The new diagnosis won’t simply lump all cases together. DSM-5 includes new qualifiers (including intellectual disability, language ability, and regression) and severity levels (1 to 3) designed to capture the wide range of symptoms. To receive a diagnosis of autism spectrum disorder, a child must present with deficits in two categories: social communication and restricted, repetitive behavior. A severity level is assigned to each of these dimensions. A child may walk out of an evaluation by a developmental pediatrician with the following diagnosis: “autism spectrum disorder with intellectual delay and regression; social communication severity level 3; restricted, repetitive behavior severity level 2.”
A child who exhibits no restricted, repetitive behaviors may walk out with a new diagnosis instituted in DSM-5: social communication disorder. It’s unclear how this new diagnosis will affect the autism community. Ideally, it will allow clinicians to identify opportunities for intervention. King mentions as an example a child with ADHD who doesn’t respect personal space or take turns. But Hibben says the new diagnosis is “a way to appease those who might lose their Asperger’s diagnosis, although it might not get them anything.” Thirty-seven states, plus the District of Columbia, have passed laws regulating insurance coverage of autistic children, but those laws won’t apply to those with social communication disorder, since it’s not part of the autistic spectrum. “We’ll have to watch that carefully,” Ursitti says.
She won’t be the only one. The entire mental health community has eyes on the APA now. Although many clinicians welcome the new edition, the votes of no-confidence have already begun. Psychology Today reports that there are calls for a DSM-5 boycott not only in the United States but also in England, France, Australia, Spain, and Italy. And National Institute of Mental Health Director Thomas Insel dismissed the DSM for its “lack of validity,” adding “Patients with mental disorders deserve better.”
But even the members of the APA task force aren’t carving any DSM diagnostic criteria in stone. You may have noticed that with this revision, the APA has gone from the Roman numerals that were used previously (i.e., DSM-IV) to Arabic numbers (DSM-5). King explains, “This is meant to reflect that this is DSM-5.0, with the expectation that there can be ongoing updates and refinements that won’t require the creation of a whole new version. This is more of an evolving document than what we’ve had in the past.”
King should be careful what he wishes for. If there’s anything besides fractiousness that unites the autism community, it’s our persistent advocacy. We won’t hesitate to let the APA know how the DSM changes are affecting us—and they will doubtlessly affect us differently. We’ll see how the task force will consider that avalanche of feedback.