By Dr. Stephen Shore-
With an expected publication of May 2013, the upcoming Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) has created much controversy in how the condition of autism will be defined, diagnosed, and provided services in education and the community. One important question centers on potential loss of or relabeling of individuals currently considered as being the autism spectrum. Another concern is possible effects stemming from the removal of subtypes such as Asperger Syndrome, Pervasive Development Disorder- Not Otherwise Specified, Low Functioning, and High Functioning Autism in favor of the single category "Autism Spectrum Disorder".
While a number of prospective studies on the effects the changes brought about by these changes have been conducted, it remains unknown for certain what will happen. What we do know is that there will be a period of transition from the old to the new. Let us begin by look at what the DSM is and what it isn't.
What is the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5)?
Initially published with the first edition in 1952, the DSM currently serves three main purposes. First, like it's predecessors, the DSM-5 is meant to summarize of characteristics of "disorders" listed in the reference. The DSM is not meant to be an exhaustive list of characteristics for use as a diagnostic tool.
To the credit of the authors, the DSM is a "work in progress" (APA, 2000, p. XXX), suggesting this reference is based on current information which expected to change as results from new research becomes available. Modifications are expected to be more frequent which explains the change from Roman to Arabic numerals denoting the edition. Finally, rather than being the "bible" for diagnosis, the DSM is actually meant for coding insurance reimbursement forms which explains why each label is given a number.
What are the Implications for People on the Autism Spectrum
At this point, it seems that what is now considered as the autism spectrum will be narrowed. Individuals at what is considered to be at the more severely affect section may be relabeled as having a "Global Delay" whereas many who are considered to have "High Functioning Autism" may be reclassified with "Social Communication Disorder". Possible implications are enormous. On one hand, individuals who have built an identity of having Asperger Syndrome will lose that label in favor of either Autism Spectrum Disorder, Social Communication Disorder, or perhaps no label at all. There are questions as to how services will be affected. For example, new structures on defining and providing educational and other supports will have to be constructed. Will, for example, the sensory issues persons with Asperger Syndrome be taken into account with the new Social Communication Disorder? And similarly, what about those partitioned into Global Delay?
Results of the Change
Amidst much discussion, research, and controversy, it is hard to predict the eventual outcome of the changes. Some will benefit whereas other may lose supports they are used to having. What can be said is that it will be quite a transition to a brave new world of "Autism Spectrum Disorder".
Stephen Shore, Ed.D. Assistant Professor of Special Education, Adelphi University. Internationally renowned author, constultant, and presenter on issues related to the autism spectrum