Monday, October 25, 2010

What Autism Spectrum Disorder Severity Criteria Are Being Evaluated In The DSM-5 Clinical Field Trials?

Deborah Brauser, in an article on the Medscape Today website, advises that the APA has begun field trials for the DSM-5 diagnostic critieria including severity criteria which makes the APA's failure to disclose the proposed severity criteria curious, at least to this interested father of a 14 year old,  with an Autistic Disorder (DSM-IV) diagnosis and assessed with profound developmental delays:
October 19, 2010 — The American Psychiatric Association (APA) has announced that standardized field trials have now started in preparation for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). .... Severity measures, through the use of questionnaires and other tools to help assess patient symptom severity on a rating scale, will also be examined during the field trials, as will "cross-cutting dimensional measures." These are tools for "assessing symptoms that occur across a wide range of diagnoses, such as anxiety or sleep problems." 
Severity criteria are being examined in the field trials which are already underway? If  so, if severity criteria for the New Autism Spectrum Disorder, Autistic Disorder in the DSM-5, are already established,  then why are they still not mentioned on the DSM-5 web site which tells interested persons to check back for updates on the subject?

Some disorders do have severity criteria posted on the DSM-5 web site:

Bipolar II Disorder
Personality Disorder Types
Attenuated Psychotic Symptoms Syndrome

Not all of the disorders, existing, newly proposed disorders or reclassified disorders have severity criteria published on the DSM-5 site. Presumably different work groups for the DSM-5 have reported in with their proposed criteria at different times but the fact that the severity criteria are being assessed in the field trials has to mean that each of the proposed disorders have in fact had the associated severity criteria established.  An article published in the American Journal of Psychiatry, Moving Toward DSM-5: The Field Trials,confirms that the clinical field trials will include evaluation of the related severity criteria for each disorder being studied, including autism:

"Formal field trials will involve the testing of between two and five specific diagnoses at any one site. The diagnoses tested at a site will depend on their relative frequency there. For example, major depressive disorder and complex somatic symptom disorder can be evaluated at a general medical clinic, but autism spectrum disorders require evaluation in a specialty psychiatric clinic specializing in these disorders.  ...... At each site, a research coordinator, trained and monitored centrally, will record each successive entry to the clinic over a specific time period to provide necessary sampling weights for that site's variance in reliability and validity. DSM-IV diagnoses obtained for clinical purposes at each site will be used to place each consenting patient into either a stratum likely to be rich in a target diagnosis at that clinic or a stratum consisting of a random sample of all other diagnoses. The goal is to recruit 50 patients per stratum per site, a total of 150 to 300 patients for each diagnosis under evaluation, to have adequate power for a site-specific determination of precision. Two DSM-5-trained clinicians who are new to the patient will be assigned to conduct independent clinical interviews of the same patient at least 4 hours, but not more than 2 weeks, apart. The attending clinician will be able to observe the interviews. The interviewing clinicians will know the target diagnoses at that site but will be blinded to the stratum to which each patient is assigned and to the attending clinician's diagnosis. The interviewing clinician at each session will be provided the patient's current crosscutting assessments, conduct a clinical interview with the patient, make one or more categorical diagnoses using DSM-5 criteria, and complete associated dimensional severity ratings.   [bold and underline emphases added]

The Autism Spectrum Disorder(s), including their severity criteria, are being evaluated at  clinical field trials now under way and yet the severity criteria are not posted despite entreaties by the DSM-5 to check back for updates under that category.  It would seem reasonable to speculate that their are reasons for this failure and that those reasons relate to the feedback received, much of it from persons who objected to Aspergers being grouped together with Autistic Disorder, with its high number of persons who are also Intellectually Disabled.

Any speculation about motives for the failure to disclose the autism spectrum disorder severity criteria is exactly that .... speculation. Unfortunately the APA has provided no  real information for the public to consider as clinical field trials are underway which could impact the lives of many persons with Autism Disorders, including the 75-80% who have  allegedly "co-morbid" intellectual disabilities.  The public, in the midst of such an important process, a process trumpeted wide and far for its transparency and public participation,  is simply left to speculate.

1 comment:

Anonymous said...

I agree. It's about time the severity criteria proposed will be published on the website. Ever since the DSM5 website was launched in February, the message to check back for details has been on the site. If they're doing field trials with severity criteria, one would wonder what these criteria are. It has a lot of implications, after all.