January 21, 2012

End to the Autism Epidemic....?

The DSM has been revised many times in the past, but never has it stirred up much controversy than it has now, with the proposed change in the definition and diagnosis criteria for Autism.

The APA is currently completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which will be published in 2013. The DSM is the standard reference that healthcare providers use to diagnose mental and behavioral conditions. As such, it influences availability of treatments as well as insurance coverage.

Under the current definition, a person can qualify for an ASD diagnosis by exhibiting at least 6 of 12 behaviors that include deficits in social interaction, communication or repetitive behaviors. Under the proposed definition, the person would have to exhibit three deficits in social interaction and communication and at least two repetitive behaviors. The APA has also proposed that a new category be added to the DSM – Social Communication Disorder. This would allow for a diagnosis of disability in social communication without the presence of repetitive behavior.

What does this mean for Occupational therapists? How will this affect the services we provide? While it seems that the proposed change is rationalized by scientific trials, it is concerning the effects it will have on access to services for persons who suffer from autistic symptoms. If a child who is already diagnosed were to be reassessed using the new system and, if they did not qualify for an Autism Spectrum Disorder (ASD) the second time around, could this affect their eligibility for future services? What if a child is improving through intensive therapies, but still needs the services, would he or she be able to retain them? Families are struggling to get services as it is and with this new system, it would be disheartening to learn that their child will no longer be entitled to receive occupational therapy and/or speech therapy, services that have proven time and again to make significant improvements in children and adults with autism. Evidence based research supports descriptions in the literature regarding the behavioral changes that children with autism can make when participating in intervention.

Likewise, “the scientific rationale behind the changes actually are quite solid. The different distinctions among the subtypes (Autism, PDD-NOS, Asperger Syndrome, and so on) don’t map onto different causes or different treatment approaches. For example, a very similar treatment approach would likely be used for (someone) who has Asperger syndrome, as would be used for a child with high functioning autism. The only distinction between Asperger syndrome and High Functioning Autism in the current system has to do with how much speech the child had by 3 years of age. It has been difficult for even expert clinicians to make reliable distinctions among the subtypes because these distinctions rely on people’s recollection of very early history. So, it does make sense to use a broad category – ASD. In addition, for each person, the doctor will need to describe the severity of symptoms, presence, and degree of intellectual and language disability, and other factors, such as presence of medical conditions (e.g. GI distress) and genetic etiology (e.g. fragile X). (http://blog.autismspeaks.org).

All in all, parents, caregivers and special education advocates must become knowledgeable about the proposed diagnostic revisions for Autism Spectrum Disorder and the possible effects on students receiving autism related services. Lee Anne Owens (www.specialeducationadvisor.com) suggests, “It is imperative that attention is given to the APA’s development of ASD secondary feature definitions and the specific qualifiers that will be attached to an autism diagnosis as well. Becoming informed and educated about these changes and additions is necessary in order to be your student’s best, most effective educational and medical advocate.” (www.specialeducationadvisor.com).
For more information of the proposed DSM 5 revision on ASD, please look at the links below:
·      http://www.dsm5.org/Documents/12-03%20Autism%20Spectrum%20Disorders%20-%20DSM5.pdf (News Release on Proposed Criteria for ASD)

http://blog.autismspeaks.org/2012/01/20/chat-dsm5/ (LIVE Chat with Geri Dawson, PhD & Lisa Goring. Analyzing DSM-5)

**Credit for references go to:
· Case-Smith, J., Bryan, T. (1999). The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy. 53(5): 489-97.
· www.specialeducationadvisor.com
· http://blog.autismspeaks.org

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