DSM 5 Field Trials - Initial Report

Autism Speaks, America's autism activisim and research organisation, has just released a report into their initial findings from the DSM 5 Field Trials.  Determined to discover if the proposed new criteria for autism spectrum conditions (especially the removal of Asperger Syndrome as a separate diagnosis) would disadvantage those who currently have a diagnosis and therefore receive funding for services, the study has found that DSM 5 does NOT reduce the number of children who receive a diagnosis.

I recommend you read the full report here at the Autism Speaks website

The Autism Avalanche

A Melbourne paediatrician told me today that 70% of her clients present with an autism spectrum condition, including autistic disorder, Asperger Syndrome and PDD-NOS.  She makes new diagnoses of ASC at least 2-3 times a day.  Where are they coming from?  Why the avalanche of new cases now, and what effect will the DSM5 have?

According to a report released last month by the US Government's Centers for Disease Control and Prevention (CDC) up to 1 in every 88 children has an autism spectrum condition.  This prevalence has increased by 78% since 2000, from 1 in every 150 children.  

Why such an increase?  The jury is still out, but it could be largely because of increased awareness - that is parents teachers and health care professionals are more aware of what to look for, and are referring ever younger children to professionals for diagnosis.

Of course, scientists the world over are examining a number of potential environmental and genetic reasons for the increase, and deserve more funding to continue their important work.

The Big Issue with DSM 5

On February 18th 2012 Asperger Syndrome Support Network Victoria (ASSN) hosted a party to celebrate 21 years of providing support and information services to the Victorian Asperger community.  International Aspergers Day was chosen to honour Dr Hans Asperger's birthday, the Austrian paediatrician who first described the syndrome in 1944.  

ASSN Vic patron, clinical psychologist and ASD specialist Dr Richard Eisenmajer gave a brief talk on the history of Asperger Syndrome, and likely changes the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will bring.  Due for release in May 2013 DSM 5 is expected to subsume Asperger's Disorder within the Autism Spectrum, meaning it will no longer exist as a diagnosis in its own right.  Instead a person who would currently be diagnosed as having Asperger Syndrome will receive a diagnosis of 'Autism Spectrum Disorder, Asperger type' with a rating of mild, moderate or severe.  

An recent article at USA Today News discusses various viewpoints on what this change will bring - here

The American Psychiatric Society has responded to recent criticism and explained their aims regarding Aspergers and autism via their latest news release:

The Work Group has proposed that autism, Asperger‘s disorder, pervasive developmental disorder (not otherwise specified) and childhood disintegrative disorder be consolidated within the overarching category of ASD. The change signals how symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders. The new category is expected to help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of providing general labels that tend not to be consistently applied across different clinics and centers.

Developing more useful diagnostic criteria for clinicians and individuals with ASD has been the core objective of the Work Group‘s efforts. For example, the proposed measures indicate increased sensitivity in regard to age of onset. DSM-IV requires functioning delays to be present prior to age 3; DSM-5 criteria would extend this until ―social demands exceed limited capacities,‖ as long as symptoms were present in early childhood. Despite what some critics have suggested, the issue of containing autism rates was not considered by the Work Group, nor was it a factor in revising the criteria.

 To read the full article, click here

Definition of Asperger Syndrome set to change

In case you've not been following this issue, here's a quick link to the latest New York Times article on how the removal of Asperger Syndrome as a separate diagnosis to autism spectrum disorders is expected to affect our community.  While this is an American article discussing American issues, it will affect us here in Australia as the American Psychiatric Association Diagnostic and Statistics Manual, DSM, is the main tool used by Australian helath professionals to diagnose Asperger Syndrome and autism.

If you'd like to read about the proposed changes to the DSM V in detail, click here to go to the American Psychiatric Association's own website pages discussing the rationale behind the proposed change.

Confirmation

Scientific research has finally confirmed what parents and practitioners already know - behavioural intervention therapies really do work with children and adolescents on the autism spectrum.  As reported by Autism Speaks in their latest newsletter, five types of behavioural therapies were covered:

1. early intensive behavioural intervention of 25+ hours per week for 2 years or more
2. briefer, targeted behavioural intervention for 6 months
3. parent delivered early interventions
4. group social skills programs for teens
5. cognitive behavioural therapy for anxiety and aggression

To read more about this, click here to go to Autism Speaks Science News page or here to go to the orignal report in December 2011 issue of Current Opinion in Pediatrics