DSM-5 and Autism Spectrum Disorder (ASD): A Review from the Autistic Community

DSM-5 and Autism Spectrum Disorder: A Review from the Autistic Community

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a widely used diagnostic tool in the field of psychiatry. It provides criteria for the diagnosis of various mental health conditions, including Autism Spectrum Disorder (ASD). The ASD community has reviewed the DSM-5 criteria and identified areas of agreement and concern. This article will provide an overview of the DSM-5 criteria for ASD and the review from the autistic community.

DSM-5 Criteria for ASD

The DSM-5 criteria for ASD include two core domains: social communication and restricted, repetitive behaviors and interests (RRBIs). To receive a diagnosis of ASD, an individual must exhibit persistent deficits in social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. The DSM-5 also includes a severity scale for ASD, which ranges from level 1 (requiring support) to level 3 (requiring very substantial support).

Review from the Autistic Community

The Autistic Self Advocacy Network (ASAN) has reviewed the DSM-5 criteria for ASD and identified areas of agreement and concern. ASAN recognizes the benefits of the unified ASD diagnosis under DSM-5, which is seen as an improvement over the DSM-IV criteria. The inclusion of sensory issues within the criteria and the acknowledgment of the contextual nature of autistic traits are highlighted as positive developments. However, concerns are raised regarding the potential loss of sensitivity in the diagnosis, particularly for adolescents, adults, women, and other underserved groups.

Areas of Agreement and Concern

ASAN agrees with the unification of the disparate DSM-IV autism spectrum diagnoses into a unified ASD diagnosis under DSM-5. This is seen as a positive development both from the standpoint of expanding access to service provision and as a means of showing fidelity to the research literature.

The inclusion of sensory issues within the criteria represents a significant step forward that will likely do much to add to research and practice supporting that area of autistic experience. Additionally, an acknowledgement in the criteria presents a step forward, acknowledging that while onset must occur by early childhood, recognition of autistic traits may not occur until adolescence or well into adulthood due to more supportive and less demanding social environments.

However, ASAN is concerned about the potential loss of sensitivity in the diagnosis, particularly for adolescents, adults, women, and other underserved groups. The shift from requiring two of four social communication traits to be met within the DSM-IV to requiring three of three within the DSM-5 is seen as a point of concern, as it may lead to inappropriate discouragement of autistic traits and denial of access to services for some individuals on the autism spectrum.

The introduction of a severity scale for the ASD diagnosis is also a point of concern, as it may lead to inappropriate discouragement of autistic traits and denial of access to services for some individuals on the autism spectrum.

Impact on Under-Represented Groups

ASAN emphasizes the need to enhance the sensitivity of the ASD diagnosis to ensure that individuals from under-represented groups, such as women and girls, adults, and racial and ethnic minorities, are more likely to be identified. The unique challenges faced by adults on the autism spectrum, including the transition to independence and the lack of structured support, are highlighted. The authors stress the importance of addressing these issues in the DSM-5 criteria to improve access to diagnoses and services for under-represented communities.

Recommendations

ASAN proposes specific adjustments to the diagnostic criteria, such as enhancing sensitivity in the social communication domain and including motor and movement issues within the criteria. The authors also recommend incorporating specific considerations for under-represented groups in the accompanying text to the ASD diagnosis.

Furthermore, they suggest linking the Social Communication Disorder diagnosis to the broader autism spectrum and exploring ways to ensure that individuals likely to be shifted to this diagnosis retain the practical and research benefits of a connection to the broader autism spectrum.

In conclusion, the DSM-5 criteria for ASD have been reviewed by the autistic community, and areas of agreement and concern have been identified. The review emphasizes the importance of considering the impact of diagnostic criteria on diverse groups within the autism community and provides specific recommendations to address the identified issues. Medical specialists in the fields of neurology and psychiatry should take these recommendations into account when diagnosing and treating individuals on the autism spectrum.