verbal and nonverbal communication. Additional changes to the DSM-5 terminology include:

Transitioning from the term “mental retardation” to the more commonly accepted “intellectual disability.”
Stuttering is now referred to as “Childhood-Onset Fluency Disorder.”
Diagnoses of reading disorder, mathematics disorder, disorder of written expression and learning disorder not otherwise specified are now referred collectively as “Specific Learning Disorder.”
Diagnosis of Social Phobia is now referred to as “Social Anxiety Disorder.”
"Hoarding Disorder” was added to the classification of Anxiety Disorders.

Visit the APA’s Highlights of Change from DSM-IV-TR to DSM-5 for more information on changes to disability categorization.

Moving Forward

At this point, it is unclear what the lasting impacts the new DSM-5 will have on special education. However, it is important to recognize the significance of the publication, and its far-reaching effects in relation to disability advocacy, mental health care and specialized services for both children and adults. Conflicting views aside, the DSM-5 has made alterations to a number of “mainstream” disabilities and disorders. Becoming well-versed in the DSM-5 will allow you to become a strong advocate for your students, children and peers who are diagnosed with a disability.

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