W4 DSM Reclassification of Autism Spectrum Disorder.docx

DSM Reclassification of Autism Spectrum Disorder Gina Marwick College of Humanities and Social Sciences, Grand Canyon University PCN-673 Developmental Disabilities Dr. Laklieshia Izzard August 2, 2023

DSM Reclassification of Autism Spectrum Disorder There have been long-standing controversies with the American Psychological Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), particularly surrounding autism. However, the American Psychiatric Association is constantly reviewing the DSM and trying to improve upon the diagnostic criteria for several disorders, including autism. The most current version of the DSM is the recently released DSM-5-TR, which came out in March 2022. This paper will discuss the significant changes between the DSM-IV and DSM-5- TR, the benefits and consequences of the DSM-5-TR changes in a home setting, and the benefits and consequences of the changes in a school setting. Significant Changes Between DSM-IV-TR and DSM-5-TR The APA made substantial changes to autism classification from DSM-IV-TR to the DSM-5 by combining autism, Asperger’s syndrome, childhood disintegrative disorder, and pervasive development disorder not otherwise specified in the new terminology of Autism Spectrum Disorder (APA, 2013b). In another significant change, the DSM-5 also combined the language and social deficiencies into one category, making three areas instead of two (Wright, 2013). Additionally, the DSM-5 also states that an Autism Spectrum Disorder (ASD) diagnosis requires “persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following” (APA, 2013a). The DSM-5-TR added two words to this statement, so it now reads “…as manifested by all of the following” (Hess, 2022). These two additional words added clarity to the diagnostic criteria that every following criterion had to be met for diagnosis, rather than any of the following (Hess, 2022). There are other disorders that were previously separated from autism in the DSM-IV but are now under the umbrella of ASD in the DSM-5 and DSM-5-TR. Rett’s, which was originally

included in the DSM-IV under pervasive developmental disorders (APA, 2000), is now included as an ASD diagnosis. While under review, the committee decided that although Rett’s syndrome has autistic features, it has a genetic cause. Therefore those with Rett’s syndrome will have to meet all the other diagnostic criteria to qualify for an ASD diagnosis (Oberman & Kaufmann, 2020). This also holds true for Asperger’s syndrome and pervasive developmental disorder not otherwise specified. That being said, those with previously established autism diagnosis due to Rett’s syndrome, Asperger’s syndrome, or pervasive developmental disorder not otherwise specified should still be given an ASD diagnosis under the DSM-5 recommendations (APA, 2013). Another significant change to the DSM-5-TR is it now also allows practitioners to include an additional “behavioral problem” rather than “behavioral disorder” in their diagnosis. This change has the potential for the practitioner to include in their notes any observed behavioral concerns despite the child not meeting a complete diagnostic criterion from the DSM (Stanborough, 2023). This allows the practitioner some freedom in their observations and a clearer picture of all the child’s behavior. Benefits and Consequences of the DSM-5-TR Changes in a Home Setting Practitioners using the DSM-5 could have mistakenly diagnosed people with ASD who may not meet all the criteria. However, with the addition of the words "all of," the criteria have become much more clear. While researchers are currently assuming this will not be an issue, only more research will determine whether the diagnosis rate remains constant. If this does reduce diagnosis, there may be kids that no longer qualify for early intervention services. This is concerning because research across all learning disabilities shows that early intervention is key to the child's future development, and an official diagnosis is needed to access services in the

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United States ( Volkmar et al., 2012). In addition, the change of including behavioral problems may broaden practitioners mind’s to any concerning behavior brought to their attention by parents rather than dismissing it because it does not fit diagnostic criteria. Because of this change, anyone collaborating on the child's therapies could get a clearer picture of the child's needs and create a more helpful intervention plan and increase everyone’s understanding of the interplay of their child’s behaviors. Benefits and Consequences of the DSM-5-TR Changes in a School Setting In a school setting, the more specified criteria in the DSM-5-TR could lead to underdiagnoses of children that may benefit from accommodation. An official diagnosis is needed to qualify for 504 and IEP plans, special education aides, and other school services. This could lead to teachers having to support students on their own or school counselors having to advocate for services for a student without a diagnosis. If this is the case, there could be life-long learning consequences for the student for not only their educational outlook but also their self- esteem. Not receiving school-based services can also harm their ability to interact with their peers and make them more susceptible to bullying and manipulation. The student having their needs met would be dependent on the kindness and advocacy of the staff rather than what is required by law. Similar to the home setting, with the inclusion of any behavior problems, teachers, school counselors, and psychologists can now bring additional behaviors to those in charge of diagnosis or therapies that may not have met previous diagnostic criteria. There may even be behavior problems that were only exhibited at school that would have been previously missed or not included. This wording change has the potential to open new collaboration between school and private therapeutic staff to better support student outcomes.

Conclusion While it is important to evaluate and revise diagnostic procedures constantly, it is also essential to consider the impact the revisions will have on those being diagnosed. Quantitative and qualitative research plays a crucial role in determining if there are any unintended consequences to revisions of the DSM. Looking at the number of ASD diagnoses, as well as feedback from parents, school staff, and other stakeholders, is imperative to the process as the American Psychiatric Association continues to refine its criteria. Unfortunately, the impact of such revisions cannot be known until the diagnostic criteria have been out for some time. So it is up to mental health practitioners, researchers, and the American Psychiatric Association itself to conduct research, listen to feedback in real-time, and make necessary changes for the common good.

References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). https://doi.org/10.1176/ajp.152.8.1228 American Psychiatric Association. (2013b). Highlights of changes from DSM-IV-TR to DSM-5 . Psychiatry.org. https://www.psychiatry.org/File %20Library/Psychiatrists/Practice/DSM/APA_DSM_Changes_from_DSM-IV-TR_- to_DSM-5.pdf Hess, P. (2022, March 17). DSM-5 revision tweaks autism entry for clarity . Spectrum. https://www.spectrumnews.org/news/DSM-5-revision-tweaks-autism-entry-for- clarity/#:~:text=Whereas%20the%20DSM%2D5%20wording,clinicians%20to%20use %20additional%20diagnostic Mayes, S. D., Black, A., & Tierney, C. D. (2013). DSM-5 under-identifies PDDNOS: Diagnostic Agreement between the DSM-5, DSM-IV, and checklist for autism spectrum disorder. Research in Autism Spectrum Disorders , 7 (2), 298–306. https://doi.org/10.1016/j.rasd.2012.08.011 Oberman, L. M., & Kaufmann, W. E. (2020). Autism Spectrum Disorder Versus Autism Spectrum Disorders: Terminology, Concepts, and Clinical Practice. Frontiers in psychiatry , 11 , 484. https://doi.org/10.3389/fpsyt.2020.00484 Stanborough, R. (2023, April 7). DSM-5TR updates autism diagnostic criteria . Educational & Psychological Assessments for Clinicians & Educators. https://www.wpspublish.com/blog/dsm-5tr-updates-autism-diagnostic-criteria Volkmar, F. R., Reichow, B., & McPartland, J. (2012). Classification of autism and related conditions: progress, challenges, and opportunities. Dialogues in clinical

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neuroscience , 14 (3), 229–237. https://doi- org.lopes.idm.oclc.org/10.31887/DCNS.2012.14.3/fvolkmar Wright, J. (2015, September 4). DSM-5 redefines autism . Spectrum. https://www.spectrumnews.org/opinion/DSM-5-redefines-autism/#:~:text=The%20DSM %2D5%20also%20combines,show%20restrictive%20and%20repetitive%20behaviors.