Search This Blog

Tuesday, January 24, 2012

DSM-V: Pros and Cons

At The Huffington Post, Allen Frances writes:
The pressure for services naturally stretches the boundary to include children with a heterogeneous array of problems that place them in vaguely defined territory, further and further away from classic autism. Any effort toward a more precise definition will narrow the spectrum and therefore seem to threaten the services that have been tied to the diagnosis.
So how can we accomplish both important goals -- i.e. achieve a more precise diagnosis of autism AND not deprive services for those who need them? I think the best solution is to decouple school services from the DSM diagnosis of autism. Instead of DSM diagnosis, the child's specific learning and behavioral problems should guide eligibility and individualized planning.
Children who now get inappropriately labeled autistic should lose the inaccurate diagnosis, but not lose the needed services.
But this proposal raises the question: if not DSM, what?  Absent a clear (if flawed) set of criteria, how do officials decide who gets services?

At CNN, Jennifer A. Pinto-Martin writes:
One positive outcome of revising the criteria could be an impetus for the development of more targeted services and therapies that can better serve the needs of children across the autism spectrum. ...
Insurance companies will be motivated to reimburse for therapy that can demonstrate improvement in functioning, and a more targeted approach has a better chance of achieving this goal.
From the perspective of medical research, the change in criteria is both good and bad. The search for the cause of autism has been hampered by the current one-size-fits all definition. Many researchers believe that the various subtypes of autism may well have differing causes. By narrowing the diagnostic criteria, researchers can sort those with the disorder with great clarity and consistency of symptoms.
On the other hand, monitoring changes in the prevalence of autism over time -- an important, ongoing research initiative -- will be hampered. Tracking prevalence is one of the major tools in epidemiologic investigations because it gives us useful clues about the causes and risk factors for health problems. By changing the way in which children are labeled, we will face a decrease in prevalence. Finding out the real change in risk from an artificial increase or decrease can be difficult.