Embracing the autism spectrum
Often called a neurodevelopmental disorder, autism is characterized by impaired social interaction and communication—such as delayed language development, avoiding prolonged eye-contact and sometimes difficulty making friends—as well as restricted and repetitive behavior, such as repeated vocal quirks or gestures. In the DSM-IV, autistic disorder, Asperger's and childhood disintegrative disorders, along with pervasive developmental disorders not otherwise specified (PDD-NOS), are distinct diagnoses listed in the same chapter. The DSM-5 combines them all into a single new diagnosis named autism spectrum disorder (ASD). The APA argues that the symptoms of these disorders are so similar that they belong to the same continuum, rather than constituting separate entities. Some people in the Asperger's community maintain that Asperger's is different enough from autistic disorder to merit its own category, worrying that they will lose an important part of their identity; others in the community applaud the change, embracing the idea of a continuum. Some parents have pointed out that the change may in fact help children who have been denied after-school programs or assistance from insurance companies because Asperger's was considered too mild to warrant such support.
The APA has also made it more difficult for someone to get a diagnosis of autism. As Scientific American has previously reported, the DSM-IV offered 2,027 different ways to be diagnosed with autism; the DSM-5 provides just 11. That reduction might sound drastic but, overall, many psychiatrists agree that this is a helpful change. They argue that past criteria were too loose: Some people who received a diagnosis probably did not have autism, and this misdiagnosis has surely contributed to skyrocketing rates of autism diagnoses worldwide since the 1980s. The U.S. Centers for Disease Control and Prevention estimates that one in 88 children in the nation is diagnosed with an autism spectrum disorder.
By early 2012, however, several studies had tested the new DSM-5 autism criteria and concluded that they were too strict, excluding some high-functioning people on the milder end of the spectrum. In October 2012 a larger and more comprehensive analysis of data from more than 5,000 children concluded that the DSM-5 autism criteria identified 91 percent of children who received a diagnosis of autism or a related developmental disorder under DSM-IV. A few tweaks suggested by the smaller studies published in early 2012 might have made the DSM-5 criteria even more inclusive and helped to identify the 9 percent of children neglected in the October 2012 study. Yet when it came time to finalize the DSM-5 at the end of 2012, the APA decided to stick with the stricter criteria, as confirmed by Catherine Lord of Weill Cornell Medical College, one of the work group members who helped revise the definitions.
Attenuated psychosis syndrome was too weak to make the cut
The APA originally proposed adding a new disorder to the DSM-5 called attenuated psychosis risk syndrome, which was intended to identify children with warning signs that precede full-blown psychosis—signs such as hallucinated voices or images. Critics pointed to research showing that two thirds of children who would meet the proposed criteria never develop serious psychosis (see “At Risk for Psychosis?” by Carrie Arnold; Scientific American MIND, September/October 2011). Related research suggests that 11 percent of the general population sometimes hears voices or engages in moments of intense magical thinking without any distress or interference in work and social life. Allen Frances, chair of the DSM-IV Task Force and the most vociferous critic of the new manual, called attenuated psychosis syndrome the "single worst DSM-5 proposal." As with disruptive mood dysregulation disorder, the fear was that children who did not need medication would be given powerful antipsychotics with potentially harmful side effects such as trembling, suppressed immunity and weight gain. The APA acknowledged the criticism and, after disappointing tests of the proposed criteria, moved attenuated psychosis risk syndrome out of the DSM-5's main section into section 3, reserved for conditions that require further research before they are considered formal disorders.
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8 Comments
Add CommentI see nothing here addressing Complex Post Traumatic Stress as a disorder or syndrome or recognizing it at all. Did that not make the cut for this latest manual, or just not for this article?
Reply | Report Abuse | Link to thisI suspect that these manuals tend to disregard many disorders, as insurance companies prefer it that way.
Reply | Report Abuse | Link to thisA travesty of scientific evidence
Reply | Report Abuse | Link to thisAPA does not seem too worried about the serious risk of false positives, which may have dire negative consequences such as unsuitable drugs, professional exclusion, social labelling.
Reads like a conspiracy between insurance companies and mental health professionals, in which mess people with serious and curable syndromes may well be missed.
You didn't discuss the changes in the eating disorder criteria that are also rather controversial.
Reply | Report Abuse | Link to thisI suspect that this manual will continue to pathologize normal variants of the human personality, and stigmatize those bearing them. While in school, I tended to fidget and look out the window. Now I'm told that that's a symptom of "attention deficit disorder" for which powerful psychoactive drugs are indicated. Never mind that I maintained a 90+ average throughout. Never mind that our ancestors needed a periodic fix on their surroundings if they expected to be the diner and not the dinner. Never mind that our ancestors made their living running for hours on end and killing large animals with primitive weapons. Nothing in biology makes sense except in the light of evoluton, but that doesn't stop fat pigs behind desks from dispensing psychiatric diagnoses to robust healthy rambuntious kids.
Reply | Report Abuse | Link to thisI was never good at matching names with faces or interpreting body language. Now I'm told those are symptoms of Asperger's Syndrome; never mind that I compensate very well with written and spoken language and I do not consider myself sick.
Hardly a day passes when I do not think of President Kennedy. This does not affect my functioning in the least, except on November 22, the anniversary of his assassination, when I am not in the mood for entertainment or Thanksgiving dinner. Now I'm told I have "complicated grief," but all I experience is natural grief for a political idol the like of whom I do not expect to see again in my lifetime.
All this is giving me (complicated?) grief, and calls to mind the abuse of psychiatry by the Soviets to quell political dissent. If you have a biochemical, brain imaging or other definitive test for your diagnosis - fine. Otherwise, throw away the cookie cutter and celebrate humanity's pizzazz.
Geez! Another bestseller for APA. More money folks.
Reply | Report Abuse | Link to thisUnfortunately, commentors are not familiar with the body of work done on DSM, not to mention the study required to become conversant with psychology.
Reply | Report Abuse | Link to thisTo address only a couple misunderstandings:
DSM is a large manual, far beyond the 7 extremely short pages of this article.
Unedited internet comments on subjects which take decades of study to develop coherent understanding are particularly inappropriate.
Although I've studied psychology and related disciplines for sometime, I did not do so for therapeutic reasons. That said, almost no comment on the subject on this or other websites takes into account the real empathy which those involved in the therapeutic disciplines and the development of DSM, as well, have for others, ALL others.
SA is not a panacea site such as MSN Health or any site in which glib curealls are offered for illness or personal difficulties or desires. It is a digest of information which might be used as portal to specific peer-reviewed literature for those who seek knowledge of rigorous research encompassing the lifetimes of hundreds of thousands of dedicated individuals.
I am framing my criticism in terms of a social problem: failure of many in society to respect others, and promoting this disrespect of individuals, groups, and disciplines of professional dedication (ANY discipline, whether within their own culture or outside of it), through using internet comment as aggressive outlet for personal frustration elsewhere.
Commentors might look more insightuflly into their own motivations before attacking others.
How about G.A.S. ? Guitar Acquisition Syndrome? http://www.steelydan.com/gas.html
Reply | Report Abuse | Link to thisLuckily I've recovered. Sadly many haven't.