Re-defining autism: The DSM-5 debate continues

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istock photoThis month, we will see the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders, and perhaps one of the most anticipated events this year for those in the mental health field.

Ahead of the release of DSM-5, Molecular Autism has published commentaries from the labs of Catherine Lord and Fred Volkmar, both world leaders in autism and the autism phenotype, offering their perspectives on the new DSM-5 criteria for the autism spectrum.

The commentary by Lord’s group is broadly positive about the changes on the basis that they recognize core symptoms of autism spectrum disorders, as well as clinical features that are not specific to autism spectrum disorders. In contrast, Volkmar’s group raises some concern about DSM-5, in light of evidence that some high-functioning individuals will no longer meet diagnostic criteria for autism spectrum disorders, thereby becoming ineligible for services and treatment. They also question the removal of the subgroup of Asperger syndrome in this new edition of the manual as too extreme a move, as its symptoms will instead fall under the new single category termed “autism spectrum disorder”. Simon Baron-Cohen and Joseph Buxbaum, the Editors-in-Chief of Molecular Autism, have commented on this debate in an accompanying Editorial.

The DSM is used in a number of countries and is still hugely influential despite its controversy. However, on 29th April, the National Institute of Mental Health (NIMH) – the world’s biggest mental health research funder – announced that it was withdrawing its support of DSM-5 and would be “re-orienting its research away from DSM categories.” This is on the premise that, although the editions have provided “reliability” in ensuring that clinicians use the same terms in the same ways, they lack “validity”. As an alternative approach, the NIMH has launched the Research Domain Criteria (RDoC) project with the aim of transforming diagnosis by incorporating imaging, genetics, cognitive science, and other levels of information to pave the way for a new classification system.

DSM-5 has also been met with criticisms from the British Psychological Society, which recommends a change from using “diagnostic frameworks” to a description based specifically on an individual’s experienced problems.

What these changes will mean for the diagnosis of autism spectrum disorders in the decades to come remains to be seen. Follow the debate on Twitter at #DSM5.

Elizabeth Bal
Senior Journal Development Editor, BioMed Central