Nevertheless, they warned of "significant public health ramifications regarding service eligibility" if the DSM-5 criteria are adopted. The group also found that specificity was improved with the DSM-5 criteria. Using data from a 1993 DSM-IV field trial as the reference, the Yale researchers estimated that DSM-5's diagnostic sensitivity was 25% for those with Asperger's syndrome in DSM-IV, 76% for those with autistic disorder, and 28% for those with PDD-NOS. Swedo said the group's view was that "pervasive developmental disorder" is a misnomer insofar as it does not involve deficits or delays in every aspect of development - in fact, it is largely restricted to social communication. The work group also had two motivations for doing away with PDD-NOS as a category. One study of diagnoses made at 11 different clinics showed that rates of Asperger and PDD-NOS diagnoses varied enormously whereas autism was diagnosed much more consistently.Īnother factor arguing in favor of a single autism spectrum disorder, Swedo said, was that the types of symptoms in autism, Asperger's syndrome, PDD-NOS, and childhood integrative disorder were very similar what differed was the severity or predominance of different symptoms. She said a literature review indicated poor specificity and sensitivity for the DSM-IV diagnoses of Asperger's syndrome and PDD-NOS. Swedo's group has proposed to collapse them all into a single "autism spectrum disorder" with one set of checklist criteria coupled with severity ratings in social communication, restricted interests, and repetitive behaviors. In DSM-IV, autism disorder, Asperger's syndrome, and two related conditions - childhood integrative disorder and what was called "pervasive developmental disorder not otherwise specified (PDD-NOS)" - were separate diagnoses with their own separate criteria. Other changes to the criteria included a reworked organizational scheme. In some cases, children may reach their teens before their social and communication deficits cause them serious trouble. The rationale, according to Swedo, is that although the delays and deficits in autism spectrum disorders are present, probably in infancy and certainly in toddlerhood, they may escape notice until later because young children often aren't required to socialize extensively and parents may provide enough care and support to mask the delays and deficits. In the draft for DSM-5 - although Swedo and APA officials emphasized that the document has not been finalized yet - the strict age requirement is dropped, instead stating that symptoms must have been present in early childhood. "I can assure you that it is not true," she told APA meeting attendees. In fact, she said, the Yale study and hence the Times and other reports messed up. She was especially incensed by reports in consumer media about the Yale group's study, led by a New York Times article with a "blaring" headline that read, " New Definition of Autism May Exclude Many, Study Suggests." The Yale study, according to the Times article, found that most patients with Asperger's syndrome and about 25% of those with overt autism would not qualify for those diagnoses under DSM-5.īloggers in the autism spectrum community then got the numbers wrong and claimed that DSM-5 would deprive 65% of all autism patients of their diagnoses, "striking fear in the hearts of families," Swedo said. Swedo spoke at the American Psychiatric Association's (APA) annual meeting, in her role as chairperson of the work group developing new diagnostic criteria for neurodevelopmental disorders in DSM-5, the forthcoming fifth edition of the APA's Diagnostic and Statistical Manual of Mental Disorders.
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