A Guide to DSM-5

Bret S. Stetka, MD; Christoph U. Correll, MD

May 21, 2013

Autism Spectrum Disorders

The Change

DSM-5 includes a single ASD category that does not differentiate between the previously used diagnoses. The new criteria group the following formerly distinct diagnoses into a single ASD diagnosis: autistic disorder, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS).

The Implications

Among the most controversial of the DSM-5 revisions, this change was made owing to the DSM-5 Task Force's dimensional approach to categorizing psychopathology. Although there was concern that a large percentage of persons formerly diagnosed with an ASD would fall outside of the new diagnostic criteria, and thus be ineligible for certain services, this seems unlikely in most situations. Rather, patients will be diagnosed more consistently across a single spectrum, with indicators of different severity of symptoms.

In a commentary published on Medscape in June 2012, DSM-5 Task Force Chair, Dr. David Kupfer, commented, "Advocates for those who suffer from Asperger syndrome and autism disorders want to ensure that children with DSM-IV-defined conditions are not denied services under DSM-5. Our field trial data do not show that people with treatment needs will be negatively affected, and all will be helped because clinicians will be guided by more explicit definitions and descriptions of symptoms and behaviors."

However, concern remains that the revised criteria could result in a confounding of very heterogeneous clinical presentations, with mild PDD-NOS on the one end and severe autism on the other. On the other hand, clinicians can diagnose across a meaningfully related spectrum of symptoms and behaviors -- recognizing overlapping features of and differences in individual presentations and focusing on the severity of the symptoms, which will help guide treatment approaches more directly. Clinicians will probably need to take some time to discuss with parents any changes in the diagnosis of their children based on DSM-5 criteria.