Saturday, October 09, 2010

Have Severity Criteria for the DSM-5's New Autism Spectrum Disorder Been Abandoned?

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.


AutisticWisdom said...

I still think they plan on removing the ID from autism and just making it "co-morbid". How ironic it's "co-morbid" with 80% of the population who qualifies for the diagnosis.

AutisticWisdom said...

I suspect they want to remove ID from the diagnosis altogether and just call it a common "co-morbid" condition. Too bad 80% of the autistic population has this "co-morbid" condition.

Elyse Bruce said...

Severity is an important aspect of any diagnosis whether we're talking Autism Spectrum Disorders or other diagnoses. Without quantifying severity, putting into place the appropriate supports for the individual becomes far more fractured than it needs to be.

MyTruth said...

Background: living on a military base, as a parent I have been blamed (ah, Bruno B.!): accused of not controlling my child, told to institutionalize him, etc. I've fought many, many battles to secure services in the face of deployments (of course there are services availbale in Podunk! -there's only a six year waiting list on a three year deployment!)

I freaked - and continue to freak- with the broad-band ASD Dx. Supermarket conversation: "well, you really have to check out blah - my neighbor's kid is autistic, and he talks and seems to be doing much better than your kid" "You really should put him on that new baseball team - he'd burn off some energy" "dear, there are all kinds of programs and services out there for kids with autism - why aren't you using them?" These people are all talking about things that are not available to my son.

Back to my mantra: get rid of the gatekeepers and their labels.