DSM-IV TR (current standard) DSM-5 (May, 2013)

Transcription

1 DSM-IV TR (current standard) DSM-5 (May, 2013) "Pick Six" Impaired social interaction (two required) Reciprocity, nonverbal behavior, relationships, shared interests Plus one of the following communication skill problems required Eye contact, language, initiate/sustain interactions, imaginative play (no language impairment required for Asperger's Disorder) (no cognitive impairment required for Asperger's Disorder) Plus one of the following repetitive behavior patterns Routines, stereotypic, restricted interests, sensory, preoccupations Plus Onset before age 3 And impairment of social or language or symbolic/imaginative play Not Rett's Disorder or Childhood Disintegrative Disorder "All Four Required" Impaired social and communicative interaction (all three required) Reciprocity, nonverbal behavior, relationships (shared interests, etc) Plus any two of the following required Eye contact, language, initiate/sustain interactions, imaginative play Body language, understanding, tolerance for change, symbolic play Ritualized patterns, focus on details Plus two of the following repetitive behavior patterns Routines, stereotypic, restricted interests, sensory, preoccupations Plus Onset in early childhood (not necessarily before age 3) or later And symptoms together limit and impair everyday functioning Not just General Developmental Delay 2012 Steve Kossor Permission to duplicate is granted to parents and their advocates

2 The primary purpose of diagnosis is to classify and categorize a person to establish a rationale and justification for treatment funding. A person s treatment plan is not defined by their diagnosis. If it were, then only one treatment plan would be needed to treat any person with autism. We all know the truism If you ve met one person with Autism, you ve met one person with Autism. so it is obvious that diagnosis has relatively little to do with responsible, ethical treatment planning. The highlighted section is the DSM-IV TR standard for diagnosing autism which is the current standard defined by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders, version IV (Text Revision). Note that many state Medicaid Plans explicitly reference the DSM-IV diagnostic criteria so that they may require the use of DSM-IV criteria to establish the medical necessity of a treatment plan under Medicaid, while the PRIVATE insurance industry adopts the DSM-5 standard. 1

3 The highlighted section is the proposed DSM-5 definition of autism spectrum disorder which is expected be the standard as of May of 2013 for diagnosing autism spectrum disorders according to the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders, version 5. 2

4 The highlighted area summarizes the DSM-IV TR standards by identifying key disability areas. Some people have referred to DSM-IV as a pick six standard which seems to be more liberal than the all four required standard seemingly set by DSM-5. Both of these perceptions of the DSM standard are oversimplified, incorrect and misleading. Circle the concepts in the highlighted section below the DSM-IV TR standard. You can check to make sure that the highlighted concepts are actually contained in the DSM-IV TR standard directly above. Note that, under DSM-IV TR the child s condition must have had an onset before age 3. DSM-5 sets no such limit on the age of the child; this is a significant improvement. 3

5 Now, circle the exact same words in the highlighted section below the DSM-5 standard. You can check to make sure that the circled concepts are actually contained in the DSM-5 standard directly above. You will notice that all of the DSM-IV TR standards are incorporated into the DSM-5 standards and that DSM-5 actually includes standards that were overlooked in DSM-IV. Thus, DSM-5 is actually a better definition of Autism spectrum disorders than DSM-IV. It is also more aligned with the world standard of diagnostic classification (the International Classification of Diseases version 10 or ICD- 10). The biggest difference between DSM-IV TR and DSM-5 is that DSM-5 requires the condition to limit and impair every day functioning. Under DSM-IV TR, it is possible to diagnose high functioning Autism (sometimes called Asperger s Disorder) that does not limit and impair every day functioning. However, if a person s functioning is not limited or impaired, then the existence of a clinical syndrome or disabling condition is debatable the person may not be normal but if they are not impaired, there is no need for a diagnosis because there is no need for funding to treat their condition. Note that the extent to which a condition serves to limit and impair every day functioning is a continuum. It is not required that the condition severely impairs functioning, but some level of limitation and impairment is obviously necessary in order to justify the diagnosis of any disorder. This is the Diagnostic and Statistical Manual of Mental Disorders, and is used to determine if funding for the treatment of mental disorders is appropriate. Autism Spectrum Disorders in DSM-5 are, just as in DSM-IV TR, mental disorders. If they were not, it could present grave consequences for treatment funding through Medicaid s EPSDT program and any number of recently passed state laws mandating funding for the treatment of Autism Spectrum Disorders. 4