By Cristina Mestre
Changes to the fifth edition of the
manual, known as DSM-5, were revealed in January, and the manual itself will be published in May.
Among the most controversial of the changes to the
DSM-5 are those regarding the definition of autism, which currently
falls under the diagnostic category of Pervasive Developmental Disorders, or PDD. In the new manual, autism will be referred to as Autism Spectrum
Disorder (ASD). In honor of World Autism Awareness Day today,
we asked Martin Lubetsky, M.D., clinical service chief for Child and Adolescent Psychiatry and the Center for Autism and Developmental
Disorders at Western Psychiatric Institute and Clinic of UPMC, to
explain the significance of the DSM-5’s new classification for autism.
Q: Can you give us a quick overview of autism?
A: Autism is a developmental neurobiological disorder, characterized by
severe and pervasive impairments in social interaction and communication skills
(verbal and nonverbal), and by restricted, repetitive patterns of behavior,
interests or activities.
Q: What are the autism-related changes in the new edition
of the DSM?
A: Under DSM-5, the separate diagnostic subcategories
under PDD in DSM-IV will now be subsumed under one category - Autism Spectrum Disorder. This puts
autistic disorder, Asperger’s disorder, pervasive developmental disorder not
otherwise specified (PDD-NOS) and childhood disintegrative disorder ALL under
The new ASD diagnostic category will include
specifiers for severity and verbal abilities, and will also include associated
features such as known genetic disorders, epilepsy and intellectual disability.
Severity levels are based on the amount of support needed by an individual with
ASD; e.g., an ASD patient could be considered “level 1,” “level 2” or “level
The new ASD diagnostic category will also combine
the current three domains of autism symptoms (social impairment, communication
impairment, and repetitive/restricted behaviors) into two domains (social interaction
and communication deficits, and restricted interests/repetitive behaviors).
Q: I’ve read that a lot of people are concerned with these changes, can
you explain why?
A: Many parents and professionals are questioning the
new DSM-5 revised diagnosis of
autism. One concern raised is whether individuals currently diagnosed with
Asperger’s disorder and PDD-NOS may not meet the new criteria. The DSM-5 committee has stated that
individuals who currently have a diagnosis on the autism spectrum will retain
their ASD diagnosis. A second concern
raised is whether there would be risk of
change in school placement or funding for treatment, if a child with autism
does not meet the new criteria. A third concern
is whether there would be a loss of “identity” for individuals diagnosed with
Asperger’s disorder who will fit into the broader ASD category.
Q: What is the APA’s rationale for these changes?
A: The DSM-5 committee has defended the new
categorization as an improvement in accuracy and reliability of diagnosis of
ASD. The APA notes that the new version is more
precise, and that autism is defined by a common set of behaviors, therefore
should be classified based on severity.
Furthermore, the new criteria are considered to be more thorough.
Q: What autism services and treatments are offered
at the Center for Autism and Developmental Disorders at Western Psychiatric
Institute and Clinic (WPIC) of UPMC?