Update on Diagnostic Classification in Autism

Bryan H. King; Noa Navot; Raphael Bernier; Sara Jane Webb


Curr Opin Psychiatry. 2014;27(2):105-109. 

In This Article

Important New Changes in the DSM-5

Three additional and very significant changes to the ASD criteria in DSM-5 address concerns about diagnostic conversion and diagnostic independence. First is the inclusion of 'by history' in the assessment of diagnostic criteria. As noted above, unfortunately this criterion was not part of early draft criteria that were circulated for review, and many studies comparing the impact of the transition from DSM-IV to DSM-5 would likely have yielded different results had the full criteria set been utilized. Second, the insertion of a 'grandfather' clause in the DSM-5, such that individuals with established diagnoses of PDD should simply be given the diagnosis of ASD, was not part of draft criteria. A final and similarly important change to the criteria for autism relates to the elimination of 'trumping rules' that had previously prevented the co-diagnosis of attention deficit hyperactivity disorder or of schizophrenia in the setting of autism.

Lastly, a new disorder, social communication disorder, was added outside the autism spectrum to provide a diagnostic cover for individuals with significant difficulties with social communication, but who have no history of repetitive or restricted behaviors. Some have suggested that individuals who previously may have been given the diagnosis of PDD-NOS may be shifted into this diagnosis (and thus inappropriately off the spectrum), and the argument has also been made that social communication deficits are the singular defining feature of the autism (or social communication development) spectrum.[31] On the contrary, one could equally assert that individuals with social communication or social interaction deficits (e.g. the individual who impulsively interrupts, speaks too loudly, violates personal space, etc.) in the absence of any restricted or repetitive behavior history should not have been given a diagnosis of PDD-NOS in the first place – for example, that PDD-NOS was only a default because of the absence of a better way to capture a deficit in social communication pragmatics.