What’s in a Name? Changing the Way We Identify Autism Severity
Most people have heard about the changes with the DSM-5, but how many have looked into the name changes it implements for autism? This author has and while asking others the question from most was--Why did they have to abolish important disorders to a numbered category?
It first must be said that there were other changes made to the DSM-5 as it pertains to the umbrella of autistic spectrum disorders, for information on those changes you are urged to further look it up. This article only covers the condensing and renaming of the descriptive names.
Changes to the Names of Autism
This author cannot argue that with the old way there was instant visual recognition. The more severe the child’s deficits the more severe they placed on the autism spectrum. Much like any other parent-of an autistic child--I hate change of any kind! Obviously these changes are not an exclusion from that rule; however there are good reasons to change the way things are done sometimes.
According to the DSM-IV the descriptive names of autism where:
• Severe Autism (Low Functioning)
• Moderate Autism (Moderate Functioning)
• Asperger’s Syndrome
• Mild Autism (High Functioning)
The DSM-5 has them listed as follows:
• Autism Level 1
• Autism Level 2
• Autism Level 3
Essentially what they have done is taken severe autism and renamed it Autism Level 3. They then removed Asperger’s Syndrome from the spectrum subsequently combining it in with Moderate Autism making Autism Level 2. PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) was also removed from the spectrum subsequently combining it with Mild Autism making Autism Level 1.
It has to be disclosed that it bothers this author greatly that the Asperger’s and PDDNOS diagnoses have been removed and combined into levels 1 and 2. This annoyance centers from the fact that these children are undeniably special in ways that should not be so simply defined by the world as being high or moderately functioning. It would have to be imagined that the disdain for these changes from parents that have children diagnosed with these disorders has to be heightened quite a bit from mine.
The Reasons for these Changes
There are two main causes for these changes that this author can see. One clearly stated by Dr. Bryan King, director of Seattle Children’s Autism Center, he also served on the board charged with overhauling the DSM-IV criteria, “There wasn’t any evidence after 17 years that the DSM-IV diagnoses reflected reality. There was no consistency in the way Asperger’s or PDD-NOS was applied”. Also made clear is that these changes do not require a new diagnosis, current diagnoses will be transferred automatically to the new ASD 1, 2, or 3.
One of the problems faced by the DSM-IV is the way one child was diagnosed and then classified fluctuated considerably dependent on where the child was seen. For instance, a big problem that parents were seeing is that in one state insurance may cover services for mild/high functioning autism, but refuse to acknowledge PDDNOS, same thing concerning Asperger’s Syndrome. It’s hard to get treatment if your disorder isn’t even recognized as being on the autism spectrum by your insurance. You also have to look at the assorted ways doctors diagnosed and treated autism. These changes as a whole give consistency. Doctors and Researchers are hoping to eliminate the confusion.
The other reason for this change is more of an international one. They are looking for a “Harmonization of the ICD-11 and the DSM-5. Reason this is needed can be said no better than said by Dr. Michael B. First in his work with the New York State Psychiatric Institute. He stated that the “differences in the ICD-10 and the DSM-IV definitions for the same disorder impede international communication and research efforts. The forthcoming parallel development of the DSM-5 and ICD-11 offers an opportunity to harmonize the two classifications”. What better reason for change than to unite the globe in how autism is defined and researched?
This author questions how significant a change can be made globally when currently the ICD-10 has eight categories under autism, where the DSM-IV had 5 and the DSM-5 has 3. Not to mention it is rumored that the ICD-11 is going to keep the Asperger’s diagnosis separately. I do have to say that I love the idea and the effort being put into place In order to implement changes across the nation.
There are too many "What ifs," “I don’t knows”, and “Maybe’s” encompassing this one disorder to allow any one answer to hold up across any board. As high as the prevalence numbers currently are we can’t afford a system that fights itself as much as it fights us parents. Are these name changes going to change any one of the problems we face as a community, internationally or domestically? No, more than likely they won’t; however, it does bring us one step closer to a unity that we need. Maybe we should give it a chance while we wait to see what the next changes they make will be.
The British Journal of Psychiatry: Harmonisation of ICD-11 and DSM-V: opportunities and challenges
US National Library of Medicine, National Institutes of Health: Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders