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Monday, March 25, 2019

DSM-5 and Diagnosis

Kristine M. Kulage and colleagues have an article at the Journal of Autism and Developmental Disorders titled "How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis."
Despite advances in understanding pathophysiology in ASD, it remains a behaviorally defined clinical syndrome. As such, the diagnosis is often based on several variables including the parental historical presentation of concerns, demonstration of such  ehaviors during evaluations, clinical providers’ experience, rating instruments, and final determination based on clinically agreed upon diagnostic guidelines set forth by the DSM. Revisions in updated DSM classification may change an individual’s diagnosis. In reviewing studies published in the five years since publication of the DSM-5, which  as more stringent criteria required for an ASD diagnosis, our study findings indicate that a significant number of individuals who qualified for a DSM-IV-TR ASD diagnosis would not meet DSM-5 criteria.

ADDM Network data also continue to demonstrate that ASD prevalence rates are rising even with tightened DSM-5 diagnostic criteria
. If true positive diagnoses are actually increasing, parental awareness and acceptance, less stigmatization, better trained clinicians, more thorough data collection methods, and even increasing genetic tendencies could be contributing factors. In addition, comorbid diagnoses are now allowable for ASD under DSM-5, enabling clinicians to give multiple comorbid diagnoses of intellectual disability, ASD, and ADHD, which could also explain why ASD rates have continued to rise since publication of the DSM-5.