The Diagnostic Transformation of Autism




The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V) brought about many changes in psychiatric diagnosis.  Among them, the criteria used to diagnose Autism underwent a number of alterations.  To begin, the previous manual (DSM-IV TR) outlined three Autism diagnoses: Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.  With the most recent edition, there now exists only one Autism diagnosis: Autism Spectrum Disorder.  The “spectrum” has certainly widened and is supposed to be used to describe those who are nonverbal to those with only mild Autism ribbonsymptoms.

Now more than ever, a thorough and careful evaluation is needed to determine whether a child meets criteria.  This begins with an extensive interview including the child’s history (medical, developmental, social, language, play, and behavior), a detailed description of current concerns, observations across a minimum of two sessions, and a collection of objective data (testing, parent questionnaires, teacher surveys).  Consideration of alternative explanations for a child’s presenting concerns is also done, including cultural and social factors.

A year after its inception, the consequences of the diagnostic changes are still taking shape.  From a personal clinical experience, the new criteria makes diagnosis more specific.  Where before, criteria may have been liable to greater subjectivity, attempts to resolve this in the new edition have been made and we are defining Autism with ever greater clarity.