(A goal of the task force in developing the manual has been to reduce the use of NOS diagnoses to classify patients who do not fit into more explicit diagnostic categories.) These children have typically been diagnosed with PDD-NOS. Related also to recent research on autism is the inclusion of a new diagnosis, social communication disorder, designed to capture children who have severe deficits in social communication and interaction but who lack the restrictive and repetitive behavior patterns necessary for ASD. Swedo noted also that the DSM-5 criteria indicate that symptoms must be present in the “early developmental period,” reflecting research that has shown the disorder is evident as early as age 24 months. The three levels are “requiring support,” “requiring substantial support,” and “requiring very substantial support.”įor instance, for the symptom of “deficits in social communication and social interaction,” a patient requiring “very substantial support” would be one who has “severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.” Similarly, for “repetitive/restrictive behaviors” a patient requiring very substantial support would be one who exhibits inflexibility of behavior and extreme difficulty coping with change, as well as “great distress/difficulty changing focus or action.” In addition, the criteria include three levels of severity for both principal symptoms to indicate the level of supportive services required by an individual patient. The latter can be used by clinicians to specify features of the disorder with which some individual patients may present, such as if the autism is accompanied by intellectual impairment or is associated with a known genetic/medical or environmental/acquired condition. The new criteria describe “deficits in social communication and social interaction” and “restrictive and repetitive behavior patterns”-the two principal symptoms associated with ASD-along with an expanded number of specifiers. “The DSM-5 Neurodevelopmental Work Group spent a great deal of time evaluating the reliability and validity of the separate DSM-IV diagnoses and concluded that there was no evidence to support continued separation of the diagnoses,” Susan Swedo, M.D., chair of the Work Group on Neurodevelopmental Disorders, told Psychiatric News. That change reflects the fact that much research has indicated a lack of concordance across clinical centers treating autism in how the four DSM-IV diagnoses have been applied. Possibly the most significant change-and certainly one that received much public scrutiny-is the consolidation of DSM-IV criteria for autism, Asperger’s, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specific (PDD-NOS)-into one diagnostic category called autism spectrum disorder (ASD). The appearance of the chapter on neurodevelopmental disorders at the beginning of Section 2 reflects the developmental-or “lifespan”-approach taken by the DSM-5 Task Force to the organization of the text: disorders more frequently diagnosed in childhood appear at the beginning of the manual and disorders more common to older adults (such as neurocognitive disorders) appear at the end. The chapter on neurodevelopmental disorders, the first set of criteria appearing in Section 2 of the manual, also includes the addition of “social communication disorder,” reorganization of criteria for learning disorders, and changes to the criteria for intellectual disability (known in DSM-IV as mental retardation). A major change to the description and organization of criteria for autism and related disorders tops the major revisions clinicians can expect to see for neurodevelopmental disorders in DSM-5, to be published in May.
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