Changes in the DSM- 5 Autism Definition could neg. impact Millions

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Changes in DSM-5 Autism Definition Could Negatively Impact Millions

Autism organizations concerned that autism diagnostic changes will jeopardize

services, impair tracking, and disrupt research around the globe.

WASHINGTON, DC – Proposed changes to the diagnostic criteria for autism spectrum

disorders in the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders – 5 (DSM-5) will potentially disrupt appropriate and

necessary services to hundreds of thousands of individuals in the US, hamper the

ability to track the numbers of people with autism, and interfere with efforts

to establish biological causes of autism.

" The proposed criteria make it significantly more difficult to qualify for an

autism spectrum diagnosis and they completely eliminate the categories of

PDD-NOS and Asperger's Disorder, " stated Fournier, National Autism

Association President. " In a well-intentioned desire to improve the specificity

of an ASD diagnosis, the new criteria may, in fact, go too far and create

unintended consequences. It is critically important that any diagnosis address

all the symptoms of an individual and allow them the supports they need. "

The new criteria, rationale and previous criteria are available at:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94

Currently, the federal government is spending millions of dollars to track

prevalence of ASDs in 11 states; the 2000 birth cohort is due out this year. The

Individuals with Disabilities Education Act (IDEA) requires schools to report

the number of students with autism annually. Both sets of data have shown

dramatic increases in autism spectrum disorders. One in 110 children in the US

is now affected by autism compared to one in 10,000 in the early 1980's. By

significantly changing the criteria for diagnosis, the new DSM-5 will impair the

ability of public health officials to compare future rates of autism spectrum

disorders to past rates, since the definition will have changed.

Accurate projections of trends in autism rates are critical to planning

educational interventions, Medicaid and adult services. " By analogy, if the

medical community chose to only count melanoma in the future instead of all

types of skin cancer, it would look like skin cancer rates had gone down, even

though other types were still present and needed treatment, " said Ginger ,

Canary Party Executive Director.

In addition, incidence and prevalence are critically important to investigating

environmental causes of autism. " Toxic exposures to the general population

change over time and having good consistent epidemiology allows researchers to

judge the likelihood of a toxin being involved in autism, " stated Uram,

SafeMinds Executive Director. " The APA's new criteria should add a specific

mechanism to map the old diagnoses onto the new ones in order to allow

researchers to compare new and old datasets. We also would like to see the APA

address the issue of regressive autism by including age of onset as part of the

criteria. The etiologies of infantile vs. regressive autism may be entirely

different, but the new criteria do not distinguish them in any way. "

A primary concern for parents is the likelihood that many children on the autism

spectrum may not be diagnosed under the new criteria, thereby depriving them of

appropriate early intervention and treatment. " Even in the states that have

passed autism insurance legislation, the tightening of the criteria for autism

may exclude children who need treatment with Applied Behavior Analysis, " said

Holland, Managing Director of the Birt Center for Autism Law and

Advocacy. " Our organizations advocate that the criteria should err on the side

of over-diagnosing rather than under-diagnosing since no harm is likely from

providing educational services to a young child, but great potential can be lost

by not providing treatment. " Early intensive treatment improves outcomes for

children with autism, making it highly cost-effective for tax-payers when

compared to providing adult services.

" The autism community strongly recommends that the proposed DSM-5 autism

spectrum disorder diagnostic criteria be revisited with these concerns in mind, "

concludes Sallie Bernard, President of SafeMinds. " These issues are too

important to remain unresolved. "

For more complete documentation of community concerns and questions, please

visit www.safeminds.org. If your organization would like to sign onto these

concerns, please contact kweisman@....