One goal of the recent revisions was to improve specificity of the ASD diagnosis, reducing the number of false positive cases. Since ASD continues to be defined by a pattern of developmental and behavioral symptoms, changes to the diagnostic criteria come with potential trade-offs. These specifiers provide information about etiology, co-morbidities (e.g., intellectual disability, language delay, and medical conditions such as seizures), and pattern of onset. Other changes included adding ratings of the severity of the two symptom domains and several clinical specifiers. The DSM-5 criteria place greater emphasis on the two core symptom domains of ASD (social communication and restrictive, repetitive behaviors), and no longer consider verbal abilities as a diagnostic feature. In an effort to reflect what has been learned through research and practice since that time, the DSM-5 released in 2013 removed the PDD category and the accompanying subtypes (Autistic Disorder, Asperger Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder – Not Otherwise Specified) with a single disorder, Autism Spectrum Disorder (ASD).
Starting with the DSM-III in 1980, autism was categorized as a Pervasive Developmental Disorders (PDD). In this statement, the IACC describes a range of research, practice, and policy implications that arise as a result of the changes in the DSM criteria which deserve consideration as the DSM-5 is implemented in research, clinical, and educational settings. Any revision of the diagnostic criteria must be made with great care so as to not have the unintended consequence of reducing critical services aimed at improving the ability of persons with autism.
1, 2 Although the DSM-5 diagnostic criteria are intended primarily for use by clinicians and researchers in their diagnostic assessments, the IACC is aware that it is important to also remember that these the criteria also have a direct impact on people who have the disorders and their families, and their ability to assess symptoms and obtain services that can help them optimize their health, well-being and quality of life. The DSM-5 criteria were published in May 2013. It was the goal of the Neurodevelopmental (ND) Workgroup for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to meet these standards. The committee recognizes the need for diagnostic criteria for ASD that reflect current scientific knowledge and progress and define the wide range of symptom expression associated with this disorder. The Interagency Autism Coordinating Committee (IACC) is a Federal advisory committee, composed of Federal and public members, that coordinates all efforts within the Department of Health and Human Services (HHS) concerning autism spectrum disorder (ASD). IACC Statement Regarding Scientific, Practice and Policy Implications of Changes in the Diagnostic Criteria for Autism Spectrum Disorder