DSM-5 Autism Spectrum Disorders
(still under consideration)
Over the last decade and a half autism has been rising with the numbers of autism disorder diagnoses increasing from 1 in 500 to 1 in 110. There can be no doubt that a significant part of that expansion occurred with the expansion of the diagnostic criteria for autism in the DSM-IV and in particular with the grouping together of autistic disorder and Aspergers Disorder in one category, the Pervasive Developmental Disorder category. There is no serious dispute that part of the startling increase in autism disorders is due to the 1994 changes but as 1994 recedes further into the past, and as the number of autism increases continuing to rise significantly the 1994 changes grow less and less credible as a satisfactory explanation for the rising autism disorder diagnoses. With each upward revision in autism disorder estimates by the CDC it is becoming increasingly clearer that we are in the midst of real increases in autism disorders. Those who deny that autism is actually increasing need help in clinging to their faith like insistence that autism is not rising, that there is no autism epidemic.
The autism epidemic deniers have had to expand, and vary, their diagnostic change arguments to include increased autism awareness and ascertainment, allegedly expanded autism services resulting in diagnostic substitution and so on. Even in the face of December 2009 statements by Dr. Tom Insel, Director of the IACC, that diagnostic change and ascertainment factors could only account for approximately 50% of autism disorder increases the deniers cling to their quasi-religious faith that autism is not, can not, be increasing but they are running out of credible arguments to make their case. Even the deniers insistence that autism disorders are 100% genetic, and therefore could not possibly be increasing, is starting to lose ground to a paradigm which suggests that autism results from the interaction of genetic and environmental factors. The autism epidemic deniers are growing desperate and their assertions that autism is not increasing are growing more tired and unconvincing with each upward estimate in numbers of persons affected by autism disorders. The autism epidemic deniers need help and help may be on the way in the form of a gift from the APA ..... the DSM-5.
The American Psychiatric Association announced in press release 09-65, December 09 2009, that the DSM 5 release date was postponed with publication now scheduled for May 2013. The postponement is probably frustrating but, once published, the DSM-5 should still be a gift to autism epidemic deniers. The DSM-V Neurodevelopmental Disorders Work Group April 2009 Report recommends that the Pervasive Developmental Disorder (PDD) category be renamed to the Autism Spectrum Disorders which will officially combine the old PDD disorders into one spectrum of disorders. The spectrum would be divided according to severity of symptoms with new descriptions of the diagnostic criteria for each category of severity..
These changes appear to be quite substantial and may, or may not, prove to be of benefit in understanding what are already commonly called autism spectrum disorders. But with the conversion of the PDD category to an officially recognized autism spectrum of disorders it is inevitable that those who simply do not want to believe that autism disorders are actually increasing will once again point to diagnostic definition change to explain, and deny, any future autism disorder increases. They will certainly argue, at the very least, that the 2013 increase in estimated autism cases renders it impossible to determine whether any post 2013 increase in autism estimates are real or resulting from the 2013 diagnostic changes.
Sixteen years later autism increases are still blamed on the 1994 DSM changes. The 2013 changes should help postpone acknowledging the reality of autism increases for at least a further sixteen years. The autism epidemic deniers, thanks to this expected gift from the American Psychiatric Association, will have a powerful new tool to continue their fight until at least 2029.