The American Psychiatric Association's board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.
The board vote is the last step before the manual is formally released at the APA's annual meeting next May. The association's Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV.
In a statement issued barely an hour after the APA's release, the chief science officer for Autism Speaks, Geraldine Dawson, PhD, said the group remained "concerned about the impact of the new DSM-5 criteria when they are used in real world settings. The field trials are somewhat reassuring that the criteria are working well, but these trials are based on a relatively small number of children. We still have very little information about the impact of the DSM-5 on diagnosis of autism spectrum disorder in young children and adults."
Dawson said the group believes it is "crucial" that diagnosis and access to services be monitored once DSM-5 is in use. "We want to make sure that no one is excluded from obtaining a diagnosis and accessing services who needs them."
In fact, some of the changes proposed for DSM-5 would loosen the criteria, as the head of the APA's work group on autism spectrum disorders explained at the 2012 APA meeting.
Susan Swedo, MD, of the National Institute of Mental Health, noted that the work group was seeking to drop an age-based exclusion in the DSM-IV criteria.
The other major change proposed for DSM-5 was a reorganization that would collapse a number of autism-related conditions treated as separate disorders in DSM-IV into a single "autism spectrum disorder" category.
Those changes were blasted by some in the autism advocacy community, but Swedo argued that the criticisms were unfounded.
In announcing the APA board's action, James H. Scully, MD, medical director and chief executive officer of APA, said, "At every step of development, we have worked to make the process as open and independent as possible. The level of transparency we have strived for is not seen in any other area of medicine."