Physicians may face tough questions about latest diagnostic proposal for autism

Physicians who treat autism will face a wave of fresh questions — and some family and caregiver pressure — as debate intensifies over the latest diagnostic criteria proposals.

The American Psychiatric Association is now vetting proposed new autism diagnostic criteria for the 5th edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5).

The most recent proposal by the DSM-5 Neurodevelopment Work Group would consolidate several previously distinct diagnoses into a new category of autism spectrum disorder in 2013. These include: autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive development disorder not otherwise specified (PDD-NOS).

“The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions,” according to James Scully, MD, Medical Director of the Academic Pediatric Association (APA).

Researchers at the Yale School of Medicine have concluded that some patients may no longer qualify as autistic anywhere along the new spectrum. Yale Child Study Center Director, Fred Volkmar, MD, projects that approximately half of at least one group of individuals with no intellectual disabilities — as diagnosed during 1994 DSM-IV field trials — may no longer qualify for an autism diagnosis.

“Use of such labels, particularly in the United States, can have important implications for service,” Volkmar said. “Major changes in diagnosis also pose issues for comparing results across research studies.”

The NIH estimates that one child out of 1,000 US children has [autism spectrum disorder].

The Autism Society estimates that the United States faces approximately $90 billion in annual autism costs, based on a $3.5 to $5 million lifetime cost of caring for a child.

“Given the potential implications of these findings for service eligibility, our findings offer important information for consideration by the task force finalizing DSM-5 diagnostic criteria,” Volkmar said.

John T. Riley, senior policy analyst at the National Education
Association, expects the new criteria to be helpful as “this was a category that was so broad.”

“It’s not the label that’s going to drive services,” he said. “If the student needs support in school to be successful, the [Individualized Education Program] is going to make sure they are successful.”

He added that each special needs student is evaluated every 3 years to determine what services should be continued or discontinued.

“My guess is that the driving force is determining whether the student is proficient in the course work,” Riley said, adding that even if a student is no longer diagnosed as autistic but still requires support, they can apply for learning modifications under the Americans With Disabilities Act.

www.pediatrics.org/cgi/doi/10.1542/peds.2011-1717

www.nichd.nih.gov/publications/pubs/autism/overview/howManyHaveAutism.cfm