The Differences Between Autism in the DSM-IV and the DSM-V

Autism

As of late I have heard a lot of questions about the difference between Autism and Autism Spectrum Disorders (or ASD’s) in the DSM-IV versus the DSM-V. We all know that the terms Autism and ASD are often used interchangeably. ASD is an umbrella diagnosis, with many separate disorders encompassing it. Since the DSM-V came out there have been some changes. So, what is the difference in the two? Here's a real quick break-down of the changes.

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First, what is Autism? Autism is a “developmental disability that affects a person's ability to communicate, understand language, play, and interact with others.” It fits under the umbrella of an Autism Spectrum Disorder. Autism is a behavioral syndrome not an illness or a disease. This means that its definition is based on patterns of behaviors that a person exhibits. No two Autistic people present with the exact same symptoms. Autism is a neurological disability that is “presumed to be present from birth and is always apparent before the age of three.”

Signs of Autism per The National Institutes of Health:

-Communication Issues such as: not responding to his/her name by 12 months of age; in inability to explain what he/she wants; just doesn't seem to follow directions; Seems to hear sometimes, but not other times; Doesn't point or wave "bye-bye"; Used to say a few words or babble, but now does not

-Social Behavior such as: Not smiling when smiled at; Having poor eye contact; Seeming to prefer to play alone; Gets things for him/herself only; Seems to be in his/her "own world"; Seems to tune people out; Is not interested in other children; Doesn't point out interesting objects by 14 months of age; Doesn't like to play "peek-a-boo" as a toddler or baby; Doesn't try to attract his/her parent's attention

-Stereotypical Behaviors such as: Getting "stuck" doing the same things over and over and can't move on to other things; Showing unusual attachments to toys, objects, or routines; Spends a lot of time lining things up or putting things in a certain order; Repeats words or phrases (sometimes called echolalia)

-Other Behaviors such as: Not playing "make believe" or pretend by 18 months of age; Having odd movement patterns; Not knowing how to play with toys; Does things "early" compared to other children; Walking on his/her toes; Not liking to climb on things such as stairs; Doesn't imitate silly faces; Seems to stare at nothing or wander around with no purpose; Throws intense or violent tantrums; Is overly active, uncooperative, or resistant; Seems overly sensitive to noise; Doesn't like to be swung or bounced on his/her parent's knee, etc.

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Although autism affects the functioning of the brain, the specific cause of autism is unknown. Though there are many suspicions as to what could cause Autism. Scientists have pinpointed several genetic mutations and duplications that cause it, as well as some environmental suspicions. In fact, it is widely assumed that there are likely multiple causes. Each of these causes may manifest in different forms, or subtypes, of Autism.

The difference between Autism and ASD is just that Autism Spectrum Disorder (ASD) is a popular term that refers to ‘a broad definition of Autism including the classical form of the disorder as well as closely related disabilities that share many of the core characteristics.”

What’s the difference between the DSM-IV and the DSM-V?

Per the DSM-IV ASD included Autism along with the following diagnoses and classifications:

(1) Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), which refers to a collection of features that resemble autism but may not be as severe or extensive
(2) Rett's syndrome, which affects girls and is a genetic disorder with hard neurological signs, including seizures, that become more apparent with age
(3) Asperger syndrome, which refers to individuals with autistic characteristics but relatively intact language abilities
(4) Childhood Disintegrative Disorder, which refers to children whose development appears normal for the first few years, but then regresses with the loss of speech and other skills until the characteristics of autism are conspicuous.
In DSM-IV, autism diagnosis was based on “a triad of symptoms, including language delays, social communication deficits, and repetitive or restrictive behaviors.”

According to the new DSM-5 criteria, autism diagnosis guidelines include two criteria domains:
-Social interaction domain (including language and social communication deficits)
-Repetitive or restrictive behaviors

Most children previously diagnosed with Autistic disorder, Asperger’s Disorder, Pervasive Developmental Disorder-not otherwise specified (PDD-NOS), or Childhood Disintegrative Disorder are now diagnosed under the single title of Autism Spectrum Disorder (ASD).The biggest changes are that the DSM V’s new ASD diagnosis excludes many individuals with Asperger’s disorder and PDD-NOS and lists Autism in levels such as Autism level 1, 2, and 3.

Since the changes I’ve been able to identify over 418 studies on the changes. These studies consistently reported decreases in ASD diagnosis by using DSM-5 criteria. There were statistically significant pooled decreases in subgroups of Autistic disorder and Pervasive Developmental Disorder-not otherwise specified; however, the Asperger’s disorder pool decrease was not significant. It seems the changes with the DSM-5 will likely decrease the number of individuals diagnosed with ASD, particularly the PDD-NOS subgroup. Basically, the DSM-V groups Autism together into smaller groups than the DSM-IV did. It lowers the prevalence numbers and it makes things a little easier for doctors and psychologists that use it.

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