What’s the Autism Spectrum according to the DSM-V?

 Diagnosing Autism Spectrum Disorders has changed significantly over this past decade.

Diagnosing Autism Spectrum Disorders has changed significantly over this past decade.

Sometimes when we think of Autism Spectrum Disorder (ASD) or autism in general, we imagine the old criteria of this disorder which has recently changed over the last decade with the release of the DSM-V. There are new definitions and criteria for autism in comparison to the definitions most of us were familiar with when the DSM-IV was the standard for diagnosing mental health disorders. Since there can be some confusion surrounding autism as defined by the DSM-IV-TR (the old American Manual of Psychiatric Diagnoses) and autism spectrum disorder (the more PC term), we're going to go over some of the major changes. It's important for us to clarify all that the autism spectrum encompasses, and work to remove any and all stigmas while spreading awareness and understanding surrounding this disorder.

Major Changes Surrounding Autism from the DSM-IV to the DSM-V

When the DSM-IV-TR was considered the gold standard for diagnoses in the U.S. autism fell under the diagnosis of “Pervasive Developmental Disorders” or PDD, which was an umbrella term that contained five separate diagnoses under it. The DSM-V deleted the five separate diagnoses when it was released, and now terms everything on one spectrum of autism. The criteria for many of the stages of the spectrum have changed as well since the DSM-V was published. Some of you may be wondering just exactly what the five different disorders falling under PDD were that are now termed ASD, and that's a wonderful query. We're going to go over them right now, as well as the different diagnostic criteria associated with each in terms of the level of severity these cluster of symptoms are at on the spectrum.

PDD According to the DSM-IV-TR

The DSM-IV-TR defined the different levels of severity now defined on the autism spectrum to be five different diagnoses according to their unique symptoms and levels of severity. Grouped under PDD, the basic criteria for these disorders entail behavioral patterns that are unusual and detrimental to one's ability to function, as well as significant detriments in social skills and interpersonal communications. There are also deficiencies in emotional intelligence in those who suffer from one of these disorders. The five categories according to the DSM-IV-TR were termed:

  • Autistic Disorder

  • Rett's Disorder

  • Childhood Disintegrative Disorder

  • Asperger's Disorder

  • PDD-NOS (not otherwise specified, as symptoms do not fit into any other category)

Before we go over just how these have changed in the DSM-V in terms of severity and more strict diagnostic criteria, we'll discuss the differential features that were used to categorize these different disorders in the past.

Autistic Disorder

This is categorized by remarkably abnormalities and impairments in social skills and communication, as well as impairments in development. Interests are also restricted for this category. The ways this disorder manifest varies greatly depending on the age of the person who has this disorder, the developmental level they are operating at. This disorder was further broken down into Early Infantile Autism, Kanner's Autism and Childhood Autism. In order to diagnose someone with this disorder, they used to be required to have at least six symptoms associated with impairments in social interactions, communication, and restricted, repetitive, or stereotyped behaviors, interests, etc.

  • Group 1: Impairments in social interactions that manifests in at least two of the symptoms including:

    • Lack of development of friendships appropriate for one's age (inability to form social bonds)

    • Inability to use nonverbal communication/behaviors such as:

      • eye contact

      • body language

      • social gestures (pointing, etc.)

      • facial expressions

    • Inability to share personal interests, activities, joy, triumphs, etc. with others

    • Impairments in social emotional intelligence

  • Group 2: Communication deficiencies that present in a person in at least one of the following ways:

    • Delayed speech, or a lack of speech

    • Inability to initiate or carry on a conversation with others

    • Repeating certain words or using quirky language

    • Inability to pretend or use make-believe when playing (no social modeling, etc.)

  • Group 3: Behavioral patterns that are repetitive, stereotypical of autism according to interest, quirks, activities, etc. that present in at least one of the following ways:

    • Cannot vary from one's routine without causing extreme distress

    • Extreme preoccupation with a specific interest or object

    • Repetitive physical body movements

In addition to the above criteria, there must also be developmental delays or abnormalities in social functioning, social communication, and imaginative play before the age of 3, and these cannot be accounted for more accurately by Rett's Disorder or Childhood Disintegrative Disorder.

Rett's Disorder

This disorder was specified as a variety of developmental delays or deficits that follow normal functioning after birth. There is a loss of hand skills that were once present, psychomotor retardation, and an interest in one's social environment fades after a few years of onset. There are also some issues with expression and language development.

Childhood Disintegrative Disorder

A child diagnosed with this disorder would experience normal development for at least two years, then would experience a decline in at least two skills which include language, social skills, an ability to adapt, an ability to control bodily functions (bladder and bowels), social interactions, communication, or behavioral patterns, interests, etc.

Asperger's Disorder

This disorder is categorized by the same impairments listed for Autism Disorder pertaining to social skills and behavioral patterns and interests, but without the delays or issues in language, cognitive development, self-help skills, an ability to adapt, and a general curiosity about the world or environment as a child.

PDD-NOS

This entails a presence of the symptoms associated with autistic disorder that cannot be met because of later onset, or atypical presentations of symptoms, etc.

Autism Spectrum Disorder According to the DSM-V

With the unveiling of the DSM-V, we saw the dissolution of the five aforementioned disorders. These were replaced with one diagnosis: Autism Spectrum Disorder (ASD). It's important to note, however, that the diagnostic criteria for this also changed, so not every disorder that once fell into a form of PDD is diagnosed as ASD today. Some of the diagnostic criteria have been reduced, while those who fall into the umbrella of symptoms are not simply rated by severity rather than grouped according to the features they were prior. There's a distinct increase in the specifics needed to reach a diagnosis, and a distinction between the clinical and non-clinical. Approximately 25% of children who once received a PDD disorder will not be diagnosed with ASD now. This is incredibly interesting to note considering autism rates have been on a drastic rise over the years. It's interesting to ponder what the rates would be now over the past ten years had this diagnostic criteria not been changed. Or, are we comparing apples to oranges when viewing the statistics surrounding Autism Disorder as it is now only one form of severity of ASD?

Regardless of the statistics, ASD is a clear and present issue affecting one in 59 children today. If you or someone you know has someone in their life who has ASD and would like some help intervening, we offer a variety of services to help child and family adjust and thrive. Feel free to contact us for more information

Jayna Nickert