PDD-NOS Diagnoses and the Proposed DSM-5 Definition of Autism
Pervasive Developmental Disorder Diagnoses and the Proposed DSM-5 Definition of Autism
People who receive an autism diagnosis, using DSM-IV are told they have one of three conditions: Autism, Asperger's, or Pervasive Developmental Disorder not otherwise specified (PDD-NOS). The question is, how is the diagnoses determined? Is there a coherent sense of classification, or is it merely arbitrary? What factors determine which category an individual will be categorized?
For years, many experts have contended that the generalization of the current criteria for autism diagnoses and related disorders was contributing to the increase in reported rates, which has ballooned to one child in 88, according to some estimates.
The proposed new DSM-5 criteria has become a heated issue for families with children diagnosed with autism because it is putting their access to treatment services at risk. Over the years, the Autism Spectrum Disorder (ASD) sub-category diagnosis of PDD-NOS, also call “atypical autism,” has often been used as a way for caregivers to have access to services without the stigma of the “autism” label. The diagnosis of PDD–NOS is commonly assigned to higher-functioning individuals who exhibit deficits in the areas of social interaction and communication but who do not meet the full DSM-IV criteria for autism.
DSM-IV vs DSM-5 Comparison
Following the current definition, a person can qualify for a PDD diagnosis by exhibiting at least six out of 12 behaviors; under the proposed definition , the person would have to exhibit deficits in three social interaction and communication contexts plus a minimum of two out of four restrictive repetitive patterns of behaviors. The proposed revised definition is much narrower, thus giving rise to fear that it would exclude many individuals currently receiving services under the PDD diagnosis.
(DSM-IV refers to the current Diagnostic and Statistical Manual - 4th Edition published by the American Psychiatric Association and is used to diagnose mental illnesses. DSM - Edition 5 is due for publication in May 2013 and will replace the DSM-IV.)
Impact of the Proposed Changes
A January 2012 NY Times article, mentioned a study that found the proposed revisions to the American Psychiatric Association’s definition of Autism could exclude about three-quarters of those now diagnosed with milder forms of autism called Asperger syndrome or PDD - NOS.
These proposed revisions, which would take effect in 2013, can put into jeopardy the availability of life-changing services which autism experts assert can improve an individual with ASD’s ability to socialize, communicate and ultimately live independently.
This debate among autism professionals over how to define autism has spilled over into the autism community-at-large, causing fear and anger among many parents and advocates.
Latest Updates - Autism Diagnosis Revision
Below are a few links with updated information on the status of the DSM-5 criteria.
American Journal of Psychiatry, October 1, 2012
Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders
The Huffington Post, October 24, 2012
An article by Catherine Lord Ph.D, a member of the Neurodevelopmental Disorders Work Group, addressing the fears over a new autism diagnosis.
Read full Huffington Post article here:
Ending Fear Over the New Autism Diagnosis
Diagnosing autism spectrum disorder is not as simple as a broken bone or heart disease. There are no physical tests. Autism professionals know that parents and caregivers are worried about the proposed changes and the potential for the diagnosis criteria to be more restrictive. This would lead to less accessibility to services.
However, the latest findings, based on the results of the October 2012 study referred to above, found that most children with a current DSM-IV PDD-NOS diagnosis would maintain an ASD diagnosis under the proposed DSM-5 definition.
We recommend that you consult with your autism professionals to determine how the proposed changes may affect your child’s future access to treatment services.