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What the DSM-5 Portends for Research, Diagnosis, and Treatment of Autism Spectrum Disorders

  • Autism Spectrum Disorders (D Mandell, Section Editor)
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Abstract

In May 2013 the APA will release DSM-5, which will restructure the diagnostic classification for autism spectrum disorders (ASDs) into a single category. The proposed changes in DSM-5 aim to better reflect the current state of research by consistently identifying the core features in social/communication and restrictive and repetitive behaviors that are specific to ASDs. This review describes the empirical and theoretical bases of research in the nosology of ASDs, given the impending shift in DSM-5 diagnostic criteria. General issues in diagnosis and prevalence are described, with differences between DSM-IV and DSM-5 highlighted. To address concerns about the application of the proposed DSM-5 criteria, the current literature assessing the sensitivity and specificity of the proposed DSM-5 criteria is reviewed. Last, we discuss the implications of the changes in DSM-5 for the treatment of ASDs and recommend areas for future research.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Kanner L. Autistic disturbances of affective contact. Nerv Child. 1943;250(2):217–50.

    Google Scholar 

  2. Lord C, et al. Autism from 2 to 9 years of age. Arch Gen Psychiatry. 2006;63(6):694–701.

    Article  PubMed  Google Scholar 

  3. Gotham K, et al. The Autism Diagnostic Observation Schedule: revised algorithms for improved diagnostic validity. J Autism Dev Disord. 2007;37(4):613–27.

    Article  PubMed  Google Scholar 

  4. Wing L, Gould J. Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. J Autism Dev Disord. 1979;9(1):11–29.

    Article  PubMed  CAS  Google Scholar 

  5. Volkmar F, et al. Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. 1999;38(12 Suppl):32S–54.

    PubMed  CAS  Google Scholar 

  6. Rutter M, Le Couteur A, Lord C. In: WPS, editor. Autism diagnostic interview-revised-WPS. Los Angeles: Western Psychological Services; 2003.

    Google Scholar 

  7. Wing L, et al. The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. J Child Psychol Psychiatry. 2002;43(3):307–25.

    Article  PubMed  Google Scholar 

  8. Lord C, et al. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000;30(3):205–23.

    Article  PubMed  CAS  Google Scholar 

  9. Stone WL, Coonrod EE, Ousley OY. Brief Report: Screening Tool for Autism in Two-Year-Olds (STAT): Development and Preliminary Data. J Autism Dev Disord. 2000;30(6):607–12.

    Article  PubMed  CAS  Google Scholar 

  10. Schopler E, et al. Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord. 1980;10(1):91–103.

    Article  PubMed  CAS  Google Scholar 

  11. Stone WL, et al. Can Autism Be Diagnosed Accurately in Children Under 3 Years? J Child Psychol Psychiatry. 1999;40(02):219–26.

    Article  PubMed  CAS  Google Scholar 

  12. Cox A, et al. Autism spectrum disorders at 20 and 42 months of age: stability of clinical and ADI-R diagnosis. J Child Psychol Psychiatry. 1999;40(5):719–32.

    Article  PubMed  CAS  Google Scholar 

  13. Kim SH, Lord C. Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. J Child Psychol Psychiatry. 2012;53(2):143–51.

    Article  PubMed  Google Scholar 

  14. Fombonne E, Quirke S, Hagen A. Prevalence and interpretation of recent trends in rates of pervasive developmental disorders. Mcgill J Med. 2009;12(2):73.

    PubMed  Google Scholar 

  15. Lotter V. Epidemiology of autistic conditions in young children. Soc Psychiatry Psychiatr Epidemiol. 1966;1(3):124–35.

    Google Scholar 

  16. Saracino J, et al. Diagnostic and Assessment Issues in Autism Surveillance and Prevalence. J Dev Phys Disabil. 2010;22(4):317–30.

    Article  Google Scholar 

  17. Kawamura Y, Takahashi O, Ishii T. Reevaluating the incidence of pervasive developmental disorders: Impact of elevated rates of detection through implementation of an integrated system of screening in Toyota, Japan. Psychiatry Clin Neurosci. 2008;62(2):152–9.

    Article  PubMed  Google Scholar 

  18. Investigators, ADDM. Prevalence of Autism Spectrum Disorders- Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Atlanta: CDC; 2012.

    Google Scholar 

  19. Foundation TKF. State Health Facts. 2012; Available from: statehealthfactos.org.

  20. Mandell DS, Palmer R. Differences among states in the identification of autistic spectrum disorders. Arch Pediatr Adolesc Med. 2005;159(3):266–9.

    Article  PubMed  Google Scholar 

  21. Palmer RF, et al. School District Resources and Identification of Children With Autistic Disorder. Am J Public Health. 2005;95(1):125–30.

    Article  PubMed  Google Scholar 

  22. Cuccaro ML, et al. Professional perceptions of children with developmental difficulties: the influence of race and socioeconomic status. J Autism Dev Disord. 1996;26(4):461–9.

    Article  PubMed  CAS  Google Scholar 

  23. Maenner MJ, Arneson CL, Durkin MS. Socioeconomic disparity in the prevalence of autism spectrum disorder in Wisconsin. WMJ. 2009;108(5):253–5.

    PubMed  Google Scholar 

  24. King MD, Bearman PS. Socioeconomic Status and the Increased Prevalence of Autism in California. Am Sociol Rev. 2011;76(2):320–46.

    Article  PubMed  Google Scholar 

  25. Durkin MS, et al. Socioeconomic Inequality in the Prevalence of Autism Spectrum Disorder: Evidence from a U.S. Cross-Sectional Study. PLoS One. 2010;5(7):e11551.

    Article  PubMed  Google Scholar 

  26. Kim YS, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011;168(9):904–12.

    Article  PubMed  Google Scholar 

  27. Pinborough-Zimmerman J, et al. Changes in the Administrative Prevalence of Autism Spectrum Disorders: Contribution of Special Education and Health from 2002–2008. J Autism Dev Disord. 2012;42(4):521–30.

    Article  PubMed  Google Scholar 

  28. Wiggins LD, et al. Retention of Autism Spectrum Diagnoses by Community Professionals: Findings From the Autism and Developmental Disabilities Monitoring Network, 2000 and 2006. J Dev Behav Pediatr. 2012;33(5):387–95. doi:10.1097/DBP.0b013e3182560b2f.

    Article  PubMed  Google Scholar 

  29. Rice C. Prevalence of autism spectrum disorders - autism and developmental disabilities monitoring network, United States, 2006. MMWR Surveill Summ. 2009;58(SS10):1–20.

    Google Scholar 

  30. Shattuck PT. The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education. Pediatrics. 2006;117(4):1028–37.

    Article  PubMed  Google Scholar 

  31. Lord C, et al. A Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders. Arch Gen Psychiatry. 2011.

  32. Gernsbacher MA, Dawson M, Hill Goldsmith H. Three Reasons Not to Believe in an Autism Epidemic. Curr Dir Psychol Sci. 2005;14(2):55–8.

    Article  Google Scholar 

  33. Happe F. Why fold asperger syndrome into autism spectrum disorder in the DSM-5? Simons Foundation Autism Research Initiative News and Opinion. 2011.

  34. Association AP. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington DC: American Psychiatric Association; 1987.

    Google Scholar 

  35. Szatmari P. The validity of autistic spectrum disorders: A literature review. J Autism Dev Disord. 1992;22(4):583–600.

    Article  PubMed  CAS  Google Scholar 

  36. APA. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Washington DC: American Psychiatric Association; 2000.

    Google Scholar 

  37. Wing L, Potter D. The epidemiology of autistic spectrum disorders: is the prevalence rising? Ment Retard Dev Disabil Res Rev. 2002;8(3):151–61.

    Article  PubMed  Google Scholar 

  38. •• Ozonoff S. Editorial: DSM-5 and autism spectrum disorders - two decades of perspectives from the JCPP. J Child Psychol Psychiatry. 2012;53(9):e4–6. This virtual review analyzed 12 papers from the past 20 years of JCCP, to trace the changes in the conceptualization of ASDs. Evidence is provided to indicate that there may not be a difference between Asperger's syndrome and autistic disorder.

    Article  PubMed  Google Scholar 

  39. Frith U. Emanuel Miller lecture: confusions and controversies about Asperger syndrome. J Child Psychol Psychiatry. 2004;45(4):672–86.

    Article  PubMed  Google Scholar 

  40. Macintosh KE, Dissanayake C. Annotation: The similarities and differences between autistic disorder and Asperger's disorder: a review of the empirical evidence. J Child Psychol Psychiatry. 2004;45(3):421–34.

    Article  PubMed  Google Scholar 

  41. Fombonne E. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord. 2003;33(4):365–82.

    Article  PubMed  Google Scholar 

  42. Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA. 2001;285(24):3093–9.

    Article  PubMed  CAS  Google Scholar 

  43. Prevention CfDCa. Autism Spectrum Disorders. 2012 March 29, 2012 [cited 2012 July 8, 2012]; Available from: http://www.cdc.gov/ncbddd/autism/data.html.

  44. Kraemer HC. DSM Categories and dimensions in clinical and research contexts. In: Helzer JE et al., editors. Dimensional approaches in diagnostic classification. Arlington: American Psychiatric Association; 2008. p. 5–17.

    Google Scholar 

  45. Association, AP. DSM-5. 2012.

  46. •• Huerta M, et al. Application of DSM-5 criteria to 3 samples of children with DSM-IV diagnoses of PDD. Am J Psychol. In Press. This is the most recent, comprehensive analysis of the sensitivity and specificity of DSM-5 criteria, applied to a large sample of children with PDDs. Majority of children were found to retain their PDD diagnosis.

  47. McPartland JC, Reichow B, Volkmar FR. Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry. 2012;51(4):368–83.

    Article  PubMed  Google Scholar 

  48. Mattila ML, et al. Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. J Am Acad Child Adolesc Psychiatry. 2011;50(6):583–92 e11.

    Article  PubMed  Google Scholar 

  49. Worley JA, et al. Stability of symptoms of autism spectrum disorders in toddlers: an examination using the Baby and Infant Screen for Children with aUtIsm Traits-Part 1 (BISCUIT). Dev Neurorehabil. 2011;14(1):36–40.

    Article  PubMed  Google Scholar 

  50. Swedo SE, et al. Commentary from the DSM-5 Workgroup on Neurodevelopmental Disorders. J Am Acad Child Adolesc Psychiatry. 2012;51(4):347–9.

    Article  PubMed  Google Scholar 

  51. Mandy WP, Charman T, Skuse DH. Testing the construct validity of proposed criteria for DSM-5 autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2012;51(1):41–50.

    Article  PubMed  Google Scholar 

  52. Frazier TW, et al. Validation of proposed DSM-5 criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2012;51(1):28–40 e3.

    Article  PubMed  Google Scholar 

  53. Gibbs V, et al. Brief Report: An Exploratory Study Comparing Diagnostic Outcomes for Autism Spectrum Disorders Under DSM-IV-TR with the Proposed DSM-5 Revision. J Autism Dev Disord. 2012;42(8):1750–6.

    Article  PubMed  Google Scholar 

  54. Taheri A, Perry A. Exploring the Proposed DSM-5 Criteria in a Clinical Sample. J Autism Dev Disord. 2012.

  55. Wing L, Gould J, Gillberg C. Autism spectrum disorders in the DSM-V: better or worse than the DSM-IV? Res Dev Disabil. 2011;32(2):768–73.

    Article  PubMed  Google Scholar 

  56. Kapp S, Ne'eman A. ASD in DSM-5: What the research shows and recommendations for change. Washington: ASAN; 2012.

    Google Scholar 

  57. Worley P. Integrity: the key to quality in community-based medical education? (Part two). Educ Health (Abingdon). 2002;15(2):129–38.

    Article  Google Scholar 

  58. Fein D, et al. Brief Report: Pervasive Developmental Disorder Can Evolve into ADHD: Case Illustrations. J Autism Dev Disord. 2005;35(4):525–34.

    Article  PubMed  Google Scholar 

  59. Frazier TW, et al. Prevalence and correlates of psychotropic medication use in adolescents with an autism spectrum disorder with and without caregiver-reported attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2011;21(6):571–9.

    Article  PubMed  Google Scholar 

  60. Davis NO, Kollins SH. Treatment for Co-Occurring Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Neurotherapeutics. 2012.

  61. Watson SM, et al. Psychosocial Treatments for ADHD: A Systematic Appraisal of the Evidence. J Atten Disord. 2012.

  62. McCracken JT, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002;347(5):314–21.

    Article  PubMed  CAS  Google Scholar 

  63. Pliszka S. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894–921.

    Article  PubMed  Google Scholar 

  64. Carey B. New definition of autism may exclude many, study suggests. New York: The New York Times; 2012.

    Google Scholar 

  65. US Congress. Individuals with Disabilities Education Improvement Act of 2004. Washington, DC: U.S. Congress, Editor; 2004.

  66. •• Ne'eman A, Kapp S. What are the Stakes? An Analysis of the Impact of the DSM-5 Draft Autism Criteria on Law, Policy and Service Provision. Washington, DC: Autistic Self Advocacy Network; 2012. This recent policy brief from the perspective of the autism self-advocacy community analyzes the policy implications DSM-5 may have for individuals with autism. Four major areas are discussed: access to income supports, access to special education, access to non-discrimination protections and access to Medicaid.

    Google Scholar 

  67. Coordination, IACC. Autism Spectrum Disorder Research Publications Analysis Report: The Global Landscape of Autism Research. Washington, DC: U.S. Department of Health & Human Services; 2012.

    Google Scholar 

  68. Worley JA, Matson JL. Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria. Res Autism Spectr Disord. 2012;6(2):965–70.

    Article  Google Scholar 

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Disclosure

S. Mahjouri: research support from National Institute of Child Health & Human Development (NICHD) and Simons Foundation; C.E. Lord: research support from National Institute of Mental Health, Health Resources and Services Administration, NICHD, and Simons Foundation, and royalties from Western Psychological Services.

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Correspondence to Saara Mahjouri.

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Mahjouri, S., Lord, C.E. What the DSM-5 Portends for Research, Diagnosis, and Treatment of Autism Spectrum Disorders. Curr Psychiatry Rep 14, 739–747 (2012). https://doi.org/10.1007/s11920-012-0327-2

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