Have the severity criteria for Autistic Disorder, the New Autism Spectrum Disorder in the DSM-5, been dropped?
The severity page for Autistic Disorder has encouraged readers for several months, at least since June 1 2010 when I looked, to check the DSM-5 web site regularly for updates. I checked today October 9 2010 and there are still no severity criteria recommendations posted for Autistic Disorder. News releases are now being published for the sites selected for field trials.
The rationale for creating one NASD includes appears to acknowledge that the new spectrum should be described by reference to severity and even includes a separate page to address severity criteria:
Because autism is defined by a common set of behaviors, it is best represented as a single diagnostic category that is adapted to the individual’s clinical presentation by inclusion of clinical specifiers (e.g., severity, verbal abilities and others) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability and others.) A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”.
If the severity criteria are considered important aspects of the New Autism Spectrum Disorder why are clinical field trials being instituted before severity criteria are established? The heaviest initial criticism of the new combined Autism Spectrum Disorder came largely from those with Aspergers or family members of those with Aspergers concerned about being lumped together with Autistic Disorder and the high numbers of persons with Autistic Disorder and the "associated" feature of Intellectual Disability. Any mention of Intellectual Disability in connection with the new combined diagnosis will undoubtedly invite more hostile reaction. Yet it would be absurd, if not intellectually dishonest, to describe Autism Spectrum Disorder by severity without including Intellectual Disability as one of the severity criteria.
Despite the suggestion that interested persons check the severity page of the DSM-5 web page regularly for updates there have been none to date. But the clinical field trials for the new Autism Spectrum Disorder are going ahead and sites for the trials are being selected and announced.Why go ahead for with field trials for a diagnosis which is not yet completed with respect to necessary severity criteria?
Frankly, I am doubtful that the new combined Autism Spectrum Disorder in the DSM-5 will include any references to severity criteria or to "associated" features like intellectual disability; a feature "associated" with approximately 75-80% of persons with the current DSM-IV Autistic Disorder diagnosis. I am afraid that the severity criteria will be dropped out of fear of political correctness challenges from those who do not want "autism" mentioned in the same breath as intellectual disability.
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