As a parent or guardian of a child with an autism spectrum disorder (ASD) diagnosis, you have probably heard reference to the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 1952, the American Psychiatric Association (APA) created the first edition of the DSM, which served as the first official manual of mental disorders for clinical use.
Definition and criteria of autism in the DSM-5
According to the DSM-5, an ASD diagnosis requires persistent deficits in social communication and social interaction across multiple contexts. This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors used for social interaction, and in developing, maintaining and understanding relationships.
Severity is based on social communication impairments and restricted, repetitive patterns of behavior. This must include at least two of the following behaviors: stereotyped or repetitive motor movements, inflexible adherence to routines, fixated interests that are abnormal in intensity or focus, or hyper- or hypo-reactivity to sensory input.
Symptoms must be present in the early developmental period and must cause clinically significant impairment in social, occupational or other important areas of current functioning.
Lastly, these disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and ASD frequently co-occur; to make comorbid diagnoses of ASD and intellectual disability, social communication should be below that expected for general developmental level.
What has changed in the DSM-5?
Every few years, the APA revises the DSM. The DSM-5, released in 2013, is the current main guide for mental health providers in the U.S., and it provides standards for making ASD diagnoses. This version shows some changes in the way experts diagnose ASD compared to the previous version.
Under the DSM-IV ASD diagnosis, doctors could diagnose patients with four separate disorders: autism, Asperger’s disorder, childhood disintegrative disorder, or pervasive developmental disorder not otherwise specified. Due to inconsistent application of these separate diagnoses, the DSM-5 puts them all under the main diagnosis of ASD. If your child previously received a categorized ASD diagnosis, you should know that your healthcare provider could still indicate this diagnosis alongside the current DSM-5 standards for ASD.
The DSM-5 consolidated three categories of symptoms of ASD into two. There is also an addition of sensory issues as a symptom under the restricted/repetitive behavior category including hyper- or hypo-reactivity to sensory input.
The DSM-5 also specifies a new diagnosis, social communication disorder, for disabilities in social communication without restricted, repetitive behaviors. This is a communication disorder, not an ASD diagnosis. Some children who had previously received a diagnosis of PDD-NOS may now receive a diagnosis of social communication disorder. However, this would apply only to newly diagnosed people.
Under the DSM-5, individuals with an ASD diagnosis must show symptoms from early childhood, even if healthcare professionals do not recognize those symptoms until later. This encourages an earlier ASD diagnosis but allows that for children whose symptoms may not be fully recognized until later to receive the diagnosis.
Challenges in diagnosing autism
Diagnosing ASD is complex. No single symptom can conclusively determine an ASD diagnosis. The CDC notes, “Some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.”
Your child may also find difficulty receiving an ASD diagnosis due to differences in how ASD manifests according to gender. Healthcare professionals identify ASD at nearly four times the rate in boys compared to girls. If you believe your child have ASD, it is essential to speak with your child’s healthcare providers and advocate for the necessary diagnostic assessments and evaluations,
Navigating your child’s autism diagnosis
Maxim Behavioral is continually growing our footprint of applied behavior analysis (ABA) and ASD-related service offices nationwide. We pride ourselves in our compassionate certified behavioral clinicians, so your family receives an individualized program based on your child’s needs. If you need support navigating your child’s ASD diagnosis, we are here to help! Contact your local Maxim office for more information.
