The DSM-IV-TR, the current version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is currently undergoing revision and will ultimately be replaced by the DSM-V. The Report of the DSM-V Neurodevelopmental Disorders Work Group, Susan Swedo M.D., November 2008 lists various issues being examined by that group, many of which could have a dramatic impact on public understanding of what constitutes autism. I strongly encourage everyone with an interest in autism disorders to read this summary report.
Autism as a distinct disorder category began with the 1980 DSM-III, described initially as infantile autism and revised to autistic disorder in 1987. The DSM-IV revision added the "pervasive developmental disorders" which are commonly described today as the Autism Spectrum of Disorders. Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) were added to autistic disorder in this category.
The addition of these additional categories dramatically increased the numbers of children being diagnosed with "autism". A major controversy has ensued over whether the astonishing increase in autism diagnoses is due entirely to this expansion combined with greater social awareness as some believe. Others hold to the view that environmental causes or triggers, particularly vaccines, have contributed, in whole or in part, to the dramatic upswing in autism diagnoses.
Personally I think it is obvious that a substantial portion of the increase is attributable to the expansion of the diagnostic categories of autism in the DSM. But I do not think sufficient research has been done to conclude that the increases are due entirely to the definition changes. Even on the vaccine theory I have never accepted that either side of that debate has been made conclusively.
Another controversy generated by the expansion of the definitions of autism has arisen from the grouping together of persons with normal and even exceptional communication and functioning abilities with persons like my son who has limited communication and functioning ability. From this grouping has arisen a group of high functioning, anti-cure, anti-treatment, autistic persons with excellent communication skills and with an aggressive social/political agenda. Some have appeared before courts, political bodies, in the mainstream media and on the internet to wage political warfare against parents seeking to help their own, generally more severely disabled, autistic children.
The Report states that there are several questions still under discussion for Autism Spectrum Disorders:
1) How to describe the “spectrum” of disorders now known as ASD (e.g., how many domains will define the disorder);
2) What is the specificity of repetitive behaviors in ASD and how might they be better defined;
3) Whether Childhood Disintegrative Disorder (CDD) is a unique and separate disorder, and if so, what are its defining characteristics;
4) Whether autism is a life-long diagnosis or whether it is possible to recover/remit to the point where the diagnosis is no longer applicable;
5) Whether Asperger’s disorder is the same as “high-functioning autism”;
6) How the DSM-V can alert clinicians to common medical comorbidities (including genetic disorders, epilepsy/EEG abnormalities and sleep, or GI problems) and potential biomarkers;
7) How to include consideration of severity and impairment in diagnosis (currently defined as “qualitative impairments”) and how to integrate these with the overall structure of DSM-V; and
8) How/where to discuss cultural influences on diagnosis (e.g., Korean use of reactive attachment disorder rather than ASD to avoid family stigmatization).
These are all important issues and, like most autism discussions, will undoubtedly generate considerable controversy when the DSM-V is finally released.
The addition of these additional categories dramatically increased the numbers of children being diagnosed with "autism". A major controversy has ensued over whether the astonishing increase in autism diagnoses is due entirely to this expansion combined with greater social awareness as some believe. Others hold to the view that environmental causes or triggers, particularly vaccines, have contributed, in whole or in part, to the dramatic upswing in autism diagnoses.
Personally I think it is obvious that a substantial portion of the increase is attributable to the expansion of the diagnostic categories of autism in the DSM. But I do not think sufficient research has been done to conclude that the increases are due entirely to the definition changes. Even on the vaccine theory I have never accepted that either side of that debate has been made conclusively.
Another controversy generated by the expansion of the definitions of autism has arisen from the grouping together of persons with normal and even exceptional communication and functioning abilities with persons like my son who has limited communication and functioning ability. From this grouping has arisen a group of high functioning, anti-cure, anti-treatment, autistic persons with excellent communication skills and with an aggressive social/political agenda. Some have appeared before courts, political bodies, in the mainstream media and on the internet to wage political warfare against parents seeking to help their own, generally more severely disabled, autistic children.
The Report states that there are several questions still under discussion for Autism Spectrum Disorders:
1) How to describe the “spectrum” of disorders now known as ASD (e.g., how many domains will define the disorder);
2) What is the specificity of repetitive behaviors in ASD and how might they be better defined;
3) Whether Childhood Disintegrative Disorder (CDD) is a unique and separate disorder, and if so, what are its defining characteristics;
4) Whether autism is a life-long diagnosis or whether it is possible to recover/remit to the point where the diagnosis is no longer applicable;
5) Whether Asperger’s disorder is the same as “high-functioning autism”;
6) How the DSM-V can alert clinicians to common medical comorbidities (including genetic disorders, epilepsy/EEG abnormalities and sleep, or GI problems) and potential biomarkers;
7) How to include consideration of severity and impairment in diagnosis (currently defined as “qualitative impairments”) and how to integrate these with the overall structure of DSM-V; and
8) How/where to discuss cultural influences on diagnosis (e.g., Korean use of reactive attachment disorder rather than ASD to avoid family stigmatization).
These are all important issues and, like most autism discussions, will undoubtedly generate considerable controversy when the DSM-V is finally released.
autism
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