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Sunday, May 26, 2013

Problems with DSM-5 Definition

At The Huffington Post, Frances identifies two major flaws in the DSM-5 definition of Autistic Spectrum Disorder:
A truncated version of its Criterion A reads as follows: 
"A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following...
1. Deficits in social-emotional reciprocity;
2. Deficits in nonverbal communicative behaviors used for social interaction;
3. Deficits in developing, maintaining, and understanding relationships."
The DSM 5 examples offered for each of these three items are vague enough to overlap into normality, but I wouldn't have made a big fuss about this.
The really fatal flaw here is that no instructions are given as to whether one item, two items, or all three items must be present to make the diagnosis of Autism Spectrum Disorder. The diagnosis will vary dramatically from rater to rater, institution to institution, and place to place depending on which of these three different possible convention is chosen. It will be even more impossible than it is now to determine rates of autism and why they shift so much over time.
The second fatal flaw comes in the following statement attached to the end of the criteria set for Autism Spectrum Disorder:
"Note: Individuals with a well established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social communication disorder. "
This throws wide open to raters the choice of using DSM-IV criteria or DSM-5 criteria depending on their personal preferences.